A thorough examination of the supra-aortal vessels can explain the causes of circulatory ocular fundus changes. The Doppler ultrasonic method seems to be the best for this purpose. The main risk factors for cerebral vessels are high blood pressure and diabetes, and they should be medically treated. The use of prophilactic cardiac glycosid therapy seems unwarranted since a physiological cardiac insufficiency due to age exists just as little as the so-called ‘old heart’. Hypotension that would not require a medical treatment as such needs treatment, however, if suspicious fundus changes are present. Vasodilators do not improve the cerebral circulation, but preparations diminishing blood viscosity are here advisable. In cases of acute obstruction a fibrinolytic approach seems reasonable. A prophylactic treatment with antisclerotics is certainly to late when clinical manifestations occur.