June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Relationships between Retinal Nerve Fiber Layer and Brain Changes in Age-Related Macular Degeneration
Author Affiliations & Notes
  • Arthika Chandramohan
    Duke University School of Medicine, Durham, NC
  • Jonathan P Wright
    Stony Brook Medical School, Stony Brook, NY
  • Xuan Duong Fernandez
    Brain Imaging Analysis Center, Durham, NC
  • Jie Zhuang
    Brain Imaging Analysis Center, Durham, NC
  • Leon Kwark
    Duke University School of Medicine, Durham, NC
    Duke Eye Center, Durham, NC
  • Sina Farsiu
    Duke University School of Medicine, Durham, NC
    Duke Eye Center, Durham, NC
  • Scott W Cousins
    Duke University School of Medicine, Durham, NC
    Duke Eye Center, Durham, NC
  • David Madden
    Brain Imaging Analysis Center, Durham, NC
  • Eleonora M Lad
    Duke University School of Medicine, Durham, NC
    Duke Eye Center, Durham, NC
  • Heather E Whitson
    Duke University School of Medicine, Durham, NC
    Duke Eye Center, Durham, NC
  • Footnotes
    Commercial Relationships Arthika Chandramohan, None; Jonathan Wright, None; Xuan Duong Fernandez, None; Jie Zhuang, None; Leon Kwark, None; Sina Farsiu, None; Scott Cousins, None; David Madden, None; Eleonora Lad, None; Heather Whitson, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2819. doi:
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    • Get Citation

      Arthika Chandramohan, Jonathan P Wright, Xuan Duong Fernandez, Jie Zhuang, Leon Kwark, Sina Farsiu, Scott W Cousins, David Madden, Eleonora M Lad, Heather E Whitson; Relationships between Retinal Nerve Fiber Layer and Brain Changes in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2819.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

People with AMD, compared to sighted peers, have lower performance on cognitive tests, a two-fold increased risk of incident Alzheimer's, and steeper cognitive decline, yet it remains unknown whether AMD and cognitive impairment reflect similar neurodegenerative processes affecting both brain and retina. We use data from our ongoing prospective cohort study to investigate whether AMD patients with worse cognition or more altered brain connectivity have worse retinal damage measured by nerve fiber thickness (NFL).

 
Methods
 

We present interim data from 12 subjects (average age 73.3 ±7.4, 66% female), all with NVAMD in at least one eye, who underwent resting state MRI and these neurocognitive tests: Rapid Distinction Test (RDT), Wechsler Logical Memory, Item Recall, Verbal Fluency (Phonemic and Semantic), and the Fuld Object-Memory test. From macular Spectral Domain Optical Coherence Tomography (OCT), three-dimensional OCT image cubes were manually segmented for NFL thickness. Resting state MRI images were analyzed for strength of functional connectivity (FC) between relevant brain regions. Strong FC implies that metabolic activity of two regions rises and falls in concert. We assessed two visual processing centers and two regions from the default mode network (DMN), a brain network in which connectivity is strong in healthy persons but deteriorates with age and brain dysfunction. Two-way correlations were constructed between relevant variables.

 
Results
 

Half the subjects had NVAMD OU (we used NFL from the eye with better visual acuity in these subjects). Average binocular visual acuity was 0.37 (±0.21) LogMAR, and length of symptoms was 7.2 (±10) years. We found no relationship between NFL thickness and any of 8 cognitive test scores or FC measures.

 
Conclusions
 

The lack of significant correlations may indicate that NFL thickness is an imperfect marker of neuronal damage in NVAMD due to non-linear changes in thickness from fluid accumulation to scarring as the disease progresses. Alternatively, our findings may suggest that cognitive changes in AMD do not arise from concurrent neurodegenerative processes but are the result of reduced cognitive reserve or stimulation in the context of vision loss. To help distinguish between these possible explanations, future work should examine whether other biomarkers of retinal damage correlate to worse cognition or brain changes in AMD.  

 
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