Doctors have long known that the human eyes offer a view into an individual's overall health but are totally unaware that a regular, simple eye examination can reveal just as much. A discovery that has led to excitement and hope in the field of Ophthalmology and Optometry, as one simple eye test could feasibly replace the costly traditional stroke CT scans and the complex blood tests. Eyes are indeed a window to the soul.

Globally, stroke remains a leading cause of physical disability and even death, although many cases are linked to modifiable risk factors that can possibly be prevented. People who are 65 years or older are more vulnerable to all kinds of strokes, and roughly 50 percent of people who have had a stroke reportedly can't live longer than one year.

By definition, a stroke is a medical condition in which blocked or insufficient blood flow to some parts of the human brain causes cellular damage that often leads to their eventual death. Strokes are of two types, which include ischemic, caused by a lack of blood flow to the brain, and hemorrhagic, which results from internal bleeding in the brain or between its membranes.

The condition can be diagnosed using a physical examination with imaging support from a CT scan or an MRI. The scans are important to rule out bleeding but may not be necessarily as helpful for ischemia, as it does not appear on the CT scan early on. However, ECG (electrocardiogram) and some blood tests are used to determine the risk factors and the possible causes.

Stroke is associated with several risk factors like hypertension, higher cholesterol, excessive tobacco smoking, obesity, and diabetes mellitus, as well as end-stage kidney disease and atrial fibrillation. However, uncontrolled high blood pressure remains the most significant risk factor overall. Other categories of risk factors include metabolic risks (which contribute to 69 percent of all strokes worldwide), environmental risks (which constitute 37 percent), and behavioral risk factors (accounting for 35 percent), respectively.

There is also a widespread belief that strokes are usually high in bathrooms due to the wrong approach to bathing, but such a claim is not entirely true. The higher ratio of strokes associated with showers may indicate a small risk of hemorrhagic stroke while in the bathroom. Moreover, studies related to those assertions did not clearly establish a causal relationship between bathing and stroke, nor did they identify associated risk factors. Conclusively, the majority of bathing-related stroke cases were found to have occurred outside the bathtub, suggesting little involvement.

To prevent strokes, the risk factors must first be reduced using behaviour change and lifestyle modification. Acetylsalicylic acid (ASA), Aspirin, or statins can also be used following doctors' recommendations.

For treatment, anticoagulant medication (i.e. blood thinners) such as Heparin or Warfarin is prescribed for people with atrial fibrillation, while victims with problematic carotid narrowing may require surgery to open up the brain's arteries.

As a medical emergency, ischemic strokes can be treated with thrombolytic drugs (i.e. clot busters) such as tPA (tissue plasminogen activator) that can break down the blood clot if detected within 3-4 hours of onset. Hemorrhagic strokes, on the other hand, are treated with surgery called “stroke rehabilitation” for the recovery of lost function. However, and unfortunately, such services (surgery) are not available in much of the world.

Vascular Fingerprint: The Simple Eye Test

In January 2025, Medical News Today reported that research published in the journal “Heart” has found that a “vascular fingerprint” on the retina can be used to predict a person’s stroke risk, offering a noninvasive, accessible, and effective method for enhancing current screening practices, even beyond the conventional tests as we know them.

In that research, the retinas of more than 45,000 participants from the U.K. Biobank were analyzed to look for measurable biomarker indicators in the blood vessels of their retinas, upon which a total of 118 measurable retinal vascular indicators were identified. From those indicators, 29 were significantly associated with a participant’s first-time stroke risk, while changes in these indicators were linked to an increased stroke risk of up to 19 percent.

In simple terms, “vascular fingerprint” refers to the unique retinal parameters or patterns in an individual’s retina. According to Dr. Alexander Solomon (a surgical neuro-ophthalmologist and strabismus surgeon at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA), the human retina is an extension of his brain that reflects higher-risk changes associated with increased risk of stroke.

The currently available risk prediction models of stroke rely heavily on invasive procedures that involve blood tests, ultrasounds, CT scans, and MRIs, which are costly and unfavorable for large-scale screening programs. However, the newly discovered retinal-based approach leverages a noninvasive, simple diagnostic tool that could be integrated seamlessly into routine eye exams.

Some professors of experimental ophthalmology and sharp vision, such as Mingguang He, believe that the noninvasive nature of retinal analysis paves the way for easier, cheaper, and more accessible stroke risk screening, including in primary healthcare facilities. He argued that, even when combined with just age and gender stroke risk factors, the retinal vascular “fingerprint” is still as good as the use of traditional risk factors alone. Moreover, the conventional blood tests for stroke risk prediction are limited by relatively low accuracy, invasiveness, and high cost.

The retina is one of the few places in the body where noninvasive but direct observation of blood vessels can be made, and any change noticed can indicate systemic vascular conditions such as hypertension, diabetes, and atherosclerosis. So, to Dr. He, this discovery can be a leap forward in preventive medicine, as it offers hope for reducing the global burden of stroke, including using the same method for predicting other disease risks like heart disease and dementia. Other certified vascular surgeons like Dr. Christopher Yi were also in support of this “exciting and innovative discovery.”

Key Facts: The Global Burden of Stroke

Worldwide, the incidence of ischemic stroke accounts for an average of 65.3 percent, while hemorrhagic strokes range around 34.6 percent. The ischemic strokes are proportionally more prevalent in high-income countries, with 74.9 percent compared to 63.4 percent in lower- and middle-income nations.

In terms of gender vulnerability, males are more susceptible to stroke than females, with 95 percent or 6.3 million incidents occurring in men compared to 47.4 percent or 5.7 million incidents in women.

According to the Global Stroke Fact Sheet 2025 by the World Stroke Organization (WSO), stroke remains the second leading cause of death among non-communicable disorders (NCDs), causing about 7 million deaths in 2021 alone. It's also the third leading cause of combined death and disability, known as DALYs (disability-adjusted life-years lost), accounting for well over 160 million DALYs in the world.

In 2023 alone, stroke was reported to have affected over 15 million people worldwide. In 2021, stroke was responsible for approximately 10 percent of total deaths, making it the third biggest cause of death worldwide, with over 12 million incidents and 94 million prevalent cases.

Between 1990 and 2021, the absolute number of cases (incidents) of strokes has substantially increased by up to 70 percent, with prevalent cases at 86 percent, mortality cases at 44 percent, and a cumulative DALYs of up to 32 percent.

More than 87 percent of deaths by stroke occurred in low- and middle-income countries, with over 89 percent of corresponding DALYs residing there. The disparity between high-income and low-income countries has always been parallel and glaring. From 1990 to 2010, it was reported that the annual incidence of stroke decreased by approximately 10 percent in the developed world but increased by the same percentage in the developing world. Economically, the global cost of stroke is estimated at US$890 billion per year: this translates to about 0.66 percent of the global GDP, which is also projected to almost double by 2050.

Written by Ibrahim Ismail Elnafat

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Sources:

Classification of strokes https://en.wikipedia.org/wiki/Stroke

Predicting stroke through eye vascular fingerprint https://www.medicalnewstoday.com/articles/how-doctors-predict-stroke-risk-through-eye-vascular-fingerprint?utm_source=

Strokes in bathrooms https://pubmed.ncbi.nlm.nih.gov/28341200/

Stroke medications https://www.heartandstroke.ca/stroke/treatments/medications

Stroke treatment. https://www.cdc.gov/stroke/treatment/index.html

World Stroke Organization: Global Stroke Fact Sheet 2025 https://pmc.ncbi.nlm.nih.gov/articles/PMC11786524/