Purpose: To compare longitudinal retinal and choroidal imaging findings in patients with mild cognitive impairment and cognitively normal control participants. Methods: Eyes of patients with mild cognitive impairment and cognitively normal controls were imaged using Zeiss Cirrus HD-5000 optical coherence tomography (OCT) with AngioPlex OCT angiography (OCTA). Macular vessel density and perfusion density were assessed. The Mini-Mental State Examination was administered at study entry and at least 18 months later. The velocity of change in OCT and OCTA parameters was compared between controls, nonamnestic patients with mild cognitive impairment, and amnestic patients with mild cognitive impairment. Results: Eighty-five eyes of 43 patients with mild cognitive impairment and 85 eyes of 43 control participants were analyzed at baseline, and 45% of those were analyzed at an average follow-up of 28 months. The entire cohort of patients with mild cognitive impairment demonstrated faster rates of decline in perfusion density (/year) in 3-mm circle (P = .02) and ring (P = .01) as well as in vessel density (mm-1/year) in 3-mm circle (P = .05) and ring (P = .04) vs control participants. Amnestic patients with mild cognitive impairment demonstrated faster decline in perfusion density in 3-mm circle compared with nonamnestic patients with mild cognitive impairment (P = .04) and control participants (P = .007). Amnestic patients had a greater rate of decline in vessel density in 3-mm circle compared with nonamnestic patients (P = .03) and control participants (P = .02). The entire group of patients with mild cognitive impairment and the subgroup of nonamnestic patients had a faster rate of decline in perfusion density compared with control participants (P = .01 and P < .001, respectively). Conclusions: The rate of decline in perfusion and vessel density was faster in the entire cohort of patients with mild cognitive impairment compared with control participants, with no significant change in Mini-Mental State Examination score. Amnestic patients with mild cognitive impairment demonstrated faster rates of decline in perfusion and vessel density compared with nonamnestic patients with mild cognitive impairment.