Microvascular Research · Nov 2, 2026
The retinal microvasculature as a predictive window for systemic vascular health in CKM syndrome: A narrative review
By Chowdhury D, Singh G, Bodakhe SH
The cardiovascular-kidney-metabolic (CKM) syndrome is a pathophysiologic continuum resulting from the synergistic interactions between metabolic dysregulation, chronic kidney disease and cardiovascular disease. The syndrome progresses insidiously, initiating a cascade of systemic microvascular injury, oxidative stress, and inflammation, often preceding apparent, permanent multiorgan failure. Traditional systemic markers often do not detect early endothelial dysfunction and there is an unmet clinical need for non-invasive biomarkers to detect subclinical damage. In this narrative review, we explore the emerging field of oculomics which considers the retina as an easily accessible living biopsy of the systemic micro-circulation. The retinal vascular network, nephrons and myocardium have common embryological origins and similar anatomical characteristics, so that changes in the retinal vascular network are a direct manifestation of pathological changes occurring in the nephrons and heart at the same time. Modern ultrahigh resolution imaging modalities such as optical coherence tomography angiography (OCTA) enable physicians to quantify subclinical parameters such as capillary depletion, arteriolar constriction, and neural layer atrophy. These dynamic retinal fingerprints can be identified to aid in early risk stratification of the CKM continuum, including hypertension, diabetes, chronic kidney disease, and atherosclerosis. Furthermore, these eye measures are sensitive pharmacodynamic endpoints that allow for real-time in vivo monitoring of systemic microvascular responses to novel cardiometabolic drugs. Oculomics, through the integration of portable imaging technologies, algorithms for deep learning, and multi-omics circulating biomarkers, has the ability to translate CKM risk assessment into primary care settings.