Background The retina has become an area of increasing interest as a potential biomarker for neurodegeneration, as it is easily accessible and patient friendly. Previous studies have shown changes in the vasculature of the retina in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in a cross sectional design. In this study we explore longitudinal retinal microvascular changes in amyloid beta positive (AB +) participants compared with amyloid beta negative (AB‐) participants. Method We analysed data from 159 cognitively normal participants (mean age 70.6 SD ± 5.91, 55% females) for changes in four microvascular parameters at baseline and 2 year follow up. (mean time between visits 2.2 years ± 0.23 SD) (Table 1) Amyloid status was obtained from positron emission tomography scans (PET) performed in both 2015 and 2019. The Cirrus 5000 Optical Coherence Tomography Angiography (OCT‐A) was used to obtain baseline and follow up measurements of the optic nerve head (ONH) and macula. Result In total, data from 123 AB‐ participants and 37 AB+ participants were included in the analysis. AB (+) participants were further divided into converters (AB‐+,n = 19) and those positive on both PET scans. (AB ++, n = 18) A decrease in vessel density (VD) of the ONH in AB++ participants was demonstrated over time, (p = 0.04) however no change over time was found for VD in the macula inner and outer ring or foveal avascular zone (FAZ). (Figure 2) The VD was found to be consistently higher amongst AB++ participants in the macula inner and outer rings (p<0.05) and the FAZ area was higher in AB‐+ participants. (p<0.05) Conclusion This study showed change in VD over time for the ONH region in participants who have been AB + for 4 years or longer. These participants further demonstrated a higher VD in the macula inner and outer rings compared to AB—and AB‐+ participants. Additional longitudinal studies where amyloid status is present for longer periods of time amongst cognitively healthy participants should be undertaken to see if these OCTA microvascular changes could be used as a biomarker in preclinical AD.