RNFL and GCIPL thicknesses are associated with future MACE, even after adjusting for CVRF, suggesting OCT-measured retinal layer thickness could contribute to the assessment of cardiovascular risk.
Key Findings
Results
Retinal nerve fiber layer (RNFL) thickness was statistically associated with incident major adverse cardiovascular events (MACE) after adjustment for cardiovascular risk factors.
Adjusted hazard ratio (aHR) for RNFL thickness and incident MACE: 0.92 (95% CI 0.89–0.96, p < 0.001)
Models were cause-specific hazard models adjusted for cardiovascular risk factors (CVRF)
Analysis included 51,293 UK Biobank participants with a median follow-up of 14.7 years
MACE was defined as stroke, myocardial infarction, or cardiovascular death
Results
Ganglion cell-inner plexiform layer (GCIPL) thickness was statistically associated with incident MACE after adjustment for cardiovascular risk factors.
Adjusted hazard ratio (aHR) for GCIPL thickness and incident MACE: 0.96 (95% CI 0.92–1.00, p = 0.04)
Association was statistically significant but of smaller magnitude compared to RNFL
Same cause-specific hazard model framework adjusted for CVRF was used
Study population drawn from the UK Biobank retrospective cohort
Results
RNFL thickness was more strongly associated with incident myocardial infarction than with stroke.
aHR for RNFL thickness and incident myocardial infarction: 0.94 (95% CI 0.88–0.99, p = 0.02)
Subanalyses were performed separately for incident stroke and myocardial infarction
This differential association suggests possible organ-specific or pathophysiological specificity of retinal layer thinning
Results
GCIPL thickness was more strongly associated with incident stroke than with myocardial infarction.
aHR for GCIPL thickness and incident stroke: 0.90 (95% CI 0.83–0.96, p = 0.003)
This association was stronger than the overall MACE association for GCIPL (aHR 0.96)
The stronger stroke association of GCIPL may reflect shared neurovascular pathophysiology between the retina and brain
Subanalyses for stroke and MI were performed separately within the same cohort framework
Methods
The study utilized a large retrospective cohort of 51,293 UK Biobank participants with a long median follow-up period.
Cohort size: 51,293 participants
Median follow-up time: 14.7 years
Retinal measurements were obtained using optical coherence tomography (OCT)
OCT was described as a 'noninvasive, low-cost' imaging modality
The study design was retrospective
Background
Prior research has shown thinning of certain retinal layers in patients with previous CVD, motivating investigation of whether OCT could predict future events.
OCT has 'recently shown thinning of certain retinal layers in patients with previous CVD'
The current study extended this to prospective prediction of incident MACE rather than cross-sectional association
CVD is described as 'the leading cause of death worldwide', providing the clinical motivation
What This Means
This research suggests that the thickness of specific layers at the back of the eye, measured using a non-invasive eye scan called optical coherence tomography (OCT), can predict future serious heart and brain events — such as heart attacks, strokes, or cardiovascular death — even in people who don't yet have known cardiovascular disease. Analyzing data from over 51,000 participants followed for nearly 15 years on average, the researchers found that thinner retinal nerve fiber layers and thinner ganglion cell layers were both linked to a higher risk of these major cardiovascular events, even after accounting for standard risk factors like blood pressure and cholesterol.
Interestingly, the two retinal layers showed somewhat different patterns: the nerve fiber layer was more closely linked to future heart attacks, while the ganglion cell layer was more strongly linked to future strokes. This may reflect the fact that the retina and brain share similar blood vessel structures and disease processes, making the eye a potential 'window' into cardiovascular and neurological health.
This research suggests that routine eye scans, which are already widely available and relatively inexpensive, could one day play a role in identifying people at higher risk of heart attacks and strokes before these events occur. This could complement existing cardiovascular risk assessment tools and help target preventive treatments more effectively, though further research would be needed to establish how OCT measurements might be practically integrated into clinical risk scoring.
Hänsel M, Deseoe J, Herzog L, Davoudi N, Kana V, Menze B, et al.. (2026). Retinal layer thickness as a potential marker for future cardiovascular events - a UK Biobank cohort study using optical coherence tomography.. Journal of neurology. https://doi.org/10.1007/s00415-026-14175-4