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    Choroid and choriocapillaris changes in early-stage Parkinson's disease: a swept-source optical coherence tomography angiography-based cross-sectional study. Alzheimer's research & therapy BACKGROUND:Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the aging population. Previous literature has reported thinning of the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and photoreceptor layer in PD patients. However, very few studies have used swept-source optical coherence tomography (SS-OCT) to study the choroid and choriocapillaris vascular changes in PD and their correlations with altered contrast sensitivity. METHODS:PD patients and controls were enrolled in the current study. We used a CSV-1000E instrument to assess contrast sensitivity and performed SS-OCT and SS-OCTA to measure outer retinal thickness, choroidal thickness, choriocapillaris flow density, choroidal vascular volume (CVV), and choroidal vascular index (CVI). RESULTS:One hundred eyes of 52 PD patients and 200 eyes of 100 healthy controls were recruited in the present study. Our study found remarkably impaired contrast sensitivity in PD patients (all P < 0.05). Significant thinning of the outer retinal layer and the choroid was appreciated in the PD group compared with the healthy controls (all P < 0.05). Choriocapillaris flow density, CVI, and CVV were significantly decreased in PD patients compared with healthy controls (all P < 0.05). Contrast sensitivity was weakly associated with outer retina thickness in the 3 mm circular area, with 3 cycles per degree being the most relevant (r = 0.535, P < 0.001). CONCLUSION:Our study indicates that there is a significant decrease in contrast sensitivity, outer retina thickness, choriocapillaris flow density, CVI, and CVV in PD patients. This research has also identified a positive correlation between outer retina thickness and contrast sensitivity. 10.1186/s13195-022-01054-z
    Retinal and Choroidal Changes in Patients with Parkinson's Disease Detected by Swept-Source Optical Coherence Tomography. Satue Maria,Obis Javier,Alarcia Raquel,Orduna Elvira,Rodrigo Maria J,Vilades Elisa,Gracia Hector,Otin Sofia,Fuertes Maria I,Polo Vicente,Larrosa Jose M,Pablo Luis E,Garcia-Martin Elena Current eye research PURPOSE:To evaluate the ability of new Swept source (SS) optical coherence tomography (OCT) technology to detect changes in retinal and choroidal thickness in patients with Parkinson's disease (PD). DESIGN:Observational case-control cross sectional study, developed from January to May 2016. METHODS:In total, 50 eyes from 50 patients diagnosed with PD and 54 eyes of 54 healthy controls underwent retinal and choroidal assessment using SS DRI Triton OCT (Topcon), using the 3D Wide protocol. Total macular thickness and peripapillary data (retinal, ganglion cell layer [GCL+, GCL++] and retinal nerve fiber layer [RNFL] thickness) were analyzed. Macular and peripapillary choroidal thickness was evaluated (Figure 1). RESULTS:Significant peripapillary retinal thinning was observed in PD patients in total average (p = 0.017), in the nasal (p = 0.038) and temporal (p = 0.004) quadrants and in superotemporal (p = 0.004), nasal (p = 0.039), inferotemporal (p = 0.019), and temporal (p = 0.003) sectors. RNFL and GCL ++ thickness showed a significant reduction in the inferotemporal sector (p = 0.026 and 0.009, respectively). No differences were observed in macular retinal thickness between controls and patients. Choroidal thickness was found to have increased in all sectors in PD patients compared with controls, both in the macular (inner nasal, p = 0.015; inner inferior, p = 0.030; outer nasal, p = 0.012; outer inferior, p = 0.049) and the peripapillary area (total thickness, p = 0.011; nasal, p = 0.025; inferior, p = 0.007; temporal, p = 0.003; inferotemporal, p = 0.003; inferonasal, p = 0.016) Conclusion: New SS technology for OCT devices detects retinal thinning in PD patients, providing increased depth analysis of the choroid in these patients. The choroid in PD may present increased thickness compared to healthy individuals; however, more studies and histological analysis are needed to corroborate our findings. 10.1080/02713683.2017.1370116
    Characterization of Retinal Microvascular and Choroidal Structural Changes in Parkinson Disease. Robbins Cason B,Thompson Atalie C,Bhullar Paramjit K,Koo Hui Yan,Agrawal Rupesh,Soundararajan Srinath,Yoon Stephen P,Polascik Bryce W,Scott Burton L,Grewal Dilraj S,Fekrat Sharon JAMA ophthalmology Importance:Noninvasive retinal imaging may detect structural changes associated with Parkinson disease (PD) and may represent a novel biomarker for disease detection. Objective:To characterize alterations in the structure and microvasculature of the retina and choroid in eyes of individuals with PD and compare them with eyes of age- and sex-matched cognitively healthy control individuals using optical coherence tomography (OCT) and OCT angiography (OCTA). Design, Setting, and Participants:This cross-sectional study was conducted at the Duke Neurological Disorders Clinic in Durham, North Carolina. Individuals aged 50 years or older with a diagnosis of PD were eligible for inclusion and underwent an evaluation and diagnosis confirmation before enrollment. Control individuals aged 50 years or older and without subjective cognitive dysfunction, a history of tremor, or evidence of motor dysfunction consistent with parkinsonism were solicited from the clinic or the Duke Alzheimer's Disease Prevention Registry. Individuals with diabetes, glaucoma, retinal pathology, other dementias, and corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity worse than 20/40 Snellen were excluded. Data were analyzed between January 1, 2020, and March 30, 2020. Exposures:All participants underwent OCT and OCTA imaging. Main Outcomes and Measures:Generalized estimating equation analysis was used to characterize the association between imaging parameters and PD diagnosis. Superficial capillary plexus vessel density (VD) and perfusion density (PFD) were assessed within the ETDRS 6 × 6-mm circle, 6 × 6-mm inner ring, and 6 × 6-mm outer ring, as was the foveal avascular zone area. Peripapillary retinal nerve fiber layer thickness, macular ganglion cell-inner plexiform layer thickness, central subfield thickness, subfoveal choroidal thickness, total choroidal area, luminal area, and choroidal vascularity index (CVI) were measured. Results:A total of 124 eyes of 69 participants with PD (39 men [56.5%]; mean [SD] age, 71.7 [7.0] years) and 248 eyes of 137 control participants (77 men [56.2%]; mean [SD] age, 70.9 [6.7] years) were analyzed. In the 6 × 6-mm ETDRS circle, VD (β coefficient = 0.37; 95% CI, 0.04-0.71; P = .03) and PFD (β coefficient = 0.009; 95% CI, 0.0003-0.018; P = .04) were lower in eyes of participants with PD. In the inner ring of the 6 × 6-mm ETDRS circle, VD (β coefficient = 0.61; 95% CI, 0.20-1.02; P = .003) and PFD (β coefficient = 0.015; 95% CI, 0.005-0.026; P = .004) were lower in eyes of participants with PD. Total choroidal area (β coefficient = -1.74 units2; 95% CI, -3.12 to -0.37 units2; P = .01) and luminal area (β coefficient = -1.02 units2; 95% CI, -1.86 to -0.18 units2; P = .02) were greater, but CVI was lower (β coefficient = 0.5%; 95% CI, 0.2%-0.8%; P < .001) in eyes of individuals with PD. Conclusions and Relevance:This study found that individuals with PD had decreased retinal VD and PFD as well as choroidal structural changes compared with age- and sex-matched control participants. Given the observed population differences in these noninvasive retinal biomarkers, further research into their clinical utility in PD is needed. 10.1001/jamaophthalmol.2020.5730
    Retina thickness in atypical parkinsonism: a systematic review and meta-analysis. Ma Xiaoli,Wang Yujie,Wang Nan,Zhang Ruijun Journal of neurology BACKGROUND AND PURPOSE:To investigate the retina thickness assessed using optical coherence tomography in atypical parkinsonism in comparison with health controls (HC) and patients with Parkinson's disease (PD). METHODS:PubMed and EMBASE were searched for potentially eligible studies that reported retina thickness in atypical parkinsonism [including progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal degeneration] in comparison with that of HC and PD patients from their dates of inception to Jan 24, 2021. Mean difference (μm) of the thickness of peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) were pooled with random effects model. RESULTS:We included ten studies eligible for inclusion criteria. Average pRNFL thickness and average CMT were thinner in PSP [pooled mean difference (μm) of - 4.71, 95% CI (- 7.15, - 2.27); - 15.12, 95% CI (- 16.93, - 13.30)] and in MSA [- 5.37, 95% CI (- 6.59, - 4.15); - 5.93, 95% CI (- 11.00, - 0.87)] compared with HC, and were thinner in PSP [- 5.81, 95% CI (- 8.92, - 2.69); - 10.63, 95% CI (- 20.29, - 0.98)] and in MSA [- 0.35 μm, 95% CI (- 5.72, 5.01); - 7.42 μm [95% CI (- 12.46, - 2.38)] compared with PD. The pRNFL thickness was thinning in superior, inferior and nasal quadrants, and CMT was thinning in outer sectors in MSA compared with HC. CONCLUSIONS:The retina thickness was significantly thinner in PSP and MSA than those in HC and PD. The specific patterns of retina thinning in MSA could be clinical importance for differentiation among atypical parkinsonism. 10.1007/s00415-021-10703-6
    OCT in Alzheimer's disease: thinning of the RNFL and superior hemiretina. Cunha João Paulo,Proença Rita,Dias-Santos Arnaldo,Almeida Rita,Águas Helena,Alves Marta,Papoila Ana Luísa,Louro Carlota,Castanheira-Dinis António Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie BACKGROUND:Peripapillary retinal nerve fiber layer (pRNFL) and internal macular layer thinning have been demonstrated in Alzheimer's disease (AD) with optical coherence tomography (OCT) studies. The purpose of this study is to compare the pRNFL thickness and overall retinal thickness (RT) in AD patients with non-AD patients, using spectral domain optical coherence tomography (SD-OCT) and determine the sectors most characteristically affected in AD. METHODS:A cross-sectional study was performed to determine the pRNFL and overall macular RT thicknesses in AD and non-AD patients, attending a tertiary hospital center. For pRNFL, the global and six peripapillary quadrants were calculated, and for overall RT values, the nine Early Treatment Diabetic Retinopathy Study (ETDRS) areas were used. A multiple regression analysis was applied to assess the effects of disease, age, gender, spherical equivalent, visual acuity, intraocular pressure, axial length and blood pressure on pRNFL and overall macular RT. RESULTS:A total of 202 subjects, including 50 eyes of 50 patients with mild AD (mean age 73.10; SD = 5.36 years) and 152 eyes of 152 patients without AD (mean age 71.03; SD = 4.62 years). After Bonferroni correction, the pRNFL was significantly thinner for the AD group globally and in the temporal superior quadrant (10.76 μm and 20.09 μm mean decrease, respectively). The RT thickness was also decreased in superior sectors S3 and S6 (mean thinning of 9.92 μm and 11.65 μm, respectively). Spearman's correlation coefficient showed a direct association between pRNFL in the temporal superior quadrant and RT in superior S6 and S3 sectors (r = 0.41; p < 0.001 and r = 0.28; p < 0.001, respectively). CONCLUSIONS:Patients with AD showed a significant thickness reduction in global and temporal superior quadrants in pRNFL and in superior pericentral and peripheral sectors of RT. These findings may reflect a peripapillary and retinal changes characteristic of AD, suggesting the importance of SD-OCT as a potential adjuvant in early diagnosis of AD. Further studies are needed to understand which retinal layers and macular sectors are more useful as potential ocular biomarker over time in AD. 10.1007/s00417-017-3715-9
    Update on visual function and choroidal-retinal thickness alterations in Parkinson's disease. Obis J,Satue M,Alarcia R,Pablo L E,Garcia-Martin E Archivos de la Sociedad Espanola de Oftalmologia Parkinson's disease (PD) is a neurodegenerative process that affects 7.5 million people around the world. Since 2004, several studies have demonstrated changes in various retinal layers in PD using optical coherence tomography (OCT). However, there are some discrepancies in the results of those studies. Some of them have correlated retinal thickness with the severity or duration of the disease, demonstrating that OCT measurements may be an innocuous and easy biomarker for PD progression. Other studies have demonstrated visual dysfunctions since early phases of the disease. Lastly, the most recent studies that use Swept Source OCT technology, have found choroidal thickness increase in PD patients and provide new information related to the retinal degenerative process in this disease. The aim of this paper is to review the literature on OCT and PD, in order to determine the altered retinal and choroidal parameters in PD and their possible clinical usefulness, and also the visual dysfunctions with higher impact in these patients. 10.1016/j.oftal.2018.01.004
    The specific pattern of retinal nerve fiber layer thinning in Parkinson's disease: a systematic review and meta-analysis. Huang Lele,Wang Chen,Wang Wanting,Wang Yujie,Zhang Ruijun Journal of neurology BACKGROUND AND PURPOSE:The peripapillar nerve fiber layer (pRNFL) thinning in different retinal quadrants or sectors remains controversy. We conducted a systematic review and meta-analysis on the pattern of pRNFL thinning in Parkinson's disease (PD) patients to provide a biomarker for PD differential diagnosis. METHODS:We systematically searched PubMed and EMBASE to identify studies comparing pRNFL thickness in PD patients and health controls using spectral domain-optical coherence tomography from inception to April 25, 2020. Random effects mode was used to pool mean difference (μm) of the average thickness of pRNFL and the thickness of pRNFL in four quadrants (superior, inferior, nasal and temporal) and in the subdivisions of superior (superonasal and superotemporal sectors) and inferior quadrants (inferonasal and inferotemporal sectors) between PD patients and health controls. RESULTS:We included 32 studies (33 sets of data) enrolling 2126 PD eyes and 2318 health control eyes. Between the eyes of PD patients and that of health controls, the pooled mean difference (μm) of average pRNFL was - 4.85 (95% CI [- 6.12, - 3.58]); the pooled mean difference (μm) of four quadrants were - 2.30 (95% CI [- 3.32, - 1.28], nasal), - 2.74 (95% CI [- 4.34, - 1.14], temporal), - 5.24 (95% CI [- 7.04, - 3.43], superior) and - 7.29 (95% CI [- 9.23, - 5.34], inferior); those of four sectors were - 5.16 (95% CI [- 7.70, - 2.62], superotemporal), - 3.55 (95% CI [- 5.87, - 1.23], superonasal), - 9.19 (95% [- 13.27, - 5.12], inferotemporal) and - 7.62 (95% CI [- 11.84, - 3.40], inferonasal). CONCLUSION:In PD patients, pRNFL thinning followed a specific pattern with inferotemporal thinning most and nasal quadrant thinning least. 10.1007/s00415-020-10094-0
    Evaluation of Choroidal and Retinal Thickness Changes in Parkinson's Disease Using Spectral Domain Optical Coherence Tomography. Moschos Marilita M,Chatziralli Irini P Seminars in ophthalmology PURPOSE:The purpose of this study was to evaluate retinal and choroidal thickness in patients with Parkinson's disease (PD) using spectral domain-optical coherence tomography (SD-OCT). MATERIAL AND METHODS:Participants in our study were 31 PD patients and 25 age-matched healthy controls. All participants underwent best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, dilated fundoscopy, and SD-OCT. Macular and retinal nerve fiber layer (RNFL) thickness and choroidal thickness in all quadrants were recorded. RESULTS:There was a statistically significant reduction in average, superior, and temporal RNFL thickness, average ganglion cell complex, and choroidal thickness in the subfoveal area and in all quadrants between patients with PD and controls. CONCLUSIONS:The role of the choroidal vasculature in the pathophysiology of PD should be further scrutinized. 10.1080/08820538.2017.1307423