Patients at Elevated Risk for Heart Failure Exhibit Reduced Retinal Perfusion

On this episode of the JVRD Author’s Forum podcast, retina specialist Manjot K. Gill, MD, MS, discusses her article, “Patients at Elevated Risk for Heart Failure Exhibit Reduced Retinal Perfusion,” published in the Journal of VitreoRetinal Diseases. 

Host Dr. Timothy Murray speaks with Dr. Gill about the emerging field of oculomics and the potential for retinal imaging to detect systemic disease before clinical symptoms develop. Using OCT angiography (OCTA), the study evaluated patients at elevated 10-year risk for heart failure and found reduced retinal perfusion compared with age-matched controls. 

The discussion highlights how retinal imaging may offer a noninvasive biomarker for identifying patients with subclinical cardiovascular disease, supporting earlier intervention and more personalized risk assessment. Dr. Gill also explores how advances in OCTA and artificial intelligence are expanding the role of the retina in understanding systemic health and disease.

For more information, visit www.ASRS.org/JVRDForum.

Welcome to ASRS’s Journal of Vitreoretinal Diseases (JVRD) Author’s Forum. As the official peer-reviewed scientific journal of the American Society of Retina Specialists (ASRS), JVRD delivers rigorous, clinically meaningful research that informs and advances retina care worldwide. Join Editor-in-Chief Dr. Timothy Murray as he engages leading investigators in thoughtful discussions about the latest studies published in JVRD — highlighting practical insights, clinical pearls, and the real-world impact of emerging innovations in our field.

Transcript

SPEAKER_01 0:03

Welcome to ASRS's Journal of Vitrietal Diseases Authors Forum. I'm your host, Dr. Timothy Murray, Editor-in-Chief of JVRD. On each episode of the JVRD Authors Forum, I will interview innovative retinal researchers on their studies featured only in JVRD and how these studies will impact our patients' care in our clinics. Tune in to hear directly from investigators about the clinical implications of the newest and highest quality research in the field of retina. Welcome to JVRD's Author Podcast. I'm joined today by Dr. Manja Gill, Professor of Ophthalmology and Medical Education, Vice Chair of Clinical Performance, Director of Vitredinal Fellowship at the Department of Ophthalmology for Northwestern University's Feinberg School of Medicine in Chicago. Welcome, Dr. Gill.

SPEAKER_00 1:03

Thank you so much for having me, Tim. Happy to be here.

SPEAKER_01 1:06

We're going to talk today about your paper that discusses patients at elevated risk for heart failure exhibit reduced retinal perfusion. What made you think about this and why do you think it was important?

SPEAKER_00 1:20

So, Tim, you know, my research area of interest really centers on oculomics. And this is a really kind of an emerging field where we are using the retina as a biomarker to gain insight into systemic disease. And, you know, my first foray into this area really stemmed from looking at patients with long COVID, and we found ocular signals. And so that led me to think about other disease states that we may be able to use the retina to help inform and give us information in terms of earlier detection of disease.

SPEAKER_01 2:11

But with AI and some of the newer algorithms coming out, I think it's becoming very clear that there are that it is an amazing biomarker.

SPEAKER_00 2:22

Absolutely, I couldn't agree more. We know from fundus photography that we're able to get cardiovascular risk scores for disease, even looking at kidney disease detection from fundus photography. There's data out there that looks at OCT and OCTA in terms of Alzheimer's detection. But this study really was targeted towards a population where they don't have established heart failure but are at risk for heart failure. And so we do know that in patients with established heart failure, that there certainly is decreased ocular perfusion. But what I really wanted to study was a population that was at risk to see if there was ways through imaging the eye that we may be able to detect those that are at risk.

SPEAKER_01 3:13

And so you used cardiac scores to stratify risk and then evaluated the patients in that perspective?

SPEAKER_00 3:22

Yes, exactly. So there's something known as the uh pooled cohort equation, which is a gender and sex validated um equation that uh predicts heart failure risk, a 10-year risk. And so what we did is um looked at patients that had a greater than 5% risk over 10 years, and studied those eyes with OCTA and then compared them to age-matched controls.

SPEAKER_01 3:56

Dr. Gill, one of the things that I thought was so fascinating here was that in the past we've had to use algorithms and sort of cohort analysis to predict risk. And what you've suggested here is that we can look directly at the individual patients' anatomy to determine their specific risk. I find that a little bit exciting. Is that what you were hoping to find?

SPEAKER_00 4:20

Yes, that's that's exactly right, uh, Tim, is you know, all of these algorithms are really not uh designed on an individual-patient level. And so this really, you know, in my mind, is sort of the ultimate of precision medicine. So that was the goal of the study is to really identify can we see any signals in the eye in patients who are in fact at risk for heart failure? And uh if so, then you know, this may provide turn out to be a very powerful tool that uh we can use to identify patients at risk. It allows for earlier detection and uh you know greater precision in terms of identifying patients that we may want to be able to intervene earlier.

SPEAKER_01 5:05

So I think we all understand that the perfusion decrease with cardiac disease when it's advanced. It suggests maybe that there's a window that we could intervene before the patient is severely compromised. Is that kind of one of the hopes of this kind of work?

SPEAKER_00 5:22

That's exactly right. So, you know, as I stated earlier, we certainly know and it makes sense that when you have reduced cardiac output in established heart failure, that we are going to see reduced perfusion. And in fact, the earliest signals is that there is reduced perfusion on OCTA in the deeper layers. And then as the cardiac output diminishes, we see it in the more superficial layers. What our findings suggested is that even in patients without established heart failure, who are just had a greater than 5% risk over 10 years, that we did in fact see a similar signal of reduced perfusion. So clearly, this does not seem to be driven by reduced cardiac output. But as we suggest that there may be shared similarities between the coronary vasculature, the coronary arteries, and the vessels in the deep capillary plexus, which may be susceptible to the similar um inflammatory pathways of ischemia, and therefore we're being able to detect subclinical heart disease.

SPEAKER_01 6:28

And you know, I I find that that I'm still beginning to understand the power of OCTA. So I think we're seeing things that we didn't even think to look for, and this would be an excellent example of that.

SPEAKER_00 6:42

That's exactly right. Um and I think we're gonna be learning more and more about um different signals that we can see in the eye with respect to systemic disease. And, you know, if you think about it, it makes sense. You know, the retina really is an extension of the brain, it shares similar embryologic origin. And um there's evidence, as I said, that the cerebral and coronary vasculature also share a lot of similarities with the retinal vasculature. So it really does make sense that this would provide a really nice window into the systemic health.

SPEAKER_01 7:16

Yeah, and I think, you know, as as good as we are at looking at these kinds of images, I'm amazed at what AI has been able to see. You know, you commented on you can tell if a patient's a smoker or not, if it's a man or a woman, you can find the age range usually within five years, you can look at general health. So I feel like this is going to integrate an AI platform to give us the information without it being so hard for us to look at. Are you hoping that's the case?

SPEAKER_00 7:46

That that's exactly what you know I wanted to do the study for is to see, first of all, can we see a signal in patients such as this who are at risk? And then, yes, that is where we will have to leverage um AI, not just, you know, first of all, for quantification, because um, you know, it's very difficult for us in the clinic to actually segment and you know make these quantifications. So we will need algorithms in order to have quantifiable metrics and then really leverage AI and deep learning models to identify these patients en masse.

SPEAKER_01 8:22

Yeah, and I think as we get more and more data coming in from our clinical assessment of our patients, we we we do need processing help for us to understand better. I'm amazed how well we look at images as it is. Um, but then when I realize that AI can see things that I can't, it's a little humbling.

SPEAKER_00 8:42

I couldn't agree with you more, but you know, and this is what's I think really so fascinating for us as retina specialists is that, you know, we've been looking into retinas, looking in patients' eyes uh for our entirety of our careers, uh, making diagnosis of sight-threatening disease. But now the eye really, you know, it's no pun intended when we say it really is the window to the soul, and we can learn so much more information.

SPEAKER_01 9:06

I'm glad you were able to get the window to the soul in there. That was exactly what we needed. So, Dr. Mandrak Gill, thank you for joining us on JVRD's Author Podcast talking to us about patients at elevated risk for heart failure exhibit reduced retinal perfusion. Pleasure to have you with us tonight.

SPEAKER_00 9:26

Thank you so much, Tim. Really enjoyed speaking with you.

SPEAKER_01 9:29

Thanks for tuning in to the JVRD Authors Forum. You can watch and listen to more episodes on the ASRS YouTube channel and on popular podcast directories, including Apple Podcasts and Spotify. Visit www.asrs.org forward slash JVRD forum on the ASRS website to learn more. See you soon.