Search

Introduction: Alzheimer’s disease (AD) is the most common form of dementia affecting the central nervous system, and alteration of several visual structures has been reported. Structural retinal changes are usually accompanied by changes in visual function in this disease. The aim of this study was to analyse the differences in visual function at different stages of the pathology (family history group (FH+), mild cognitive impairment (MCI), mild AD and moderate AD) in comparison with a control group of subjects with no cognitive decline and no family history of AD. Methods: We included 53 controls, 13 subjects with FH+, 23 patients with MCI, 25 patients with mild AD and, 21 patients with moderate AD. All were ophthalmologically healthy. Visual acuity (VA), contrast sensitivity (CS), colour perception, visual integration, and fundus examination were performed. Results: The analysis showed a statistically significant decrease in VA, CS and visual integration score between the MCI, mild AD and moderate AD groups compared to the control group. In the CS higher frequencies and in the colour perception test (total errors number), statistically significant differences were also observed in the MCI, mild AD and moderate AD groups with respect to the FH+ group and also between the control and AD groups. The FH+ group showed no statistically significant difference in visual functions compared to the control group. All the test correlated with the Mini Mental State Examination score and showed good predictive value when memory decline was present, with better values when AD was at a more advanced stage. Conclusion: Alterations in visual function appear in subjects with MCI and evolve when AD is established, being stable in the initial stages of the disease (mild AD and moderate AD). Therefore, visual psychophysical tests are a useful, simple and complementary tool to neuropsychological tests to facilitate diagnosis in the preclinical and early stages of AD., Research Network RETIBRAIN, Spanish Ministry of Science and Innovation, Spanish Ministry of Economy and Competitiviness, NEUROCENTRO. IL-C, Complutense University of Madrid, Depto. de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Glaucoma is a neurodegenerative disease of the retina characterized by the irreversible loss of retinal ganglion cells (RGCs) leading to visual loss. Degeneration of RGCs and loss of their axons, as well as damage and remodeling of the lamina cribrosa are the main events in the pathogenesis of glaucoma. Different molecular pathways are involved in RGC death, which are triggered and exacerbated as a consequence of a number of risk factors such as elevated intraocular pressure (IOP), age, ocular biomechanics, or low ocular perfusion pressure. Increased IOP is one of the most important risk factors associated with this pathology and the only one for which treatment is currently available, nevertheless, on many cases the progression of the disease continues, despite IOP control. Thus, the IOP elevation is not the only trigger of glaucomatous damage, showing the evidence that other factors can induce RGCs death in this pathology, would be involved in the advance of glaucomatous neurodegeneration. The underlying mechanisms driving the neurodegenerative process in glaucoma include ischemia/hypoxia, mitochondrial dysfunction, oxidative stress and neuroinflammation. In glaucoma, like as other neurodegenerative disorders, the immune system is involved and immunoregulation is conducted mainly by glial cells, microglia, astrocytes, and Müller cells. The increase in IOP produces the activation of glial cells in the retinal tissue. Chronic activation of glial cells in glaucoma may provoke a proinflammatory state at the retinal level inducing blood retinal barrier disruption and RGCs death. The modulation of the immune response in glaucoma as well as the activation of glial cells constitute an interesting new approach in the treatment of glaucoma., Santander-Universidad Complutense de Madrid, Depto. de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Fac. de Medicina, TRUE, pub

Copyright © 2015 Elena Salobrar-Garcia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited., Purpose. To analyze in mild Alzheimer's disease (MAD) patients, GDS-4 (Reisberg Scale), whether or not some psychophysical tests (PTs) support OCT macular findings in the same group of MAD patients reported previously. Methods. Twenty-three MAD patients and 28 age-matched control subjects with mean Mini Mental State Examination of 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision were included. Best-corrected visual acuity (VA), contrast sensitivity (CS) (3, 6, 12, and 18 cpds), color perception (CP), and perception digital test (PDT) were tested in one eye of each patient. Results. In comparison with the controls, MAD patients presented (i) a significant decrease in VA, PDT, and CS for all spatial frequencies analyzed, especially the higher ones, and (ii) a significant increase in unspecific errors on the blue axis (P < 0.05 in all instances). In MAD patients, a wide a ROC curve was plotted in all PTs. Conclusions. In MAD, CS, VA, and the tritan axis in CP were impaired. The PTs with the greatest predictive value are the higher spatial frequencies in CS and tritan unspecific errors in CP. PT abnormalities are consistent with the structural findings reported in the same MAD patients using OCT., Ministerio de Ciencia e Innovación (MICINN), Ministerio de España de Educación, Cultura y Deporte, RETICs prevención, detección precoz y tratamiento de la patología ocular prevalente degenerativa y crónica (OFTARED) (Ministerio de España de Ciencia e Innovación), Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Although several postmortem findings in the retina of patients with Alzheimer's disease (AD) are available, new biomarkers for early diagnosis and follow-up of AD are still lacking. It has been postulated that the defects in the retinal nerve fiber layer (RNFL) may be the earliest sign of AD, even before damage to the hippocampal region that affects memory. This fact may reflect retinal neuronal-ganglion cell death and axonal loss in the optic nerve in addition to aging., Ministerio de Ciencia e Innovación (MICINN), Redes temáticas de investigación cooperativa en salud (RETICs), Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

En Open Access en la web del editor. Submission: Mar 17, 2015 Acceptance: Aug 22, 2015 Publication Dec 31, 2015, The purpose of this paper is to conduct a review of studies on cystoid macular edema published in the last seven years. Cystoid macular edema is a major cause of loss of visual acuity. It is the final common pathway of many diseases and can be caused by numerous processes including inflammatory, vascular, adverse drug reactions, retinal dystrophy or intraocular tumors. These processes disrupt the blood-retinal barrier, with fluid extravasation to the macular parenchyma. Imaging tests are essential for both detection and monitoring of this pathology. Fluorescein angiography and autofluorescence show the leakage of liquid from perifoveal vessels into the tissue where it forms cystic spaces. Optical coherence tomography is currently the gold standard technique for diagnosis and monitoring. This allows objective measurement of retinal thickness, which correlates with visual acuity and provides more complete morphological information. Based on the underlying etiology, the therapeutic approach can be either surgical or medical with anti-inflammatory drugs. We found that disruption of the blood-retinal barrier for various reasons is the key point in the pathogenesis of cystoid macular edema, therefore we believe that studies on its treatment should proceed on this path., Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Memoria final del Proyecto de Innovación Docente diseñado para permitir a los alumnos que cursan la asignatura de Técnicas de Diagnóstico Ocular para Ópticos-Optometristas, impartida en el 4º curso del Grado de Óptica y Optometría la posibilidad de obtener los conocimientos de manera telemática, para poder realizar las prácticas hospitalarias sin problemas.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disease that severely impairs the patient’s mobility, as it mainly affects the upper and lower motor neurons in the spinal cord. In addition, alterations have also been demonstrated in different parts of the central nervous system (CNS), such as the brain and brainstem. The retina is a projection to the brain and is considered as a “window” to the CNS. Moreover, it is possible to use the retina as a biomarker in several neurodegenerative diseases, even in the absence of major visual impairment. Classically, it was thought that the eyes were not affected in ALS, with respect to extraocular muscles, whereas the remainder of the muscles of the body were distressed. Nevertheless, retinal changes have recently been found in this pathology and could help in diagnosis, follow-up, and even monitoring therapies in this disease.

Permitir a los alumnos deportistas de alto nivel (DAN) que cursan la asignatura de Oftalmología, impartida en el 4º curso del Grado de Medicina, la posibilidad de obtener los conocimientos de esta asignatura de manera telemática con libertad de horarios, permitiendo seguir el curso al igual que el resto de sus compañeros.

Glaucoma is an age-related neurodegenerative disease that begins at the onset of aging. In this disease, there is an involvement of the immune system and therefore of the microglia. The purpose of this study is to evaluate the microglial activation using a mouse model of ocular hypertension (OHT) at the onset of aging. For this purpose, we used both naive and ocular hypertensives of 15-month-old mice (early stage of aging). In the latter, we analyzed the OHT eyes and the eyes contralateral to them to compare them with their aged controls. In the eyes of aged naive, aged OHT and aged contralateral eyes, microglial changes were observed compared to the young mice, including: (i) aged naive vs young naive: An increased soma size and vertical processes; (ii) aged OHT eyes vs young OHT eyes: A decrease in the area of the retina occupied by Iba-1 cells and in vertical processes; and (iii) aged contralateral vs young contralateral: A decrease in the soma size and arbor area and an increase in the number of microglia in the outer segment layer. Aged OHT eyes and the eyes contralateral to them showed an up-regulation of the CD68 expression in the branched microglia and a down-regulation in the MHCII and P2RY12 expression with respect to the eyes of young OHT mice. Conclusion: in the early phase of aging, morphological microglial changes along with changes in the expression of MHCII, CD68 and P2RY12, in both naive and OHT mice. These changes appear in aged OHT eyes and the eyes contralateral to them eyes.

La Enfermedad de Alzheimer (EA) es una degeneración primaria, caracterizada por la afectación de las funciones cognitivas corticales, con un alto impacto a nivel funcional, un establecimiento lento y progresivo y por la aparición de depósitos de beta amiloide y los ovillos neurofibrilares. La retina es una proyección embrionaria del diencéfalo, y se consideran parte del sistema nervioso central. La degeneración producida en la retina y en el nervio óptico en la EA puede originarse por vía retrógrada desde la corteza visual o por vía directa desde la propia retina causada por los depósitos. Estos cambios anatómicos pueden ser detectados con técnicas de diagnóstico oftalmológicas que posibiliten el seguimiento de los cambios según progresa la neurodegeneración. Objetivos: Detectar los cambios que se producen en la retina, así como los cambios funcionales que se originan secundariamente, mediante pruebas psicofísicas oftalmológicas no invasivas y tomografía de coherencia óptica, en dos poblaciones de pacientes con EA, diferenciadas por el grado de evolución de la patología; comparando los resultados con una población control..., Alzheimer's disease (AD) is a primary degenerative disease that establishes itself slowly and progressively, involves the appearance of amyloid beta deposits and neurofibrillary tangles and affects cortical cognitive functions in ways that strongly reduce level of functioning. AD can cause degeneration in the retina and optic nerve either directly as a result of amyloid beta deposits or secondarily as a result of degradation of the visual cortex. This raises the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. Aim: To detect retinal changes and associated functional changes in two groups of AD patients with mild and moderate disease and in a group of healthy controls using non-invasive psychophysical ophthalmological tests and optical coherence tomography...

The retina is part of the central nervous system (CNS), and therefore, in Alzheimer’s disease (AD), retinal and optic nerve degeneration could take place. This degeneration leads to neurofunctional changes that can be detected early and followed up throughout the evolution of the disease. As opposed to other CNS structures, the eye is easily accessible for in vivo observation. Retinal organization allows for the identification of its different neurons, and in consequence, detection of minimal changes taking place during neurodegeneration is possible. Functional vision studies performed on AD patients in recent years have shown how visual acuity, contrast sensitivity, color vision, and visual integration vary with the progression of neurodegeneration. The development of optical coherence tomography in ophthalmology has meant a breakthrough in retinal exploratory techniques, allowing the obtention of high-resolution images using light. This technique enables retinal analysis in the earliest stages of AD, being considered as a biomarker of neuronal damage. Given AD’s high prevalence and its expected increase, it is important to perform easy tests that cause minimal discomfort to the patients at a low cost while offering abundant information on the stage of the disease.

The optic nerve (ON) is constituted by the axons of the retinal ganglion cells (RGCs). These axons are distributed in an organized pattern from the soma of the RGC to the lateral geniculated nucleus (where most of the neurons synapse). The key points of the ON are the optic nerve head and chiasm. This chapter will include a detailed and updated review of the ON different parts: RGC axons, glial cells, connective tissue of the lamina cribrosa and the septum and the blood vessels derivate from the central retina artery and from the ciliary system. There will be an up-to-date description about the superficial nerve fibre layer, including their organization, and about prelaminar, laminar and retrolaminar regions, emphasizing the axoplasmic flow, glial barriers, biomechanics of the lamina cribrosa and the role of the macro- and microglia in their working.

Over the last few decades, the importance of ophthalmic examination in neurodegenerative diseases of the CNS has reportedly increased. The retina is an extension of the CNS and thus should not be surprising to find abnormal results in both the test exploring visual processing and those examining the retina of patients with CNS degeneration. Current in vivo imaging techniques are allowing ophthalmologists to detect and quantify data consistent with the histopathological findings described in the retinas of Alzheimer’s disease (AD) patients and may help to reveal unsuspected retinal and optic‐nerve repercussions of other CNS diseases. In this chapter, we perform an analysis of the physiological changes in ocular and cerebral ageing. We analyse the ocular manifestations in CNS disorders such as stroke, AD and Parkinson’s disease. In addition, the pathophysiology of both the eye and the visual pathway in AD are described. The value of the visual psychophysical tests in AD diagnosis is reviewed as well as the main findings of the optical coherence tomography as a contribution to the diagnosis and monitoring of the disease. Finally, we examine the association of two neurodegenerative diseases, AD and glaucoma, as mere coincidence or possible role in the progression of the neurodegeneration.

Most studies employing experimental models of unilateral glaucoma have used the normotensive contralateral eye as the normal control. However, some studies have recently reported the activation of the retinal macroglia and microglia in the uninjured eye, suggesting that the eye contralateral to experimental glaucoma should not be used as a control. This review analyzes the studies describing the contralateral findings and discusses some of the routes through which the signals can reach the contralateral eye to initiate the glial reactivation.