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PurposeThe arteriole-to-venule ratio (AVR) is widely used for investigating subclinical cerebral microangiopathy. The possible occurrence of retinal vascular caliber changes was investigated in a population of hyperhomocysteinaemic (plasma total homocysteine (tHcy) >13 μmol/l) adult epileptic patients.MethodsRetinal photographs of cases and controls were evaluated for generalized narrowing of the retinal arterioles, measured as AVR, by graders masked to case–control status using standardized protocols. Plasma total homocysteine (tHcy) levels were assayed by HPLC.ResultsSixty-seven patients (36M/31F, 36.4±7.5 years of age; mean level of tHcy 22.8±11.4 μmol/l), and 75 control subjects (42M/33F, 35.4±8.5 years of age; mean level of tHcy 7.8±2.3 μmol/l) were enroled. No retinal caliber changes were detected in any patient and healthy subject. The analysis of retinal photographs failed to identify any difference in the venular diameters, arteriolar diameters, and AVR measurements between the two groups (P=0.98).Conclusionswe showed that adult hyperhomocysteinaemic epileptic patients do not show any changes in retinal vascular caliber assessed by the measurement of AVR.Eye (2009) 23, 1532–1534; doi:10.1038/eye.2008.326; published online 31 October 2008 [ABSTRACT FROM AUTHOR]