Intereye retinal asymmetry is linked to cardiovascular risk
In 46,836 adults, each standard deviation increase in retinal nerve fiber layer asymmetry raised heart failure hazard by 1.15 and atrial fibrillation hazard by roughly 1.07.
Journal of the American Heart Association
In a prospective cohort study of 46,836 UK Biobank participants, researchers investigated whether structural asymmetry between eyes predicts incident cardiovascular disease. Participants underwent bilateral optical coherence tomography imaging and were followed for incident coronary heart disease, myocardial infarction, atrial fibrillation, and heart failure over a median follow-up of 9.22 to 9.38 years, with a maximum follow-up of 12.86 years.
Participants who developed cardiovascular disease consistently showed greater retinal asymmetry. Retinal nerve fiber layer asymmetry demonstrated the most consistent associations across outcomes, modestly improving cardiovascular risk prediction compared with mean retinal thickness alone. Exploratory proteomic analyses linked this asymmetry to circulating signatures involved in extracellular matrix remodeling, inflammation, and insulin-like growth factor signaling.
Why it matters
Retinal imaging provides a noninvasive readout of systemic microvascular integrity. Measuring asymmetry between paired organs may capture systemic vascular aging and inflammatory decline earlier than average tissue measurements.
Caveats
Because this study is observational, it cannot establish a causal relationship between retinal asymmetry and cardiovascular disease. Furthermore, the improvements in risk prediction were modest, and the proteomic associations remain exploratory.
The paper
Intereye Retinal Asymmetry, Incident Cardiovascular Disease, and Circulating Proteomic Signatures
Shanghai Jiao Tong University
Journal of the American Heart Association · 29 Sep 2026