Abstract
ABSTRACTAimThis review aims to critically analyze the current literature on the relationship of optical coherence tomography (OCT) measures to cognition and dementia.BackgroundOptical coherence tomography, a noninvasive method of imaging neuroretinal layers, and OCT angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases. There is now an increasing body of evidence relating the structural and microvascular changes of the retina to cognitive impairment.Review resultsIn general, several studies have found decreased retinal nerve fiber layer (RNFL) thickness in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) and an association between RNFL thickness and continuous measures of cognitive ability, though findings were inconsistent across studies. In many studies, associations were found for specific regions of the RNFL but not with overall thickness. Studies linking OCT measures to non-Alzheimer’s dementia were lacking, and limited work has been done on persons with past cognitive decline but who remain cognitively normal (the ideal stage at which to target treatment). Common limitations of prior studies include a failure to account for intraocular pressure (IOP) and axial length.ConclusionCurrent research suggests a potential association between retinal findings observed on OCT and cognitive impairment. Methodologically robust research accounting for important covariates and looking at changes in OCT and/ or cognition is needed to better characterize the association between OCT and cognitive ability.Clinical significanceFurther research is warranted to determine whether OCT findings can help identify the etiology of cognitive decline and/or serve as objective markers of AD. If this is the case, OCT may also help identify the presence of disease processes in cognitively normal individuals.How to cite this article: Lee MJ, Abraham AG, Swenor BK, Sharrett AR, Ramulu PY. Application of Optical Coherence Tomography in the Detection and Classification of Cognitive Decline. J Curr Glaucoma Pract 2018;12(1):10-18.
Highlights
IntroductionA noninvasive method of imaging neuroretinal layers, and Optical coherence tomography (OCT) angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases
Optical coherence tomography, a noninvasive method of imaging neuroretinal layers, and OCT angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases
Clinical significance: Further research is warranted to determine whether OCT findings can help identify the etiology of cognitive decline and/or serve as objective markers of Alzheimer’s disease (AD)
Summary
A noninvasive method of imaging neuroretinal layers, and OCT angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases. Review results: In general, several studies have found decreased retinal nerve fiber layer (RNFL) thickness in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) and an association between RNFL thickness and continuous measures of cognitive ability, though findings were inconsistent across studies. An increasing body of literature suggests that OCT may be used in patients with cognitive impairment to identify structural thinning of specific neuroretinal layers as a surrogate for neurodegeneration in the brain. While past studies have focused on structural OCT measures, recent advances allow OCT machines to acquire a retinal angiogram through a technique known as OCT angiography, which detects submillimeter regions of nonperfusion that may be analogous to the microinfarcts seen in the autopsied brains of patients with either vascular or mixed dementia. We review the literature associating structural retinal and retinovascular findings with cognitive impairment and discuss the clinical implications
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