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Manchanda R, Samanta R, Narayan ML, Kumar M, Tiwari A, Agarwal A, Bahurupi Y, Kumari S, Kumar N. Connecting the Dots: Exploring the Relationship between Optical Coherence Tomography and 99mTc-TRODAT-1 SPECT Parameters in Parkinson's Disease. Ann Indian Acad Neurol 2024; 27:188-195. [PMID: 38751926 PMCID: PMC11093162 DOI: 10.4103/aian.aian_31_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background and Objective While optical coherence tomography (OCT) is explored as a potential biomarker in Parkinson's disease (PD), technetium-99m-labeled tropane derivative (99mTc-TRODAT-1) single-photon emission computed tomography (SPECT) imaging has a proven role in diagnosing PD. Our objective was to compare the OCT parameters in PD patients and healthy controls (HCs) and correlate them with 99mTc-TRODAT-1 parameters in PD patients. Materials and Methods This cross-sectional study included 30 PD patients and 30 age- and gender-matched HCs. Demographic data, PD details including Movement Disorders Society Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III) and Hoehn-Yahr (HY) staging, and OCT parameters including macular and peripapillary retinal nerve fiber layer (RNFL) thickness in bilateral eyes were recorded. PD patients underwent 99mTc-TRODAT-1 SPECT imaging. The terms "ipsilateral" and "contralateral" were used with reference to more severely affected body side in PD patients and compared with corresponding sides in HCs. Results PD patients showed significant ipsilateral superior parafoveal quadrant (mean ± standard deviation [SD] = 311.10 ± 15.90 vs. 297.57 ± 26.55, P = 0.02) and contralateral average perifoveal (mean ± SD = 278.75 ± 18.97 vs. 269.08 ± 16.91, P = 0.04) thinning compared to HCs. Peripapillary RNFL parameters were comparable between PD patients and HCs. MDS-UPDRS-III score and HY stage were inversely correlated to both ipsilateral (Spearman rho = -0.52, P = 0.003; Spearman rho = -0.47, P = 0.008) and contralateral (Spearman rho = -0.53, P = 0.002; Spearman rho = -0.58, P < 0.001) macular volumes, respectively. PD duration was inversely correlated with ipsilateral temporal parafoveal thickness (ρ = -0.41, P = 0.02). No correlation was observed between OCT and 99mTc-TRODAT-1 SPECT parameters in PD patients. Conclusion Compared to HCs, a significant thinning was observed in the ipsilateral superior parafoveal quadrant and the contralateral average perifoveal region in PD patients. Macular volume and ipsilateral temporal parafoveal thickness were inversely correlated with disease severity and duration, respectively. OCT and 99mTc-TRODAT-1 SPECT parameters failed to correlate in PD patients.
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Affiliation(s)
- Rajat Manchanda
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ramanuj Samanta
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manishi L. Narayan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mritunjai Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashutosh Tiwari
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajai Agarwal
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sweety Kumari
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Ophthalmology, MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Niraj Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Neurology, All India Institute of Medical Sciences, Bibinagar, Hyderabad Metropolitan Region, Telangana, India
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Alves JN, Westner BU, Højlund A, Weil RS, Dalal SS. Structural and functional changes in the retina in Parkinson's disease. J Neurol Neurosurg Psychiatry 2023; 94:448-456. [PMID: 36806480 PMCID: PMC7614544 DOI: 10.1136/jnnp-2022-329342] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/05/2023] [Indexed: 02/19/2023]
Abstract
Parkinson's disease is caused by degeneration of dopaminergic neurons, originating in the substantia nigra pars compacta and characterised by bradykinesia, rest tremor and rigidity. In addition, visual disorders and retinal abnormalities are often present and can be identified by decreased visual acuity, abnormal spatial contrast sensitivity or even difficulty in complex visual task completion. Because of their early onset in patients with de novo Parkinson's disease, the anatomical retinal changes and electrophysiological modification could be valuable markers even at early stages of the disease. However, due to the concomitant occurrence of normal ageing, the relevance and specificity of these predictive values can be difficult to interpret. This review examines retinal dysfunction arising in Parkinson's disease. We highlight the electrophysiological delays and decreased amplitude in the electroretinography recorded in patients and animal models. We relate this to coexisting anatomical changes such as retinal nerve fibre layer and macular thinning, measured using optical coherence tomography, and show that functional measures are more consistent overall than optical coherence-measured structural changes. We review the underlying chemical changes seen with loss of retinal dopaminergic neurons and the effect of levodopa treatment on the retina in Parkinson's disease. Finally, we consider whether retinal abnormalities in Parkinson's disease could have a role as potential markers of poorer outcomes and help stratify patients at early stages of the disease. We emphasise that retinal measures can be valuable, accessible and cost-effective methods in the early evaluation of Parkinson's disease pathogenesis with potential for patient stratification.
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Affiliation(s)
- Jordan N Alves
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Britta U Westner
- Radboud University, Donders Institute for Brain, Cognition and Behaviours, Nijmegen, The Netherlands
| | - Andreas Højlund
- Department of Linguistics, Cognitive Science & Semiotics, Aarhus University, Aarhus, Denmark
| | - Rimona Sharon Weil
- Dementia Research Centre, University College London, London, UK.,Movement Disorders Consortium, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Sarang S Dalal
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
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3
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Huntington’s disease and neurovascular structure of retina. Neurol Sci 2022; 43:5933-5941. [DOI: 10.1007/s10072-022-06232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
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4
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Multimodal brain and retinal imaging of dopaminergic degeneration in Parkinson disease. Nat Rev Neurol 2022; 18:203-220. [PMID: 35177849 DOI: 10.1038/s41582-022-00618-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a progressive disorder characterized by dopaminergic neurodegeneration in the brain. The development of parkinsonism is preceded by a long prodromal phase, and >50% of dopaminergic neurons can be lost from the substantia nigra by the time of the initial diagnosis. Therefore, validation of in vivo imaging biomarkers for early diagnosis and monitoring of disease progression is essential for future therapeutic developments. PET and single-photon emission CT targeting the presynaptic terminals of dopaminergic neurons can be used for early diagnosis by detecting axonal degeneration in the striatum. However, these techniques poorly differentiate atypical parkinsonian syndromes from PD, and their availability is limited in clinical settings. Advanced MRI in which pathological changes in the substantia nigra are visualized with diffusion, iron-sensitive susceptibility and neuromelanin-sensitive sequences potentially represents a more accessible imaging tool. Although these techniques can visualize the classic degenerative changes in PD, they might be insufficient for phenotyping or prognostication of heterogeneous aspects of PD resulting from extranigral pathologies. The retina is an emerging imaging target owing to its pathological involvement early in PD, which correlates with brain pathology. Retinal optical coherence tomography (OCT) is a non-invasive technique to visualize structural changes in the retina. Progressive parafoveal thinning and fovea avascular zone remodelling, as revealed by OCT, provide potential biomarkers for early diagnosis and prognostication in PD. As we discuss in this Review, multimodal imaging of the substantia nigra and retina is a promising tool to aid diagnosis and management of PD.
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CUNHA LP, PIRES LA, CRUZEIRO MM, ALMEIDA ALM, MARTINS LC, MARTINS PN, SHIGAEFF N, VALE TC. Optical coherence tomography in neurodegenerative disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:180-191. [DOI: 10.1590/0004-282x-anp-2021-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023]
Abstract
ABSTRACT Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not widely available. Therefore, it is highly desirable to search for noninvasive, easily accessible, low-cost clinical biomarkers suitable for large-scale population screening, in order to focus on making diagnoses at the earliest stages of the disease. In this scenario, imaging studies focusing on the structures of the retina have increasingly been used for evaluating neurodegenerative diseases. The retina shares embryological, histological, biochemical, microvascular and neurotransmitter similarities with the cerebral cortex, thus making it a uniquely promising biomarker for neurodegenerative diseases. Optical coherence tomography is a modern noninvasive imaging technique that provides high-resolution two-dimensional cross-sectional images and quantitative reproducible three-dimensional volumetric measurements of the optic nerve head and retina. This technology is widely used in ophthalmology practice for diagnosing and following up several eye diseases, such as glaucoma, diabetic retinopathy and age-related macular degeneration. Its clinical impact on neurodegenerative diseases has raised enormous interest over recent years, as several clinical studies have demonstrated that these diseases give rise to reduced thickness of the inner retinal nerve fiber layer, mainly composed of retinal ganglion cells and their axons. In this review, we aimed to address the clinical utility of optical coherence tomography for diagnosing and evaluating different neurodegenerative diseases, to show the potential of this noninvasive and easily accessible method.
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Affiliation(s)
- Leonardo Provetti CUNHA
- Universidade Federal de Juiz de Fora, Brazil; Universidade de São Paulo, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | - Leopoldo Antônio PIRES
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | | | | | - Luiza Cunha MARTINS
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | | | - Nadia SHIGAEFF
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | - Thiago Cardoso VALE
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
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Suciu VI, Suciu CI, Nicoară SD, Perju-Dumbravă L. Circumpapillary Retinal Nerve Fiber Layer OCT Imaging in a Parkinson’s Disease Cohort—A Multidisciplinary Approach in a Clinical Research Hospital. J Pers Med 2022; 12:jpm12010080. [PMID: 35055395 PMCID: PMC8780025 DOI: 10.3390/jpm12010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: The purpose of this paper is to report the data of the first study in a Clinical Research Hospital, in the Transylvania region, focusing on the Spectral Domain Optical Coherence Tomography (SD-OCT) measurements in the early stages of Parkinson’s disease (PD), and to compare the results with age-matched healthy controls. (2) Methods: This study assessed the circumpapillary retinal nerve fiber layer (cpRNFL) SD-OCT measurements (Heidelberg Spectralis, Heidelberg Engineering, Germany) of two study groups: patients suffering from PD (Hoehn−Yahr stages 1–3) and healthy controls. Secondary objectives were to investigate the reported visual symptoms by evaluating the color vision, contrast sensitivity, and the central visual defects for macular disease using standardized charts. Subjects with prior history of ophthalmologic diseases, advanced stages of PD (Hoehn−Yahr stages 4–5), or with psychiatric conditions were not included in this study. The same team of neurologists and ophthalmologists evaluated all individuals in order to have comparable data and to eliminate inter-examiner differences. All subjects were recruited from the same Clinical Research Hospital in the Transylvania region, Romania. (3) Results: 72% of the PD patients (n = 17) in this study reported visual symptoms. In respect to the ophthalmologic chart evaluation for PD patients, the most frequent disturbances were identified in the Ishihara color perception testing (33%). The regression analysis showed significant results for the Ishihara testing in relation to the cpRNFL thinning in the temporal retinal sectors for both eyes. cpRNFL thinning was predominantly contralateral to the parkinsonism (p = 0.001). The temporal and global values of the cpRNFL were significantly lower in all PD patients < 70 years old, compared to the age-matched healthy controls. (4) Conclusions: Specific patterns of cpRNFL thinning were found in the PD subjects younger than 70 years. A multidisciplinary approach is essential for a complete evaluation of PD patients.
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Affiliation(s)
- Vlad-Ioan Suciu
- Department of Neuroscience, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Correspondence:
| | - Corina-Iuliana Suciu
- Department of Ophthalmology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.-I.S.); (S.-D.N.)
| | - Simona-Delia Nicoară
- Department of Ophthalmology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.-I.S.); (S.-D.N.)
| | - Lăcrămioara Perju-Dumbravă
- Department of Neuroscience, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
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7
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Cesareo M, Di Marco E, Giannini C, Di Marino M, Aiello F, Pisani A, Pierantozzi M, Mercuri NB, Nucci C, Mancino R. The Retinal Posterior Pole in Early Parkinson's Disease: A Fundus Perimetry and SD-OCT Study. Clin Ophthalmol 2021; 15:4005-4014. [PMID: 34675469 PMCID: PMC8500491 DOI: 10.2147/opth.s323944] [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] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the structure and function of the retinal posterior pole in patients with early Parkinson's disease (PD) and to identify possible biomarkers correlated with clinical features. Patients and Methods A cross-sectional case-control study of 21 patients with PD and 22 age-matched healthy controls (HC) was conducted. All subjects underwent full ophthalmological examinations, fundus perimetry (FP) and spectral domain-OCT (SD-OCT) of the entire retinal posterior pole and peripapillary retinal nerve fiber layer (pRNFL). Results We analyzed 41 eyes from 21 patients (14 males and 7 females) with early PD (Hoehn and Yahr scale (H&Y) equal to or less than stage 2) and 41 eyes from 22 HC (12 males and 10 females). We found no significant difference in the pRNFL thickness between patients with PD and HC. The statistical analysis of the SD-OCT posterior pole area, consisting of 64 values for each retinal layer, revealed a decrease in the outer nuclear layer (ONL) thickness in patients with PD (p < 0.0001). On the contrary, a significant increase in the thickness of the outer plexiform layer (OPL) (p < 0.0001) and of the retinal pigmented epithelium (RPE) (p= 0.002) compared to healthy controls was detected. Other retinal layers showed no significant statistical differences. The differential light sensitivity (DLS) values measured by FP were significantly lower in patients than the healthy controls (15 [13-16.2] vs 17.95 [16.08-18.96] p<0.0001). Conclusion Our results showed that DLS and retinal structure differed in the posterior pole between patients with early PD and controls. Thickening of the OPL may represent accumulation of α-synuclein in the OPL of patients with PD.
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Affiliation(s)
- Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ernesto Di Marco
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Clarissa Giannini
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Di Marino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mariangela Pierantozzi
- Parkinson's Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Fondazione Santa Lucia I.R.C.C.S, Rome, Italy
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raffaele Mancino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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Past, present and future role of retinal imaging in neurodegenerative disease. Prog Retin Eye Res 2021; 83:100938. [PMID: 33460813 PMCID: PMC8280255 DOI: 10.1016/j.preteyeres.2020.100938] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Retinal imaging technology is rapidly advancing and can provide ever-increasing amounts of information about the structure, function and molecular composition of retinal tissue in humans in vivo. Most importantly, this information can be obtained rapidly, non-invasively and in many cases using Food and Drug Administration-approved devices that are commercially available. Technologies such as optical coherence tomography have dramatically changed our understanding of retinal disease and in many cases have significantly improved their clinical management. Since the retina is an extension of the brain and shares a common embryological origin with the central nervous system, there has also been intense interest in leveraging the expanding armamentarium of retinal imaging technology to understand, diagnose and monitor neurological diseases. This is particularly appealing because of the high spatial resolution, relatively low-cost and wide availability of retinal imaging modalities such as fundus photography or OCT compared to brain imaging modalities such as magnetic resonance imaging or positron emission tomography. The purpose of this article is to review and synthesize current research about retinal imaging in neurodegenerative disease by providing examples from the literature and elaborating on limitations, challenges and future directions. We begin by providing a general background of the most relevant retinal imaging modalities to ensure that the reader has a foundation on which to understand the clinical studies that are subsequently discussed. We then review the application and results of retinal imaging methodologies to several prevalent neurodegenerative diseases where extensive work has been done including sporadic late onset Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. We also discuss Autosomal Dominant Alzheimer's Disease and cerebrovascular small vessel disease, where the application of retinal imaging holds promise but data is currently scarce. Although cerebrovascular disease is not generally considered a neurodegenerative process, it is both a confounder and contributor to neurodegenerative disease processes that requires more attention. Finally, we discuss ongoing efforts to overcome the limitations in the field and unmet clinical and scientific needs.
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Tian J, Smith G, Guo H, Liu B, Pan Z, Wang Z, Xiong S, Fang R. Modular machine learning for Alzheimer's disease classification from retinal vasculature. Sci Rep 2021; 11:238. [PMID: 33420208 PMCID: PMC7794289 DOI: 10.1038/s41598-020-80312-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/15/2020] [Indexed: 12/31/2022] Open
Abstract
Alzheimer's disease is the leading cause of dementia. The long progression period in Alzheimer's disease provides a possibility for patients to get early treatment by having routine screenings. However, current clinical diagnostic imaging tools do not meet the specific requirements for screening procedures due to high cost and limited availability. In this work, we took the initiative to evaluate the retina, especially the retinal vasculature, as an alternative for conducting screenings for dementia patients caused by Alzheimer's disease. Highly modular machine learning techniques were employed throughout the whole pipeline. Utilizing data from the UK Biobank, the pipeline achieved an average classification accuracy of 82.44%. Besides the high classification accuracy, we also added a saliency analysis to strengthen this pipeline's interpretability. The saliency analysis indicated that within retinal images, small vessels carry more information for diagnosing Alzheimer's diseases, which aligns with related studies.
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Affiliation(s)
- Jianqiao Tian
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32611, USA
| | - Han Guo
- College of Electrical Engineering, Zhejiang University, Hangzhou, 310000, China
| | - Boya Liu
- School of Information and Telecommunication Engineering, Beijing University of Posts & Telecommunications, Beijing, 100876, China
| | - Zehua Pan
- School of Electrical and Information Engineering, Beijing Jiaotong University, Beijing, 100044, China
| | - Zijie Wang
- School of Mathematical Science, East China Normal University, Shanghai, 200062, China
| | - Shuangyu Xiong
- Department of Data Science, East China Normal University, Shanghai, 200062, China
| | - Ruogu Fang
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA. .,Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, 32611, USA. .,Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, 32610, USA.
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10
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Brown GL, Camacci ML, Kim SD, Grillo S, Nguyen JV, Brown DA, Ullah SP, Lewis MM, Du G, Kong L, Sundstrom JM, Huang X, Bowie EM. Choroidal Thickness Correlates with Clinical and Imaging Metrics of Parkinson's Disease: A Pilot Study. JOURNAL OF PARKINSON'S DISEASE 2021; 11:1857-1868. [PMID: 34275909 PMCID: PMC8530855 DOI: 10.3233/jpd-212676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is marked clinically by motor symptoms and pathologically by Lewy bodies and dopamine neuron loss in the substantia nigra pars compacta (SNc). Higher iron accumulation, assessed by susceptibility MRI, also is observed as PD progresses. Recently, evidence has suggested that PD affects the retina. OBJECTIVE To better understand retinal alterations in PD and their association to clinical and SNc iron-related imaging metrics. METHODS Ten PD and 12 control participants (2 eyes each) from an ongoing PD imaging biomarker study underwent enhanced depth imaging optical coherence tomography evaluation. Choroidal (vascular) thickness and nerve layers were measured in 4 subregions [superior, temporal, inferior, and nasal] and at 3 foveal distances (1, 1.5, and 3 mm). These metrics were compared between PD and control groups. For significantly different metrics, their associations with clinical [levodopa equivalent daily dosage (LEDD), motor and visuospatial function] and SNc susceptibility MRI metrics [R2* and quantitative susceptibility mapping (QSM)] were explored. RESULTS Compared to control participants, PD participants had a thicker choroid (p = 0.005), but no changes in nerve layers. Higher mean choroidal thickness was associated with lower LEDD (p < 0.01) and better visuospatial function (p < 0.05). Subregion analyses revealed higher choroidal thickness correlated with lower LEDD and better motor and visuospatial measures. Higher mean choroidal thickness also was associated with lower nigral iron MRI (p < 0.05). CONCLUSION A small cohort of PD research participants displayed higher choroidal thickness that was related to better clinical performance and less nigral pathology. These intriguing findings warrant further investigation.
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Affiliation(s)
- Gregory L. Brown
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mona L. Camacci
- Department of Ophthalmology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sean D. Kim
- Department of Ophthalmology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Stephanie Grillo
- Department of Ophthalmology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - James V. Nguyen
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Douglas A. Brown
- Department of Ophthalmology, Temple University-Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Sarah P. Ullah
- Department of Ophthalmology, Pittsburgh University School of Medicine, Pittsburgh, PA, USA
| | - Mechelle M. Lewis
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Guangwei Du
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffrey M. Sundstrom
- Department of Ophthalmology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Ophthalmology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Kinesiology, Penn State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Esther M. Bowie
- Department of Ophthalmology, Temple University-Lewis Katz School of Medicine, Philadelphia, PA, USA
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Huang L, Wang C, Wang W, Wang Y, Zhang R. The specific pattern of retinal nerve fiber layer thinning in Parkinson’s disease: a systematic review and meta-analysis. J Neurol 2020; 268:4023-4032. [DOI: 10.1007/s00415-020-10094-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
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12
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Silverstein SM, Demmin DL, Schallek JB, Fradkin SI. Measures of Retinal Structure and Function as Biomarkers in Neurology and Psychiatry. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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13
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Retinal nerve fiber layer thickness in patients with essential tremor and Parkinson’s disease. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.661757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Alkabie S, Lange A, Manogaran P, Stoessl AJ, Costello F, Barton JJS. Optical coherence tomography of patients with Parkinson's disease and progressive supranuclear palsy. Clin Neurol Neurosurg 2019; 189:105635. [PMID: 31855622 DOI: 10.1016/j.clineuro.2019.105635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/23/2019] [Accepted: 12/07/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine if Parkinson's disease (PD) and progressive supranuclear palsy (PSP) differed on retinal measurements using optical coherence tomography (OCT). PATIENTS AND METHODS In a prospective, controlled, cross-sectional cohort study, we recruited patients with PD or PSP for more than three years, as well as control subjects. We measured peripapillary retinal nerve fiber layer (RNFL) thickness and macular volume using spectral-domain OCT. The association between these OCT measures and the disease characteristics of duration and disability were examined using a linear mixed effect model. RESULTS We analyzed eyes from n = 12 PD patients, n = 11 PSP patients, and n = 12 control subjects. RNFL thickness was reduced in eyes from patients with PSP, but there were no differences in macular volume between groups. RNFL thickness and macular volume were not significantly different between eyes from patients with PD and controls. Worse disability was associated with reduced macular volumes. CONCLUSION PSP but not PD is associated with thinning of the peripapillary RNFL when symptoms have been present for more than three years.
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Affiliation(s)
- Samir Alkabie
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada; Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, NY, USA; Department of Neurology, Kings County Hospital, Brooklyn, NY, USA.
| | - Alex Lange
- Neuro-ophthalmology, Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada; Vista Klinik, Vista Diagnostics and Laser Vista, Binningen, Switzerland
| | - Praveena Manogaran
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - A Jon Stoessl
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Fiona Costello
- Neuro-ophthalmology, Department of Clinical Neurosciences and Surgery, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Jason J S Barton
- Neuro-ophthalmology, Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
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15
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Yap TE, Balendra SI, Almonte MT, Cordeiro MF. Retinal correlates of neurological disorders. Ther Adv Chronic Dis 2019; 10:2040622319882205. [PMID: 31832125 PMCID: PMC6887800 DOI: 10.1177/2040622319882205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Considering the retina as an extension of the brain provides a platform from which to study diseases of the nervous system. Taking advantage of the clear optical media of the eye and ever-increasing resolution of modern imaging techniques, retinal morphology can now be visualized at a cellular level in vivo. This has provided a multitude of possible biomarkers and investigative surrogates that may be used to identify, monitor and study diseases until now limited to the brain. In many neurodegenerative conditions, early diagnosis is often very challenging due to the lack of tests with high sensitivity and specificity, but, once made, opens the door to patients accessing the correct treatment that can potentially improve functional outcomes. Using retinal biomarkers in vivo as an additional diagnostic tool may help overcome the need for invasive tests and histological specimens, and offers the opportunity to longitudinally monitor individuals over time. This review aims to summarise retinal biomarkers associated with a range of neurological conditions including Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and prion diseases from a clinical perspective. By comparing their similarities and differences according to primary pathological processes, we hope to show how retinal correlates can aid clinical decisions, and accelerate the study of this rapidly developing area of research.
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Affiliation(s)
- Timothy E. Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - Shiama I. Balendra
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Melanie T. Almonte
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - M. Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, 11–43 Bath Street, London, EC1V 9EL UK
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16
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Ma LJ, Xu LL, Mao CJ, Fu YT, Ji XY, Shen Y, Chen J, Yang YP, Liu CF. Progressive Changes in the Retinal Structure of Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:85-92. [PMID: 29480221 DOI: 10.3233/jpd-171184] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many optical coherence tomography (OCT) studies have reported alterations in the retinal nerve fiber layer (RNFL) in Parkinson's disease (PD) and other neurodegenerative diseases. However, whether retinal alterations are a biomarker for PD is still controversial. OBJECTIVE To investigate potential correlations between PD and morphological changes in retina using OCT and to determine its usefulness as a biomarker of disease progression in PD. METHODS We performed a cross-sectional study on patients with PD (N = 37) and age-matched controls (N = 42), followed by a longitudinal study of the PD patients (N = 22) over approximately 2.5 years. RESULTS The average retinal nerve fiber layer (RNFL) thickness (p < 0.001), total macular thickness (p = 0.001), and macular volume (p = 0.001) were decreased in PD patients compared to controls and had further decreased at the follow-up visit (p < 0.05 for all). The average RNFL thickness and the total thickness of macular were negatively correlated with age in PD patients at baseline. Linear regression analysis revealed that age (p = 0.002, p = 0.003, respectively) and LEDD (p = 0.011, p = 0.013, respectively) were correlated to total thickness and volume of macular in 22 PD patients in the follow-up study. However, no correlation was found between RNFL and other parameters. CONCLUSIONS PD progression is associated with pronounced retinal structure changes, which can be quantified by OCT. Patterns of RNFL and macular damage detected by the noninvasive technology of OCT can be a useful biomarker for evaluating the progression of PD.
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Affiliation(s)
- Li-Jing Ma
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling-Li Xu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng-Jie Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun-Ting Fu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao-Yan Ji
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Shen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya-Ping Yang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China.,Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China
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17
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Mailankody P, Lenka A, Pal PK. The role of Optical Coherence Tomography in Parkinsonism: A critical review. J Neurol Sci 2019; 403:67-74. [PMID: 31228766 DOI: 10.1016/j.jns.2019.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/11/2019] [Accepted: 06/09/2019] [Indexed: 12/21/2022]
Abstract
Optical coherence tomography (OCT) has been evaluated as a tool to assess retinal changes in various neurodegenerative disorders. Parkinson's disease (PD), is a neurodegenerative disorder wherein dopaminergic deficiency results in some of the symptoms. As retina also has high concentration of dopamine, it would be of interest for both the clinician as well as the basic scientist to know if there is a correlation between the clinical features and the retinal changes. The objective of this review is to critically evaluate the literature and study the utility of OCT as a tool to evaluate retinal changes in PD.
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Affiliation(s)
- Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - Abhishek Lenka
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
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18
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Chrysou A, Jansonius NM, van Laar T. Retinal layers in Parkinson's disease: A meta-analysis of spectral-domain optical coherence tomography studies. Parkinsonism Relat Disord 2019; 64:40-49. [PMID: 31054866 DOI: 10.1016/j.parkreldis.2019.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 03/15/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with Parkinson's disease experience visual symptoms, partially originating from retinal changes. Since 2011, multiple case-control studies using spectral-domain OCT, which allows for studying individual retinal layers, have been published. The aim of this study was to substantiate the occurrence, extent, and location of retinal degeneration in Parkinson's by meta-analysis. METHODS Spectral-domain OCT case-control data were collected by performing a search in PubMed and Embase with terms: "optical coherence tomography" and "parkinson", up to November 5th, 2018. Studies with fewer than 10 patients or controls were excluded. We performed a random effects meta-analysis. Heterogeneity was evaluated with I2 statistics; publication bias with Egger's and Begg's tests. RESULTS Out of 77 identified studies, 36 were included, totaling 1916 patients and 2006 controls. A significant thinning of the peripapillary retinal nerve fiber layer (d = -0.42; 95% confidence interval -0.54 to -0.29) and the combined ganglion cell and inner plexiform layers (d = -0.40; -0.72, to -0.07) was found. The inner nuclear layer and outer plexiform layer did not show significant changes. Heterogeneity ranged from 3 to 92%; no publication bias was found. CONCLUSIONS Parkinson's patients show significant thinning of the inner retinal layers, resembling changes found in glaucoma and other neurodegenerative diseases like Alzheimer's. Study of different cell layers in-vivo is possible by moving from time-to spectral domain OCT. Retinal degeneration may be affiliated with neurodegenerative pathology overall, and could serve as a biomarker in neurodegenerative disorders. Longitudinal research including clinical correlations is needed to determine usefulness in Parkinson's disease.
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Affiliation(s)
- Asterios Chrysou
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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19
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Winter AW, Salimi A, Ospina LH, Roos JCP. Ophthalmic manifestations of Gaucher disease: the most common lysosomal storage disorder. Br J Ophthalmol 2019; 103:315-326. [PMID: 30612093 DOI: 10.1136/bjophthalmol-2018-312846] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/07/2018] [Accepted: 11/24/2018] [Indexed: 11/04/2022]
Abstract
Gaucher disease (GD) results from a deficiency of glucocerebrosidase activity and the subsequent accumulation of the enzyme's metabolites, principally glucosylsphingosine and glucosylceramide. There are three principal forms: Type I, which is the most common, is usually considered non-neuronopathic. Type II, III and IIIc manifest earlier and have neurological sequelae due to markedly reduced enzyme activity. Gaucher's can be associated with ophthalmological sequelae but these have not been systematically reviewed. We therefore performed a comprehensive literature review of all such ophthalmic abnormalities associated with the different types of Gaucher disease. We systematically searched the literature (1950 - present) for functional and structural ocular abnormalities arising in patients with Gaucher disease and found that all subtypes can be associated with ophthalmic abnormalities; these range from recently described intraocular lesions to disease involving the adnexae, peripheral nerves and brain. In summary, Gaucher can affect most parts of the eye. Rarely is it sight-threatening; some but not all manifestations are amenable to treatment, including with enzyme replacement and substrate reduction therapy. Retinal involvement is rare but patients with ocular manifestations should be monitored and treated early to reduce the risk of progression and further complications. As Gaucher disease is also associated with Parkinsons disease and may also confer an increased risk of malignancy (particularly haematological forms and melanoma), any ocular abnormalities should be fully investigated to exclude these potential underlying conditions.
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Affiliation(s)
- Aaron W Winter
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ali Salimi
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Luis H Ospina
- Department of Pediatric Ophthalmology and Neuro-Ophthalmology, Sainte-Justine Hospital, University of Montréal, Montréal, Québec, Canada
| | - Jonathan C P Roos
- Department of Ophthalmology, Norfolk & Norwich University Hospitals, Norfolk, UK .,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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20
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Guo L, Normando EM, Shah PA, De Groef L, Cordeiro MF. Oculo-visual abnormalities in Parkinson's disease: Possible value as biomarkers. Mov Disord 2018; 33:1390-1406. [DOI: 10.1002/mds.27454] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Li Guo
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Eduardo M. Normando
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
| | - Parth Arvind Shah
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Lies De Groef
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Neural Circuit Development and Regeneration Research Group, Department of Biology; University of Leuven; Leuven Belgium
| | - M. Francesca Cordeiro
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
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21
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Rohani M, Meysamie A, Zamani B, Sowlat MM, Akhoundi FH. Reduced retinal nerve fiber layer (RNFL) thickness in ALS patients: a window to disease progression. J Neurol 2018; 265:1557-1562. [PMID: 29713825 DOI: 10.1007/s00415-018-8863-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/03/2018] [Accepted: 04/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess RNFL thickness in ALS patients and compare it to healthy controls, and to detect possible correlations between RNFL thickness in ALS patients and disease severity and duration. METHODS Study population consisted of ALS patients and age- and sex-matched controls. We used the revised ALS functional rating scale (ALSFRS-R) as a measure of disease severity. RNFL thickness in the four quadrants were measured with a spectral domain OCT (Topcon 3D, 2015). RESULTS We evaluated 20 ALS patients (40 eyes) and 25 healthy matched controls. Average RNFL thickness in ALS patients was significantly reduced compared to controls (102.57 ± 13.46 compared to 97.11 ± 10.76, p 0.04). There was a significant positive correlation between the functional abilities of the patients based on the ALSFRS-R and average RNFL thickness and also RNFL thickness in most quadrants. A linear regression analysis proved that this correlation was independent of age. In ALS patients, RNFL thickness in the nasal quadrant of the left eyes was significantly reduced compared to the corresponding quadrant in the right eyes even after adjustment for multiplicity (85.80 ± 23.20 compared to 96.80 ± 16.96, p = 0.008). CONCLUSION RNFL thickness in ALS patients is reduced compared to healthy controls. OCT probably could serve as a marker of neurodegeneration and progression of the disease in ALS patients. RNFL thickness is different among the right and left eyes of ALS patients pointing to the fact that asymmetric CNS involvement in ALS is not confined to the motor system.
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Affiliation(s)
- Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran.,Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Alipasha Meysamie
- Department of Community and Preventive Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Zamani
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fahimeh Haji Akhoundi
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Vali-e-Asr Sq., Beh-Afarin Blvd, Tehran, 1417613151, Iran.
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22
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Unlu M, Gulmez Sevim D, Gultekin M, Karaca C. Correlations among multifocal electroretinography and optical coherence tomography findings in patients with Parkinson's disease. Neurol Sci 2018; 39:533-541. [PMID: 29349656 DOI: 10.1007/s10072-018-3244-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/02/2018] [Indexed: 11/26/2022]
Abstract
To assess the correlation between functional and anatomical evaluations with multifocal electroretinography (mfERG) and spectral-domain optical coherence tomography (SD-OCT) in patients with Parkinson's disease (PD). This cross-sectional study involved 116 eyes of 58 patients with PD and 30 age- and sex-matched control subjects. All study participants underwent a comprehensive neuro-ophthalmic examination, retinal single-layer thicknesses and volumes, and peripapillary retinal nerve fiber layer (pRNFL) measurements with SD-OCT, and the patients' mfERG recordings were evaluated. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), and photoreceptor layer (PR) thicknesses, and mRNFL, RPE, and PR volumes were found lower in PD compared to those of controls, while outer plexiform layer (OPL) volumes were increased (p < 0.05). We found delayed implicit times and decreased amplitudes in the mfERG of PD patients versus those in control subjects (p < 0.05). We found significant correlations between outer macular volumes, PR thicknesses, and N1 amplitudes of rings 2 and 3and P1 amplitudes of rings 3, 4, and 5. Our study revealed thinning of both inner and outer retinal single layers, increased OPL volume, and delayed implicit times and decreased amplitudes in the mfERG of PD patients versus control subjects and correlation between structural and functional parameters. Our findings point out that SD-OCT and mfERG could both serve as non-invasive tools for evaluating ophthalmic manifestations of Parkinson's disease.
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Affiliation(s)
- Metin Unlu
- School of Medicine, Ophthalmology Department, Erciyes University, 38039, Kayseri, Turkey.
| | - Duygu Gulmez Sevim
- School of Medicine, Ophthalmology Department, Erciyes University, 38039, Kayseri, Turkey
| | - Murat Gultekin
- School of Medicine, Neurology Department, Erciyes University, 38039, Kayseri, Turkey
| | - Cagatay Karaca
- School of Medicine, Ophthalmology Department, Erciyes University, 38039, Kayseri, Turkey
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23
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La Morgia C, Di Vito L, Carelli V, Carbonelli M. Patterns of Retinal Ganglion Cell Damage in Neurodegenerative Disorders: Parvocellular vs Magnocellular Degeneration in Optical Coherence Tomography Studies. Front Neurol 2017; 8:710. [PMID: 29312131 PMCID: PMC5744067 DOI: 10.3389/fneur.2017.00710] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/08/2017] [Indexed: 12/02/2022] Open
Abstract
Many neurodegenerative disorders, such as Parkinson’s disease (PD) and Alzheimer’s disease (AD), are characterized by loss of retinal ganglion cells (RGCs) as part of the neurodegenerative process. Optical coherence tomography (OCT) studies demonstrated variable degree of optic atrophy in these diseases. However, the pattern of degenerative changes affecting the optic nerve (ON) can be different. In particular, neurodegeneration is more evident for magnocellular RGCs in AD and multiple system atrophy with a pattern resembling glaucoma. Conversely, in PD and Huntington’s disease, the parvocellular RGCs are more vulnerable. This latter pattern closely resembles that of mitochondrial optic neuropathies, possibly pointing to similar pathogenic mechanisms. In this review, the currently available evidences on OCT findings in these neurodegenerative disorders are summarized with particular emphasis on the different pattern of RGC loss. The ON degeneration could become a validated biomarker of the disease, which may turn useful to follow natural history and possibly assess therapeutic efficacy.
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Affiliation(s)
- Chiara La Morgia
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.,Neurology Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lidia Di Vito
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Valerio Carelli
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.,Neurology Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele Carbonelli
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
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24
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Aydin TS, Umit D, Nur OM, Fatih U, Asena K, Nefise OY, Serpil Y. Optical coherence tomography findings in Parkinson's disease. Kaohsiung J Med Sci 2017; 34:166-171. [PMID: 29475464 DOI: 10.1016/j.kjms.2017.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/29/2017] [Accepted: 11/14/2017] [Indexed: 11/27/2022] Open
Abstract
The aim of this study is to compare optical coherence tomography (OCT) findings of retinal thickness (RT) and retinal nerve fiber layer thickness (RNFLT) of idiopathic Parkinson's disease (IPD) patients to those of healthy subjects, and to investigate whether there is any relationship between the severity of the disease and the RNFLT values. This prospective study was included 25 IPD patients and 29 healthy controls. In the IPD group, the Hoehn and Yahr (H&Y), Unified Parkinson's Disease Rating Scale (UPDRS), and Mini-Mental State Exam (MMSE) were performed. Intraocular pressure (IOP), visual acuity (VA), spherical equivalent, axial length (AL), and central corneal thickness (CCT) were measured using OCT in both groups. The RT was measured in the central retinal (RTc), nasal (RTn), and temporal (RTt) segments. Nasal (RNFLTn), nasal superior (RNFLTns), nasal inferior (RNFLTni), temporal (RNFLTt), temporal superior (RNFLTts), and temporal inferior (RNFLTti) measurements were made and mean RTFLT was calculated (RNFLTg) for each individual. In the patient group, IOP and VA values were statistically significantly lower The RTn and RNFLTg were significantly thinner in the patient group. There was no statistically significant relationship between the severity of IPD and these findings. In our study, RNFLTg and RTn were found to be thinner in the IPD group, which may have caused lower VA scores. The effects of retinal dopamine depletion on RT and RNFLT, and lower IOP values in the non-glaucomatous IPD patients should be further investigated.
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Affiliation(s)
- Turkoglu Sule Aydin
- Department of Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Dogan Umit
- Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Ogun Muhammed Nur
- Department of Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
| | - Ulas Fatih
- Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Keles Asena
- Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Ozturk Yavas Nefise
- Department of Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Yildiz Serpil
- Department of Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
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25
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Moschos MM, Chatziralli IP. Evaluation of Choroidal and Retinal Thickness Changes in Parkinson’s Disease Using Spectral Domain Optical Coherence Tomography. Semin Ophthalmol 2017; 33:494-497. [DOI: 10.1080/08820538.2017.1307423] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marilita M. Moschos
- Electrophysiology Laboratory, 1st Department of Ophthalmology, University of Athens, Athens, Greece
| | - Irini P. Chatziralli
- Electrophysiology Laboratory, 1st Department of Ophthalmology, University of Athens, Athens, Greece
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26
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Ocular and visual disorders in Parkinson's disease: Common but frequently overlooked. Parkinsonism Relat Disord 2017; 40:1-10. [PMID: 28284903 DOI: 10.1016/j.parkreldis.2017.02.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 11/23/2022]
Abstract
Patients with Parkinson's disease (PD) often compensate for their motor deficits by guiding their movements visually. A wide range of ocular and visual disorders threatens the patients' ability to benefit optimally from visual feedback. These disorders are common in patients with PD, yet they have received little attention in both research and clinical practice, leading to unnecessary - but possibly treatable - disability. Based on a literature search covering 50 years, we review the range of ocular and visual disorders in patients with PD, and classify these according to anatomical structures of the visual pathway. We discuss six common disorders in more detail: dry eyes; diplopia; glaucoma and glaucoma-like visual problems; impaired contrast and colour vision; visuospatial and visuoperceptual impairments; and visual hallucinations. In addition, we review the effects of PD-related pharmacological and surgical treatments on visual function, and we offer practical recommendations for clinical management. Greater awareness and early recognition of ocular and visual problems in PD might enable timely instalment of tailored treatments, leading to improved patient safety, greater independence, and better quality of life.
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Cabrera DeBuc D, Somfai GM, Koller A. Retinal microvascular network alterations: potential biomarkers of cerebrovascular and neural diseases. Am J Physiol Heart Circ Physiol 2016; 312:H201-H212. [PMID: 27923786 DOI: 10.1152/ajpheart.00201.2016] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/04/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022]
Abstract
Increasing evidence suggests that the conditions of retinal microvessels are indicators to a variety of cerebrovascular, neurodegenerative, psychiatric, and developmental diseases. Thus noninvasive visualization of the human retinal microcirculation offers an exceptional opportunity for the investigation of not only the retinal but also cerebral microvasculature. In this review, we show how the conditions of the retinal microvessels could be used to assess the conditions of brain microvessels because the microvascular network of the retina and brain share, in many aspects, standard features in development, morphology, function, and pathophysiology. Recent techniques and imaging modalities, such as optical coherence tomography (OCT), allow more precise visualization of various layers of the retina and its microcirculation, providing a "microscope" to brain microvessels. We also review the potential role of retinal microvessels in the risk identification of cerebrovascular and neurodegenerative diseases. The association between vision problems and cerebrovascular and neurodegenerative diseases, as well as the possible role of retinal microvascular imaging biomarkers in cerebrovascular and neurodegenerative screening, their potentials, and limitations, are also discussed.
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Affiliation(s)
- Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida;
| | - Gabor Mark Somfai
- Semmelweis University, Budapest, Hungary.,Augenzentrum, Pallas Kliniken, Olten, Switzerland
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; and.,Department of Physiology, New York Medical College, Valhalla, New York
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Kobayashi M. Delayed saccade to perceptually demanding locations in Parkinson’s disease: analysis from the perspective of the speed–accuracy trade-off. Neurol Sci 2016; 37:1841-1848. [DOI: 10.1007/s10072-016-2678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
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Macular sub-layer thinning and association with pulmonary function tests in Amyotrophic Lateral Sclerosis. Sci Rep 2016; 6:29187. [PMID: 27383525 PMCID: PMC4935870 DOI: 10.1038/srep29187] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/16/2016] [Indexed: 01/24/2023] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a complex neurodegenerative disorder that may have anterior visual pathway involvement. In this study, we compare the macular structure of patients with ALS to healthy controls, and examine correlations between macular sub-layer thickness measurements and pulmonary function tests and disease duration. ALS patients underwent optical coherence tomography (OCT) imaging to obtain macular cube scans of the right eye. Macular cube OCT data from age-matched healthy subjects were provided by the OCT reading center. Semi-automated retinal segmentation software was used to quantify macular sub-layers. Pulmonary function tests and time since symptom onset were collected retrospectively from the electronic medical records of ALS patients. Macular retinal nerve fiber layer was significantly thinner in ALS patients compared to healthy controls (P < 0.05). Total macular and other sub-layer thicknesses were not reduced in the ALS cohort. Macular retinal nerve fiber layer thickness positively correlated with forced vital capacity % predicted and forced expiratory volume in 1 second % predicted (P < 0.05). In conclusion, analysis of OCT measurements supports the involvement of the anterior visual pathway in ALS. Subtle structural thinning in the macular retinal nerve fiber layer correlates with pulmonary function tests.
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Mailankody P, Battu R, Khanna A, Lenka A, Yadav R, Pal PK. Optical coherence tomography as a tool to evaluate retinal changes in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:1164-9. [DOI: 10.1016/j.parkreldis.2015.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/11/2015] [Accepted: 08/06/2015] [Indexed: 01/16/2023]
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Mendoza-Santiesteban CE, Palma JA, Martinez J, Norcliffe-Kaufmann L, Hedges TR, Kaufmann H. Progressive retinal structure abnormalities in multiple system atrophy. Mov Disord 2015; 30:1944-53. [PMID: 26359930 DOI: 10.1002/mds.26360] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Objective measures of disease progression that can be used as endpoints in clinical trials of MSA are necessary. We studied retinal thickness in patients with MSA and assessed changes over time to determine its usefulness as an imaging biomarker of disease progression. METHODS This was a cross-sectional study including 24 patients with MSA, 20 with PD, and 35 controls, followed by a longitudinal study of 13 MSA patients. Patients were evaluated with high-definition optical coherence tomography and the Unified Multiple System Atrophy Rating Scale. Evaluations were performed at baseline and at consecutive follow-up visits for up to 26 months. RESULTS MSA subjects had normal visual acuity and color discrimination. Compared to controls, retinal nerve fiber layer (P = 0.008 and P = 0.001) and ganglion cell complex (P = 0.013 and P = 0.001) thicknesses were reduced in MSA and PD. No significant differences between MSA and PD were found. Over time, in patients with MSA, there was a significant reduction of the retinal nerve fiber layer and ganglion cell complex thicknesses, with estimated annual average losses of 3.7 and 1.8 μm, respectively. CONCLUSIONS Visually asymptomatic MSA patients exhibit progressive reductions in the thickness of the retinal nerve fiber layer and, to a lesser extent, in the macular ganglion cell complex, which can be quantified by high-definition optical coherence tomography. Specific patterns of retinal nerve fiber damage could be a useful imaging biomarker of disease progression in future clinical trials.
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Affiliation(s)
- Carlos E Mendoza-Santiesteban
- Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York, USA.,New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Jose-Alberto Palma
- Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Jose Martinez
- Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Lucy Norcliffe-Kaufmann
- Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Thomas R Hedges
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Horacio Kaufmann
- Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York, USA
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Correlation Between Structural and Functional Retinal Changes in Parkinson Disease. J Neuroophthalmol 2015; 35:254-8. [DOI: 10.1097/wno.0000000000000240] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Measuring hemoglobin levels in the optic disc of Parkinson's disease patients using new colorimetric analysis software. PARKINSONS DISEASE 2014; 2014:946540. [PMID: 25587487 PMCID: PMC4284935 DOI: 10.1155/2014/946540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022]
Abstract
Objective. To evaluate a new method of measuring hemoglobin (Hb) levels and quantifying the color changes in the optic nerve head of Parkinson's disease (PD) patients. We also compared differences in retinal nerve fiber layer (RNFL) thicknesses obtained using spectral domain optical coherence tomography (OCT) device between PD group and healthy group. Methods. One hundred and fifty-five PD patients and 91 sex- and age-matched healthy subjects were included in this cross-sectional study. OCT examinations and one photograph of the optic disc were performed. The Laguna ONhE (“optic nerve hemoglobin”; Insoft SL, Tenerife, Spain) software was used to analyze the Hb level on the acquired optic disc photographs. Results. PD patients exhibited significantly reduced mean optic disc Hb percentages (57.56% in PD, 67.63% in healthy subjects; P = 0.001) as well as reduced Hb in almost all analyzed sectors, with the largest differences detected in the inferior and nasal sectors. RNFL parameters were significantly reduced in PD patients compared with healthy subjects, especially in the inferior quadrant. Conclusions. Measurements of optic disc Hb levels obtained with the Laguna ONhE software had good ability to detect optic nerve color changes (more papillary paleness and consequently this could suggest optic atrophy and axonal loss) in PD patients.
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Schneider JS, Ault ME, Anderson DW. Retinal pathology detected by optical coherence tomography in an animal model of Parkinson's disease. Mov Disord 2014; 29:1547-51. [PMID: 25070726 DOI: 10.1002/mds.25974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/24/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is a noninvasive procedure for analysis of retinal morphology. Significant changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) in Parkinson's disease (PD) have been reported, and the current study was performed to examine whether such changes can also be detected in an animal model of PD. METHODS Optical coherence tomography measurements of peripapillary RNFL thickness, macula volume, and foveal thickness were obtained from 10 normal and five 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated cynomolgus monkeys with stable Parkinsonian signs. RESULTS Average RNFL thickness was significantly decreased in Parkinsonian monkeys compared with controls, with statistically significant RNFL thinning found in nasal and inferior quadrants. Macula volume and foveal thickness were also significantly reduced in Parkinsonian animals compared with controls. CONCLUSIONS As described in PD, RNFL thinning, reduced macula volume, and reduced foveal thickness also occurs in monkeys with MPTP-induced Parkinsonism. These findings pave the way for additional studies in which OCT may be used to track changes in the retina that might be present very early in the PD pathological process, perhaps preceding the onset of motor signs.
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Affiliation(s)
- Jay S Schneider
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Roth NM, Saidha S, Zimmermann H, Brandt AU, Isensee J, Benkhellouf-Rutkowska A, Dornauer M, Kühn AA, Müller T, Calabresi PA, Paul F. Photoreceptor layer thinning in idiopathic Parkinson's disease. Mov Disord 2014; 29:1163-70. [DOI: 10.1002/mds.25896] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/20/2014] [Accepted: 03/03/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nicolas M. Roth
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Shiv Saidha
- Department of Neurology; Beaumont University Hospital; Republic of Ireland
- Department of Neurology; John Hopkins School of Medicine; Baltimore Maryland USA
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Justine Isensee
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | | | - Matthias Dornauer
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Andrea A. Kühn
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
- Department of Neurology; Charité-Universitätsmedizin Berlin; Germany
| | - Thomas Müller
- Department of Neurology; St. Joseph Hospital; Berlin Germany
| | - Peter A. Calabresi
- Department of Neurology; John Hopkins School of Medicine; Baltimore Maryland USA
| | - Friedemann Paul
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
- Department of Neurology; Charité-Universitätsmedizin Berlin; Germany
- Experimental and Clinical Research Center; Charité-Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine; Berlin Germany
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36
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Yu JG, Feng YF, Xiang Y, Huang JH, Savini G, Parisi V, Yang WJ, Fu XA. Retinal nerve fiber layer thickness changes in Parkinson disease: a meta-analysis. PLoS One 2014; 9:e85718. [PMID: 24465663 PMCID: PMC3897496 DOI: 10.1371/journal.pone.0085718] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/02/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Parkinson disease (PD) is a neurodegenerative process that leads to a selective loss of dopaminergic neurons, mainly in the basal ganglia of the brain. Numerous studies have analyzed the ability of optical coherence tomography (OCT) to detect retinal nerve fiber layer (RNFL) thickness abnormalities and changes in PD, but the results have not always been consistent. Therefore, we carried out a meta-analysis to evaluate the RNFL thickness measured with OCT in PD. METHODS AND FINDINGS Case-control studies were selected through an electronic search of the Cochrane Controlled Trials Register, PUBMED and EMBASE. For the continuous outcomes, we calculated the weighted mean difference (WMD) and 95% confidence interval (CI). The statistical analysis was performed by RevMan 5.0 software. Thirteen case-control studies were included in the present meta-analysis, containing a total of 644 eyes in PD patients and 604 eyes in healthy controls. The results of our study showed that there was a significant reduction in average RNFL thickness in patients with PD compared to healthy controls (WMD = -5.76, 95% CI: -8.99 to -2.53, P = 0.0005). Additionally, differences of RNFL thickness in superior quadrant (WMD = -4.44, 95% CI: -6.93 to -1.94, P = 0.0005), inferior quadrant (WMD = -7.56, 95% CI: -11.33 to -3.78, P<0.0001), nasal quadrant (WMD = -3.12, 95% CI: -5.63 to -0.61, P = 0.01) and temporal quadrant (WMD = -4.63, 95% CI: -7.20 to -2.06, P = 0.0004) were all significant between the two groups. CONCLUSION In view of these results and the noninvasive nature of OCT technology, we surmise that OCT could be a useful tool for evaluating the progression of the Parkinson disease. TRIAL REGISTRATION ClinicalTrials.gov NCT01928212.
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Affiliation(s)
- Ji-guo Yu
- Department of Ophthalmology, The Central Hospital of Wuhan, Hubei, China
| | - Yi-fan Feng
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Xiang
- Department of Ophthalmology, The Central Hospital of Wuhan, Hubei, China
| | - Jin-hai Huang
- The Affiliated Eye Hospital of Wenzhou Medical University, Zhejiang, China
| | | | | | - Wan-ju Yang
- Department of Ophthalmology, The Central Hospital of Wuhan, Hubei, China
| | - Xun-an Fu
- Department of Ophthalmology, The Central Hospital of Wuhan, Hubei, China
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Bodis-Wollner I, Miri S, Glazman S. Venturing into the no-man's land of the retina in Parkinson's disease. Mov Disord 2013; 29:15-22. [PMID: 24339212 DOI: 10.1002/mds.25741] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/07/2013] [Accepted: 10/11/2013] [Indexed: 12/31/2022] Open
Abstract
The development of optical coherence tomography (OCT) has led to increasing interest in the retina in Parkinson's disease (PD). The retina is a multilayered tissue: looking into the eye from the outside, these layers comprise the nerve fiber layer (NFL); the ganglion cell layer (GCL); the inner plexiform layer (IPL), which contains the interconnecting plexus, including tyrosine hydroxylase-positive (dopaminergic) fibers of amacrine cells; the inner nuclear layer; and several outer retinal layers. Commercial spectral-domain OCT has a specific program for detecting peripapillary NFL defects and a different macular program for diabetic retinopathy. Specific programs for PD are not commercially available. Taking all studies together, it seems that macular programs have a higher diagnostic yield than NFL programs, but the numbers of studies and examined patients are relatively small. It is not certain that all retinal thinning in PD is due to dopaminergic neuronal loss. When applying OCT, the where (region of interest) and the what of the focus of automated programs must be considered. With these caveats, one could take advantage of the power of OCT for looking in-depth into the terra incognita of individual retinal layers at the fovea and perhaps at other appropriate retinal locations.
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Affiliation(s)
- Ivan Bodis-Wollner
- Department of Neurology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA; Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, USA; SUNY Eye Institute, SUNY Downstate Medical Center, Brooklyn, New York, USA
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Abstract
PURPOSE OF REVIEW This review investigates the contribution of optical coherence tomography (OCT) to monitoring of neurodegeneration in the anterior visual pathway of patients with neuromyelitis optica, Alzheimer's disease, and Parkinson's disease. Despite a 'normal' regular ophthalmologic examination, some patients present visual complaints, and OCT might better explain the mechanism associated to neuronal and axonal losses that contribute to this clinical condition. RECENT FINDINGS The eye can be considered a 'window' to the central nervous system that can be directly accessed through OCT. Prior studies have suggested that pathologic processes in the brain are very similar to what happens in the eye in neurodegenerative diseases, and OCT has confirmed these abnormalities regarding the anterior visual pathway. It is supposed that transsynaptic neurodegeneration in lesions of the posterior visual pathway may play a role in the neurodegeneration process of the anterior visual pathway. SUMMARY Retinal nerve fiber layer, retinal ganglion cells, and inner retinal layers are considered surrogate biomarkers in the progression of neurodegenerative diseases. Because OCT is able to accurately measure neuropathological ocular features, its application has increased both in neuroprotection studies and in treatment. In fact, it may prove to be a unique evaluation tool in comparison with conventional visual tests. VIDEO ABSTRACT (Supplementary Digital content 1, http://links.lww.com/COOP/A10).
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Schneider M, Müller HP, Lauda F, Tumani H, Ludolph AC, Kassubek J, Pinkhardt EH. Retinal single-layer analysis in Parkinsonian syndromes: an optical coherence tomography study. J Neural Transm (Vienna) 2013; 121:41-7. [DOI: 10.1007/s00702-013-1072-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/19/2013] [Indexed: 01/02/2023]
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McNeill A, Roberti G, Lascaratos G, Hughes D, Mehta A, Garway-Heath DF, Schapira AH. Retinal thinning in Gaucher disease patients and carriers: results of a pilot study. Mol Genet Metab 2013; 109:221-3. [PMID: 23639447 PMCID: PMC3682181 DOI: 10.1016/j.ymgme.2013.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 12/02/2022]
Abstract
Both Gaucher disease patients and heterozygous glucocerebrosidase mutation carriers are at increased risk of Parkinson's disease. Retinal thinning has been reported in early Parkinson's disease. Here we used optical coherence tomography to demonstrate thinning of the retinal ganglion cell layer in Gaucher disease patients and carriers who manifest clinical markers of potential early neurodegeneration. Optical coherence tomography may help identify Gaucher disease patients and carriers at increased risk of developing Parkinson's disease.
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Affiliation(s)
- Alisdair McNeill
- Department of Clinical Neurosciences, UCL Institute of Neurology, UK
| | - Gloria Roberti
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Gerassimos Lascaratos
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
| | - Atul Mehta
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
| | - David F. Garway-Heath
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Anthony H.V. Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, UK
- Corresponding author at: Department of Clinical Neurosciences, Upper Level 3, UCL Institute of Neurology, Royal Free Campus, Pond Street, London NW3 2PF, UK. Fax: + 44 20 7472 6829.
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Effectiveness of averaging strategies to reduce variance in retinal nerve fibre layer thickness measurements using spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2013; 251:1841-8. [PMID: 23589277 DOI: 10.1007/s00417-013-2337-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Automated detection of subtle changes in peripapillary retinal nerve fibre layer thickness (RNFLT) over time using optical coherence tomography (OCT) is limited by inherent image quality before layer segmentation, stabilization of the scan on the peripapillary retina and its precise placement on repeated scans. The present study evaluates image quality and reproducibility of spectral domain (SD)-OCT comparing different rates of automatic real-time tracking (ART). METHODS Peripapillary RNFLT was measured in 40 healthy eyes on six different days using SD-OCT with an eye-tracking system. Image brightness of OCT with unaveraged single frame B-scans was compared to images using ART of 16 B-scans and 100 averaged frames. Short-term and day-to-day reproducibility was evaluated by calculation of intraindividual coefficients of variation (CV) and intraclass correlation coefficients (ICC) for single measurements as well as for seven repeated measurements per study day. RESULTS Image brightness, short-term reproducibility, and day-to-day reproducibility were significantly improved using ART of 100 frames compared to one and 16 frames. Short-term CV was reduced from 0.94 ± 0.31 % and 0.91 ± 0.54 % in scans of one and 16 frames to 0.56 ± 0.42 % in scans of 100 averaged frames (P ≤ 0.003 each). Day-to-day CV was reduced from 0.98 ± 0.86 % and 0.78 ± 0.56 % to 0.53 ± 0.43 % (P ≤ 0.022 each). The range of ICC was 0.94 to 0.99. Sample size calculations for detecting changes of RNFLT over time in the range of 2 to 5 μm were performed based on intraindividual variability. CONCLUSION Image quality and reproducibility of mean peripapillary RNFLT measurements using SD-OCT is improved by averaging OCT images with eye-tracking compared to unaveraged single frame images. Further improvement is achieved by increasing the amount of frames per measurement, and by averaging values of repeated measurements per session. These strategies may allow a more accurate evaluation of RNFLT reduction in clinical trials observing optic nerve degeneration.
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42
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Satue M, Garcia-Martin E, Fuertes I, Otin S, Alarcia R, Herrero R, Bambo MP, Pablo LE, Fernandez FJ. Use of Fourier-domain OCT to detect retinal nerve fiber layer degeneration in Parkinson's disease patients. Eye (Lond) 2013; 27:507-14. [PMID: 23429414 PMCID: PMC3626016 DOI: 10.1038/eye.2013.4] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 12/26/2012] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To demonstrate axonal loss in the retinal nerve fiber layer (RNFL) of patients with Parkinson's disease (PD) and to evaluate the ability of Fourier-domain optical coherence tomography (OCT) to detect RNFL degeneration and retinal thinning in these patients. METHODS PD patients (n=100) and healthy subjects (n=100) were included in the study and underwent visual acuity, color vision, and OCT examinations using two next-generation Fourier-domain devices (Spectralis and Cirrus). Differences in the RNFL thicknesses were compared between patients and controls. RESULTS RNFL thicknesses were significantly reduced in PD patients compared with healthy subjects, especially those obtained using the Spectralis OCT, in the inferotemporal quadrant (155.6±16.5 μm in healthy eyes vs 142.1±24.9 μm in patients, P=0.040) and in the superotemporal quadrant (142.6±20.9 μm in healthy eyes vs 132.77±18.6 μm in PD patients, P=0.046). Significant differences were observed between controls and patients in relation to mean macular thickness (P=0.031), foveal thickness (P=0.030), and inferior outer thickness (P=0.019). CONCLUSION PD is associated with RNFL loss and retinal thinning, which is detectable by Fourier-domain OCT measurements.
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Affiliation(s)
- M Satue
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
| | - E Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
| | - I Fuertes
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
| | - S Otin
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
| | - R Alarcia
- Department of Neurology, Miguel Servet University Hospital, Zaragoza, Spain
| | - R Herrero
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
| | - M P Bambo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
| | - L E Pablo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
| | - F J Fernandez
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragones Institute of Health Sciences, Research Department, Zaragoza, Spain
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