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Hamedani AG. Vision loss and hallucinations: perspectives from neurology and ophthalmology. Curr Opin Neurol 2021; 34:84-88. [PMID: 33230034 DOI: 10.1097/wco.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to summarize the evidence for visual impairment as a risk factor for visual hallucinations in neurologic disease and recent advances in our understanding of the central visual pathways that mediate this association. RECENT FINDINGS Recent studies have described the prevalence Charles Bonnet syndrome and questioned its lack of association with cognitive impairment, used advanced neuroimaging to show that disinhibition of the occipital lobe is involved in the pathogenesis of visual hallucinations in Parkinson's disease, and demonstrated that visual impairment because of eye disease is a consistent risk factor for visual hallucinations across a number of different neurodegenerative disease populations. SUMMARY Through connections between the primary visual cortex and other brain structures, visual function is closely tied to visual hallucinations. Given that the vast majority of vision loss is caused by ophthalmic disease, much of which is preventable or treatable, the detection and treatment of vision loss in at-risk populations may reduce the burden and consequences of visual hallucinations in older adults.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Retinal structural changes in mood disorders: The optical coherence tomography to better understand physiopathology? Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110080. [PMID: 32827610 DOI: 10.1016/j.pnpbp.2020.110080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mood disorders are particularly common, disabling conditions. Diagnosis can be difficult as it may involve different pathophysiological assumptions. This could explain why such disorders are resistant to treatment. The retina is part of the central nervous system and shares a common embryonic origin with the brain. Optical coherence tomography (OCT) is an imaging technique for analysing the different layers of the retina. We reviewed studies that examined the retina with OCT in mood disorders. METHODS We conducted Pubmed search and additional manual research based on the bibliography in each of selected articles. We found and analysed 11 articles relevant to our subject. RESULTS This literature review confirms that it is possible to use OCT to detect neurodegeneration and neuroinflammation in mood disorders. Their impact is thought to depend on the duration and severity of the disease, and whether it is in acute or chronic stage. The differences seen in studies dealing with depression and those looking at bipolar disorder may reflect the particular characteristics of each disorder. A number of OCT parameters can be proposed as biomarkers of active or chronic inflammation and neurodegeneration. Markers of predisposition to an at-risk mental state are also suggested. LIMITATIONS The main limitation is selection bias, studies including more varied population would help to confirm and precise these results. CONCLUSION OCT is thus a particularly promising tool for evaluating some of the etiopathogenetic mechanisms involved in mood disorders. The combination with other approaches could help to find more specific biomarkers.
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53
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Carazo-Barrios L, Archidona-Arranz A, Claros-Ruiz A, García-Basterra I, Garzón-Maldonado FJ, Serrano-Castro V, Gutiérrez-Bedmar M, Barbancho MÁ, De la Cruz Cosme C, García-Campos JM, García-Casares N. Correlation between retinal nerve fibre layer thickness and white matter lesions in Alzheimer's disease. Int J Geriatr Psychiatry 2021; 36:935-942. [PMID: 33387372 DOI: 10.1002/gps.5496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Early diagnosis in Alzheimer's disease (AD) is crucial in order to implement new therapeutic strategies. The retina is embryologically related to the brain. Thus, the possible usefulness of optical coherence tomography (OCT) in the early detection of AD is currently being studied. Our aim was to study the relationship between retinal nerve fiber layer (RNFL) thickness and AD. METHODS We undertook an observational, analytical, cross-sectional study with consecutive sampling of 32 patients with AD or mild cognitive impairment and a group of healthy controls (C). The total number of eyes studied was 64. An ophthalmological and a comprehensive neuropsychological evaluation were performed in all participants. Quantification of white matter lesions and study of atrophy of the hippocampus by cerebral magnetic resonance were also performed. RESULTS We observed a significant linear trend towards a thinning of RNFL as the degree of cognitive deterioration increased, in the superior and temporal quadrants of the retina. A significant correlation was also noted between the mean thickness of the RNFL of the left temporal quadrant and occipital white matter lesions (r = -0.579, p = 0.038). CONCLUSIONS OCT could be a safe, rapid noninvasive tool providing useful biomarkers in the early detection of cognitive deterioration and AD.
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Affiliation(s)
- Lina Carazo-Barrios
- Department of Neurology, University Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | | | | | | | | | - Miguel Ángel Barbancho
- Department of Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
- Department of Clinical Neurology, Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), University of Málaga, Spain
| | | | - Jose M García-Campos
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
- Department of Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
- Department of Clinical Neurology, Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), University of Málaga, Spain
| | - Natalia García-Casares
- Department of Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
- Department of Clinical Neurology, Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), University of Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
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54
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Fereshetian S, Agranat JS, Siegel N, Ness S, Stein TD, Subramanian ML. Protein and Imaging Biomarkers in the Eye for Early Detection of Alzheimer's Disease. J Alzheimers Dis Rep 2021; 5:375-387. [PMID: 34189409 PMCID: PMC8203283 DOI: 10.3233/adr-210283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
Alzheimer's disease (AD) is one of the most common causes of dementia worldwide. Although no formal curative therapy exists for the treatment of AD, considerable research has been performed to identify biomarkers for early detection of this disease, and thus improved subsequent management. Given that the eye can be examined and imaged non-invasively with relative ease, it has emerged as an exciting area of research for evidence of biomarkers and to aid in the early diagnosis of AD. This review explores the current understanding of both protein and retinal imaging biomarkers in the eye. Herein, primary findings in the literature regarding AD biomarkers associated with the lens, retina, and other ocular structures are reviewed.
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Affiliation(s)
- Shaunt Fereshetian
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
| | - Joshua S. Agranat
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Nicole Siegel
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Steven Ness
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Manju L. Subramanian
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
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55
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Donix M, Wittig D, Hermann W, Haussmann R, Dittmer M, Bienert F, Buthut M, Jacobi L, Werner A, Linn J, Ziemssen T, Brandt MD. Relation of retinal and hippocampal thickness in patients with amnestic mild cognitive impairment and healthy controls. Brain Behav 2021; 11:e02035. [PMID: 33448670 PMCID: PMC8119792 DOI: 10.1002/brb3.2035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Investigating retinal thickness may complement existing biological markers for dementia and other neurodegenerative diseases. Although retinal thinning is predictive for cognitive decline, it remains to be investigated if and how this feature aligns with neurodegeneration elsewhere in the brain, specifically in early disease stages. METHODS Using optical coherence tomography and magnetic resonance imaging, we examined retinal thickness as well as hippocampal structure in patients with amnestic mild cognitive impairment and healthy controls. RESULTS The groups did not differ in hippocampal and retinal thickness measures. However, we detected a correlation of peripapillary retinal nerve fiber layer thickness and hippocampal thickness in healthy people but not in cognitively impaired patients. The ratio of hippocampus to retina thickness was significantly smaller in patients with mild cognitive impairment and correlated positively with cognitive performance. CONCLUSIONS Different temporal trajectories of neurodegeneration may disrupt transregional brain structure associations in patients with amnestic mild cognitive impairment.
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Affiliation(s)
- Markus Donix
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Dierk Wittig
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany.,Department of Ophthalmology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Wiebke Hermann
- Department of Neurology, University Hospital, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Robert Haussmann
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maren Dittmer
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Bienert
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maria Buthut
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Liane Jacobi
- Department of Neurology, Sächsisches Krankenhaus Arnsdorf, Arnsdorf, Germany
| | - Annett Werner
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany.,Department of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jennifer Linn
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Moritz D Brandt
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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56
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Chua SYL, Lascaratos G, Atan D, Zhang B, Reisman C, Khaw PT, Smith SM, Matthews PM, Petzold A, Strouthidis NG, Foster PJ, Khawaja AP, Patel PJ. Relationships between retinal layer thickness and brain volumes in the UK Biobank cohort. Eur J Neurol 2021; 28:1490-1498. [PMID: 33369822 PMCID: PMC8261460 DOI: 10.1111/ene.14706] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/12/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
Background and purpose Current methods to diagnose neurodegenerative diseases are costly and invasive. Retinal neuroanatomy may be a biomarker for more neurodegenerative processes and can be quantified in vivo using optical coherence tomography (OCT), which is inexpensive and noninvasive. We examined the association of neuroretinal morphology with brain MRI image‐derived phenotypes (IDPs) in a large cohort of healthy older people. Methods UK Biobank participants aged 40 to 69 years old underwent comprehensive examinations including ophthalmic and brain imaging assessments. Macular retinal nerve fibre layer (mRNFL), macular ganglion cell‐inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) and total macular thicknesses were obtained from OCT. Magnetic resonance imaging (MRI) IDPs assessed included total brain, grey matter, white matter and hippocampal volume. Multivariable linear regression models were used to evaluate associations between retinal layers thickness and brain MRI IDPs, adjusting for demographic factors and vascular risk factors. Results A total of 2131 participants (mean age 55 years; 51% women) with both gradable OCT images and brain imaging assessments were included. In multivariable regression analysis, thinner mGCIPL, mGCC and total macular thickness were all significantly associated with smaller total brain (p < 0.001), grey matter and white matter volume (p < 0.01), and grey matter volume in the occipital pole (p < 0.05). Thinner mGCC and total macular thicknesses were associated with smaller hippocampal volume (p < 0.02). No association was found between mRNFL and the MRI IDPs. Conclusions Markers of retinal neurodegeneration are associated with smaller brain volumes. Our findings suggest that retinal structure may be a biomarker providing information about important brain structure in healthy older adults.
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Affiliation(s)
- Sharon Y L Chua
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Gerassimos Lascaratos
- Kings College Hospital, London, UK.,Department of Ophthalmology, School of Medicine, King's College London, London, UK
| | - Denize Atan
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Bing Zhang
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles Reisman
- Topcon Healthcare Solutions, Research and Development, Oakland, NJ, USA
| | - Peng T Khaw
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Stephen M Smith
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul M Matthews
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Axel Petzold
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Nicholas G Strouthidis
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Merten N, Paulsen AJ, Pinto AA, Chen Y, Dillard LK, Fischer ME, Huang GH, Klein BEK, Schubert CR, Cruickshanks KJ. Macular Ganglion Cell-Inner Plexiform Layer as a Marker of Cognitive and Sensory Function in Midlife. J Gerontol A Biol Sci Med Sci 2020; 75:e42-e48. [PMID: 32490509 DOI: 10.1093/gerona/glaa135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neurodegenerative diseases are public health challenges in aging populations. Early identification of people at risk for neurodegeneration might improve targeted treatment. Noninvasive, inexpensive screening tools are lacking but are of great potential. Optical coherence tomography (OCT) measures the thickness of nerve cell layers in the retina, which is an anatomical extension of the brain and might be indicative of common underlying neurodegeneration. We aimed to determine the association of macular ganglion cell-inner plexiform layer (mGCIPL) thickness with cognitive and sensorineural function in midlife. METHOD This cross-sectional study included 1,880 Beaver Dam Offspring Study participants (aged 27-93 years, mean 58) who participated in the 10-year follow-up examination. We assessed cognitive function and impairment, hearing sensitivity thresholds and impairment, central auditory processing, visual impairment, and olfactory impairment. We measured mGCIPL using the Cirrus 5000 HD-OCT Macular Cube Scan. Multivariable linear and logistic regression models adjusted for potential confounders were used to determine associations between mGCIPL thickness and cognitive and sensorineural functions, as well as for comparing participants with a thin mGCIPL (1 SD below average) to the remainder in those functions. RESULTS Thinner mGCIPL was associated with worse cognitive function, worse central auditory function, and visual impairment. We found an association of mGCIPL thickness with hearing sensitivity in women only and no association with impairment in hearing, olfaction, and cognition. Results on the thin group comparisons were consistent. CONCLUSIONS mGCIPL thickness is associated with cognitive and sensorineural function and has the potential as a marker for neurodegeneration in middle-aged adults.
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Affiliation(s)
- Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - A Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Lauren K Dillard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Communication Sciences and Disorders, College of Letters and Science, University of Wisconsin-Madison
| | - Mary E Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Karen J Cruickshanks
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
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58
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Gavín A, Garcia-Martin E, Garcia-Campayo J, Viladés E, Orduna E, Satué M. The use of optical coherence tomography in the evaluation of patients with bipolar disorder. ACTA ACUST UNITED AC 2020; 96:141-151. [PMID: 32912807 DOI: 10.1016/j.oftal.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022]
Abstract
Bipolar disorder (BD) is a mental disorder characterised by episodes of extremal mood changes. In recent years, some researchers found neurodegeneration in patients with BD using Magnetic Resonance Imaging. Evaluation of the optic nerve and the retinal layers using optical coherence tomography (OCT) has proved to be a useful, non-invasive tool for diagnosis and monitoring of neurodegenerative diseases. Accordingly, a decrease in the retinal nerve fibre layer and the ganglion cell complex measured by OCT was found in patients with BD in different studies, suggesting that BD is a neurodegenerative process in addition to a psychiatric disorder. Therefore, the neuro-ophthalmological evaluation of these patients could be used as a marker for diagnosis of this disease. This work analyses literature on retinal degeneration in bipolar disorder patients, and evaluates the ability of OCT devices in the detection of neuronal degeneration affecting the different retinal layers in these patients, and its possible role in the diagnosis and monitoring of the disease.
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Affiliation(s)
- A Gavín
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España.
| | - E Garcia-Martin
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
| | - J Garcia-Campayo
- Servicio de Psiquiatría, Hospital Universitario Miguel Servet, Zaragoza, España; Departamento de Psicología y Sociología, facultad de ciencias sociales y humanas, Universidad de Zaragoza, Zaragoza, España
| | - E Viladés
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
| | - E Orduna
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
| | - M Satué
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
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Wu SZ, Masurkar AV, Balcer LJ. Afferent and Efferent Visual Markers of Alzheimer's Disease: A Review and Update in Early Stage Disease. Front Aging Neurosci 2020; 12:572337. [PMID: 33061906 PMCID: PMC7518395 DOI: 10.3389/fnagi.2020.572337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023] Open
Abstract
Vision, which requires extensive neural involvement, is often impaired in Alzheimer's disease (AD). Over the last few decades, accumulating evidence has shown that various visual functions and structures are compromised in Alzheimer's dementia and when measured can detect those with dementia from those with normal aging. These visual changes involve both the afferent and efferent parts of the visual system, which correspond to the sensory and eye movement aspects of vision, respectively. There are fewer, but a growing number of studies, that focus on the detection of predementia stages. Visual biomarkers that detect these stages are paramount in the development of successful disease-modifying therapies by identifying appropriate research participants and in identifying those who would receive future therapies. This review provides a summary and update on common afferent and efferent visual markers of AD with a focus on mild cognitive impairment (MCI) and preclinical disease detection. We further propose future directions in this area. Given the ease of performing visual tests, the accessibility of the eye, and advances in ocular technology, visual measures have the potential to be effective, practical, and non-invasive biomarkers of AD.
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Affiliation(s)
- Shirley Z. Wu
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
| | - Arjun V. Masurkar
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Laura J. Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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60
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Peng C, Kwapong WR, Xu S, Muse FM, Yan J, Qu M, Cao Y, Miao H, Zhen Z, Wu B, Han Z. Structural and Microvascular Changes in the Macular Are Associated With Severity of White Matter Lesions. Front Neurol 2020; 11:521. [PMID: 32714262 PMCID: PMC7344221 DOI: 10.3389/fneur.2020.00521] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose: This study aimed to characterize the microvascular and structural changes in the macular that occur in white matter hyperintensities (WMH) using optical coherence tomographic angiography. We also aimed to explore the association between macular microvascular and structural changes with focal markers of brain tissue on MRI in WMH using the Fazekas scale. Methods: This study enrolled healthy participants who were stroke- and dementia-free. MRI was used to image the cerebral white matter lesions, and Fazekas scale was used to evaluate the severity of the white matter lesions. Optical coherence tomography angiography (OCT-A) was used to image the radial peripapillary capillaries (RPCs), macular capillary plexuses [superficial capillary plexus (SCP) and deep capillary plexus (DCP)] and thickness around the optic nerve head, peripapillary retinal nerve fiber layer (pRNFL). Results: Seventy-four participants were enrolled and divided into two groups according to their Fazekas score (Fazekas scores ≤ 1 and ≥2). Participants with Fazekas score ≥2 showed significantly reduced RPC density (P = 0.02) and DCP density (P = 0.012) when compared with participants with Fazekas score ≤ 1. Participants with Fazekas score ≥2 showed reduced pRNFL (P = 0.004) when compared to participants with Fazekas score ≤ 1. Fazekas scores were significantly associated with the pRNFL thickness (Rho = −0.389, P = 0.001), RPC density (Rho = −0.248, P = 0.035), and DCP density (Rho = −0.283, P = 0.015), respectively. Conclusions: Microvascular impairment and neuro-axonal damage are associated with the disease cascade in WMH. We have shown that RPC and DCP densities are significantly affected, and these impairments are associated with the severity of the disease and cognitive function. OCT-A could be a useful tool in quantifying the retinal capillary densities in WMH.
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Affiliation(s)
- Chenlei Peng
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Shasha Xu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Farah Mohamed Muse
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jueyan Yan
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Man Qu
- Taizhou Central Hospital, Taizhou University Hospital, Zhejiang, China
| | - Yungang Cao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hanpei Miao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Zhenxiang Zhen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Wu
- West China Hospital, Sichuan University, Sichuan, China
| | - Zhao Han
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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61
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Ward DD, Mauschitz MM, Bönniger MM, Merten N, Finger RP, Breteler MMB. Association of retinal layer measurements and adult cognitive function: A population-based study. Neurology 2020; 95:e1144-e1152. [PMID: 32586900 DOI: 10.1212/wnl.0000000000010146] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To quantify the associations of peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell layer (mGCL) volume with cognitive functioning and to investigate how demographic and vascular health factors affect these associations in a population-based sample of adults. METHODS The sample included the first 3,000 participants (age range 30-95 years) of the Rhineland Study (recruited from March 2016 to December 2018) who underwent spectral-domain optical coherence tomography and cognitive assessment at 1 of 2 identical study centers in Bonn, Germany. We used multiple linear regression models to examine the relationships between retinal layer measurements and cognitive functioning after adjustment for confounders, and we examined the moderating effects of demographic and vascular health factors. RESULTS The analytical sample included 2,483 participants who were 54.3 years old (SD 13.8 years) on average. After full adjustment, each 1-SD decrease in mGCL volume was associated with a greater decrease in global function than that of pRNFL thickness (β = -0.048 [95% confidence interval (CI) -0.077 to -0.018] vs β = -0.021 [95% CI -0.049 to 0.007]). These relationships increased in strength with advancing age, were stronger in participants with hypertension, and were reversed in current smokers relative to nonsmokers. CONCLUSIONS mGCL volume is more strongly related to adult cognitive functioning than pRNFL thickness, making it a better potential biomarker of neurodegeneration. Age and vascular health factors play important roles in determining the strength and direction of this association.
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Affiliation(s)
- David D Ward
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Matthias M Mauschitz
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Meta M Bönniger
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Natascha Merten
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Robert P Finger
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Monique M B Breteler
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison.
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Bannai D, Lizano P, Kasetty M, Lutz O, Zeng V, Sarvode S, Kim LA, Hill S, Tamminga C, Clementz B, Gershon E, Pearlson G, Miller JB, Keshavan M. Retinal layer abnormalities and their association with clinical and brain measures in psychotic disorders: A preliminary study. Psychiatry Res Neuroimaging 2020; 299:111061. [PMID: 32145500 PMCID: PMC7183910 DOI: 10.1016/j.pscychresns.2020.111061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 01/06/2023]
Abstract
Studies utilizing optical coherence tomography (OCT) in psychosis have identified abnormalities in retinal cytoarchitecture. We aim to analyze retinal layer topography in psychosis and its correlation with clinical and imaging parameters. Macular retinal images were obtained via OCT in psychosis probands (n = 25) and healthy controls (HC, n = 15). Clinical, cognitive and structural MRI data were collected from participants. No thinning was noted for the retinal nerve fiber, ganglion cell or inner plexiform layers. We found significant thinning in the right inner temporal, right central, and left inner superior quadrants of the outer nuclear layer (ONL) in probands compared to HC. Thickening of the outer plexiform layer (OPL) was observed in the right inner temporal, left inner superior, and left inner temporal quadrants. The right inner temporal and left inner superior quadrants of both the OPL and ONL showed significant inverse correlations. Retinal pigment epithelium thinning correlated with worse mania symptoms, and thinning in the ONL was associated with worse cognitive function. ONL thinning was also associated with smaller total brain and white matter volume. Our findings suggest that outer retinal layers may provide additional insights into the pathophysiology of psychosis, possibly reflecting synaptic or inflammatory aberrations that lead to retinal pathologies.
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Affiliation(s)
- Deepthi Bannai
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paulo Lizano
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Megan Kasetty
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Olivia Lutz
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Victor Zeng
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suraj Sarvode
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Department of Opthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Scot Hill
- Department of Psychology, Rosalind Franklin University, Chicago, IL, USA
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brett Clementz
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Elliot Gershon
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago, IL, USA
| | | | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA; Retina Service, Department of Opthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Matcheri Keshavan
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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63
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Anderson DE, Holstein SA, Kedar S. Visual Pathway Degeneration in Chemotherapy-Related Neurotoxicity: A Review and Directions for Future Research. Neuroophthalmology 2020; 44:139-147. [PMID: 32395165 DOI: 10.1080/01658107.2019.1702703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022] Open
Abstract
Chemotherapy-related neurotoxicity (CRNT) is an emerging public health concern. Visual pathway degeneration may be a symptom of CRNT. We surveyed the current literature for evidence of visual pathway degeneration in cancer patients receiving chemotherapy. A systematic review was conducted in PubMed. Six published articles met our inclusion criteria. The studies showed reduced retinal thickness, primarily in the retinal nerve fibre layer, and impaired inner retinal function in patients receiving chemotherapy. In summary, the current literature suggests chemotherapy may induce visual pathway degeneration. Future research may benefit from improving study design, exploring mechanisms of chemotherapy-related visual pathway degeneration, and incorporating these findings into biomarker development.
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Affiliation(s)
- David E Anderson
- Department of Ophthalmology & Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sarah A Holstein
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Hematology & Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sachin Kedar
- Department of Ophthalmology & Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
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64
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Kelman JC, Hodge C, Stanwell P, Mustafic N, Fraser CL. Retinal nerve fibre changes in sports-related repetitive traumatic brain injury. Clin Exp Ophthalmol 2020; 48:204-211. [PMID: 31691473 DOI: 10.1111/ceo.13673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022]
Abstract
IMPORTANCE There is limited literature on the use of optical coherence tomography in the assessment of retinal nerve fibre layer (RNFL) thickness in sports-related repetitive mild traumatic brain injury. BACKGROUND To evaluate RNFL thickness in professional rugby league players. RNFL thinning may serve as a proxy for wider white matter degeneration. DESIGN Cross-sectional observational study. PARTICIPANTS Thirteen retired Australian professional rugby league players were recruited. METHODS Participants underwent binocular optical coherence tomography to measure RNFL thickness. Each participant underwent a complete ophthalmic assessment to exclude concurrent disease. MAIN OUTCOME MEASURES RNFL thickness of each eye were compared with a normative database. RESULTS Participants had played professional Rugby League for 18 years on average and reported sustaining 15 sports-related concussions throughout their career. The RNFL in participants was four micrometres thinner than that of matched normative data. Cohort average RNFL thickness was reduced in 12 out of 14 optical coherence testing parameters. These findings were statistically significant in the left inferonasal [P = .013] and left nasal [P = .006] sectors. There was no statistically significant relationship between RNFL thickness and other visual measures. CONCLUSIONS AND RELEVANCE This study is the first to demonstrate RNFL thinning in a cohort of retired Australian professional Rugby League players. RNFL changes have been shown to correlate with cerebral white matter loss and neurodegeneration. Optical coherence tomography may serve as a safe and economical means of screening for repetitive traumatic brain injury related neurodegeneration in contact sport athletes.
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Affiliation(s)
- Julian C Kelman
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Hodge
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter Stanwell
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nina Mustafic
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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65
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Qu M, Kwapong WR, Peng C, Cao Y, Lu F, Shen M, Han Z. Retinal sublayer defect is independently associated with the severity of hypertensive white matter hyperintensity. Brain Behav 2020; 10:e01521. [PMID: 31875660 PMCID: PMC7010590 DOI: 10.1002/brb3.1521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To investigate the association of specific retinal sublayer thicknesses on optical coherence tomography (OCT) imaging with brain magnetic resonance imaging (MRI) markers using the Fazekas scale in hypertensive white matter hyperintensity (WMH) subjects. METHODS Eighty-eight participants (32 healthy controls and 56 hypertensive white matter hyperintensity subjects) underwent retinal imaging using the OCT and MRI. A custom-built algorithm was used to measure the thicknesses of the retinal nerve fiber layer (RNFL) and ganglion cell layer and inner plexiform layer (GCIP). Focal markers for white matter hyperintensities were assessed on MRI and graded using the Fazekas visual rating. RESULTS Hypertensive WMH showed significantly reduced (p < .05) RNFL and GCIP layers when compared to healthy controls, respectively. A significant correlation was found between the RNFL (ρ = -.246, p < .001) and GCIP (ρ = -.338, p < .001) of the total participants and the Fazekas score, respectively. Statistical differences were still significant (p < .05) when correlations were adjusted for intereye correlation, age, hypertension, smoking, body mass index, and diabetes. Among the cases of hypertensive WMH, higher Fazekas scores were significantly associated (p < .05) with the thinning of both the RNFL and GCIP layers after adjustment of age and other risk factors. CONCLUSIONS Retinal degeneration in the RNFL and GCIP was independently associated with focal lesions in the white matter of the brain and deteriorates with the severity of the lesions. We suggest that imaging and measurement of the retinal sublayers using the OCT may provide evidence on neurodegeneration in WMH.
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Affiliation(s)
- Man Qu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Taizhou Central Hospital, Taizhou University Hospital, Taizhou, China
| | | | - Chenlei Peng
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Zhao Han
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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66
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Spaide RF. Measurable Aspects of the Retinal Neurovascular Unit in Diabetes, Glaucoma, and Controls. Am J Ophthalmol 2019; 207:395-409. [PMID: 31078537 DOI: 10.1016/j.ajo.2019.04.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To study the structural and angiographic optical coherence tomography (OCT) data of the macula from controls, patients with diabetes, and patients with glaucoma to evaluate neurovascular and structural relationships. METHODS This was a retrospective study of 89 eyes from 49 patients in a community-based retinal referral practice with diabetes, glaucoma, and normal controls. The patients were evaluated with OCT to include retinal nerve fiber layer (RNFL) thickness measurement and ganglion cell layer (GCL) volume determination. The vascular density of the radial peripapillary capillary network and the vascular plexuses in the macula were evaluated with OCT angiography. The main outcome measures were the data obtained per disease state and the interrelationships the data displayed. RESULTS The mean GCL volumes were significantly lower than the control group in both the diabetic (P = .016) and glaucoma (P < .001) groups. The difference between the diabetic and glaucoma groups was not significant (P = .052). The mean global vascular density was greater in the control group than the diabetic group (P = .002) and the glaucoma group (P < .001). The mean RNFL thicknesses were lowest in the glaucoma group. Both the diabetic and glaucoma groups had significantly lower radial peripapillary network and deep vascular plexus density values compared to controls. CONCLUSIONS Although there are important differences in disease pathogenesis between diabetes and glaucoma, they share certain similarities in the structural and angiographic abnormalities eventually produced. This suggests that, in addition to canonical pathways of disease, a component of both could represent neurodegenerative disease, offering the possibility for the development of new treatments. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.
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67
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Mutlu U, Colijn JM, Ikram MA, Bonnemaijer PWM, Licher S, Wolters FJ, Tiemeier H, Koudstaal PJ, Klaver CCW, Ikram MK. Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia: A Population-Based Study. JAMA Neurol 2019; 75:1256-1263. [PMID: 29946702 DOI: 10.1001/jamaneurol.2018.1563] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Retinal structures may serve as a biomarker for dementia, but longitudinal studies examining this link are lacking. Objective To investigate the association of inner retinal layer thickness with prevalent and incident dementia in a general population of Dutch adults. Design, Setting, and Participants From September 2007 to June 2012, participants from the prospective population-based Rotterdam Study who were 45 years and older and had gradable retinal optical coherence tomography images and at baseline were free from stroke, Parkinson disease, multiple sclerosis, glaucoma, macular degeneration, retinopathy, myopia, hyperopia, and optic disc pathology were included. They were followed up until January 1, 2015, for the onset of dementia. Exposures Inner retinal layer thicknesses (ie, retinal nerve fiber layer [RNFL]) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses measured on optical coherence tomography images. Main Outcomes and Measures Odds ratios and hazard ratios for incident dementia per SD decrease in retinal layer thickness adjusted for age, sex, education, and cardiovascular risk factors. Results Of 5065 individuals eligible for optical coherence tomography scanning, 3289 (64.9%) (mean [SD] age 68.9 [9.9] years, 1879 [57%] women) were included in the analysis. Of these 3289 individuals, 41 (1.2%) already had dementia. Thinner GC-IPL was associated with prevalent dementia (odds ratio per SD decrease in GC-IPL, 1.37 [95% CI, 0.99-1.90]). No association was found of RNFL with prevalent dementia. During 14 674 person-years of follow-up (mean [SD], 4.5 [1.6] years), 86 individuals (2.6%) developed dementia of whom 68 (2.1%) had Alzheimer disease. Thinner RNFL at baseline was associated with an increased risk of developing dementia (hazard ratio per SD decrease in RNFL, 1.44 [95% CI, 1.19-1.75]), which was similar for Alzheimer disease (hazard ratio, 1.43 [95% CI, 1.15-1.78]). No association was found between GC-IPL thickness and incident dementia (hazard ratio, 1.13 [95% CI, 0.90-1.43]). Conclusions and Relevance Thinner RNFL is associated with an increased risk of dementia, including Alzheimer disease, suggesting that retinal neurodegeneration may serve as a preclinical biomarker for dementia.
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Affiliation(s)
- Unal Mutlu
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johanna M Colijn
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Pieter W M Bonnemaijer
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter J Koudstaal
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
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68
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Spatial analysis of thickness changes in ten retinal layers of Alzheimer's disease patients based on optical coherence tomography. Sci Rep 2019; 9:13000. [PMID: 31506524 PMCID: PMC6737098 DOI: 10.1038/s41598-019-49353-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/24/2019] [Indexed: 12/22/2022] Open
Abstract
The retina is an attractive source of biomarkers since it shares many features with the brain. Thickness differences in 10 retinal layers between 19 patients with mild Alzheimer’s disease (AD) and a control group of 24 volunteers were investigated. Retinal layers were automatically segmented and their thickness at each scanned point was measured, corrected for tilt and spatially normalized. When the mean thickness of entire layers was compared between patients and controls, only the outer segment layer of patients showed statistically significant thinning. However, when the layers were compared point-by point, patients showed statistically significant thinning in irregular regions of total retina and nerve fiber, ganglion cell, inner plexiform, inner nuclear and outer segment layers. Our method, based on random field theory, provides a precise delimitation of regions where total retina and each of its layers show a statistically significant thinning in AD patients. All layers, except inner nuclear and outer segments, showed thickened regions. New analytic methods have shown that thinned regions are interspersed with thickened ones in all layers, except inner nuclear and outer segments. Across different layers we found a statistically significant trend of the thinned regions to overlap and of the thickened ones to avoid overlapping.
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69
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Peripapillary retinal nerve fibre layer thinning in genetic generalized epilepsy. Seizure 2019; 71:201-206. [PMID: 31386963 DOI: 10.1016/j.seizure.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the peripapillary retinal nerve fibre layer (RNFL) between patients with genetic generalized epilepsy (GGE) and healthy controls. METHODS This prospective observational study was conducted on adults aged 18-60 years. The study group comprised 26 consecutive patients who met the inclusion criteria and 26 healthy age- and sex-matched healthy adults. Peripapillary RNFL thickness was measured by spectral domain optical coherence tomography. RESULTS The average peripapillary RNFL thickness was significantly thinner for GGE patients (98.61 μm) than for healthy controls (104.77 μm) (p = 0.016). Similar results were obtained for the left eye. The peripapillary RFNL thickness of all quadrants was lower for GGE patients than for healthy controls, but it was significant only in the superior (p = 0.009) and inferior (p = 0.024) quadrants for both eyes. CONCLUSIONS Our results suggest that the peripapillary RNFL is significantly thinner in GGE patients than in healthy participants. We concluded that this microstructural feature might be an intrinsic feature of GGE.
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70
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Cabrera DeBuc D, Gaca-Wysocka M, Grzybowski A, Kanclerz P. Identification of Retinal Biomarkers in Alzheimer's Disease Using Optical Coherence Tomography: Recent Insights, Challenges, and Opportunities. J Clin Med 2019; 8:jcm8070996. [PMID: 31323964 PMCID: PMC6678943 DOI: 10.3390/jcm8070996] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022] Open
Abstract
This review will highlight recent insights into measuring retinal structure in Alzheimer’s disease (AD). A growing body of evidence indicates that disturbances in retinal blood flow and structure are related to cognitive function, which can severely impair vision. Optical coherence tomography (OCT) is an optical imaging technology that may allow researchers and physicians to gain deeper insights into retinal morphology and clarify the impact of AD on retinal health and function. Direct and noninvasive measurement of retinal morphology using OCT has provided useful diagnostic and therapeutic indications in several central nervous system (CNS) diseases, including AD, multiple sclerosis, and Parkinson disease. Despite several limitations, morphology assessment in the retinal layers is a significant advancement in the understanding of ocular diseases. Nevertheless, additional studies are required to validate the use of OCT in AD and its complications in the eye.
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Affiliation(s)
- Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10-082 Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-554 Poznan, Poland
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71
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Maharani A, Dawes P, Nazroo J, Tampubolon G, Pendleton N, Bertelsen G, Cosh S, Cougnard-Grégoire A, Dawes P, Delcourt C, Constantinidou F, Goedegebure A, Helmer C, Ikram MA, Klaver CCW, Leroi I, Maharani A, Meester-Smor M, Nael V, Oosterloo N, Pendleton N, Schirmer H, Tampubolon G, Tiemeier H, von Hanno T. Associations Between Self-Reported Sensory Impairment and Risk of Cognitive Decline and Impairment in the Health and Retirement Study Cohort. J Gerontol B Psychol Sci Soc Sci 2019; 75:1230-1242. [DOI: 10.1093/geronb/gbz043] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Indexed: 01/31/2023] Open
Abstract
Abstract
Objectives
We aimed to determine whether self-assessed single (hearing or visual) and dual sensory (hearing and visual) impairments are associated with cognitive decline and incident possible cognitive impairment, no dementia (CIND) and probable dementia.
Method
Data were drawn from the 1996–2014 surveys of the Health and Retirement Study (HRS), involving 19,618 respondents who had no probable dementia and who were aged 50 years or older at the baseline. We used linear mixed models to test the association between self-assessed sensory impairment and cognitive decline followed by a Cox proportional hazard model to estimate the relative risk of incident possible CIND and probable dementia associated with the presence of sensory impairment.
Results
Respondents with self-assessed single and dual sensory impairment performed worse in cognitive tests than those without sensory impairment. The fully adjusted incidence of developing possible CIND was 17% higher for respondents with hearing impairment than those without hearing impairment. Respondents with visual impairment had 35% and 25% higher risk for developing possible CIND and probable dementia, respectively, than those without visual impairment. Respondents with dual sensory impairment at baseline were 38% and 26% more likely to develop possible CIND and probable dementia, respectively, than those with no sensory impairment.
Discussion
Self-assessed sensory impairment is independently associated with cognitive decline and incident possible CIND and probable dementia. Further studies are needed to identify the mechanism underlying this association and to determine whether treatment of sensory impairment could ameliorate cognitive decline and delay the onset of dementia among older adults.
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Affiliation(s)
- Asri Maharani
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Piers Dawes
- Division of Human Communication, Development & Hearing, University of Manchester, UK
| | - James Nazroo
- Sociology and Cathie Marsh Institute for Social Research, University of Manchester, UK
| | - Gindo Tampubolon
- Sociology and Cathie Marsh Institute for Social Research, University of Manchester, UK
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Jones AR, Robbs CM, Edwards CG, Walk AM, Thompson SV, Reeser GE, Holscher HD, Khan NA. Retinal Morphometric Markers of Crystallized and Fluid Intelligence Among Adults With Overweight and Obesity. Front Psychol 2018; 9:2650. [PMID: 30622502 PMCID: PMC6309102 DOI: 10.3389/fpsyg.2018.02650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the relationship between retinal morphometric measures and intellectual abilities among adults with overweight and obesity. Methods: Adults between 25 and 45 years (N = 55, 38 females) with overweight or obesity (BMI ≥ 25.0 kg/m2) underwent an optical coherence tomography (OCT) scan to assess retinal nerve fiber layer (RNFL) volume, ganglion cell layer (GCL) volume, macular volume, and central foveal thickness. Dual-Energy X-ray absorptiometry was used to assess whole-body adiposity (% Fat). The Kaufman Brief Intelligence Test-2 was used to assess general intelligence (IQ), fluid, and crystallized intelligence. Hierarchical linear regression analyses were performed to examine relationships between adiposity and intelligence measures following adjustment of relevant demographic characteristics and degree of adiposity (i.e., % Fat). Results: Although initial bivariate correlations indicated that % Fat was inversely related to fluid intelligence, this relationship was mitigated by inclusion of other demographic factors, including age, sex, and education level. Regression analyses for primary outcomes revealed that RNFL was positively related to IQ and fluid intelligence. However, only GCL was positively related to crystallized intelligence. Conclusion: This work provides novel data linking specific retinal morphometric measures - assessed using OCT - to intellectual abilities among adults with overweight and obesity. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02740439.
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Affiliation(s)
- Alicia R. Jones
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Connor M. Robbs
- College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Caitlyn G. Edwards
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Anne M. Walk
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Sharon V. Thompson
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Ginger E. Reeser
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Hannah D. Holscher
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Naiman A. Khan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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73
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Mutlu U, Ikram MK, Roshchupkin GV, Bonnemaijer PWM, Colijn JM, Vingerling JR, Niessen WJ, Ikram MA, Klaver CCW, Vernooij MW. Thinner retinal layers are associated with changes in the visual pathway: A population-based study. Hum Brain Mapp 2018; 39:4290-4301. [PMID: 29935103 DOI: 10.1002/hbm.24246] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 01/23/2023] Open
Abstract
Increasing evidence shows that thinner retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), assessed on optical coherence tomography (OCT), are reflecting global brain atrophy. Yet, little is known on the relation of these layers with specific brain regions. Using voxel-based analysis, we aimed to unravel specific brain regions associated with these retinal layers. We included 2,235 persons (mean age: 67.3 years, 55% women) from the Rotterdam Study (2007-2012) who had gradable retinal OCT images and brain magnetic resonance imaging (MRI) scans, including diffusion tensor (DT) imaging. Thicknesses of peripapillary RNFL and perimacular GCL were measured using an automated segmentation algorithm. Voxel-based morphometry protocols were applied to process DT-MRI data. We investigated the association between retinal layer thickness with voxel-wise gray matter density and white matter microstructure by performing linear regression models. We found that thinner RNFL and GCL were associated with lower gray matter density in the visual cortex, and with lower fractional anisotropy and higher mean diffusivity in white matter tracts that are part of the optic radiation. Furthermore, thinner GCL was associated with lower gray matter density of the thalamus. Thinner RNFL and GCL are associated with gray and white matter changes in the visual pathway suggesting that retinal thinning on OCT may be specifically associated with changes in the visual pathway rather than with changes in the global brain. These findings may serve as a basis for understanding visual symptoms in elderly patients, patients with Alzheimer's disease, or patients with posterior cortical atrophy.
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Affiliation(s)
- Unal Mutlu
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad K Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gennady V Roshchupkin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pieter W M Bonnemaijer
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanna M Colijn
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johannes R Vingerling
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Mohammad A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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