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Introduction: Foundational models suggest Alzheimer's disease (AD) can be diagnosed using retinal images, but the specific structural features remain poorly understood. This study investigates retinal vascular changes in individuals with cognitive impairment in three East Asian regions., Methods: A multicenter study was conducted in Shanghai, Hong Kong, and Ningxia, collecting retinal images from 176 patients with mild cognitive impairment (MCI) or AD and 264 controls. The VC-Net deep learning model segmented arterial/venous networks, extracting 36 vascular features., Results: Significant reductions in vessel length, segment number, and vascular density were observed in cognitively impaired patients, while venous structure and complexity were correlated with the level of cognitive function., Discussion: Retinal vascular changes may serve as indicators of cognitive impairment, requiring validation in larger cohorts and exploration of the underlying mechanisms., Highlights: A deep learning segmentation model extracted diverse retinal vascular features. Significant alterations in the structure of retinal arterial/venous networks were identified. Partitioning vessel-rich retinal zones improved detection of vascular changes. Decreases in vessel length, segment number, and vascular density were found in CI individuals., (© 2025 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)