Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
Department of Ophthalmology, Washington University in St. Louis, St. Louis, Missouri, USA; Department of Developmental Biology, Washington University in St. Louis, St. Louis, Missouri, USA; Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.
Am J Ophthalmol. 2020 Oct;218:337-341. doi: 10.1016/j.ajo.2020.04.040. Epub 2020 May 6.
To address challenges associated with identifying retinal biomarkers for Alzheimer's disease (AD) and strategies for future investigation of novel ophthalmologic biomarkers.
Perspective.
Summarization of the current understanding of retinal changes that have been identified using advances in imaging technology, analysis of current research into how these changes reflect neurodegenerative pathology, and recommendations for further research in this area that will allow for the identification of unique biomarkers for early AD.
Some retinal changes detectable using various imaging modalities may reflect neurodegeneration or other AD-related pathology on a cellular level. Structural changes in both the peripapillary and macular retina and changes in vascular parameters have been identified. Some imaging findings correlate with known histopathologic findings, and some are associated with cognitive decline. However, multiple challenges exist, such as identifying retinal biomarkers that are specific to biomarker-positive AD, clinical syndrome of AD, and/or pathologic AD brain, finding features that are highly sensitive and specific to AD in patients with other eye diseases, and validating potential biomarkers in population-based longitudinal cohorts.
Further research is needed to validate retinal biomarkers for AD, with accurate classification of patients according to diagnosis and cognitive symptoms. Advances in imaging technology, big data, and machine learning, as well as carefully designed studies, will help to identify and confirm potential biomarkers and may lead to novel treatment approaches.
探讨与阿尔茨海默病（AD）视网膜生物标志物识别相关的挑战，以及未来探索新型眼科生物标志物的策略。
观点。
总结目前对使用成像技术进步识别的视网膜变化的理解，分析这些变化如何反映神经退行性病理的当前研究，以及对该领域的进一步研究建议，这将允许识别用于早期 AD 的独特生物标志物。
使用各种成像方式检测到的一些视网膜变化可能反映了细胞水平上的神经退行性变或其他 AD 相关病理。已经确定了视盘周围和黄斑视网膜的结构变化以及血管参数的变化。一些影像学发现与已知的组织病理学发现相关，而另一些则与认知能力下降相关。然而，存在多种挑战，例如确定与 AD 阳性 AD、AD 临床综合征和/或 AD 病理性脑相关的视网膜生物标志物，发现具有其他眼部疾病的 AD 患者中高度敏感和特异性的特征，以及在基于人群的纵向队列中验证潜在的生物标志物。
需要进一步研究以验证 AD 的视网膜生物标志物，根据诊断和认知症状对患者进行准确分类。成像技术、大数据和机器学习的进步以及精心设计的研究将有助于识别和确认潜在的生物标志物，并可能带来新的治疗方法。
