Retinal Optical Coherence Tomography-Angiography and Longitudinal Changes in Cognition and Cerebral Small Vessel Disease.
Overview
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, United Kingdom
- Institute for Neuroscience and Cardiovascular Research, The University of Edinburgh, United Kingdom
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, United Kingdom
- Robert O Curle Ophthalmology Suite, Institute for Regeneration and Repair, University of Edinburgh, United Kingdom
- Institute for Adaptive and Neural Computation, University of Edinburgh, United Kingdom
- Edinburgh Medical School, The University of Edinburgh, United Kingdom; and
- Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
Abstract
Background and Objectives: Cross-sectional studies suggest that retinal microvascular abnormalities measured by optical coherence tomography angiography (OCTA) are associated with cerebral small vessel disease (cSVD) and cognitive impairment, but longitudinal relationships remain unclear. We investigated whether OCTA measures are associated with brain cSVD markers and cognition over time and whether baseline OCTA was associated with brain and cognitive outcomes after mild ischemic stroke.
Methods: We conducted a prospective longitudinal cohort study recruiting patients with lacunar or mild cortical ischemic stroke (modified Rankin Scale ≤2) from a hospital stroke service. Participants underwent OCTA, brain MRI, and medical and cognitive assessment (MoCA) at baseline and 1 year. OCTA metrics included vessel density (VD), foveal avascular zone area, vessel radius, tortuosity, and flow index from superficial and deep vascular layers. MRI outcomes included white matter hyperintensity (WMH) volume, basal ganglia perivascular space (PVS) volume, and mean diffusivity in normal-appearing white matter. We used linear mixed-effects models to assess (1) whether retinal measures were associated with brain and cognitive markers over time and (2) whether baseline retinal measures were associated with 1-year outcomes, adjusting for age, sex, systolic blood pressure, smoking, diabetes, stroke severity, disability, and stroke subtype.
Results: A total of 189 participants (mean age 64.8 years; 37% female) were assessed at baseline and 154 at 1 year. Longitudinal reductions in retinal VD were associated with WMH increase (superficial layer, standardized β [95% CI] −0.045 [−0.067 to −0.023]; deep layer −0.050 [−0.074 to −0.026]). Increases in retinal VD and reductions in retinal flow were associated with increased PVS volume. Lower MoCA over 1 year tracked with decreases in deep retinal VD (0.136 [0.036–0.236]). Baseline retinal measures were associated with future outcomes: In particular, lower baseline VD in both layers was associated with worse MoCA at 1 year (superficial layer 0.125 [0.043–0.207]; deep layer 0.242 [0.162–0.322]).
Discussion: OCTA-measured retinal microvascular features are associated with cSVD progression and worsening cognition after mild stroke, while baseline OCTA was associated with future brain and cognitive outcomes. These findings suggest that OCTA holds promise as a noninvasive tool for monitoring retinal microvascular pathology in stroke populations enriched for cSVD, warranting further investigation in larger cohorts.
Reproduced under the paper's license (CC BY), from the paper cited above.
Code
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Data
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Data Availability
Data are available upon reasonable request from the MSS3 team. The OCTARIMA software is available upon request from author M.O. Bernabeu.
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Versions
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Version 3, 28 September 2026
- Publisher: n/a → Lippincott Williams & Wilkins
Version 1, 27 September 2026: the first record
Recorded: type, language, journal, volume, issue, pages, dates, 24 authors, 14 MeSH terms, 3 funders, 50 references.
Cite
This paper
Gibbon, S., Giarratano, Y., Hamid, C., Arteaga-Reyes, C., Clancy, U., Wiseman, S., Jaime Garcia, D., Backhouse, E. V., Valdés Hernández, M. D. C., Stringer, M. S., Thrippleton, M. J., Chappell, F. M., Doubal, F., Maccormick, I., Jardine, C., Hamilton, I., Barclay, G., McIntyre, D., Marin, B., . . . Wardlaw, J. M. (2026). Retinal Optical Coherence Tomography-Angiography and Longitudinal Changes in Cognition and Cerebral Small Vessel Disease. Neurology, 107(7), e218502. https://
BibTeX
@article{gibbon2026retin
author = {Gibbon, Samuel and Giarratano, Ylenia and Hamid, Charlene and Arteaga-Reyes, Carmen and Clancy, Una and Wiseman, Stewart and Jaime Garcia, Daniela and Backhouse, Ellen V and Valdés Hernández, Maria Del C and Stringer, Michael S and Thrippleton, Michael J and Chappell, Francesca M and Doubal, Fergus and Maccormick, Ian and Jardine, Charlotte and Hamilton, Iona and Barclay, Gayle and McIntyre, Donna and Marin, Borja and Panek, Oskar and Dhillon, Baljean and MacGillivray, Thomas J and Bernabeu, Miguel O and Wardlaw, Joanna M},
title = {{Retinal Optical Coherence Tomography-Angiography and Longitudinal Changes in Cognition and Cerebral Small Vessel Disease}},
journal = {Neurology},
year = {2026},
month = sep,
volume = {107},
number = {7},
pages = {e218502},
publisher = {Lippincott Williams \& Wilkins},
issn = {0028-3878},
doi = {10.1212/
url = {https://
pmid = {42743445},
pmcid = {PMC13580402}
}
RIS
TY - JOUR
AU - Gibbon, Samuel
AU - Giarratano, Ylenia
AU - Hamid, Charlene
AU - Arteaga-Reyes, Carmen
AU - Clancy, Una
AU - Wiseman, Stewart
AU - Jaime Garcia, Daniela
AU - Backhouse, Ellen V
AU - Valdés Hernández, Maria Del C
AU - Stringer, Michael S
AU - Thrippleton, Michael J
AU - Chappell, Francesca M
AU - Doubal, Fergus
AU - Maccormick, Ian
AU - Jardine, Charlotte
AU - Hamilton, Iona
AU - Barclay, Gayle
AU - McIntyre, Donna
AU - Marin, Borja
AU - Panek, Oskar
AU - Dhillon, Baljean
AU - MacGillivray, Thomas J
AU - Bernabeu, Miguel O
AU - Wardlaw, Joanna M
TI - Retinal Optical Coherence Tomography-Angiography and Longitudinal Changes in Cognition and Cerebral Small Vessel Disease
T2 - Neurology
J2 - Neurology
PY - 2026
DA - 2026/
VL - 107
IS - 7
SP - e218502
SN - 0028-3878
PB - Lippincott Williams & Wilkins
DO - 10.1212/
UR - https://
LA - en
ER -
CSL-JSON
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