The Retina – A Window to Alzheimer’s Disease

In a novel study from Queen’s University Belfast, researchers demonstrate that the eye could be a window to the brain. The results of the study, recently published in the Journal of Ophthalmic Research, show how degenerative brain diseases such as Alzheimer’s Disease (AD) can be monitored via ultra-widefield (UWF) retinal imaging.  The retina is a part of the central nervous system and shares structural and functional features with the brain. Altogether 59 AD patients and 48 controls were entered into the study.  They were imaged utilizing ultra-widefield imaging from Optos.  This advanced technology, using red and green lasers, captures a 200 degree, high-resolution digital image of the retina in less than ½  second, reaching regions of the retina that have been previously inaccessible with other methods of imaging.

Measuring biomarkers, such as drusen and vasculature width gradients in delineated quadrants of the retina, the researchers found that these changes, particularly in the peripheral retina, could be associated with degenerative brain conditions such as AD. Specifically, the markers that were chiefly considered were drusen and vasculature changes. Drusen are deposits of fats, minerals, and proteins and are normal symptoms of aging that appear as yellowish spots in the layer beneath the retina.  While they are harmless and typically begin to appear after the age of 40, an increased occurrence in number and size can contribute to the degeneration of the retina.  In the study, at baseline and follow up, the optomap images revealed that drusen accumulation, particularly in the superior nasal quadrant, were increased and significantly associated with positive AD status as compared to the number of drusen that would be normally expected in the control group. An additional novel element of the study was that by utilizing the UWF view of optomap, the width gradient of the vasculature could be observed in entirety from the macula to the far retinal periphery.  The study found that people with AD have blood vessels that are wider closer to the macula and thin as they progress further into the periphery.  This can impede the flow of blood and the essential delivery of nutrients and oxygen in the periphery, leading to further damage.

The team, led by Dr. Imre Lengyel of Queen’s University, hypothesized that changes in the peripheral retina could be important to explore the association between the eye and the brain. They concluded that their research supported their original hypothesis and that UWF retinal imaging has significant potential for monitoring AD and other degenerative brain diseases via the eye.  Utilizing optomap to evaluate progression of AD may bring important value to this effort because changes in the eye are easier to measure in relation to other methods necessary to evaluate the health of the brain.  Establishing an evidential correlation between the eye and the brain would suggest that utilizing UWF imaging could provide an easier, more expedient access to that information.  Furthermore, UWF imaging provides a much less expensive option to other methods of evaluation, such as brain scans. The researchers demonstrated that by utilizing optomap, they were able to identify early markers that could manifest many years before dementia develops as well as high risk groups who would benefit from preventative guidance. The study notes that to be a reasonable marker of early disease, pre-symptomatic, or early symptomatic patients would need to be followed up over several years to determine the predictive value of the peripheral findings.  Routine optomap exams could prove to be an earlier, easier and more cost-effective method for monitoring the progression of AD, and identifying individuals at high-risk of developing AD.

Grading of vascular parameters on UWF imaging.

Read the Full Article here….
Or visit our website to learn more about clinical studies utilizing optomap technology.

 

optomap Screening Reveals Cataract in Unsuspecting Doctor

While the exact causes of cataracts are still not entirely understood, annual eye exams are still important for the diagnoses and treatment of their formation.  Even with precautions and regular exams, by the year 2020, more than 30 million Americans are expected to develop cataracts.

Most cataracts occur gradually as we age and don’t become bothersome until after age 55. However, cataracts can also be present at birth (congenital cataracts) or occur at any age as the result of an injury to the eye (traumatic cataracts). Cataracts can also be caused by diseases such as diabetes or can occur as the result of long-term use of certain medications.  While typically forming in both eyes, cataracts may not grow at the same rate. They can develop slowly or quickly, or progress to a certain point, then not get any worse. As a result, one may not notice substantial changes in their sight. Sometimes they can significantly precede symptoms and can be so subtle as to go unnoticed without a comprehensive eye exam.

Read Dr. Young’s full testimonial by clicking on the image above.

When Vince Young, OD introduced Daytona, into his practice, he volunteered to be the imaging guinea pig while his staff trained on the device.  He was unnerved when he reviewed his images and somewhat uncertain about what he was seeing.  He knew what a posterior subcapsular cataract (PSC) looked like through the slit lamp but was surprised by what the optomap image revealed. Concerned, Young sent the image to his wife, Lindsey Brewer Young, OD. When she reviewed the image on her phone she immediately responded, questioning whose eye she was reviewing.  Learning it was her husband’s image she returned to the clinic, conducted a dilated exam, and confirmed that it was indeed a PSC that had been revealed in the optomap image.

At 40 years old, Dr. Young had no reason to suspect he would have cataracts as they are more typically associated with the elderly population. He also exhibited no symptoms or clouded vision.  A subcapsular cataract occurs at the back of the lens and can be caused by a variety of circumstances such as systemic issues and some forms of medication. PSCs are also more difficult to remove due to adhesion of the cataract to the lens capsule as well as an increased risk of capsule rupture during removal. However, Young’s cataract surgery on both eyes was successful and today his vision is fine.

Young reports that while this initial training episode was distressing, the image itself has become an excellent tool in communicating the importance of optomap and comprehensive exams to his patients.  The image hangs in the exam room and Young and his staff frequently share the story. “If the doctor didn’t know he had a cataract, how would anyone else know?” they say, underscoring the value of retinal screening. The unusual story has assisted with the elevated level of acceptance the optomap imaging has had in Young’s office.

Young stresses that the exam experience has changed with optomap in an extremely valuable way when it comes to patient education. optomap enables him to help his patients understand exactly what is occurring in their eye, or even just to provide reassurance that all is well. “Even if there is no pathology, patients want me to take the images every year. They want to see what I see.”

Dr. Young’s story demonstrates that it is not only possible for practitioners to image themselves and discover retinal pathology but also discover if significant opacities reside in the media as well.  The importance of regular, annual comprehensive eye exams cannot be expressed enough in the discussion of eye and systemic health. Visit our website to learn more about the benefits of optomap in protecting your eye health and to find an eyecare provider who used optomap technology in their practice.

 

Let’s Clear the Fog – June is Cataract Awareness Month!

June is Cataract Awareness Month and while many people may consider cataracts to simply be an inevitable aspect of aging, there is a great deal more to know and understand. Cataracts are the leading cause of vision loss in the United States, and the leading cause of blindness in the world. Although 24 million Americans over the age of 40 are affected by cataracts, the condition is more complex and nuanced than most may realize.

A cataract is an opacification of the natural lens, which inhibits or distorts the passage of light into the eye. The lens, located behind the pupil and iris, is typically transparent and transmits light onto the retina – the resulting signals become pictures in the brain.

Almost all of us realize and accept that as we age, we are likely to develop a cataract. However, the exact causes are still not entirely understood. Besides the natural aging process, there are several other possible risk factors for cataracts, such as:

  • Intense heat or long-term exposure to UV rays from the sun
  • Certain diseases, such as diabetes
  • Inflammation in the eye
  • Hereditary influences
  • Events before birth, such as German measles in the mother
  • Long-term steroid use
  • Eye injuries
  • Eye diseases
  • Smoking

As a cataract matures, it often causes glare, as well as diminished contrast and color sensitivity. With increased awareness of the process and an understanding of what will increase risk and the development and impact of cataracts can be reduced.

Throughout our life, our body replaces old cells with new ones and this includes the regeneration of the cells in our eyes. However, as we grow older, the old cells in the natural lens build up and eventually begins to block light as it tries to pass through, resulting in cloudy vision.

There are three different types of cataracts, named according to their locations:

Nuclear cataracts grow in the nucleus (inner core) of the eye’s lens. This is the most common type of cataract associated with aging.
Cortical cataracts develop in the cortex (outer section of the lens).
Posterior subcapsular cataracts form toward the back of a cellophane-like capsule that surrounds the lens. These are most common in people who are diabetic, overweight or taking steroids.

Cataracts can also be classified by cause:

Age-related cataracts form as result of aging.
Congenital cataracts occur in babies who are born with cataracts as a result of an infection, injury or poor development before birth. They can also develop during childhood.
Secondary cataracts are a result of other medical conditions, such as diabetes, or exposure to toxic substances, certain drugs (such as corticosteroids or diuretics), ultraviolet light or radiation.
Traumatic cataracts develop as the result of an injury to the eye.

Cataracts usually form in both eyes, but not at the same rate. They can develop slowly or quickly, or progress to a certain point, then not get any worse. As a result, one may not notice substantial changes in their sight.  Sometimes they can significantly precede symptoms and can be so subtle as to go unnoticed without a comprehensive eye exam.

pre-surgical cataract exam; optomap imaging (color and sensory view) reveals early Diabetic Retinopathy evident as multiple dot hemorrhages

As the U.S. population ages, more than 30 million Americans are expected to have cataracts by the year 2020.  optomap technology is being increasingly utilized in cataract surgery clinics for immediate views of the retina.  The ultra-widefield view can be captured through through problematic, medial opacities, where white light has difficulty, revealing any retinal issues that might be a concern prior to surgery, as well as, following surgery. The ability to quickly and easily observe and document retinal health before and after cataract surgery provides both the patient and practitioner a tremendous peace of mind.

While it is possible to reduce your risk of developing cataracts, unfortunately, it is not 100 percent preventable. However, choosing a healthy lifestyle can slow the progression of cataracts. It bears repeating that some ways to delay the progression of cataracts include avoiding smoking, reducing exposure to UV rays, eating healthy foods, and wearing proper eye protection to avoid eye injury and of course being proactive in vision stewardship should include obtaining an annual comprehensive eye exam. Protect your vision with optomap, visit our website to find a doctor near you!

References:
https://www.aao.org/eye-health
https://www.healthline.com/health/cataract#prevention
https://draxe.com/cataract-symptoms/