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Retinal vascular imaging is a new technology that allows detailed non\u2010invasive <jats:italic>in vivo<\/jats:italic> assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low\u2010fibre and high\u2010sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight\/obesity, childhood depression\/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. 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