Association between optic disc pallor and lacunar stroke

Objective: To test for associations between optic disc pallor and two clinical variables – ischaemic stroke subtype (cortical, lacunar), and cerebral small vessel disease (SVD) scores in a cohort of hospital patients admitted with mild stroke (Mild Stroke Study 1).

Methods: We used previously validated software PallorMetrics to quantify optic disc pallor in colour fundus photographs of patients diagnosed as having either cortical (N = 92) or lacunar (N = 92) stroke. We used logistic regression to assess the relationship between stroke type and disc pallor in several zones, and ordinal logistic regression to assess the relationship between disc pallor and total SVD score. Left and right eyes were analysed separately.

Results: In the right eye, independent of age, sex, disc area, hypertension, and diabetes, increased optic disc pallor was significantly associated with lacunar stroke in all zones (for global pallor: OR per SD increase = 1.55 [CI: 1.11 – 2.17], p = 0.011) and total SVD score in the temporal superior (standardized β = 0.36, SE = 0.15, p = 0.020) and nasal-inferior zones (standardized β = 0.44, SE = 0.15, p = 0.004) in the right eye. Weaker trends were observed in the left eye; however, these did not reach statistical significance.

Conclusion: Optic disc pallor may be associated with SVD severity and lacunar stroke, which may reflect vascular damage to the optic nerve or its pathways. Our findings underscore the utility of colour fundus photography to learn more about SVD pathology.