Changes in visual function and retinal structure in the progression of Alzheimer's disease



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García Martín, Elena Salobrar and Hoz Montañana, Rosa de and Ramírez Sebastián, Ana Isabel and López Cuenca, Inés and Rojas Lozano, Pilar and Vazirani Ballesteros, Ravi and Amarante Cuadrado, Carla and Yubero Pancorbo, Raquel and Gil Gregorio, Pedro and Pinazo Durán, Mª Dolores and Salazar Corral, Juan José and Ramirez Sebastian, Jose Manuel (2019) Changes in visual function and retinal structure in the progression of Alzheimer's disease. PLoS ONE, 14 (8). ISSN 1932-6203

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Background: Alzheimer’s Disease (AD) can cause degeneration in the retina and optic nerve either directly, as a result of amyloid beta deposits, or secondarily, as a result of the degradation of the visual cortex. These effects raise the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. This study aimed to detect retinal changes and associated functional changes in three groups of patients consisting of AD patients with mild disease, AD patients with moderate disease and healthy controls by using non-invasive psychophysical ophthalmological tests and optical coherence tomography (OCT).
Methods: We included 39 patients with mild AD, 21 patients with moderate AD and 40 age-matched healthy controls. Both patients and controls were ophthalmologically healthy. Visual acuity, contrast sensitivity, colour perception, visual integration, and choroidal thicknesses were measured. In addition, OCT and OCT angiography (OCTA) were applied.
Findings: Visual acuity, contrast sensitivity, colour perception, and visual integration were significantly lower in AD patients than in healthy controls. Compared to healthy controls, macular thinning in the central region was significant in the mild AD patients, while macular thickening in the central region was found in the moderate AD group. The analysis of macular layers revealed significant thinning of the retinal nerve fibre layer, the ganglion cell layer and the outer plexiform layer in AD patients relative to controls. Conversely, significant thickening was observed in the outer nuclear layer of the patients. However, mild AD was associated with significant thinning of the subfovea and the nasal and inferior sectors of the choroid. Significant superonasal and inferotemporal peripapillary thinning was observed in patients with moderate disease.
Conclusions: The first changes in the mild AD patients appear in the psychophysical tests and in the central macula with a decrease in the central retinal thickness. When there was a disease progression to moderate AD, psychophysical tests remained stable with respect to the decrease in mild AD, but significant thinning in the peripapillary retina and thickening in the central retina appeared. The presence of AD is best indicated based on contrast sensitivity.

Item Type:Article
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Received: March 26, 2019; Accepted: July 17, 2019; Published: August 15, 2019

Uncontrolled Keywords:Retina, Visual function, Alzheimer's disease, Degeneration, Ocular diseases, Retinal changes, Macular thinning
Subjects:Medical sciences > Medicine > Geriatrics
Medical sciences > Medicine > Ophtalmology
Medical sciences > Optics > Imaging systems
ID Code:56873
Deposited On:05 Sep 2019 12:37
Last Modified:24 Sep 2019 08:53

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