The VSL Analyzer (synonym: VSL Vascular Analysis) is a diagnostic ophthalmic procedure that can be used to examine the retinal (retina) artery/vein diameter ratio. Based on this parameter, conclusions can be drawn about the overall systemic blood circulation and the condition of the vascular system. Vascular status is analyzed with the VSL Analyzer by evaluating fundus images (images of the back of the eye) both with and without additional dilation of the pupil. Retinal artery/vein diameter ratio assessment can also be performed as part of retinal thickness determination using RTA (Retinal Thickness Analyzer). Vascular analysis by the VSL Analyzer software provides a quick and simple assessment of vascular status.
Indications (areas of application)
- Risk assessment for apoplexy (stroke)-vascular (vascular) changes in the retina correlate with the incidence (occurrence) of cardiovascular disease (CVD), which includes apoplexy. Of critical diagnostic importance for risk assessment is the determination of the retinal artery/vein diameter ratio, which is associated with both the presence of hypertension (high blood pressure) and stroke risk. This allows the use of non-invasive diagnostics for the evaluation (assessment) of cardiovascular risk factors. Comparing the vascular structure and physiology of the retinal vessels and the small vessels of the central nervous system, there is a clear homology (close relationship), so that the informative value of the test method can be considered very good.
- Risk assessment for dementia (decrease of the mind, accompanied by a deficit in cognitive, emotional and social skills) – dementia can have various causes. Vascular changes represent an important factor in the pathogenesis (disease development) of dementia.
- Risk assessment for myocardial infarction (heart attack) – a crucial risk factor for the occurrence of a heart attack is the vascular status. Hypertension not only damages the vessels, but also causes microscopic and macroscopic changes in the myocardium (heart muscle). The VSL Analyzer can be used as a non-invasive additional diagnostics to determine risk.
Contraindications
Use of the VSL Analyzer is indicated for prognostic risk assessment only and should not be used as part of the immediate diagnostic workup for an acute emergency. In a cardiac or neurologic emergency, guideline-based diagnostics are required instead.
Before the examination
In addition to the retinal vessels, other vascular systems must be examined to assess the risk of a cardiovascular event. Sonography of the carotid artery is useful as an additional noninvasive diagnostic tool, especially for assessing the risk of apoplexy, because it also has a high degree of association with stroke risk.
The procedure
The VSL Analyzer is a semiautomated image analysis method into which fundus images can be loaded, allowing the procedure to be used to infer systemic vascular status. The clinical relevance of fundus image assessment for vascular status was demonstrated in the “Atherosclerosis Risk in Communities” study conducted in the USA. The measurement of retinal vessel width using VSL Analyzer software on autofluorescence images of the retina generated with the Heidelberg Retina Angiograph (HRA) is also a well reproducible procedure. The procedure itself is not covered by public health insurance at this time and represents an IGel (individual health service – self-pay) performed by the specialist.
After the examination
Depending on the result of the diagnostic test procedure, further examination for risk assessment may be indicated in order to make a more accurate statement about the individual risk. Furthermore, it is essential to use other procedures to evaluate the risk of a cardiovascular pathological process. For example, the risk of apoplexy can be further specified by sonographic examination of the carotids (ultrasound examination of the carotid arteries).Various measures can be implemented to achieve a reduction in the risk of cardiovascular disease. Lifestyle changes with more exercise and an adequate diet are almost always helpful. Additional therapeutic measures may be necessary.
Possible complications
Because the procedure is a computerized assessment of noninvasive imaging, there is absolutely no risk of complications.
