Association between cognition and the retinal microvasculature in 11-year old children born preterm or at term

Background: Retinal microvessels can be visualized non-invasively and mirror the status of the cerebral microvasculature. Aims: To investigate whether in young children born prematurely or at term cognitive performance is related to retinal microvascular traits. Study design, subjects: In 93 prematurely born infants (birth weight < 1000g) and 87 controls born at term, we measured head circumference (HC) and determined intelligence quotient (IQ) by combining matrix reasoning and spatial span (Wechsler Non-Verbal test, Dutch version) and post-processed retinal photographs using Singapore I Vessel Assessment software (version 3.6). Outcomemeasures, results: Comparedwithcontrols, caseshadsmaller HC(51.7 vs53.4cm;p < 0.001), lowerIQ (93.9vs109.2;p < 0.001), smallerretinalarteriolar(CRAE;162.7vs174.0μm;p < 0.001)andvenular(CRVE; 234.9 vs 242.8μm; p=0.003) diameters and CRAE/CRVE ratio (0.69 vs 0.72; p=0.001). A 1-SD decrease in CRAE was associated with smaller HC (−0.53cm; p < 0.001) and lower total IQ (−3.74; p < 0.001), matrix reasoning (−1.77; p=0.004) and spatial span (−2.03; p=0.002). These associations persisted after adjustment for sex and age and risk factors for cognitive impairment, including blood pressure, body mass index and parental educational attainment. Conclusions: HC, total IQ, matrix reasoning and spatial span decrease with smaller retinal arteriolar diameter. Our findings suggest that maldevelopment of the cerebral microcirculation, as mirrored by the retinal microvasculature, has lasting effects on the growth of the brain and cognitive performance of prematurely born children.