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5 reviewsThe accessibility of the retina with the use of non-invasive and relatively Introductionlow-cost ophthalmic imaging techniques and analytics provides a Methodsunique opportunity to improve the detection, diagnosis and monitoring Retinal imaging technologyof systemic diseases. The National Heart, Lung, and Blood Institute Retinal biomarkers of systemic conducted a workshop in October 2022 to examine this concept. On diseasesthe basis of the discussions at that workshop, this Roadmap describes Developments in AI in current knowledge gaps and new research opportunities to evaluate ophthalmologythe relationships between the eye (in particular, retinal biomarkers) Knowledge gapsand the risk of cardiovascular diseases, including coronary artery Research opportunities disease, heart failure, stroke, hypertension and vascular dementia. and future directionsIdentifed gaps include the need to simplify and standardize the Conclusionscapture of high-quality images of the eye by non-ophthalmic health workers and to conduct longitudinal studies using multidisciplinary networks of diverse at-risk populations with improved implementation and methods to protect participant and dataset privacy. Other gaps include improving the measurement of structural and functional retinal biomarkers, determining the relationship between microvascular and macrovascular risk factors, improving multimodal imaging ‘pipelines’, and integrating advanced imaging with ‘omics’, lifestyle factors, primary care data and radiological reports, by using artifcial intelligence technology to improve the identifcation of individual-level risk. Future research on retinal microvascular disease and retinal biomarkers might additionally provide insights into the temporal development of microvascular disease across other systemic vascular beds.