DOI: 10.1002/alz.076460 ISSN: 1552-5260

Characterizing the Retinal and Choroidal Microvasculature and Structure in Individuals with Dementia with Lewy Bodies

Suzanna Joseph, Ariana Allen, Alice Haystead, Anita Kundu, Angela Hemesath, Cason B Robbins, Justin Ma, Kim G Johnson, Sandra Stinnett, Dilraj S Grewal, Sharon Fekrat,
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Dementia with Lewy Bodies (DLB) accounts for about 7% of dementia cases. Multimodal retinal imaging may identify biomarkers in this population since there is a growing link between retinal alterations in DLB, with exploratory studies showing phosphorylated alpha‐synuclein retinal deposits, parafoveal thinning of ganglion cell inner‐plexiform layer (GC‐IPL), and electroretinography alterations (Beach et al., 2014, Murueta‐Goyena et al., 2019, Maurage et al., 2003). We used optical coherence tomography (OCT) and OCT angiography (OCTA) to characterize differences in retinal and choroidal microvasculature and structure in individuals with DLB compared to controls with normal cognition.


A cross‐sectional comparison of patients with DLB and age‐ and sex‐matched cognitively normal controls. Exclusion criteria included retinal or optic nerve pathology, glaucoma, and diabetes. The Zeiss Cirrus HD‐5000 with AngioPlex was used to obtain OCT and OCTA images. OCT parameters measured includes central subfield thickness (CST), retinal nerve fiber layer (RNFL) thickness, GC‐IPL thickness, and choroidal vascularity index (CVI). OCTA parameters measured include superficial capillary plexus foveal avascular zone (FAZ) area, fovea‐centered 3×3mm and 6×6mm vessel density (VD) and perfusion density (PD), and optic nerve head‐centered capillary perfusion density (CPD) and capillary flux index (CFI). Generalized estimating equations adjusted for correlation among eyes of the same subject.


Thirty‐four eyes of 18 DLB patients and 85 eyes of 48 cognitively normal controls were analyzed. Cases were well‐matched to controls by age (p = 0.977) and sex (p = 0.607). DLB patients had lower Mini Mental State Exam (MMSE) scores (p < 0.001). Average GC‐IPL thickness was lower in patients with DLB compared to controls (p = 0.04). Average 4.5×4.5mm CPD was higher in patients with DLB compared to controls (p = 0.005). Average 4.5×4.5mm CFI was lower in patients with DLB compared to controls (p = 0.016).


DLB patients had attenuated GC‐IPL thickness and peripapillary CPD and CFI changes when compared to those with normal cognition. Retinal imaging metrics have the potential to serve as clinically relevant biomarkers for DLB diagnosis.

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