Eye Scan Detects Hidden Heart Disease: Retinal OCTA Spots Subclinical Coronary Atherosclerosis, Study Shows
South Korea: Reduced retinal parafoveal vascular density (PFVD), as measured by optical coherence tomography angiography (OCTA), may serve as an early indicator of subclinical coronary atherosclerosis in high-risk adults, a new study has shown. Individuals in the lowest quartile of superficial capillary plexus PFVD had significantly higher odds of obstructive coronary artery disease (CAD) and severe CAD.
The findings suggest that retinal microvascular imaging could complement traditional cardiovascular risk assessments and help identify asymptomatic patients who may benefit from further coronary evaluation.
The study was conducted by Jee Myung Yang and colleagues from the Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, and published in JAMA Cardiology. The researchers examined whether retinal microvascular changes detected by OCTA could reflect underlying coronary artery disease in individuals with elevated cardiovascular risk.
The clinic-based cross-sectional cohort study analyzed 1,286 participants who underwent both coronary computed tomography angiography (CTA) and OCTA between October 2015 and December 2020. The participants had a mean age of 64.2 years, with 37.5% being female. OCTA was used to measure superficial and deep parafoveal vascular density (PFVD), while coronary CTA assessed calcium score, presence and severity of plaque, obstructive CAD, and coronary segment involvement.
Key findings of the study include:
- Lower parafoveal vascular density (PFVD), especially in the superficial capillary plexus (SCP), was independently linked to higher coronary atherosclerotic burden.
- Participants in the lowest SCP PFVD quartile had an adjusted odds ratio of 2.91 for obstructive coronary artery disease (CAD) and 3.30 for severe CAD compared to those in the highest quartile.
- PFVD showed correlations with coronary artery calcium scores, number of vessels involved, and stenosis severity.
- Incorporating PFVD measurements into traditional cardiovascular risk models enhanced detection of severe CAD, obstructive CAD, and high-segment stenosis scores, with area under the curve (AUC) values ranging from 0.77 to 0.79.
The study highlights the potential of OCTA as a noninvasive tool for cardiovascular risk stratification. Reduced PFVD may reflect systemic microvascular impairment that parallels coronary atherosclerosis, offering a window for early detection in asymptomatic individuals.
The authors noted several limitations, including the single-center design, single-ethnicity cohort, and exclusion of participants with advanced macular disease, which may affect generalizability. Additionally, the study did not assess coronary plaque composition or differentiate between retinal arteries, veins, and capillaries, leaving room for future research using AI-assisted retinal vessel analysis.
"The research provides compelling evidence that retinal microvascular imaging via OCTA, particularly PFVD measurement, could serve as a complementary marker for identifying subclinical coronary atherosclerosis. Integrating this approach with conventional cardiovascular risk assessments may help guide timely interventions and improve preventive care strategies in high-risk populations," the authors concluded.
Reference:
Yang JM, Yang DH, Lee S, et al. Subclinical Coronary Atherosclerosis and Retinal Optical Coherence Tomography Angiography. JAMA Cardiol. Published online September 17, 2025. doi:10.1001/jamacardio.2025.3036
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