Retinal structural changes in patients with Alzheimer's disease
R.N. Guliyeva, Junior Research Associate
Acad. Z. Aliyeva National Ophthalmology Center;
TO CITE THIS ARTICLE: Guliyeva RN. Retinal structural changes in patients with Alzheimer's disease. J.ophthalmol.(Ukraine).2019;4:33-37. http://doi.org/10.31288/oftalmolzh201943337
Background: Retinal disorders in patients with Alzheimer's disease (AD) are given special attention.
Purpose: To identify optical coherence tomography (OCT)-based retinal structural changes in patients with mild or moderate AD.
Materials and Methods: Forty-five AD patients (88 eyes; age, 66.2 ± 3.44 years) with mild or moderate cognitive impairments were involved into the study. All subjects underwent a conventional eye examination and OCT measurements. For Cirrus HD-OCT imaging, the Macular Cube 512 × 128 Combo protocol was used. The RNFL, retinal ganglion cell layer (RGCL), and internal plexiform layer (IPL) thicknesses were determined using RNFL and ganglion cell complex (GCC) protocols.
Results: Compared with controls, patients with AD had 53.2% lower Mini Mental State Examination (MMSE) scores (p < 0.05). In addition, RNFL thicknesses in the temporal, superior and inferior quadrants in patients with AD were significantly (31.4%, 21.8% and 33.1%, respectively; p < 0.05) thinner compared to controls. Moreover, compared to controls, focal loss volume (FLV) and global loss volume (GLV) of GCC in AD patients were 1.7 times (p < 0.05) and 2.8 times (p < 0.01), respectively, increased, whereas central macular thickness, overall macular cube volume and average macular cube thickness were 14%, 17.8% and 3.5% decreased.
Conclusion: Our findings confirm the reports of changes in the retinal structure in patients with mild or moderate AD, particularly, the decreased GCC thickness and increased GCC FLV and GLV.
Keywords: retina, Alzheimer's disease, RNFL, thickness, GCC, macular cube
1.Alzheimer’s Association. 2013 Alzheimer’s disease facts and figures. Alzheimer’s and Dementia. 2013;9(2):208–45.
2.Colligris P, Perez de Lara MJ, Colligris B, Pintor J. Ocular Manifestations of Alzheimer's and Other Neurodegenerative Diseases: The Prospect of the Eye as a Tool for the Early Diagnosis of Alzheimer's Disease. J Ophthalmol. 2018;2018: 8538573.
3.Alzheimer's Disease International World Alzheimer Report 2016: Improving healthcare for people living with dementia. London; 2016.
4.WHO. Dementia: a Public Health Priority. World Health Organization; 2012.
5.Trebbastoni A, D’Antonio F, Bruscolini A, Marcelli M, Cecere M, Campanelli A, et al. Retinal nerve ﬁbre layer thickness changes in Alzheimer’s disease: results from a 12-month prospective case series. Neurosci Lett. 2016;629:165–70.
6.Coppola G, Di Renzo A, Ziccardi L, Martelli F, Fadda A, Manni G. et al. Optical coherence tomography in Alzheimer’s disease: a meta-analysis. PLoS One. 2015;10(8):e0134750.
7.Armstrong RA. Alzheimer's Disease and the Eye. J Optom. 2009;2(3):101-58.
8.Wu Y, Wang X, Wang N, Han Y, Lu Y. Observation Study of the Retina with the Alzheimer’s Disease or Amnestic Mild Cognitive Impairment Patients. J Clin Exp Ophthalmol. 2016;7(2):545.
9.Lim JKH, Li Q-X, He Z, Vingrys AJ, Wong VHY, Currier N, Mullen J, Bui BV, Nguyen ChTO. The Eye As a Biomarker for Alzheimer's Disease. Front Neurosci. 2016;10:536–549.
10.Ramirez AI, de Hoz R, Salobrar-Garcia E, Salazar JJ, Rojas B, Ajoy D. et al. The role of microglia in retinal neurodegeneration: Alzheimer’s disease, Parkinson, and glaucoma. Front Aging Neurosci. 2017 Jul 6;9:214.
11.The World Medical Association (WMA) Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects Adopted by the General Assembly, Seoul, Korea, October 2008.
12.Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician. J Psych Res. 1975; 12:189-98.
13.Mwanza JC, Durbin MK, Budenz DL, Sayyad FE, Chang RT, Neelakantan A, et al. Glaucoma diagnostic accuracy of ganglion cell-inner plexiform layer thickness: comparison with nerve fiber layer and optic nerve head. Ophthalmology. 2012;119(6):1151–8.
14.Parisi V, Restuccia R, Fattapposta F, Mina C, Bucci MG, Pierelli F. Morphological and functional retinal impairment in Alzheimer’s disease patients. Clin Neurophysiol. 2001;112:1860–1867.
15.Iseri PK, Altinas T, Yuksel N. Relationship between cognitive impairment and retinal morphological and visual functional abnormalities in Alzheimer disease. J Neuroophthalmol. 2006;26:18–24.
16.Berisha F, Feke GT, Trempe CL, Mcmeel JW, Schepens CL. Retinal abnormalities in early Alzheimer’s disease. Invest Ophthalmol Vis Sci. 2007;48(5):2285-9.
17.Lu Y, Li Z, Zhang X, Ming B, Jia J, Wang R, Ma D. Retinal nerve fiber layer abnormalities in early Alzheimer’s disease: Evidence in optical coherence tomography. Neurosci Lett. 2010. 9;480(1):69-72.
18.Marziani E, Pomati S, Ramolfo P, Cigada M, Giani A, Mariani C, et al. Evaluation of retinal nerve fiber layer and ganglion cell layer thickness in Alzheimer's disease using spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2013;54(9):5953–5958.
19.Cheung CY, Ong YT, Hilal S, Ikram MK, Low S, Ong YL, et al. Retinal ganglion cell analysis using high-definition optical coherence tomography in patients with mild cognitive impairment and Alzheimer's disease. J Alzheimers Dis. 2015;45(1):45–56.
20.Choi SH, Park SJ, Kim NR. Macular Ganglion Cell-Inner Plexiform Layer Thickness Is Associated with Clinical Progression in Mild Cognitive Impairment and Alzheimers Disease. Plos One. 2016;11(9): e0162202.
The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.