Association between retinal markers and cognition in older adults: a systematic review

Varshanie Jeevakumar, Rebekah Sefton, Joyce Chan, Bamini Gopinath, Gerald Liew, Tejal M. Shah, Joyce Siette*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)
17 Downloads (Pure)


Objectives To appraise the existing literature reporting an association between retinal markers and cognitive impairment in adults aged 65 years and over and to provide directions for future use of retinal scanning as a potential tool for dementia diagnosis. Design Systematic review of peer-reviewed empirical articles investigating the association of retinal markers in assessing cognitive impairment. Data sources Three electronic databases, Medline, PsycINFO and EMBASE were searched from inception until March 2022. Eligibility criteria All empirical articles in English investigating the association between retinal markers and cognition in humans aged ≥65 years using various retinal scanning methodologies were included. Studies with no explicit evaluation of retinal scanning and cognitive outcomes were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Data extraction and synthesis Data extraction was conducted by two authors (VJ, RS) and reviewed by another author (JS). Results were synthesised and described narratively. Results Sixty-seven eligible studies examining 6815 older adults were included. Majority of studies were cross-sectional (n=60; 89.6%). Optical coherence tomography (OCT) was the most commonly used retinal scanning methodology to measure the thickness of retinal nerve fibre layer, the ganglion cell complex, choroid and macula. 51.1% of cross-sectional studies using OCT reported an association between the thinning of at least one retinal parameter and poor cognition. Longitudinal studies (n=6) using OCT also mostly identified significant reductions in retinal nerve fibre layer thickness with cognitive decline. Study quality was overall moderate. Conclusion Retinal nerve fibre layer thickness is linked with cognitive performance and therefore may have the potential to detect cognitive impairment in older adults. Further longitudinal studies are required to validate our synthesis and understand underlying mechanisms before recommending implementation of OCT as a dementia screening tool in clinical practice. PROSPERO registration number CRD42020176757.

Original languageEnglish
Article numbere054657
Pages (from-to)1-21
Number of pages21
JournalBMJ Open
Issue number6
Publication statusPublished - 1 Jun 2022

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • dementia
  • haematology
  • medical ophthalmology
  • neuro-ophthalmology
  • ophthalmology


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