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Background  Chronic Obstructive Pulmonary Disease (COPD) is associated with an increased risk of myocardial infarction and stroke but it remains unclear how to identify microvascular changes in this population.    Objectives  We hypothesized that simple non-mydriatic retinal photography is feasible and can be used to assess microvascular damage in COPD.    Methods  Novel Vascular Manifestations of COPD was a prospective study comparing smokers with and without COPD, matched for age. Non-mydriatic, retinal fundus photographs were assessed using semi-automated software.    Results  Retinal images from 24 COPD and 22 control participants were compared. Cases were of similar age to controls (65.2 vs. 63.1 years,  p  = 0.38), had significantly lower Forced Expiratory Volume in one second (FEV 1)  (53.4 vs 100.1% predicted;  p  < 0.001) and smoked more than controls (41.7 vs. 29.6 pack years;  p  = 0.04). COPD participants had wider mean arteriolar (155.6 ±15 uM vs. controls [142.2 ± 12 uM];  p  = 0.002) and venular diameters (216.8 ±20.7 uM vs. [201.3± 19.1 uM];  p  = 0.012). Differences in retinal vessel caliber were independent of confounders, odds ratios (OR) = 1.08 (95% confidence intervals [CI] = 1.02, 1.13;  p  = 0.007) and OR = 1.05 (CI = 1.01, 1.09;  p  = 0.011) per uM increase in arteriolar and venular diameter respectively. FEV 1  remained significantly associated with retinal vessel dilatation r = -0.39 (p = 0.02).    Conclusions  Non-mydriatic retinal imaging is easily facilitated. We found significant arteriole and venous dilation in COPD compared to age-matched smokers without COPD associated with lung function independent of standard cardiovascular risk factors. Retinal microvascular changes are known to be strongly associated with future vascular events and retinal photography offers potential to identify this risk.    Trial registration  clinicaltrials.gov  NCT02060292 .

Simple non-mydriatic retinal photography is feasible and demonstrates retinal microvascular dilation in Chronic Obstructive Pulmonary Disease (COPD)