Retina Society 2026: Subretinal deposits in AMD may flag severe aortic stenosis that increases surgical risk

Subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) are visible on routine retinal imaging and are linked to significantly worse surgical risk scores in patients with severe aortic stenosis, a high-risk cardiovascular disease, and to markedly reduced systemic blood flow in the disease's most dangerous subtype, according to new study results¹ presented at the Retina Society 2026 annual meeting in Los Angeles.

The investigators view this finding as an important component in a foundational new disease model that connects the leading cause of blindness, AMD, directly to the leading causes of death, high risk cardiovascular diseases. This may be a major breakthrough in the ability to identify and grade the severity of both diseases, they explained.

The findings, presented by senior investigator R. Theodore Smith, MD, PhD, and colleagues Liang Wang, MD , Carlo Mannina, MD, and Stamatios Lerakis, MD, PhD, of Mount Sinai Medical Center and the New York Eye and Ear Infirmary suggest that non-invasive retinal imaging, optical coherence tomography (OCT), could help identify patients with aortic stenosis facing the greatest cardiovascular and surgical danger long before they reach the operating room. The investigators published their results in the Journal of Clinical Cardiology.

Smith explained that SDDs have been associated with high-risk cardiovascular diseases, i.e., ischemic stroke and cardiac insufficiency from either myocardial dysfunction or moderate or greater valvular disease, that may decrease systemic perfusion and subsequently ocular perfusion. This current study sought to determine the associations of SDDs with the subtypes and severity metrics in patients with severe aortic stenosis.

The researchers retrospectively reviewed 929 patients with severe aortic stenosis from Mount Sinai's cardiac valve clinic, 96 of whom underwent documented ophthalmologic evaluations to determine the SDD status. Following transthoracic echocardiography, the patients were grouped by echocardiographic subtype, i.e., classical low-flow, low-gradient (cLFLG); paradoxical low-flow, low-gradient; or high-flow low-gradient. The data collection included peak aortic jet velocity, mean aortic gradient, systemic perfusion based on the cardiac index, and the Society of Thoracic Surgeons (STS) surgical risk score.

Low flow, low gradient, high stakes

Smith and colleagues reported that in the cLFLG group, long considered the subtype with the worst prognosis, the SDDs tracked closely with disease severity, that is, the patients with SDDs had significantly lower peak aortic jet velocity (p = 0.007), lower mean aortic gradient (p = 0.001), and lower cardiac index (p = 0.006), direct measures of the systemic blood flow. Across the entire study population, the patients with SDDs also had significantly worse STS surgical risk scores than those without SDDs (p < 0.001).

Eyes on the heart: a new risk marker

The findings point to SDDs as more than an incidental retinal finding. In the highest risk cLFLG subgroup, their association with reduced cardiac index supports the idea that SDDs arise from ocular hypoperfusion, which is a direct consequence of the heart's failing systemic output. Because SDDs were tied to higher surgical risk among all patients with severe aortic stenosis, the deposits may offer clinicians a noninvasive, retina-based signal for identifying those who face both worse systemic perfusion and greater danger from surgical intervention. The authors propose SDDs as a potential imaging biomarker to help flag high-risk aortic stenosis patients for closer cardiovascular evaluation.

“This ongoing, multidiscipinary work with physician scientists in retina and cardiovascular research clearly shows a new way forward. Further collaborations on SDDs as imaging markers for high risk CVD could lead to earlier detection, which in particular is a major issue in women’s health,” Smith commented.

Reference

1. Mannina C, Wang L, Camaj A, et al. Association of subretinal drusenoid deposits in age-related macular degeneration with decreased cardiac performance and systemic perfusion in severe aortic stenosis J Clin Cardiol. 2026;7:51-7. doi:10.33696/cardiology.7.089