Cunha J P, Moura-Coelho N, Proença R P, Dias-Santos A, Ferreira J, Louro C, Castanheira-Dinis A
CHCL - Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Nova Medical School/Faculdade de Ciências Médicas (NMS/FCM), Universidade Nova de Lisboa, Centro Hospitalar de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisbon, Portugal.
Graefes Arch Clin Exp Ophthalmol. 2016 Nov;254(11):2079-2092. doi: 10.1007/s00417-016-3430-y. Epub 2016 Jul 4.
Alzheimer's disease (AD) is a prevalent, long-term progressive degenerative disorder with great social impact. It is currently thought that, in addition to neurodegeneration, vascular changes also play a role in the pathophysiology of the disease. Visual symptoms are frequent and are an early clinical manifestation; a number of psychophysiologic changes occur in visual function, including visual field defects, abnormal contrast sensitivity, abnormalities in color vision, depth perception deficits, and motion detection abnormalities. These visual changes were initially believed to be solely due to neurodegeneration in the posterior visual pathway. However, evidence from pathology studies in both animal models of AD and humans has demonstrated that neurodegeneration also takes place in the anterior visual pathway, with involvement of the retinal ganglion cells' (RGCs) dendrites, somata, and axons in the optic nerve. These studies additionally showed that patients with AD have changes in retinal and choroidal microvasculature. Pathology findings have been corroborated in in-vivo assessment of the retina and optic nerve head (ONH), as well as the retinal and choroidal vasculature. Optical coherence tomography (OCT) in particular has shown great utility in the assessment of these changes, and it may become a useful tool for early detection and monitoring disease progression in AD. The authors make a review of the current understanding of retinal and choroidal pathological changes in patients with AD, with particular focus on in-vivo evidence of retinal and choroidal neurodegenerative and microvascular changes using OCT technology.
阿尔茨海默病（AD）是一种常见的、长期进展性的退行性疾病，具有重大的社会影响。目前认为，除神经退行性变外，血管变化在该疾病的病理生理学中也起作用。视觉症状很常见，是早期临床表现；视觉功能会发生一些心理生理变化，包括视野缺损、异常对比敏感度、色觉异常、深度感知缺陷和运动检测异常。这些视觉变化最初被认为完全是由于视觉后通路的神经退行性变所致。然而，来自AD动物模型和人类病理研究的证据表明，神经退行性变也发生在前视觉通路，视网膜神经节细胞（RGCs）的树突、胞体和视神经中的轴突均受累。这些研究还表明，AD患者的视网膜和脉络膜微血管有变化。视网膜和视神经乳头（ONH）以及视网膜和脉络膜血管系统的体内评估证实了病理结果。特别是光学相干断层扫描（OCT）在评估这些变化方面显示出很大的实用性，它可能成为AD早期检测和监测疾病进展的有用工具。作者综述了目前对AD患者视网膜和脉络膜病理变化的认识，特别关注使用OCT技术对视网膜和脉络膜神经退行性变和微血管变化的体内证据。
