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Background: Optical coherence tomography (OCT) is a noninvasive method of analyzing in vivo retinal architecture. It also measures retinal nerve fiber layer (RNFL) thickness, which is useful in managing diseases of the retina. Age-related thinning of the retinal ganglion cell complex has been measured using OCT. The present study is to evaluate the RNFL and ganglion cell layer (GCL) thickness using spectral domain OCT in patients with cognitive impairment (CI) and to study the correlation between RNFL and mini–mental state examination (MMSE) scores. Materials and Methods: A case–control study was done on 88 eyes of 44 patients, of which 27 belong to mild CI (MCI) and 17 were controls. They were assessed using MMSE/MINICOG/Montreal Cognitive Assessment tests and retinal OCT for RNFL, GCL, and inner plexiform layer (GCL + IPL) analysis. Results: RNFL thickness was reduced in all quadrants, more in superior and inferior quadrants in patients with MCI. GCL + IPL layer showed overall thinning in all quadrants, of which inferonasal and inferior quadrants were thinnest. Conclusion: MCI patients were prone to develop neurodegeneration even in the absence of microvascular changes in the retina. Hence, it is suggested to carry out routine evaluation of retina with OCT in all patients above the age of 60 to detect early neurodegenerative changes for early management. It is also noted that the sensitivity of GC + IPL was higher than that of RNFL to discriminate MCI from controls.