Clinical Trials > The Eyes Have It: Retinal Imaging Shows Promise for Transforming Care

The Eyes Have It: Retinal Imaging Shows Promise for Transforming Care

By Matt Derechin Photography by Thomas R. Boggan

Every year, tens of millions of people across the United States receive routine eye exams as part of basic vision care. These retinal scans are quick, noninvasive and already embedded in everyday medical practice. What if, in that same moment, they could reveal not only the health of the eye but also early signs of stroke risk, cognitive decline and neurodegenerative disease?

“That’s the future we’re working toward,” says Oana Dumitrascu, M.D., a Mayo Clinic neurologist and physician-scientist whose research explores how the retina can serve as a window into the brain. “A tool like this could shift neurological care from reactive to proactive, from therapy when clearly symptomatic to prevention in the asymptomatic phase. It could also meaningfully address health equity, because retinal imaging is far more affordable and widely available than many of the alternatives we rely on today.”

Dr. Dumitrascu’s work sits at the intersection of neurology, ophthalmology and artificial intelligence (AI). With colleagues at Mayo Clinic in Arizona and collaborators at Arizona State University, she is applying advanced machine learning techniques to thousands of retinal images — pictures already captured every day in optometry, ophthalmology clinics and sometimes even primary care settings. Her goal is ambitious but pragmatic: to transform routine eye exams into scalable tools for assessing brain health.

In two peer-reviewed papers published in 2024, Dr. Dumitrascu and her team demonstrated that, when analyzed with AI, low-cost retinal scans can identify changes occurring in the brain before cognitive deficits are noticeable — a stage known as preclinical Alzheimer’s disease — with 85% accuracy. That type of information is traditionally obtained through expensive neuroimaging, limiting clinician’s ability to diagnose and treat Alzheimer’s earlier and more effectively.

While the results represent a major scientific advance, the idea itself took shape much earlier, during Dr. Dumitrascu’s medical training.

“One of my medical school professors once told me, ‘The eye is the window to the soul,’” she recalls. “But as I trained, I realized the eye is the window to the brain. The retina is the only place in the body where you can directly visualize blood vessels and neural tissue in living people. That insight changed everything for me.”

That realization led her to focus on what is called the eye-brain axis: the shared vascular and central neurological features of the retina and the brain. To fully understand that connection, she pursued an unconventional training path, earning dual expertise across specialties.

After completing medical school and an ophthalmology residency in Romania, Dr. Dumitrascu received an international award to continue her training in the United States. She completed a neuro-ophthalmology fellowship at UCLA’s Jules Stein Eye Institute, followed by a neurology residency at Cedars-Sinai Medical Center in Los Angeles. She later joined Mayo Clinic in Arizona to complete a fellowship in vascular neurology.

One of my medical school professors once told me, ‘The eye is the window to the soul.' But as I trained, I realized the eye is the window to the brain.
— Oana Dumitrascu, M.D.

“Each stage of my training added something essential,” she says. “I wanted a deep understanding of both the eye and the brain, especially in vascular disease and neurodegeneration, which are far more common than many people realize.”

Supported by National Institutes of Health funding, Arizona state health agencies and a Mayo Clinic-Arizona State University research alliance, Dr. Dumitrascu’s lab now combines retinal imaging, advanced AI modeling and clinical neuroscience to identify early biomarkers of stroke, vascular cognitive impairment and Alzheimer’s disease.

The next phase of the work is focused on validation and scale. Dr. Dumitrascu is planning a collaborative clinical trial that would test her retinal biomarkers prospectively in both urban medical centers and rural locations, including mobile medical settings across Arizona. By studying diverse populations in real-world settings, she hopes to demonstrate not only scientific accuracy but also real clinical utility.

“One of the most exciting aspects of this trial is where it will take place,” she says. “We want to understand how these tools perform in resource-limited environments, where access to advanced neuroimaging is scarce. That’s where the potential for impact is greatest.”

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Mayo Clinic has played a critical role in accelerating that work, providing specialized imaging equipment and access to powerful digital infrastructure and AI capabilities through Mayo Clinic Cloud. The institution’s partnership with Arizona State University has also enabled close collaboration with computer scientists focused on advanced modeling and software development — expertise essential for translating research into usable clinical tools.

Ultimately, Dr. Dumitrascu envisions a future in which retinal imaging becomes an integrated part of neurological risk assessment. An optometrist or primary care provider could one day flag early warning signs of brain disease during a routine eye exam, enabling earlier referrals, targeted prevention strategies and timely interventions, often years before symptoms emerge.

“Success for me would mean that insights from routine medical imaging measurably improve patient outcomes,” she says. “It would mean shifting our focus from treating disease after damage occurs to preventing it or detecting it early enough to change its course.”