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Craig W. Ritchie, Tunde Peto, Neda Barzegar-Befroei, Adrienne Csutak, Patricia Ndhlovu, Danielle Wilson, Bryan Corridan, Bharathi Goud, Nevil Cheesman, Imre Lengyel; Peripheral Retinal Drusen as a Potential Surrogate Marker for Alzheimer’s Dementia: A Pilot Study Using Ultra-Wide Angle Imaging. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6683.
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The development of Alzheimer’s dementia (AD) and age-related macular degeneration (AMD) share similar histopathology, vascular risk factors and genetic predisposition and both are characterized by extracellular deposit formation. In this study we examined the prevalence and spatial distribution of macular and peripheral retinal pathologies in patients with AD.
Color and autofluorescent (AF) images were taken by the Optos P200C AF ultra-wide angle laser scanning ophthalmoscope (200°) to determine phenotypic variations in 56 AD patients and 46 controls. Images were graded for the prevalence of drusen, pigmentary changes, atrophy or choroidal neovascularisation (CNV) in the macula as well as retinal periphery. The periphery was divided into two zones (zone 4 and 5) to extend the standard AMD grid and pathological distribution was recorded in four sectors within these zones. All subjects had blood taken for genotyping. Comparisons were made using the chi-squared test after adjustment for potential confounders.
There was a positive genetic association between AD and ApoE4 RS429358(p=0.09). Only one control, but 4 patients were diagnosed to have AMD based on macular pathologies. In the periphery hard drusen were present in 14/55 (25.4%) of AD patients and 2/48 (4.2%) of controls [Chi2=9.9, df=4, p=0.04]. After adjustment for age and a history of a transient ischaemic attack, this association remained strongly significant (p<0.001).
Ultra-wide angle imaging revealed a potential association between AD and AMD and a highly significant association between AD and peripheral hard drusen formation. These findings suggest that monitoring for the development and progression of pathological changes in the macula and most importantly in the periphery might become a valuable tool in detecting and monitoring the progression of AD. Further work is required to develop the understanding of this association which may lead to peripheral drusen acting as a surrogate marker for plaque development in the central nervous system.
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