EC Ophthalmology

Research Article Volume 17 Issue 5 - 2026

Spectral Domain Optical Coherence Tomography Imaging in Stroke: A Pilot Study

Elena Z Biffi1*, Alapika Jatkar2, Jessica Chung3, Zachary Turple4 and Jaspreet Chuhan2

1Department of Biological Science and Disease, New England College of Optometry, USA
2Student at the New England College of Optometry, USA
3Department of Optometry and Visual Services, Atrius Health, USA
4Beetham Eye Institute, Joslin Diabetes Center, USA

*Corresponding Author: Elena Z Biffi, Department of Biological Science and Disease, New England College of Optometry, Boston, MA, USA.
Received: February 10, 2026; Published: April 02, 2026



Background/Objectives: The retina is a direct embryologic extension of the central nervous system and, therefore, may offer biomarkers of anatomical changes in the brain due to stroke. Optical coherence tomography (OCT) offers readily available, high resolution, repeatable, non-invasive imaging of retinal anatomy. We sought to determine whether OCT-based measurements of macular thickness (MT), ganglion cell layer (GCL), and retinal nerve fiber layer (RNFL) thicknesses were associated with stroke.

Methods: In this cross-sectional observational case-control study, individuals with a prior diagnosis of primary stroke and age-matched controls underwent spectral-domain OCT (SD-OCT) imaging. MT, GCL, and RNFL thickness measurements were obtained at a single visit. Fisher exact test (2-tailed) and Mann-Whitney rank-sum or unpaired t-test were used to analyze categorical and continuous variables, respectively. Univariate and multivariate logistic regressions assessed associations between groups.

Results: Fourteen subjects (27 eyes) with prior stroke and 14 age-matched controls (27 eyes) were included for analysis. There was no significant difference in MT between cases and controls. Univariate analyses of GCL thickness showed decreased average and all-sector thickness between cases and controls. Multivariate analyses confirmed a significant reduction in average GCL thickness in cases versus controls, including in those without visual symptoms. Similarly, univariate analyses showed decreased average, superior, and inferior RNFL thicknesses in cases versus controls. Subsequent multivariate analyses confirmed a significant reduction in average RNFL thickness in prior stroke cases.

Conclusion: In this pilot study average GCL and RNFL thickness, but not MT, were significantly reduced in subjects with a history of prior stroke. These OCT-based measures may serve as potential biomarkers of stroke.

Keywords: Stroke; Imaging; Retina; Optical Coherence Tomography; Biomarker

  1. Imoisili Omoye E., et al. “Prevalence of Stroke - Behavioral Risk Factor Surveillance System, United States, 2011-2022”. Morbidity and Mortality Weekly Report 73.20 (2024): 449-455.
  2. Ovbiagele Bruce and Mai N Nguyen-Huynh. “Stroke epidemiology: advancing our understanding of disease mechanism and therapy”. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics3 (2011): 319-329. 
  3. Anogianakis Georgios., et al. “Current trends in stroke biomarkers: the prognostic role of S100 calcium-binding protein B and glial fibrillary acidic protein”. Life (Basel, Switzerland)10 (2024): 1247.
  4. Yew Kenneth S and Eric M Cheng. “Diagnosis of acute stroke”. American Family Physician8 (2015): 528-36.
  5. Zhang Yier., et al. “Advances in retinal imaging biomarkers for the diagnosis of cerebrovascular disease”. Frontiers in Neurology 15 (2024): 1393899.
  6. Ding Jie., et al. “Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data”. Journal of Hypertension 2 (2014): 207-215.
  7. Frydkjaer-Olsen Ulrik., et al. “Correlation between retinal vessel calibre and neurodegeneration in patients with type 2 diabetes mellitus in the European consortium for the early treatment of diabetic retinopathy (EUROCONDOR)”. Ophthalmic Research1 (2016): 10-16.
  8. Gopinath Bamini., et al. “Associations between retinal microvascular structure and the severity and extent of coronary artery disease”. Atherosclerosis1 (2014): 25-30.
  9. Zafar Sidra., et al. “Retinal imaging for neurological diseases: "a window into the brain"“. International Ophthalmology Clinics1 (2019): 137-154.
  10. Biffi Elena., et al. “Retinal biomarkers of cerebral small vessel disease: a systematic review”. PloS one 4 (2022): e0266974.
  11. Kashani Amir H., et al. “Past, present and future role of retinal imaging in neurodegenerative disease”. Progress in Retinal and Eye Research 83 (2021): 100938.
  12. Cheung Carol Y., et al. “Potential retinal biomarkers for dementia: what is new?”. Current Opinion in Neurology1 (2019): 82-91.
  13. Frost S., et al. “Retinal vascular biomarkers for early detection and monitoring of Alzheimer's disease”. Translational Psychiatry 2 (2013): e233.
  14. Patton Niall., et al. “The association between retinal vascular network geometry and cognitive ability in an elderly population”. Investigative Ophthalmology and Visual Science5 (2007): 1995-2000.
  15. Robbins Cason B., et al. “Assessing the retinal microvasculature in individuals with early and late-onset alzheimer's disease”. Ophthalmic Surgery, Lasers and Imaging Retina6 (2021): 336-344.
  16. Robbins Cason B., et al. “Characterization of retinal microvascular and choroidal structural changes in Parkinson disease”. JAMA Ophthalmology2 (2021): 182-188.
  17. Gao Yuan., et al. “A narrative review of retinal vascular parameters and the applications (Part II): Diagnosis in stroke”. Brain Circulation3 (2023): 129-134.
  18. Ong Yi-Ting., et al. “Microvascular structure and network in the retina of patients with ischemic stroke”. Stroke8 (2013): 2121-2127.
  19. Molero-Senosiain Mercedes., et al. “Correlation between retrograde trans-synaptic degeneration of ganglion cells and optical coherence tomography angiography following ischemic stroke”. Cureus11 (2021): e19788.
  20. Wu Yucong., et al. “Association of retinal nerve fiber layer thickness with brain microstructural changes in participants with white matter hyperintensities”. Journal of Integrative Neuroscience3 (2024): 56.
  21. Lin Chao-Wen., et al. “Reduced macular vessel density and inner retinal thickness correlate with the severity of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)”. PloS one5 (2022): e0268572.
  22. Hardin Joshua S., et al. “Factors affecting cirrus-HD OCT optic disc scan quality: a review with case examples”. Journal of Ophthalmology (2015): 746150.
  23. Armstrong Richard A. “Statistical guidelines for the analysis of data obtained from one or both eyes”. Ophthalmic and Physiological Optics: The Journal of the British College of Ophthalmic Opticians (Optometrists)1 (2013): 7-14.
  24. Jacobson Lena., et al. “Ganglion cell topography indicates pre- or postnatal damage to the retro-geniculate visual system, predicts visual field function and may identify cerebral visual impairment in children - a multiple case study”. Neuro-ophthalmology (Aeolus Press)6 (2019): 363-370.
  25. Hood Donald C., et al. “Blood vessel contributions to retinal nerve fiber layer thickness profiles measured with optical coherence tomography”. Journal of Glaucoma7 (2008): 519-528.
  26. Keller Johannes., et al. “Lesions in the posterior visual pathway promote trans-synaptic degeneration of retinal ganglion cells”. PloS one5 (2014): e97444.
  27. Lee John-Ih., et al. “Retinal changes after posterior cerebral artery infarctions display different patterns of the nasal und temporal sector in a case series”. Frontiers in Neurology 11 (2020): 508.
  28. Jindahra Panitha., et al. “The time course of retrograde trans-synaptic degeneration following occipital lobe damage in humans”. Brain: A Journal of Neurology2 (2012): 534-541.
  29. Jindahra P., et al. “Thinning of the retinal nerve fibre layer in homonymous quadrantanopia: further evidence for retrograde trans-synaptic degeneration in the human visual system”. Neuro-ophthalmology 36 (2012): 79-84.
  30. Park Hae-Young Lopilly., et al. “Transneuronal retrograde degeneration of the retinal ganglion cells in patients with cerebral infarction”. Ophthalmology 6 (2013): 1292-1299.
  31. Lim Jae-Sung and Dong-Wha Kang. “Stroke connectome and its implications for cognitive and behavioral sequela of stroke”. Journal of Stroke3 (2015): 256-267.
  32. Bianchi Marzoli Stefania., et al. “Quantification of retinal ganglion cell loss in patients with homonymous visual field defect due to stroke”. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology8 (2023): 2811-2819.
  33. Bai Xueling., et al. “Retinal thickness is indicative of visual loss in patients with occipital lobe infarction”. Frontiers in Neurology 16 (2025): 1546439.
  34. Rashid Avan Sabir., et al. “Homonymous visual field defect and retinal thinning after occipital stroke”. Brain and Behavior10 (2021): e2345.

Elena Z Biffi., et al. “Spectral Domain Optical Coherence Tomography Imaging in Stroke: A Pilot Study”. EC Ophthalmology 17.4 (2026): 01-11.

ECronicon Journal

Our Services

Quick Links

Information

Creative Commons LicenseOpen Access by ECronicon is licensed under a Creative Commons Attribution 4.0 International License
Based on a work at www.ecronicon.net