Characterizing the Retinal Microvasculature and Structure in Individuals with Dementia with Lewy Bodies

Abstract

Purpose : Dementia with Lewy Bodies (DLB) accounts for up to 7.5% of dementia cases. Multimodal retinal imaging may identify biomarkers in this population since there is a growing link between retinal alterations in DLB, with exploratory studies showing phosphorylated alpha-synuclein retinal deposits, parafoveal thinning of ganglion cell inner-plexiform layer (GC-IPL), and electroretinography alterations. We used optical coherence tomography (OCT) and OCT angiography (OCTA) to characterize differences in retinal microvasculature and structure in individuals with DLB compared to controls with normal cognition.

Methods : A cross-sectional comparison of patients with DLB and age- and sex-matched cognitively normal controls. Exclusion criteria included retinal or optic nerve pathology, glaucoma, and diabetes. The Zeiss Cirrus HD-OCT 5000 with AngioPlex was used to obtain OCT and OCTA images. OCT parameters measured includes central subfield thickness (CST), subfoveal choroidal thickness (SFCT), retinal nerve fiber layer (RNFL) thickness, and GC-IPL thickness. OCTA parameters measured include superficial capillary plexus foveal avascular zone (FAZ) area, fovea-centered 3x3mm and 6x6mm vessel density (VD) and perfusion density (PD), and optic nerve head-centered capillary perfusion density (CPD) and capillary flux index (CFI). Generalized estimating equations adjusted for correlation among eyes of the same subject.

Results : Thirty-four eyes of 18 DLB patients and 34 eyes of 18 cognitively normal patients were analyzed. Cases were well-matched to controls by age (p = 0.856), sex (p = 0.933), and smoking history (p = 0.437). DLB patients had lower Mini Mental State Exam (MMSE) scores (p < 0.001). Average 4.5x4.5mm CPD and 4.5x4.5mm temporal quadrant CPD were lower in patients with DLB compared to controls (p = 0.03, p < 0.001).

Conclusions : DLB patients had decreased peripapillary CPD when compared to those with normal cognition. Retinal imaging metrics have the potential to serve as clinically relevant biomarkers for DLB diagnosis.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.