Early identification of patients at risk of cardiovascular diseases (CVD) is crucial for effective preventive care, reducing healthcare burden, and improving patients' quality of life. This study demonstrates the potential of retinal optical coherence tomography (OCT) imaging combined with fundus photographs for identifying future adverse cardiac events. We used data from 977 patients who experienced CVD within a 5-year interval post-image acquisition, alongside 1,877 control participants without CVD, totaling 2,854 subjects. We propose a novel binary classification network based on a Multi-channel Variational Autoencoder (MCVAE), which learns a latent embedding of patients' fundus and OCT images to classify individuals into two groups: those likely to develop CVD in the future and those who are not. Our model, trained on both imaging modalities, achieved promising results (AUROC 0.78 +/- 0.02, accuracy 0.68 +/- 0.002, precision 0.74 +/- 0.02, sensitivity 0.73 +/- 0.02, and specificity 0.68 +/- 0.01), demonstrating its efficacy in identifying patients at risk of future CVD events based on their retinal images. This study highlights the potential of retinal OCT imaging and fundus photographs as cost-effective, non-invasive alternatives for predicting cardiovascular disease risk. The widespread availability of these imaging techniques in optometry practices and hospitals further enhances their potential for large-scale CVD risk screening. Our findings contribute to the development of standardized, accessible methods for early CVD risk identification, potentially improving preventive care strategies and patient outcomes.

Purpose: we investigated the potential of optical coherence tomography (OCT) as an additional imaging technique to predict future cardiovascular disease (CVD). Design: Retrospective cohort study Participants: We employed retinal optical coherence tomography (OCT) imaging data obtained from the UK Biobank. Data for 630 patients who suffered acute myocardial infarction (MI) or stroke within a 5-year interval after image acquisition, together with an equal number of participants without CVD (control group), were used to train our model (1260 subjects in total). Methods: We utilised a self-supervised deep learning approach based on Variational Autoencoders (VAE) to learn low-dimensional (latent) representations of high-dimensional 3D OCT images and to capture distinct characteristics of different retinal layers within the OCT image. A Random Forest (RF) classifier was subsequently trained using the learned latent features and participant demographic and clinical data, to differentiate between patients at risk of CVD events (MI or stroke) and non-CVD cases. Main Outcome Measures: Our predictive model, trained on multimodal data, was assessed based on its ability to correctly identify individuals likely to suffer from a CVD event (MI or stroke), within a 5-year interval after image acquisition. Results: Our self-supervised VAE feature selection and multimodal Random Forest classifier differentiate between patients at risk of future CVD events and the control group with an AUC of 0.75, outperforming the clinically established QRISK3 score (AUC = 0.597). The choroidal layer visible in OCT images was identified as an important predictor of future CVD events using a novel approach to model explanability. Conclusions: Retinal OCT imaging provides a cost-effective and non-invasive alternative to predict the risk of cardiovascular disease and is readily accessible in optometry practices and hospitals.