A recent study published in PLOS Digital Health suggests that subtle changes in the retina may be associated with atrial fibrillation (AFib) and could potentially signal an increased risk of the condition up to four years before diagnosis. AFib is a common heart rhythm disorder that can cause a racing or irregular heartbeat and increase the risk of serious complications, including stroke and heart failure.
The study analyzed optical coherence tomography (OCT) scans and color photographs of the retina from more than 90,000 people involved in two large research studies — AlzEye and the UK Biobank. The researchers focused on the retina because it provides a rare opportunity to examine blood vessels and nerve tissue non-invasively.
According to lead researcher Dr. Josef Huemer, a consultant ophthalmologist at Moorfields Eye Hospital and honorary senior research fellow at University College London’s Institute of Ophthalmology, retinal imaging could reveal subtle changes associated with cardiovascular disease. Previous research has shown that changes in the retina can be associated with conditions affecting other parts of the body.
The researchers found that people with AFib had consistently thinner macular ganglion cell-inner plexiform layers (mGCIPL). The mGCIPL contains retinal nerve cells involved in transmitting visual information between the eye and brain. Huemer explained that thinning of this layer can indicate previous degeneration, although it is not specific to AFib.
One of the study’s most notable findings involved people who did not have AFib when their eye images were taken. Those who later developed the condition had, on average, thinner mGCIPL layers about four years before they were diagnosed with AFib. The researchers said the finding could eventually help improve AFib risk assessment and identify people who may benefit from longer-term heart rhythm monitoring.
Dr. Benjamin Bert, an ophthalmologist at MemorialCare Orange Coast Medical Centre in California, suggested that one possible explanation for the findings was “silent ischaemia” — small episodes of reduced blood flow that cause tissue damage without producing obvious symptoms. Dr. Cheng-Han Chen, an interventional cardiologist, stressed that the biological connection between AFib and changes in retinal cells remained unclear.
Future studies will need to determine exactly which eye changes are associated with AFib and whether they can reliably predict who will develop the condition. Researchers will also need to establish whether the findings apply across different populations and whether eye imaging can become a practical screening tool. For now, the findings suggest that the retina may provide an important window into cardiovascular health.
Key points
- A routine eye scan may help doctors identify people at risk of developing atrial fibrillation (AFib) years before the heart condition is diagnosed.
- The study found that people who later developed AFib had, on average, thinner mGCIPL layers about four years before they were diagnosed with AFib.
- The researchers hope to develop algorithms that could eventually undergo regulatory approval for use in optometry settings to predict AFib risk.
