Correlation between Retinal Microvasculature Changes Assessed by Optical Coherence Tomography and Coronary Artery Disease

Background: Cardiovascular disease stays the main reason of mortality worldwide, and early identification of individuals at increased risk is essential for preventive management. Retinal microvasculature displays systemic vascular health, and optical coherence tomography angiography (OCTA) offers a non-invasive tool for its assessment. Patients and Methods: This study included 116 adults undergoing diagnostic coronary angiography. Based on angiographic findings, patients were allocated into 2 parallel groups: a control group with non-significant coronary stenosis (<50%) and a CAD group with significant obstruction (≥50%). All participants underwent OCTA imaging to assess superficial and deep foveal avascular zone (FAZ) areas, superficial capillary plexus (SCP) vessel density, and macular thickness. Clinical. Results: CAD patients exhibited significantly larger superficial and deep FAZ areas and markedly reduced SCP vessel density in both eyes (all p < 0.01). In univariate regression, increased FAZ size and decreased SCP density were significantly related to CAD. Nevertheless, in multivariate analysis, SCP vessel density remained the only independent retinal predictor of CAD (right eye: OR = 0.54, p < 0.001; left eye: OR = 0.57, p < 0.001). No OCTA parameter showed a significant correlation with the Syntax I or Gensini scores, indicating that retinal microvascular changes do not directly reflect angiographic severity. Conclusions: Retinal microvascular alterations detected by OCTA—particularly reduced SCP vessel density are clearly related to CAD and can work as a promising non-invasive biomarker for cardiovascular risk stratification. These findings highlight the potential role of retinal imaging in complementing traditional methods for early detection of systemic vascular dysfunction.