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Moorfields study shows signs of atrial fibrillation from eye scans four years before diagnosis


People with atrial fibrillation (AF) have distinctive biomarkers in their retinas, evident as early as four years before clinical presentation of the condition, confirms a new study led by Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The research team analysed retinal imaging


data from more than 90,000 people and discovered differences in the structure of the retina in people with AF, compared with those who do not have the condition. AF, the most common heart rhythm disorder, affects more than 1.5 million people in the UK, and substantially raises the risk of stroke, heart failure and death. Because AF often occurs intermittently, it can be missed on a standard electrocardiogram (ECG). As a consequence, many cases remain undiagnosed until a serious or life- threatening complication occurs. Moorfields patient, John Brewer, first discovered he had AF in the operating theatre, while undergoing a cataract operation under sedation, earlier this year. The surgical team noticed John was experiencing heart arrhythmia and paused the procedure to hook up an ECG, which indicated that John did have AF. Medication was then provided so the operation could be safely completed. John was given an immediate referral to see a cardiologist who has since confirmed the AF diagnosis. John said “It would have been so much easier if


at the back of the eye made up of nerve cells that connect the eye to the brain. The thinner this particular layer was, the more likely the person was to be diagnosed with AF. Notably, among patients who did not have AF when


my AF had been detected earlier through a routine retinal scan at one of my regular appointments, rather than on the operating table, which was a very distressing experience for my wife and I.” The Moorfields team set out to establish whether retinal imaging, already used routinely in community optometry practices and hospital eye clinics, could offer a non-invasive way to flag people with AF before they have a stroke or heart attack. Researchers analysed optical coherence


tomography (OCT) scans and colour retinal photographs from two datasets. In the AlzEye dataset, a Moorfields cohort with over 50,000 patients, 5,735 already had AF. In the UK Biobank cohort of around 40,000 participants, 526 had AF. Across both datasets, people with AF consistently had thinner macular ganglion cells and inner plexiform layer (mGCIPL), which is a retinal layer


their retinal images were taken, those who went on to develop AF had thinner mGCIPL layers on average four years before presenting to hospital with the condition, even after accounting for age, sex, ethnicity, hypertension, diabetes, smoking and alcohol use. This indicates that retinal changes may be detectable before a clinical diagnosis of AF is made, at a stage when the condition has no symptoms. The authors propose that the thinning they observed in people who developed or had AF could indicate mini strokes in the brain that typically occur as a result of AF before its diagnosis. The thinning could happen because blood flow to the retinal nerve cells is reduced by these strokes, they say. Senior author, Siegfried Wagner, said: “This


large-scale analysis shows that retinal imaging can pick up on structural changes within the eye that are clearly linked to AF. For patients, the value of this kind of eye imaging is that it is easy to access, quick and doesn’t involve any invasive procedures. Although not intended to replace ECG-based diagnosis, retinal imaging could act as a complementary tool, catching those most at risk of AF before it causes real harm.”


Statins linked to lower risk of dementia in diabetic patients


Early initiation of statins after diagnosis of type 2 diabetes was associated with a lower risk of dementia, according to a study presented at ESC Congress 2026. “Detecting and treating high levels of low-density


lipoprotein cholesterol (LDL-C) from midlife is highlighted as a risk factor,” explained presenter, Dr. Tummas Ternhamar from Copenhagen University Hospital, Denmark. He noted that this could be particularly important in patients with type 2 diabetes since elevated LDL-C occurs frequently in these individuals and diabetes is a highlighted risk factor for cognitive decline and dementia. “We hypothesised that early initiation of


LDL-C-lowering statins following type 2 diabetes diagnosis could be associated with a lower risk of dementia,” he commented. “We tested this in a large nationwide study using analysis methods to emulate a randomised trial and reduce some of the bias associated with observational studies,” he noted. From Danish registers, 132,585 statin-naïve individuals were identified who developed type 2


with no statin initiation, early statin treatment was associated with a 15% lower relative risk of dementia over 10 years. Late statin initiation was associated with a 10% lower relative risk of dementia over 10 years. The results were similar in women and men. Dr. Ternhamar concluded: “In individuals


diabetes from 2006 through to 2019, with follow- up until the end of 2021. Medical records were searched for diagnoses of all-cause dementia. A clone-censor-weight design was used to analyse dementia incidence in patients with no statin initiated within five years after diagnosis, in those with early statin initiation within one year and in those with late statin initiation between one and five years after diagnosis. During a median follow-up of 7.1 years, 2.7% of patients developed dementia. Compared


developing type 2 diabetes, statins were associated with a lower risk of dementia, most pronounced in those with early initiation. Statins seem to be underused in patients with type 2 diabetes, despite their protective effects against cardiovascular disease. Our findings suggest another potentially important reason to ensure that patients with type 2 diabetes and high LDL-C receive timely statin treatment.”


References 1. ‘Timing of statin treatment following diabetes diagnosis on risk of dementia: a nationwide study’ presented during the Diabetes and the heart: pharmacotherapy session at ESC Congress 2026 on 30 August.


October 2026 I www.clinicalservicesjournal.com 13


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