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Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 562-563

Commentary: Viewing Alzheimer's disease from an ophthalmologist's eyes

Neuroophthalmology Services, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Web Publication16-Mar-2020

Correspondence Address:
Dr. Shikha T Bassi
Sankara Nethralaya Main Hospital, No. 41 (Old 18), College Road, Chennai - 600 006, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2132_19

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How to cite this article:
Bassi ST. Commentary: Viewing Alzheimer's disease from an ophthalmologist's eyes. Indian J Ophthalmol 2020;68:562-3

How to cite this URL:
Bassi ST. Commentary: Viewing Alzheimer's disease from an ophthalmologist's eyes. Indian J Ophthalmol [serial online] 2020 [cited 2021 Jan 20];68:562-3. Available from: https://www.ijo.in/text.asp?2020/68/4/562/280740

In this issue of Indian Journal of Ophthalmology, Singh and Verma have compiled the results of the existing research on ocular biomarkers for the diagnosis of Alzheimer's disease(AD) into a detailed review article.[1]

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In 2011, the clinical diagnostic criteria for Alzheimer's disease dementia were revised, and research guidelines for initial stages of the disease were characterized to depict a deeper understanding of the disorder. Development of the new guidelines was led by the National Institute on Aging-Alzheimer's Association(NIA-AA) in the United States.[2] In their guidelines AD is defined by its underlying pathologic processes that can be documented by postmortem examination or invivo by biomarkers. It recognizes three general groups of biomarkers based on the nature of the pathologic process that each measures. Biomarkers of Aβ plaques, biomarkers of fibrillar tau and biomarkers of neurodegeneration or neuronal injury. These biomarkers can be fluid biomarkers or imaging biomarkers. Cerebrospinal fluid(CSF) biomarkers are the only variety of fluid biomarkers utilized in the early diagnosis of AD. The imaging biomarkers utilize modalities like structural magnetic resonance imaging(MRI), functional MRI, 18F-2-fluoro-2-deoxy-D-glucose(FDG) positron emission tomography(PET), and amyloid-PET to identify AD.

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Ocular fluid biomarkers

CSF biomarkers cannot be recommended for preventive screening due to their limited accessibility and the invasive nature of CSF collection. On the contrary, the biomarkers obtained from the blood oral, ocular, and olfactory fluids/tissues are easily accessible and less invasive to procure.[3] Anterior ocular fluid and CSF share many features, such as the similarity between blood–aqueous and blood–CSF barriers.[4] Despite that till date, aqueous biomarkers in the AD patients have not been studied as acquisition of the sample is an invasive procedure. Aqueous humor of individuals with AD may reveal higher levels of Ab42, the main biomarker found in neocortical deposits. One study has been done to evaluate the vitreous for the AD-related biomarkers utilizing the vitreous samples from the patients undergoing planned vitrectomy for other pathologies. These patients were evaluated for cognitive impairment using the mini mental status examination scores. The authors found that the patients with poor cognitive function have significantly lower vitreous humor levels of AD-related biomarkers Aβ40, Aβ42, and tTau. These biomarkers do not correlate with underlying eye conditions, suggesting their specificity in association with cognitive change.[5] At this point the correlations of AD with alternative biomarkers obtained from ocular fluids is uncertain and considered invasive as a screening tool.

Noninvasive ocular imaging biomarkers

Pupillometry is a low-cost, noninvasive technique that may be useful for monitoring cholinergic deficits which generally precedes the memory and cognitive disorders.[6] Kerbage etal. have described noninvasive methods to identify AD signatures in the human crystalline lens using invivo technique of laser scanning along with a fluorescent ligand.[7] Retinal optical coherence tomography(OCT) has been used to measure the retinal thickness and retinal vascular measurements as the noninvasive screening biomarkers. Areview article published in ophthalmology this year confirmed the associations between retinal measurements of spectral domain SD OCT and AD, highlighting the potential usefulness of SD OCT measurements as biomarkers of AD.[8] They assessed the associations between AD and measurements of ganglion cell-inner plexiform layer(GC-IPL), ganglion cell complex(GCC), macular volume, and choroidal thickness, in addition to retinal nerve fiber layer and macular thickness using SD OCT. Whereas another study published in the Alzheimers Dement (Amst), representing the largest optical coherence tomography cohort with amyloid-proven AD cases questions these claims. The authors show that retinal thickness does not discriminate AD from controls, despite evident changes on clinical, neuroimaging, and CSF measures, querying the use of retinal thickness measurements as an AD biomarker.[9] They recommended future studies, including longitudinal measurements of retinal layer thickness and specific molecular biomarkers such as amyloid, tau, and neuroinflammation, to assess the retina as a potential source of noninvasive AD biomarkers.[9] The same group has shown in another study that the retinal vasculature does not discriminate AD from control participants, despite evident changes on clinical, neuroimaging, and cerebrospinal fluid measures, querying the use of retinal vasculature measurements as AD biomarker.[10] Ongoing clinical trials using noninvasive ocular biomarkers like retinal thickness and vasculature measurements using OCT in proven AD cases can only answer these queries in the forthcoming years. We as ophthalmologists can study and present the indicators/biomarkers of the disease in the eye, but their validation, clinical application, or utilization as a research tool is up to the neurologists.

  References Top

Singh AK, Verma S. Use of ocular biomarkers as a potential tool for early diagnosis of Alzheimer's disease. Indian J Ophthalmol 2020;68:555-61.  Back to cited text no. 1
  [Full text]  
Jack CR Jr, BennettDA, BlennowK, CarrilloMC, DunnB, HaeberleinSB. NIA-AA research framework: Toward a biological definition of Alzheimer's disease. Alzheimers Dement 2018;14:535-62.  Back to cited text no. 2
LeeJC, KimSJ, HongS, KimY. Diagnosis of Alzheimer's disease utilizing amyloid and tau as fluid biomarkers. Exp Mol Med 2019;51:53.  Back to cited text no. 3
DavsonH. Acomparative study of the aqueous humour and cerebrospinal fluid in the rabbit. JPhysiol 1955;129:111-3.  Back to cited text no. 4
WrightLM, SteinTD, JunG, ChungJ, McConnellK, FiorelloM, etal. Association of cognitive function with amyloid-β and tau proteins in the vitreous humor. JAlzheimers Dis 2019;68:1429-38.  Back to cited text no. 5
FrostS, RobinsonL, RoweCC, AmesD, MastersCL, TaddeiK, etal. Evaluation of cholinergic deficiency in preclinical Alzheimer's disease using pupillometry. JOphthalmol 2017;2017:7935406.  Back to cited text no. 6
KerbageC, SadowskyCH, JenningsD, CagleGD, HartungPD. Alzheimer's disease diagnosis by detecting exogenous fluorescent signal of ligand bound to Beta amyloid in the lens of human eye: An exploratory study. Front Neurol 2013;4:62.  Back to cited text no. 7
ChanVT, SunZ, TangS, ChenLJ, WongA, ThamCC. Spectral-domain OCT measurements in Alzheimer's disease: Asystematic review and meta-analysis. Ophthalmology 2019;126:497-510.  Back to cited text no. 8
HaanJD, van de KreekeJA, KonijnenbergE, KateMT, BraberAD, BarkhofF, etal. Retinal thickness as a potential biomarker in patients with amyloid-proven early-and late-onset Alzheimer's disease. Alzheimers Dement 2019;11:463-71.  Back to cited text no. 9
HaanJD, van de KreekeJA, van BerckelBN, BarkhofF, TeunissenCE, ScheltensP, etal. Is retinal vasculature a biomarker in amyloid proven Alzheimer's disease? Alzheimers Dement(Amst) 2019;11:383-91.  Back to cited text no. 10


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