Retinal Microvascular and Structural Changes in Chronic Coronary Artery Disease and Ischemic Stroke: A Comparative OCTA and OCT Study

Objective: To characterize retinal microvascular and neuronal structures in patients with chronic-phase coronary artery disease (CAD) and ischemic stroke (IS) (≥1 year after disease onset). Methods: In total, 296 healthy controls and 302, 96, and 30 patients diagnosed with CAD, IS, and CAD+IS, respectively, underwent optical coherence tomography angiography (OCTA) to quantify vascular density (VD) in the macular superficial (SCP), deep (DCP), and choriocapillaris (CCP) plexuses. Swept-source OCT assessed retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and total retinal thickness. Intergroup differences were analyzed by covariance, and partial correlations were used to evaluate VD–structure associations. Results: Patients with CAD exhibited significant microvascular and neural deficits; compared with controls, central foveal SCP/DCP/CCP density decreased by 23.9%, 23.3% and 1.6%, respectively (all P <0.005). RNFL and GCL thicknesses were reduced ( P <0.001), with significant correlations between microvascular and neural parameters (r = 0.262–0.363; P <0.001). Patients with IS showed milder microvascular loss and localized retinal thinning, with no microvascular-neural correlations. Patients with CAD+IS demonstrated compounded microvascular loss (SCP/DCP/CCP) and exacerbated RNFL thinning ( P = 0.004). Patients with CAD exhibited widespread macular thinning ( P <0.05), whereas patients who had experienced an IS exhibited focal superior retinal thinning ( P = 0.045). Conclusion: Chronic CAD is characterized by diffuse foveal-centered microvascular loss and neural atrophy with VD–structure coupling, whereas IS presents with localized deficits. Retinal OCTA/OCT screening should be prioritized for CAD patients and integrated into cardiovascular risk management.