Retinal Imaging Identifies Disease Progression, Differentiation of Synucleinopathies

eye retina
eye retina
OCT can precisely measure changes to the retinal structure.

The eyes may have it when it comes to biomarkers of disease progression of synucleinopathies, such as multiple system atrophy (MSA), Parkinson’s disease, and dementia with Lewy bodies.  A team of researchers from New York University Langone Medical Center’s Dysautonomia Center found that disease progression can be charted via imaging of retinal thickness changes, and this technology may have applications in clinical trial design.

“Retinal imaging provides a window into the brain,” lead author Carlos E. Mendoza-Santiesteban, MD, adjunct professor in the Department of Neurology at New York University, told Neurology Advisor. “In the past, determination of disease progression of synucleinopathies was subjective and relied on clinical skill. Retinal imaging technology provides a biomarker. It is a more objective way to monitor progression of disease and observe how various therapeutic agents in development may affect disease progression,” he said.

High-definition optical coherence tomography (OCT), unlike magnetic resonance imaging, can precisely measure changes to the retinal structure. The use of OCT in neurological diseases is not new, though. It already has been shown to have value as a biomarker in diseases such as multiple sclerosis, said Dr Mendoza-Santiesteban. Through a grant from the Michael J. Fox Foundation, he and colleagues are now studying the value of OCT in discovering patterns of disease that can distinguish one synucleinopathy from another. The first in a series of planned studies focused on Parkinson’s disease and MSA.

CLINICAL CHART: Parkinsonism Treatments

Reduced retinal thicknesses is a known consequence of MSA and Parkinson’s disease, however, whether the pattern and cause are similar and whether the retinal abnormalities worsen over time have heretofore been unknown. Whereas retinal changes are largely asymptomatic in patients with MSA, they can express themselves as impaired visual acuity, color discrimination, and motion perception or visual hallucinations in patients with Parkinson’s disease and other Parkinson-like diseases. To assess whether retinal imaging can provide clues to neuro-ophthalmologic differences between MSA and Parkinson’s disease and disease progression in MSA, the team examined retinal thickness in 24 patients with MSA, 20 patients with Parkinson’s disease, and 35 controls in a cross-sectional study that was followed by a longitudinal study of 13 patients with MSA. Patients underwent OCT and were assessed via the Unified Multiple System Atrophy Rating Scale at baseline and at consecutive follow-up visits for up to 26 months.