# Central retinal volume derived from optical coherence tomography as a potential predictor of mortality in the old-aged population– results from the German AugUR study

## TL;DR

This study finds that lower central retinal volume, measured using optical coherence tomography, is linked to higher mortality risk in older people, independent of cardiovascular disease.

## Contribution

The study introduces central retinal volume as a novel mortality predictor in the elderly, independent of cardiovascular disease.

## Key findings

- Lower central retinal volume is associated with increased all-cause mortality risk in older adults.
- The association remains significant even after adjusting for multiple risk factors like age, sex, and cardiovascular disease.
- The effect is more pronounced in individuals who have exceeded their expected life expectancy.

## Abstract

To estimate mortality risk depending on central retinal volume (CRV) from optical coherence tomography (OCT) in a German cohort of the old-aged population.

In the AugUR study, a prospective population-based cohort study in individuals aged 70–95 years at baseline, we conducted multimodal retinal imaging, including spectral-domain OCT. Heidelberg Spectralis-derived CRV measurements from first examinations of 2,166 participants were included in the analyses. Within the observation period (median 5.9-years), 374 participants died. Association between CRV at baseline and mortality was analysed with Kaplan-Meier curves and Cox proportional hazard regression.

Decrease in CRV was associated with increased all-cause mortality risk. In a full model with age, sex, body weight, body size, OCT scan focus, age-related macular degeneration, smoking, cardiovascular disease, diabetes, and hypertension, hazard ratio per standard deviation lower CRV was 1.17. Cardiovascular death was not associated with CRV in the full model. However, other causes for death except cardiovascular reasons showed association with lower CRV (hazard ratio 1.25). In addition, the association was significant in those who had already exceeded their expected life expectancy (hazard ratio 1.21) but not in women below 83 years and men below 78 years, respectively.

This study indicates that lower CRV, which can be easily and automatically derived from OCT images, is a potential predictor for mortality in the old-aged population. This effect occurs independently of cardiovascular disease.

The online version contains supplementary material available at 10.1007/s00417-025-06924-4.

Retinal layer thicknesses derived from optical coherence tomography scans were reported to be associated with mortality in the UK Biobank Study

Retinal layer thicknesses derived from optical coherence tomography scans were reported to be associated with mortality in the UK Biobank Study

Lower central retinal volume is associated with increased mortality risk in an old-aged populationThis finding is independent of other competing risk factors, particularly cardiovascular disease

Lower central retinal volume is associated with increased mortality risk in an old-aged population

This finding is independent of other competing risk factors, particularly cardiovascular disease

The online version contains supplementary material available at 10.1007/s00417-025-06924-4.