Early identification of the Alzheimer’s disease process would provide the opportunity to intervene when damage to synapses and neuronal tissue is minimal.
Therefore, detection and monitoring techniques with high sensitivity are necessary, said Peter Snyder, PhD, co-chair of the Retinal Imaging and Neurodegenerative Diseases workshop, convened by the Alzheimer's Association and held in Washington in May.
The American Optometric Association (AOA) provided a report on the workshop to Primary Care Optometry News. The AOA’s chief public health officer, Michael Duenas, OD, FNAP, participated in the event that hosted 90 researchers from nine countries.
The workshop highlighted different imaging modalities and methods, identified areas of data convergence, and explored gaps and potential areas to further advance application of these technologies for clinical trials and diagnostic uses.
The purpose of the think tank session was to lay the groundwork for large-scale early detection and monitoring of mild cognitive impairment and Alzheimer’s disease, the AOA reported. According to co-chairs, Peter Snyder, PhD, and Heather Snyder, PhD, this is a necessary step in identifying effective treatments for these neurodegenerative diseases, of which early preclinical biomarkers are uniquely amenable to noninvasive retinal/ocular imaging, with the eye serving as the window to the brain.
The next important milestone, according to Peter Snyder, PhD, is “the identification of validated retinal/ocular noninvasive biomarkers that could become essential to algorithms that may contain other markers apart from retinal/ocular biomarkers.” The importance of this effort lies in the data, which predict 152 million people to develop Alzheimer’s disease by 2050, with the world cost expected to reach $2 trillion by 2030 (Patterson).
The take-away message was that amyloid-beta plaque drives tauopathy and inflammation, leading to synaptic damage and neurologic/cell disfunction, the AOA reported. The researchers’ view was that we need to identify the disease process early to intervene during the prodromal phase when damage to synapses and neuronal tissue is minimal. We, therefore, Peter Snyder, PhD, said, “need detection and monitoring techniques with high sensitivity.”
A broad range of prominent world-class researchers shared prepublication concepts at the workshop, the results of which will be compiled into a soon-to-be-released white paper that will lead, it is hoped, to larger and more effective clinical trials.
Just a few of the many highlights of the 2-day meeting included: Astronaut Larry DeLucas, OD, PhD, provided insights to amyloid-beta and protein tau structures. Brett E. Bouma, PhD, discussed advanced use of 3D macular scans and blood flow measurement. Gregory P. Van Stavern, MD, reviewed retinal nerve fiber layer algorithms with cognitive testing overlay. Maya Koronyo-Hamaoui, PhD, discussed enlarged foveal avascular zones and retinal sweet spots. Melanie Campbell, MSc, PhD, covered cross-polarized light for predicting earlier stages of disease. Peter van Wijngaarden, PhD, FRANZCO, discussed hyperspectral retinal imaging. Robert Rissman PhD, presented a real-world trial of retinal imaging. Marius Tresor Chiasseu, PD, covered building a consensus on methodology. Silvia Di Angelantonio, PhD, reviewed microglia activation at the preclinical phase and imaging of neuroinflammation in the retina. SriniVas R. Sadda, MD, presented fluorescence lifetime imaging ophthalmoscopy in neurodegenerative diseases. Chiara La Morgia, MD, PhD, discussed sleep disturbances and melanopsin-retinal ganglion cell degeneration.
The AOA said that one day Alzheimer’s disease could be another responsibility for optometry within team-based medical management. This is why it is imperative for doctors of optometry to stay current on the latest continuing education and become involved in clinical research projects. “Pairing technology and understanding of early cognitive decline is going to be essential in raising our patients’ health outcomes and preventing or slowing neurodegenerative disease,” Duenas said.
Doctors of optometry who routinely use OCT and OCT angiography are already on the leading edge of ocular and systemic disease detection, and this research shows an opportunity to make a difference, the AOA said. Altogether, 276 systemic diseases have ocular findings that can be detected during a comprehensive eye examination that, combined with optometry's geographic accessibility, position doctors of optometry to substantially contribute to Americans’ primary medical care.
Patterson C. World Alzheimer Report 2018. https://www.alz.co.uk/research/WorldAlzheimerReport2018.pdf. Accessed June 6, 2019.