Does metabolic dysfunction-associated steatotic liver disease affect the ocular circulation?

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, and its prevalence is increasing. • MASLD is a multisystemic disease affecting many systems. • The aim of this study is to evaluate ocular vascularity in patients with MASLD. • Ocular perfusion is affected in patients with MASLD due to endothelial dysfunction and vascular damage. To evaluate the choroidal thickness (CT), central retinal artery (CRA), ophthalmic artery (OA), internal carotid artery (ICA) and common carotid artery (CCA) hemodynamic parameters and the carotid intima-media thickness (CIMT) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This prospective study included 98 MASLD patients and 30 healthy controls. MASLD patients were classified into three stages via liver ultrasonography. CT was significantly decreased at all measured points in Stage 2 and Stage 3 MASLD patients versus controls and at subfoveal and nasal (500–1000-1500 µm) points in Stage 3 compared to Stage 1(all p < 0.05). A significant relationship was observed between CT and age, MASLD stage, and GGT levels. OA peak sistolik velocity (PSV), ICA PSV, enddiastolic velocity (EDV), and CCA EDV values were significantly lower in Stage 3 compared to the control group and Stage 1 while the ICA PSV and CCA EDV values were significantly lower in Stage 3 compared to Stage 2 (all p < 0.05). The CCA resistive index (RI) and pulsatile index (PI) were significantly higher in Stage 3 than in the control group and Stage 1 as with the CCA PI value in Stage 3 compared to Stage 2 (p = 0.026, p = 0.035, p = 0.011, p = 0.014, p = 0.022, respectively). CIMT was significantly higher in Stage 3 than in controls (p = 0.005). MASLD affects ocular vascular structures and may be associated with an increased risk of ocular pathologies.