Retinal Microvasculature and Emotional, Behavioral, and Cognitive Outcomes at School Age

BACKGROUND: The retinal microvasculature can serve as a window into the intracerebral vasculature, and an adverse retinal microvasculature is linked to neurocognitive disease and psychopathology in adults. We hypothesized that associations of retinal vessel calibers with emotional, behavioral, and cognitive outcomes may be present in school-age children. METHODS: This study among 3866 children was embedded in a population-based cohort study from early fetal life. Retinal microvasculature measurements were obtained from retinal photographs at age 6. At ages 6, 10, and 14, total, internalizing, and externalizing problems and attention-deficit hyperactivity disorder symptoms were measured using the Child Behavior Checklist/6-18. Autism symptoms were assessed by the Social Responsiveness Scale at ages 6 and 14. Estimated full-scale intelligence quotient was assessed using the Wechsler Intelligence Scale for Children-Fifth Edition at age 14. RESULTS: A 1-SD score wider retinal arteriolar caliber was associated with a -0.034 SD score (95% CI, -0.068 to -0.001; P value <0.05) lower externalizing problems (Child Behavior Checklist) score. However, this association attenuated into nonsignificance after adjustment for maternal and childhood confounders. No associations were observed for retinal arteriolar and venular calibers and total, internalizing, and externalizing problems (Child Behavior Checklist), attention-deficit hyperactivity disorder symptoms (Child Behavior Checklist), autism symptoms (Social Responsiveness Scale), and estimated full-scale intelligence quotient (Wechsler Intelligence Scale for Children-Fifth Edition) at ages 6, 10, and 14. CONCLUSIONS: From our results, we cannot conclude that retinal vessel calibers at age 6 are associated with emotional, behavioral, and cognitive outcomes at ages 6, 10, and 14. Longitudinal studies with repeated childhood measurements are needed to further explore these associations.