The retina as a window to

the brain from eye research

to CNS disorders
The eye as a model of the CNS (AGN) Eye-based diagnosis
of CNS disorders :
Stroke
Multiple sclerosis
Alzheimer disease
Multiple Sclerosis
• Optical coherence tomography (OCT) is a retinal imaging technique used to measure changes
in RNFL thick ness and macular volume, both of which are decreased in several
neurodegenerative disorders, including MS. Reports indicate that many patients with MS
exhibit optic neuritis as a presenting symptom; consequently, methods used for the diagnosis
of optic neuritis, such as OCT and visual evoked potentials, may be beneficial in enabling early
diagnosis of MS. Indeed, patients diagnosed with optic neuritis should be referred to a
neurologist for an MS ­directed examination. Notably, OCT has enabled quantitative measure­
ment of RNFL thinning even in patients with MS who do not have a history of optic neuritis,
and OCT measures were found to correlate with MRI outcomes in MS.
• To distinguish between MS and neuromyelitis optica (NMO)—an inflammatory demyelinating
disease of the spinal cord and optic nerve that is often mis­diagnosed as MS—is important.
Studies using OCT have shown that after episodes of optic neuritis, which tend to be more
severe in NMO, thinning of the RNFL is more pronounced in patients with NMO than in those
with MS. OCT could, therefore, aid in the differentiation of these two conditions.
Multiple Sclerosis
• Optical coherence tomography (OCT) merupakan tehnik pengambilan gambar
retina yang mengukur perubahan ketebalan RNFL dan volume macula.
• Perubahan ketebalan RNFL dan Volume makula yang menurun, terdapat pada
beberapa penyakit neurodegeneratif, termasuk MS.
• Laporan menunjukkan bahwa beberapa pasien dengan MS menunjukkan gejala
neuritis optik; Akibatnya, metode yang digunakan untuk mengdiagnosis neuritis
optik, seperti OCT dan Visual evoked potentials, memungkinkan dapat digunakan
untuk mendiagnosis MS secara dini.
• Pasien yang terdiagnosis optik neuritis harus di rujuk ke dokter neurologi untuk
pemeriksaan skrining MS. Khususnya OCT dapat mengukur secara kuantitatif
ketebalan RNFL pada pasien dengan MS yang tidak memiliki riwayat optik neuritis,
dan pengukuran OCT berkolerasi terhadap hasil MRI pada pasien MS
Multiple Sclerosis
• Untuk membedakan antara MS dan Neuromyelitis Optica (NMO),
penyakit inflammatory demyelinating pada spinal cord dan optic
nerve yang terutama sering salah diagnosis sebagai MS.
• Studi menggunakan OCT diketahui sebagai episode neuritis optik,
dimana lebih parah pada NMO, RNFL yang menipis lebih jelas pada
pasien dengan NMO dibandingkan dengan MS. Oleh karena itu OCT
dapat membantu untuk membedakan kedua kondisi ini.
Alzheimer disease
• OCT has also been used to assess RNFL thickness in patients with mild
cognitive impairment (MCI) and AD. Interestingly, RNFL thickness was
reduced both in patients with MCI and in those with AD of diferent
severities compared with healthy controls, but the difference in RNFL
thickness between patients with MCI and those with mild AD was not
statistically significant. This finding suggests that RNFL thinning is an
early event in AD pathology.
Alzheimer disease
• OCT has also been used to assess RNFL thickness in patients with mild cognitive impairment
(MCI) and AD. Interestingly, RNFL thickness was reduced both in patients with MCI and in
those with AD of diferent severities compared with healthy controls, but the difference in
RNFL thickness between patients with MCI and those with mild AD was not statistically
significant. This finding suggests that RNFL thinning is an early event in AD pathology.
• In a recent study in which curcumin was adminis­tered to label plaques of Aβ, such plaques
were detected in retinas of live AD transgenic mice before they could be detected in the
brains of these animals. As retinal Aβ plaques were also found in the eyes from patients
with AD during postmortem analyses, live imaging of the retina could be a useful tool for
early diagnosis of AD. Moreover, treatment that effectively restricted Aβ plaque burden in
brains of AD transgenic mice also caused a substantial reduction in retinal plaque burden,
which suggests that monitoring the eye can be useful not only in the diagnosis of AD, but
also for follow­up analysis of therapeutic efficacy.
Alzheimer disease
• OCT digunakan untuk menilai ketebalan RNFL pada pasien dengan
mild cognitive impairment (MCI) dan Alzheimer Disease (AD).
• Ketebalan RNFL berkurang pada kedua pasien dengan MCI dan AD
yang tingkat keparahannya berbeda dibandingkan dengan pasien
kontrol, tetapi perbedaan ketebalan antara RNFL antara pasien
dengan MCI dan AD ringan secara statistik tidak signifikan.
• Temuan ini menunjukkan bahwa penipisan RNFL sebagai bentuk awal
pada patologi AD
Alzheimer disease
• Dalam sebuah studi dimana curcumin diberikan label plak Aβ, yang
mendeteksi retina pada tikus yang hidup dengan AD transgenik yang
sebelumnya mereka tidak dapat mendeteksi otak dari hewan tersebut.
• Retina plak Aβ juga ditemukan pada mata pasien dengan AD selama
analisis postmortem, pengambilan gambaran retina secara langsung
dapat berfungsi sebagai alat diagnosis dini pada AD.
• Selain itu, terapi yang efektif membatasi beban plak Aβ (Aβ plaque
burden) di otak tikus AD transgenic menyebabkan penurunan substansial
di retinal plaque burden, yang menunjukan mata tidak hanya digunakan
untuk diagnosis AD, tetapi dapat sebagai analisis follow up terapi efikasi.