Neuroretinal and microvascular retinal features in dementia with Lewy body assessed by optical coherence tomography angiography

Neurol Sci. 2025 Jan;46(1):185-194. doi: 10.1007/s10072-024-07683-6. Epub 2024 Aug 17.

Abstract

Objective: To explore retinal changes in patients with Dementia with Lewy Bodies (DLB) using Spectral Domain-Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCTA), aiming to identify potential biomarkers for diagnosis and monitoring.

Methods: A cross-sectional study analyzed 15 DLB patients and 18 matched controls. Participants underwent physical, neurological, neuropsychological, and ophthalmological evaluations, including SD-OCT and OCTA. Logistic regression, adjusted for age, sex, and inter-eye correlation, was employed to identify retinal alterations in patients affected by DLB.

Results: OCTA revealed that DLB is associated with reduced superficial and deep vessel densities (SVD and DVD) in the macula (p < 0.01), as well as decreased peripapillary vessel density (ppVD, p < 0.01). SD-OCT parameters showed correlations with DLB, including reduced central macular thickness (CMT, p < 0.001) and thinning of the ganglion cell layer-inner plexiform layer (GCL-IPL, p < 0.01). Logistic regression (R²=0.26) identified reduced ppVD as a significant predictor of DLB (p = 0.030).

Conclusions: Impairments in retinal capillaries, especially lower ppVD, might mirror cerebral hypoperfusion in DLB, potentially due to reduced Vascular Endothelial Growth Factor (VEGF) levels and increased α-synuclein. Further investigations are warranted to confirm the causal relationship between these observations, disease severity, and progression, as well as their potential role as biomarkers for DLB.

Keywords: Dementia with Lewy Bodies (DLB); Neurodegenerative diseases; Optical Coherence Tomography Angiography (OCTA); Peripapillary vessel density (ppVD); Retinal Biomarkers; Retinal Nerve Fiber Layer (RNFL); Retinal changes; Vascular Endothelial Growth Factor (VEGF).

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Female
  • Humans
  • Lewy Body Disease* / diagnostic imaging
  • Lewy Body Disease* / pathology
  • Male
  • Middle Aged
  • Retina / diagnostic imaging
  • Retina / pathology
  • Retinal Vessels* / diagnostic imaging
  • Retinal Vessels* / pathology
  • Tomography, Optical Coherence* / methods