Skip to content
DraconiticResearch
Search Sources API
201,683 studies31 sourcesUpdated 42 min ago
Peer-reviewedCC BY 4.0PLOS Digital Health

Atrial fibrillation and retinal imaging-based oculomics: A cross-sectional and longitudinal analysis of two large cohorts

  • Josef Huemer1
  • Kelsey V. Stuart2
  • Yukun Zhou3
  • Dominic J. Williamson4
  • Peter Woodward-Court5
  • Alastair R. Mobley6
  • Arvind Chandratheva7
  • Florian Berger8
  • Nay Aung9
  • Steffen E. Petersen10
  • UK Biobank Eye and Vision Consortium11
  • Anthony P. Khawaja12
7 more authors
  • Axel Petzold13
  • Jugnoo Rahi14
  • Alastair K. Denniston15
  • Dipak Kotecha16
  • Pearse A. Keane17
  • Praveen J. Patel
  • Siegfried K. Wagner
17 affiliations
  1. 1NIHR Moorfields Biomedical Research Centre, London, United Kingdom
  2. 2Institute of Ophthalmology, University College London, London, United Kingdom
  3. 3Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
  4. 4NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  5. 5Department of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
  6. 6Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
  7. 7The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, United Kingdom
  8. 8Pediatric Cardiology, Pediatric Heart Center, University Children’s Hospital Zurich, Switzerland
  9. 9William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
  10. 10Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
  11. 11MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
  12. 12Rothschild Foundation Hospital, Paris, France
  13. 13Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
  14. 14UCL Great Ormond Street Institute of Child Health, London, United Kingdom
  15. 15Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
  16. 16Ulverscroft Vision Research Group, UCL London, London, United Kingdom
  17. 17Julius Center, University Medical Center Utrecht, the Netherlands
Read full textPDFDOICite

Abstract

We investigate the association between multimodal retinal imaging parameters with prevalent and incident atrial fibrillation (AF). For this cross-sectional and longitudinal analysis we utilized data from two independent cohorts: AlzEye (retrospective, age ≥ 40 years, 2008–2018) and UK Biobank (UKB; prospective, age 40–69 years, recruited 2006–2010). Retinal sublayer thicknesses and retinovascular indices were extracted from macular optical coherence tomography and color retinal photography, respectively. AF was ascertained via self-report and hospital admissions, association between retinal metrics with prevalent and incident AF were estimated using mixed-effects linear and frailty models. In AlzEye (n = 50,651), prevalent AF (n = 5,375; 11%) was associated with significantly smaller retinal venular calibre (-0.05 µm, 95% CI: -0.08, -0.03) and thinner macular retinal nerve fibre layer (-0.69 µm, 95% CI: -0.91, -0.46), ganglion cell-inner plexiform layer (mGCIPL; -1.96 µm, 95% CI: -2.34, -1.58), inner nuclear layer (-0.57 µm, 95% CI: -0.75, -0.38), and photoreceptor layer (-0.93 µm, 95% CI: -1.38, -0.48). Venular fractal dimension was lower (-0.08, 95% CI: -0.11, -0.06), while arteriolar fractal dimension was higher (0.05, 95% CI: 0.02, 0.08) in individuals with AF. Evidence of thinner mGCIPL was replicated in UKB (-1.19 µm, 95% CI: -1.73, -0.65). In UKB (n = 39,013 baseline without AF), 838 developed AF over a mean of 4.0 years. Adjusting for sociodemographic, clinical and lifestyle factors, each SD decrease in mGCIPL thickness was associated with a significant 27% increased hazard of AF (95% CI: 5%, 54%). Differences in the inner retinal sublayers, corresponding to retinal ganglion cells, are associated with prevalent and incident AF across two large independent cohorts, supporting the potential role of widely-accessible retinal imaging for early detection and better management of AF. Author summary: Atrial fibrillation, one of the most common heart conditions causing an irregular heart rhythm, affects millions of people worldwide and significantly increases the risk of stroke and heart failure. Detecting it early, before symptoms arise, remains a major clinical challenge. In this study, we explored whether the retina could offer clues about a person’s cardiac health. Because the retina shares structural and vascular similarities with the brain and heart, changes visible on routine eye scans may reflect broader changes occurring elsewhere in the body. Using eye imaging data from over 90,000 individuals across two large independent datasets, we found that people with atrial fibrillation show measurable thinning of specific inner retinal layers, the ganglion cell and inner plexiform layer, and the inner nuclear layer, compared to those without atrial fibrillation. Crucially, individuals with a thinner retina at baseline were significantly more likely to develop atrial fibrillation in the future, even before any cardiac diagnosis had been made, underlining the difficulty of establishing the diagnosis. These findings suggest that standard, non-invasive retinal scans which are widely used both in eye clinics and community settings, could potentially help identify individuals at elevated cardiac risk, potentially enabling earlier intervention and improved outcomes.

Related

  1. Integrated oculomics and lipidomics characterise cross-sectional retinal–lipidomic associations in a generally healthy biobank population
    Inam Ullah, Ernesto Elias Vidal Rosas, Imran Razzak +1
    Scientific ReportsPeer-reviewedCC BY 4.0Full textMedical imaging & radiologyCrossref
  2. RFM: A Lightweight Retinal Foundation Model for Generalised Oculomics
    J. Fajtl, R. A. Welikala, R. Shakespeare +14
    medRxivPreprintCC BY-NC-NDFull textEpidemiology & public healthmedRxiv
  3. Longitudinal Multimodal Retinal Imaging in Cognitively Normal Apolipoprotein E4 Carriers and Noncarriers
    Alex Choi, Alice Haystead, Rachel D'Cunha +6
    Translational Vision Science & TechnologyPeer-reviewedCC BY-NC-ND 4.0Full textMedical imaging & radiologyPMC
  4. Prediction of incident atrial fibrillation from retinal fundus images using a multimodal foundation model
    Yupeng Xu, Yige Peng, Yan Jiang +11
    NPJ Digital MedicinePeer-reviewedCC BY-NC-ND 4.0Full textMedical imaging & radiologyPMC
  5. Longitudinal Left Atrial Remodeling With Pharmacological Rhythm Versus Rate Control in Paroxysmal and Persistent Atrial Fibrillation
    Shao‐Fu Chien, Chih‐Hui Chin, Chao‐Chien Chang +2
    Echocardiography (Mount Kisco, N.Y.)Peer-reviewedCC BY-NC-NDFull textCardiovascular medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{huemer2026atrial,
  title = {{Atrial fibrillation and retinal imaging-based oculomics: A cross-sectional and longitudinal analysis of two large cohorts}},
  author = {Josef Huemer and Kelsey V. Stuart and Yukun Zhou and Dominic J. Williamson and Peter Woodward-Court and Alastair R. Mobley and Arvind Chandratheva and Florian Berger and Nay Aung and Steffen E. Petersen and UK Biobank Eye and Vision Consortium and Anthony P. Khawaja and Axel Petzold and Jugnoo Rahi and Alastair K. Denniston and Dipak Kotecha and Pearse A. Keane and Praveen J. Patel and Siegfried K. Wagner},
  journal = {PLOS Digital Health},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pdig.0001661},
  url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001661},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Atrial fibrillation and retinal imaging-based oculomics: A cross-sectional and longitudinal analysis of two large cohorts
AU  - Josef Huemer
AU  - Kelsey V. Stuart
AU  - Yukun Zhou
AU  - Dominic J. Williamson
AU  - Peter Woodward-Court
AU  - Alastair R. Mobley
AU  - Arvind Chandratheva
AU  - Florian Berger
AU  - Nay Aung
AU  - Steffen E. Petersen
AU  - UK Biobank Eye and Vision Consortium
AU  - Anthony P. Khawaja
AU  - Axel Petzold
AU  - Jugnoo Rahi
AU  - Alastair K. Denniston
AU  - Dipak Kotecha
AU  - Pearse A. Keane
AU  - Praveen J. Patel
AU  - Siegfried K. Wagner
PY  - 2026
DA  - 2026/09/10
JO  - PLOS Digital Health
DO  - 10.1371/journal.pdig.0001661
UR  - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001661
AB  - We investigate the association between multimodal retinal imaging parameters with prevalent and incident atrial fibrillation (AF). For this cross-sectional and longitudinal analysis we utilized data from two independent cohorts: AlzEye (retrospective, age ≥ 40 years, 2008–2018) and UK Biobank (UKB; prospective, age 40–69 years, recruited 2006–2010). Retinal sublayer thicknesses and retinovascular indices were extracted from macular optical coherence tomography and color retinal photography, respectively. AF was ascertained via self-report and hospital admissions, association between retinal metrics with prevalent and incident AF were estimated using mixed-effects linear and frailty models. In AlzEye (n = 50,651), prevalent AF (n = 5,375; 11%) was associated with significantly smaller retinal venular calibre (-0.05 µm, 95% CI: -0.08, -0.03) and thinner macular retinal nerve fibre layer (-0.69 µm, 95% CI: -0.91, -0.46), ganglion cell-inner plexiform layer (mGCIPL; -1.96 µm, 95% CI: -2.34, -1.58), inner nuclear layer (-0.57 µm, 95% CI: -0.75, -0.38), and photoreceptor layer (-0.93 µm, 95% CI: -1.38, -0.48). Venular fractal dimension was lower (-0.08, 95% CI: -0.11, -0.06), while arteriolar fractal dimension was higher (0.05, 95% CI: 0.02, 0.08) in individuals with AF. Evidence of thinner mGCIPL was replicated in UKB (-1.19 µm, 95% CI: -1.73, -0.65). In UKB (n = 39,013 baseline without AF), 838 developed AF over a mean of 4.0 years. Adjusting for sociodemographic, clinical and lifestyle factors, each SD decrease in mGCIPL thickness was associated with a significant 27% increased hazard of AF (95% CI: 5%, 54%). Differences in the inner retinal sublayers, corresponding to retinal ganglion cells, are associated with prevalent and incident AF across two large independent cohorts, supporting the potential role of widely-accessible retinal imaging for early detection and better management of AF. Author summary: Atrial fibrillation, one of the most common heart conditions causing an irregular heart rhythm, affects millions of people worldwide and significantly increases the risk of stroke and heart failure. Detecting it early, before symptoms arise, remains a major clinical challenge. In this study, we explored whether the retina could offer clues about a person’s cardiac health. Because the retina shares structural and vascular similarities with the brain and heart, changes visible on routine eye scans may reflect broader changes occurring elsewhere in the body. Using eye imaging data from over 90,000 individuals across two large independent datasets, we found that people with atrial fibrillation show measurable thinning of specific inner retinal layers, the ganglion cell and inner plexiform layer, and the inner nuclear layer, compared to those without atrial fibrillation. Crucially, individuals with a thinner retina at baseline were significantly more likely to develop atrial fibrillation in the future, even before any cardiac diagnosis had been made, underlining the difficulty of establishing the diagnosis. These findings suggest that standard, non-invasive retinal scans which are widely used both in eye clinics and community settings, could potentially help identify individuals at elevated cardiac risk, potentially enabling earlier intervention and improved outcomes.
SN  - 2767-3170
ER  -