516 individuals aged ≥ 40 years who underwent neck vascular ultrasound and color fundus photography simultaneously at the physical examination center of Deyang People’s Hospital in Sichuan Province from June 2020 to December 2022 using a random sampling method. Among them, there are 257 males and 259 females, aged 40 - 80 years, with an average age of 54.6 ± 16.3 years.

1) Evaluate the traditional risk factors of the enrolled patients, including age, gender, hypertension, diabetes, coronary heart disease and other medical history; Fasting venous blood was collected to measure blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and homocysteine.

2) Fundus examination: Using the CR-2 fundus camera from CANON Company in Japan, the examination is completed in a dark room. According to Keith Wagner’s classification of the presence and severity of retinal arteriosclerosis [6] [7] : 0 level: no retinal arteriosclerosis; Grade I: Mild extensive thinning of retinal arteries with enhanced reflective bands; Grade II: Retinal artery stenosis and widened reflective band, arteriovenous compression; Level III: On the basis of the above level II, accompanied by retinal hemorrhage or exudation; Grade IV: On the basis of Grade III retinal fundus changes, optic nerve papillary edema appears. The above examinations and results are determined by two qualified clinical physicians. If the grading of the fundus examination of both eyes is inconsistent, the one with higher grading will be counted.

3) Carotid artery examination method and observation indicators: The Philips EPIQ7 color ultrasound diagnostic instrument and 7.5 MHz linear array probe were used to detect the bilateral carotid arteries of the subject. Sampling location: Common carotid artery (1.0 - 1.5 cm from the bifurcation); the bifurcation of the common carotid artery and the internal carotid artery (1.0 to 1.5 cm from the bifurcation). Observation indicators: a) Intima media thickness (IMT) of the common carotid artery, defined as IMT thickening when IMT ≥ 1.0 mm; b) presence or absence of carotid plaques, whether carotid plaques are vulnerable or stable. Carotid artery plaques are defined as those with IMT ≥ 1.5 mm. For patients with carotid artery plaques, the plaques can be further divided into: (i) hypoechoic lipid soft plaques; (ii) Fibrous flat plaques with moderate echogenicity and rich collagen tissue; (iii) Ulcerative mixed type plaques with varying echogenicity; (iv) A calcified hard plaque with strong echoes and echogenic shadows. Define types (i), (ii), and (iii) of plaques as vulnerable plaques, and type (iv) of plaques as stable plaques. The plaque score method was used to score the plaque [8] , that is, without calculating the length of each plaque, only the maximum thickness (mm) of each isolated carotid atherosclerotic plaque on the same side was added to obtain the carotid plaque score on that side, and the sum of the carotid plaque scores on both sides was the total plaque score of the patient. The total plaque score of 1.1 - 5.0 is mild carotid atherosclerosis; 5.1 - 10.0 are moderate carotid atherosclerosis 10.0 is severe carotid atherosclerosis; c) The presence and severity of carotid artery stenosis: The location of the largest plaque is evaluated based on the ultrasound blood velocity of the carotid artery and the cross-sectional area of the residual cavity to determine the presence and severity of carotid artery stenosis. Based on this, the research subjects were divided into: normal or carotid artery stenosis group (vascular stenosis degree < 50%), moderate carotid artery stenosis group (stenosis degree 50% - 69%), and severe carotid artery stenosis group (stenosis degree 70% - 99%) [8] [9] .

Statistical analysis was conducted using SPSS 23.0 statistical software. Counting data is expressed in terms of rate, and inter group comparisons are made using X². The measurement data are expressed as mean ± standard deviation. The comparison of measurement data of normal distribution is performed by analysis of variance or t-test, otherwise, the rank sum test is used. Spearman rank correlation analysis of the correlation between fundus arteriosclerosis and age. Use logistic regression to analyze the risk factors of fundus arteriosclerosis and carotid arteriosclerosis. P < 0.05 indicates a statistically significant difference.

Among the 516 physical examination patients, 198 (38.4%) had normal fundus examination, and 318 (61.6%) had fundus arteriosclerosis. Among them, 166 cases were of grade I (32.2%), 86 cases were of grade II (16.7%), and 66 cases were of grade III (12.8%). No grade IV lesions were found in this group of data. Compared with those with normal fundus examination, those with grade II and III fundus arteriosclerosis were older, had a history of hypertension and diabetes, and other general conditions and risk factors were not statistically significant between the two groups (see Table 1). Spearman correlation analysis found a correlation between the degree of fundus arteriosclerosis and age (r = 0.422).

Among 516 physical examinees, 286 (55.4%) had no carotid atherosclerotic plaque, 201 (38.9%) had carotid atherosclerotic plaque, of which 58 (11.2%) were vulnerable plaque, 172 (33.3%) were stable plaque; There were 33 cases (6.4%) with carotid artery stenosis, including 23 cases (4.5%) with <50% stenosis and 10 cases (1.9%) with 50% - 69% stenosis. No stenosis ≥ 70% was found in this group of data. The IMT thickness of bilateral common carotid arteries, the incidence of carotid plaques and vulnerable plaques, the score of carotid plaques, and the presence of carotid stenosis in patients with fundus arteriosclerosis were significantly higher than those with normal fundus examination, with statistical significance (P < 0.05, see Table 1). Vascular elastic function is related to the degree of arteriolar wall sclerosis, expandability and lumen size, which are all affected by atherosclerosis. The first affected part of arteriosclerosis is the intima

and media, and vascular elastic function is mainly maintained by the elastic fibers of the media. When hardening occurs, the media is damaged, and then the arterial elastic function decreases, thereby affecting the vascular volume, resulting in hemodynamic changes [10] .

With eyeground arteriosclerosis II and III as dependent variables, the parameters with statistical significance between different grades of eyeground arteriosclerosis in the above univariate analysis as independent variables, including age, hypertension, diabetes, carotid atherosclerotic plaque, vulnerable carotid atherosclerotic plaque, carotid stenosis, bilateral common carotid artery IMT thickness and carotid plaque score, etc., Fundus arteriosclerosis was independently correlated with age, hypertension, vulnerable plaque of carotid atherosclerosis, carotid stenosis, IMT of common carotid artery, and carotid plaque score, with statistical significance (P < 0.05, see Table 2). Evidence-based medicine confirms that the occurrence of arteriosclerosis is influenced by age, blood pressure, blood lipids, diabetes, uric acid, obesity, smoking and diet habits, and the influence of various risk factors such as genetics. Fundus arteriosclerosis is a type of slow Sexual vascular disease that is one of the indications for target organ and peripheral arterial sclerosis, which is Aging manifestations of the vascular system around the body; Fundus artery microvascular abnormalities and heart. The occurrence, development, and prognosis of cerebrovascular diseases are closely related; Vascular lesions. It is systemic and can predict systemic arterial stiffness simultaneously with an increase in pulse pressure [11] .