10 Sep 20. Featured Paper
The application of optical coherence tomography angiography in cerebral small vessel disease, ischemic stroke, & dementia: a systematic review.
Link to paper in Frontiers Neurology.
Jun-Fang Zhang, Stewart Wiseman, Maria C. Valdés-Hernández, Fergus N. Doubal, Baljean Dhillon, Yun-Cheng Wu & Joanna M. Wardlaw
Objective: To investigate the application of optical coherence tomography angiography (OCTA) in cerebral small vessel disease (SVD), ischemic stroke & dementia.
Methods: We conducted a systematic search in MEDLINE (from inception) & EMBASE (from 1980) to end 2019 for human studies that measured retinal parameters in cerebral SVD, ischemic stroke, & dementia using OCTA.
Results: Fourteen articles (n = 989) provided relevant data.
Ten studies included patients with Alzheimer disease (AD) & mild cognitive impairment (n = 679), two investigated pre-symptomatic AD participants (n = 154), & two investigated monogenic SVD patients with cerebral autosomal dominant arteriopathy with subcortical infarcts & leukoencephalopathy (n = 32) & Fabry disease (n = 124).
Methods to reduce bias & risk factor adjustment were poorly reported.
Substantial methodological variations between studies precluded a formal meta-analysis.
Quantitative measurements revealed significant yet inconclusive changes in foveal avascular zone, perfusion density, & vessel density (VD) in AD, presymptomatic AD, & SVD patients.
Two (n = 160) of three studies (n = 192) showed association between decreased VD & increased white matter hyperintensities.
In three (n = 297) of seven studies (n = 563), better cognitive function was associated with increased VD.
One study (n = 52) suggested increased VD was associated with increased ganglion cell–inner plexiform layer thickness in AD yet with no covariate adjustment.
Conclusions: Changes in retinal microvasculature identified using OCTA are associated with monogenic SVD & different stages of AD, but data are limited & partly confounded by methodological differences.
Larger studies with risk factors adjustment & more consistent OCTA methods are needed to fully exploit this technology.
Cerebral small vessel disease
Optical coherence tomography angiography
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