Abstract
Aim: To assess the frequency of glaucoma-like alterations in Alzheimer's disease (AD) patients using Heidelberg Retinal Tomograph III (HRT-3) and Frequency Doubling Technology (FDT) perimetry.Methods: The study included 51 eyes of 51 AD subjects and 67 eyes of 67 age- and sex-matched controls. Subjects underwent an ophthalmological examination including measurements of intraocular pressure (IOP), Matrix FDT visual field testing, optic nerve head morphology and retinal nerve fiber layer thickness (RNFLt) assessment by slit-lamp biomicroscopy and HRT-3.Results: The frequency of alterations was significantly higher in the AD group (27.5 vs. 7.5%; p = 0.003; OR = 4.69). AD patients showed lower IOP (p = 0.000) despite not significantly different values of central corneal thickness (CCT) between the groups (p = 0.336). Of all the stereometric parameters measured by HRT-3, RNFLt was significantly lower in AD patients (p = 0.013). This group also had significantly worse results in terms of Moorfields Regression Analysis (p = 0.027). Matrix showed significantly worse Mean Deviation (MD) (p = 0.000) and Pattern Standard Deviation (PSD) (p = 0.000) values and more altered Glaucoma Hemifield Test (p = 0.006) in AD patients. Pearson's R correlation test showed that Mini Mental State Examination is directly correlated with MD (R = 0.349; p = 0.034) and inversely correlated with PSD (R = −0.357; p = 0.030).Conclusion: Patients with AD have a higher frequency of glaucoma-like alterations, as detected by the use of HRT-3. These alterations were not associated with elevated IOP or abnormal CCT values.
Highlights
The major cause of irreversible blindness worldwide, is a progressive optic neuropathy associated with degeneration of retinal ganglion cells (RGCs) and their axons, and it is characterized by a typical optic nerve appearance and corresponding visual field loss (European Glaucoma Society, 2008)
The frequency distribution of eyes with Matrix visual field alterations compatible with glaucoma associated with optic disc damage and/or Heidelberg Retinal Tomography-3 (HRT-3) assessed alterations was significantly higher in the Alzheimer’s Disease (AD) group than in controls (27.5 vs. 7.5%; ChiSquare test; p = 0.003; OR = 4.69)
Considering that epidemiological estimates are forecasting an exponential increase in Alzheimer’s disease over the 20 years, there is a risk that in the future we will face a large number of patients with optic nerve head and retinal nerve fiber layer thickness (RNFLt) alterations linked to this neurodegenerative disease
Summary
The major cause of irreversible blindness worldwide, is a progressive optic neuropathy associated with degeneration of retinal ganglion cells (RGCs) and their axons, and it is characterized by a typical optic nerve appearance and corresponding visual field loss (European Glaucoma Society, 2008). Until now, increased intraocular pressure (IOP) has been considered the major treatable risk factor for the disease. Despite the relationship between the reduction of IOP and glaucomatous damage is not yet known, the achievement of an “individual” target pressure has paramount importance. It has been clinically observed that a significant reduction of the IOP does not always stop the disease (Leske et al, 2003). Experience a progression of glaucoma even after a significant reduction of the IOP levels, whereas others show pathognomonic alterations despite the IOP is in the normal range. Studies using magnetic resonance imaging (MRI) have shown that the disease extends well beyond the eye, affecting the entire visual pathway, suggesting a possible connection with other neurodegenerative diseases (Nucci et al, 2013)
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