Evidence mapPaperPMID 42470520Full record

ArticleOphthalmology and therapy2026

Predictive Modeling of Coronary Artery Disease Using Color Fundus Photography-Based Features of Retinal Vasculature.

Natasa Jeremic, Emese Sükei, Azin Zarghami, Michael Apata, Meltem Esengönül, Maximilian Pawloff, Andreas Pollreisz, Reinhard Windhager, Matthias Hasun, Alexander Niessner and 3 more

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Article in Ophthalmology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Natasa JeremicDepartment of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Emese SükeiLaboratory for Ophthalmic Image Analysis (OPTIMA), Center for Cancer Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Azin ZarghamiDepartment of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Michael ApataLaboratory for Ophthalmic Image Analysis (OPTIMA), Center for Cancer Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Meltem EsengönülLaboratory for Ophthalmic Image Analysis (OPTIMA), Center for Cancer Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Maximilian PawloffDepartment of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Andreas PollreiszDepartment of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Reinhard WindhagerDepartment of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria.
Matthias HasunDivision of Cardiology, Department of Internal Medicine II, Clinic Landstraße, Juchgasse 30, 1030, Vienna, Austria.
Alexander NiessnerDivision of Cardiology, Department of Internal Medicine II, Clinic Landstraße, Juchgasse 30, 1030, Vienna, Austria. alexander.niessner@gesundheitsverbund.at.
Stefan SacuDepartment of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. Stefan.Sacu@meduniwien.ac.at.
Hrvoje BogunovicInstitute of Artificial Intelligence, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
Ursula Schmidt-ErfurthLaboratory for Ophthalmic Image Analysis (OPTIMA), Center for Cancer Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionCoronary artery disease (CAD) remains the leading cause of death and current screening methods are limited. Color fundus photography (CFP) has been explored in literature mostly on the basis of associations and exploratory deep learning approaches with only indirect end points. In this explorative study, we aimed to assess the predictive abilities and limitations of explainable CFP-based features using machine learning and same-visit coronary angiography (CA) outcomes as end points for the first time.

methodsPatients undergoing CA were imaged with CFP (Zeiss Clarus 500, Zeiss, Oberkochen, Germany) during the same visit. Coronary plaque burden was assessed using the Gensini Score. Retinal features were extracted using Automorph. Machine learning models were trained and evaluated using fivefold cross-validation. Shapley additive explanations (SHAP) values quantified feature importance and interactions.

resultsOf 977 screened patients, 632 (1293 eyes) were assessed. CFP features alone reached moderate predictive performance (area under the receiver operating characteristic (AUROC) 0.692). Adding dimensionally reduced CFP features to clinical baselines consistently improved performance, with the best configuration yielding an AUROC 0.775, average precision (AP) 0.752, and Brier score 0.203. Net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analyses supported improved reclassification for age + sex and basic clinical baseline models, but not for extended clinical baseline models. SHAP analysis revealed vessel width, density, and tortuosity as important vascular retinal indicators of CAD burden. Interaction analysis revealed nonlinear, age-, sex-, and diabetes-dependent effects.

conclusionsCFP features modestly improved the CAD classification beyond clinical baselines. Our findings illustrate the potential and the limitations of CFP features and indicate the need for complex modeling, methodological improvement, and multimodal approaches to achieve valuable classification efficacy.

Indexed as

Artificial intelligenceColor fundus photographyCoronary artery diseaseMachine learningOculomicsRetinal biomarkersRetinal imagingRetinal microvasculature

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.