Retinal Nerve Fiber Layer Measurement in Patients with Alzheimer’s Disease

Authors: Z. Kasl 1;  Š. Rusňák 1;  N. Jirásková 2;  P. Rozsíval 2;  M. Krčma 3;  J. Laczó 4;  M. Vyhnálek 4;  J. Hort 4
Authors‘ workplace: Oční klinika LF UK a FN Plzeň 1;  Oční klinika LF UK a FN Hradec Králové 2;  1. interní klinika LF UK a FN Plzeň 3;  Neurologická klinika 2. LF UK a FN v Motole, Praha 4
Published in: Cesk Slov Neurol N 2016; 79/112(4): 424-429
Category: Original Paper
doi: 10.14735/amcsnn2016424


Alzheimer’s disease (AD) is the most common cause of dementia syndrome and mild cognitive impairment (MCI). Current diagnostic methods are expensive, challenging and burdening for patients. Therefore, alternative diagnostic methods suitable for early diagnosis are still being sought. Evaluation of retinal nerve fiber layer (RNFL) thickness, well accessible to examination through optical apparatus, could be one of the options.

The aim of our research was to evaluate RNFL thickness in several peri-papillary quadrants of the retina by patients with AD and MCI measured with the optical coherence tomography (OCT) and to match the results with a control cohort.

Patients and methods:
24 AD patients, precisely 48 measured eyes, and 10 MCI patients, precisely19 eyes, were included. The control cohort included 26 patients, precisely 51 eyes. All patients underwent detailed ophtalmological checkup and RNFL thickness in the area circular around the optic nerve head via OCT was measured.

We did not find any statistically significant difference of RNFL thickness between the studied and control cohort in any peri-papillary quadrant of the retina.

The procedure we selected and our results have confirmed the advantages of retinal examination as a practical, timely and patient non-burdening method. Our results also contribute to the discussion on the benefits of this procedure in AD diagnostics. Previous research provided inconsistent results and they differed in used procedures and characteristics of selected cohorts. There is a need for further studies to assess utility of OCT in AD diagnostics with respect to convenience of application of this method into clinical practice.

Key words:
Alzheimer disease – optical coherence tomography – retinal nerve fiber layer

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. McKhann GM, Knopman DS, Cherkow H, et al. The diagnosis of dementia due to Alzheimer‘s disease: recommendations from the National Institute on Aging-Alzheimer‘s Association workgroups on diagnostic guidelines for Alzheimer‘s disease. Alzheimers Dement 2011;7(3):263– 9. doi: 10.1016/ j.jalz.2011.03. 005.

2. Albert MS. Changes in cognition. Neurobiol Aging 2011;32(Suppl 1):58– 63. doi: 10.1016/ j.neurobiolaging. 2011.09.010.

3. Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer‘s disease: recommendations from the National Institute on Aging-Alzheimer‘s Association workgroups on diagnostic guidelines for Alzheimer‘s disease. Alzheimers Dement 2011;7(3):280– 92. doi: 10.1016/ j.jalz.2011.03. 003.

4. Blanks JC, Torigoe Y, Hinton DR, et al. Retinal pathology in Alzheimer‘s disease. I. Ganglion cell loss in foveal/ parafoveal retina. Neurobiol Aging 1996;17(3):377– 84.

5. Guo L, Duggan J, Cordeiro MF. Alzheimer‘s disease and retinal neurodegeneration. Curr Alzheimer Res 2010;7(1):3– 14.

6. Gharbiya M, Trebbastoni A, Parisi F, et al. Choroidal thinning as a new finding in Alzheimer‘s disease: evidence from enhanced depth imaging spectral domain optical coherence tomography. Alzheimers Dis 2014;40(4):907– 17. doi: 10.3233/ JAD-132039.

7. Kergoat H, Kergoat MJ, Justino L, et al. An evaluation of the retinal nerve fiber layer thickness by scanning laser polarimetry in individuals with dementia of the Alzheimer type. Acta Ophthalmol Scand 2001;79(2): 187– 91.

8. Gao L, Liu Y, Li X, et al. Abnormal retinal nerve fiber layer thickness and macula lutea in patients with mild cognitive impairment and Alzheimer‘s disease. Arch Gerontol Geriatr 2015;60(1):162– 7. doi: 10.1016/ j.archger. 2014.10.011.

9. Kirbas S, Turkyilmaz K, Anlar O, et al. Retinal nerve fiber layer thickness in patients with Alzheimer disease. J Neuroophthalmol 2013;33(1):58– 61. doi: 10.1097/ WNO.0b013e318267fd5f.

10. Kesler A, Vakhapova V, Korczyn AD, et al. Retinal thickness in patients with mild cognitive impairment and Alzheimer‘s disease. Clin Neurol Neurosurg 2011;113(7):523– 6. doi: 10.1016/ j.clineuro.2011.02.014.

11. Parisi V, Restuccia R, Fattapposta F, et al. Morphological and functional retinal impairment in Alzheimer‘s disease patients. Clin Neurophysiol 2001;112(10):1860– 7.

12. Berisha F, Feke GT, Trempe CL, et al. Retinal abnormalities in early Alzheimer‘s disease. Invest Ophthalmol Vis Sci 2007;48(5):2285– 9.

13. Iseri PK, Altinaş O, Tokay T, et al. Relationship between cognitive impairment and retinal morphological and visual functional abnormalities in Alzheimer disease. J Neuroophthalmol 2006;26(1):18– 24.

14. Fernandes DB, Raza AS, Noqueira RG, et al. Evaluation of inner retinal layers in patients with multiple sclerosis or neuromyelitis optica using optical coherence tomography.Ophtalmology 2013;120(2):387– 94. doi: 10.1016/j. ophtha.2012.07.066.

15. Oberwarenbrock S, Schipling S, Ringelstein M, et al. Retinal damage in multiple sclerosis disease subtypes measured by high resolution optical coherence tomography. Mult Scler Int 2012;2012:530305. doi: 10.1155/ 2012/ 530305.

16. Yanni SE, Wang J, Cheng CHS, et al. Normative reference ranges for the retinal nerve fiber layer, macula and retinal layer thickness in children. Am J Ophthalmol 2013;155(2):354– 60. doi: 10.1016/ j.ajo.2012.08.010.

17. Výborný P, Fučík M, Rozsíval P. Glaukom. In: Kuchynka P et al. Oční lékařství. Praha: Grada Publishing 2007:555– 607.

18. Kousal B. Fyzikální podstata OCT vyšetření. In: Němec P, Lofflerová V, Kousal B, eds. Optická koherenční tomografie. Klinický atlas sítnicových patologií. Praha: Mladá fronta 2015:13– 6.

19. Schuman JS. Spectral domain optical coherence tomography for glaucoma (an AOS thesis). Trans Am Ophthalmol Soc 2008;106:426– 58.

20. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256(3):183– 94.

21. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis

of Alzheimer‘s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer‘ s Disease. Neurology 1984;34(7):939– 44.

22. Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment – beyond controversies towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256(3): 240– 6.

23. Hort J, Glosova L, Vyhnalek M, et al. Tau protein a beta amyloid v likvoru u Alzheimerovy choroby. Cesk Slov Neurol N 2007;70/ 103(1):30– 6.

24. Hinton DR, Sadun AA, Blanks JC, et al. Optic-nerve degeneration in Alzheimer‘s disease. N Engl J Med 1986;315(8):485– 7.

25. Curcio CA, Drucker DN. Retinal ganglion cells in Alzheimer‘s disease and aging. Ann Neurol 1993;33(3):248– 57.

26. Pakravan M, Pakbin M, Aghazadehamiri M, et al. Peripapillary retinal nerve fiber layer thickness measurement by 2 different spectral domain optical coherence tomography machines. Eur J Ophthalmol 2013;23(3):289– 95. doi: 10.5301/ ejo.5000167.

27. Pierro L, Gagliardi M, Iuliano L, et al. Retinal nerve fiber layer thickness reproducibility using seven different OCT instruments. Invest Ophthalmol Vis Sci 2012;53(9):5912– 20. doi: 10.1167/ iovs.11-8644.

28. Kierman DF, Hariprasad SM. Normative Databases in SD-OCT: a status report a comprehensive look at the evolution of OCT software design and database development. [online]. Available from URL: articleviewer.aspx?articleID=104438.

29. Paquet C, Boissonnot M, Roger F, et al. Abnormal retinal thickness in patients with mild cognitive impairment and Alzheimer‘s disease. Neurosci Lett 2007;420(2):97– 9.

30. Kromer R, Serbecic N, Hausner L, et al. Detection of retinal nerve fiber layer defects in Alzheimer‘s disease using SD-OCT. Front Psychiatry 2014;5:22. doi: 10.3389/ fpsyt.2014.00022.

31. Kirbas S, Tufekci A, Turkyilmaz K, et al. Evaluation of the retinal changes in patients with chronic migraine. Acta Neurol Belg 2013;113(2):167– 72. doi: 10.1007/ s13760-012-0150-x.

32. Bodis-Wollner I. Foveal vision is impaired in Parkinson‘ s disease. Parkinsonism Relat Disord 2013;19(1):1– 14. doi: 10.1016/ j.parkreldis.2012.07.012.

33. Chu EM, Kolappan M, Barnes TR, et al. A window into the brain: an in vivo study of the retina in schizophrenia using optical coherence tomography. Psychiatry Res 2012;203(1):89– 94. doi: 10.1016/ j.pscychresns.2011.08.011.

34. Hong SW, Ahn MD, Kang SH, et al. Analysis of peripapillary retinal nerve fiber distribution in normal young adults. Invest Ophthalmol Vis Sci 2010;51(7):3515– 23. doi: 10.1167/ iovs.09-4888.

35. Pula JH, Kattah JC, Wang H, et al. Ability of a neuro-ophthalmologist to estimate retinal nerve fiber layer thickness. Clin Ophthalmol 2012;6:1477– 81. doi: 10.2147/ OPTH.S34573.

36. Schallenberg M, Dekowski D, Kremmer S, et al. Comparison of Spectralis-OCT, GDxVCC and GDxECC in assessing retinal nerve fiber layer (RNFL) in glaucomatous patients. Graefes Arch Clin Exp Ophthalmol 2013;251(5):1343– 53. doi: 10.1007/ s00417-012-2219-x.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2016 Issue 4

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account