Objective: The purpose of this study was to assess the relation of retinal microvascular signs and incident stroke and stroke mortality in an older population. Methods: The authors took retinal photographs on baseline participants (3,654 patients aged 49+years) of the Blue Mountains Eye Study (1992 to 1994). They assessed the presence of retinopathy (microaneurysms, retinal hemorrhages) in participants without diabetes and retinal arteriolar signs in all participants using standardized grading protocols. Incident stroke/TIA/cerebrovascular death (comb ined stroke events) were identified at follow-up examinations during 1997 to 19 99. Results: During a 7-year period, 859 participants died, 97 (11.3%) of whic h died of cerebrovascular causes. Of survivors, 24 had confirmed incident stroke , and 11 had incident TIA. Combined stroke events were more frequent in particip ants with retinopathy (5.7%), with moderate/severe arteriovenous nicking (4.2% ), or with focal arteriolar narrowing (7.2%) compared with those without (1.9% ). After controlling for age, sex, systolic blood pressure, smoking, and self-r ated health, retinopathy was significantly associated with combined stroke event s (relative risk [RR] 1.7, 95%CI 1.0 to 2.8) in persons without diabetes. This association was stronger in those without severe hypertension (RR 2.7, CI 1.2 to 6.2) or in persons with two or more retinal microvascular signs (RR 2.7, CI 1.5 to 5.2). Generalized or focal arteriolar narrowing or arteriovenous nicking was not independently associated with combined stroke events after multivariate adjustment. Conclusions: In older Australians without diabetes, retinopathy signs predict stroke or stroke-related death independent of traditional stroke risk factors. Objective: The purpose of this study was to assess the relation of retinal microvascular signs and incident stroke and stroke mortality in an older population. Methods: The authors took retinal photographs on baseline participants (3,654 patients aged 49 + years) of the Blue Mountains Eye Studies (1992 to 1994). They assessed the presence of retinopathy (microaneurysms, retinal hemorrhages) in participants without diabetes and retinal arteriolar signs in all participants using standardized grading protocols. Incident stroke / TIA / cerebrovascular death (combined stroke events) at follow-up examinations during 1997 to 19 99. Results: During a 7-year period, 859 participants died, 97 (11.3%) of whic h died of cerebrovascular causes. Of survivors, 24 had confirmed incident stroke, and 11 had incident TIA. Combined stroke events were more frequent in participant with retinopathy (5.7%), with moderate / severe arteriovenous nicking (4.2%), or with focal arteriolar narrowing (7.2 After controlling for age, sex, systolic blood pressure, smoking, and self-r ated health, retinopathy was significantly associated with combined stroke event s (relative risk [RR] 1.7, 95% CI 1.0 to 2.8) in persons without diabetes. This association was stronger in those without severe hypertension (RR 2.7, CI 1.2 to 6.2) or in persons with two or more retinal microvascular signs (RR 2.7, CI 1.5 to 5.2). Generalized or focal arteriolar narrowing or arteriovenous nicking was not independently associated with combined stroke events after multivariate adjustment. Conclusions: In older Australians without diabetes, retinopathy signs predict stroke or stroke-related death independent of traditional stroke risk factors.