The accessibility of the retina with the use of non-invasive and relatively low-cost ophthalmic imaging techniques and analytics provides a unique opportunity to improve the detection, diagnosis and monitoring of systemic diseases. The National Heart, Lung, and Blood Institute conducted a workshop in October 2022 to examine this concept. On the basis of the discussions at that workshop, this Roadmap describes current knowledge gaps and new research opportunities to evaluate the relationships between the eye (in particular, retinal biomarkers) and the risk of cardiovascular diseases, including coronary artery disease, heart failure, stroke, hypertension and vascular dementia. Identified gaps include the need to simplify and standardize the capture of high-quality images of the eye by non-ophthalmic health workers and to conduct longitudinal studies using multidisciplinary networks of diverse at-risk populations with improved implementation and methods to protect participant and dataset privacy. Other gaps include improving the measurement of structural and functional retinal biomarkers, determining the relationship between microvascular and macrovascular risk factors, improving multimodal imaging ‘pipelines’, and integrating advanced imaging with ‘omics’, lifestyle factors, primary care data and radiological reports, by using artificial intelligence technology to improve the identification of individual-level risk. Future research on retinal microvascular disease and retinal biomarkers might additionally provide insights into the temporal development of microvascular disease across other systemic vascular beds.

通过使用非侵入性且相对低成本的眼科成像技术和分析来实现视网膜的可及性，为改善全身性疾病的检测、诊断和监测提供了独特的机会。国家心肺血液研究所于 2022 年 10 月举办了一次研讨会来研究这一概念。根据该研讨会的讨论，本路线图描述了当前的知识差距和新的研究机会，以评估眼睛（特别是视网膜生物标志物）与心血管疾病风险之间的关系，包括冠状动脉疾病、心力衰竭、中风、高血压和血管性痴呆。已确定的差距包括需要简化和标准化非眼科卫生工作者对眼睛的高质量图像的捕获，并使用不同高危人群的多学科网络进行纵向研究，并改进实施和方法以保护参与者和数据集隐私。其他差距包括改进结构和功能性视网膜生物标志物的测量，确定微血管和大血管危险因素之间的关系，改进多模态成像“管道”，以及将先进成像与“组学”、生活方式因素、初级保健数据和放射学报告相结合，通过利用人工智能技术提高个体层面风险识别能力。未来对视网膜微血管疾病和视网膜生物标志物的研究可能还有助于了解其他全身血管床微血管疾病的时间发展。