Optical coherence tomography to distinguish Parkinson disease versus supranuclear progressive palsy

Abstract

PurposeThe aim of the study was to examine patterns of peripapillary andretinal layer damage as a potential marker of neurodegeneration in Parkinson'sdisease (PD) compared to progressive supranuclear palsy (PSP) with 2 SD‐ OCTdevices.MethodsPeripapillary retinal nerve fiber layer (pRNFL), macular thickness (MT)and ganglion cell layer inner plexiform analysis (GCA) by Cirrus and pRNFL analysis and automaticsingle retinal layers macular segmentation by Spectralis were used to evaluate38 patients with PD and 15 patients with PSP.ResultsMean average and superior RNFL by Cirrus were thicker in PD compared to PSP (p = 0.001). The mean central, superior, supero‐temporal and infero‐temporal RNFL thicknesses by Spectralis were also significantly higher in PD compared to PSP (p < 0.05). Using Cirrus OCT, mean MT and all measurements by GCA were significantly higher in PD compared to PSP (p < 0.002). The AUC was larger for minimum GCIPL (0.912) than for average GCIPL thickness (0.850). A minimum GCIPL thickness cut‐off value of 69 μm, was able to differentiate PSP from PD (Sensitivity: 91.7%; Specificity: 72.7%). Minimum and average GCIPL thicknesses significantly correlated with Hoehn and Yahr score (p < 0.05), and with UPDRS (Unified Parkinson's Disease Rating Scale) (p < 0.005).ConclusionsThedifferential diagnosis of Parkinsonian disorders is clinical one and not alwayseasy, especially at the onset of disease. In thecurrent study, the minimum GCIPL thickness was the most sensitiveparameter to differentiate PD from PSP and it was significantly correlated withneurological score. These findings may facilitate the differential diagnosisand give insight into the degenerative processes of atypical parkinsonian syndromes.

OCT: New perspectives in neuro-ophthalmology

“…3). 20 Moreover, macular GCL thickness correlates 132 better with visual dysfunction [visual acuity (VA), low-contrast 133 letter acuity, and vision-specific quality of life measures, 134 visual field mean deviation (MD)], disability and MRI than 135 RNFL thickness. 15,18 136 The improved reproducibility of SD-OCT enhances the 137 value of the analyses use of data from individual quadrants 138 in the longitudinal evaluation of MS patients.…”

“…Moreover 18 the superior correlation with clinical measures compared to peripapillary retinal nerve fiber layer (pRNFL) suggests that GCL anal-19 ysis might be a better approach to examine MS neurodegeneration. 20 In disorders with optic disk edema, such as ischemic optic neuropathy, papillitis and papilledema, reduction in RNFL thickness 21 caused by axonal atrophy is difficult to distinguish from a swelling resolution. In this setting, and in buried optic nerve head drusen 22 (ONHD), GCL analysis may provide more accurate information than RNFL analysis and it might be an early structural indicator of 23 irreversible neuronal loss.…”

Optical Coherence Tomography as a Biomarker in the Differential Diagnosis between Parkinson’s Disease and Atypical Parkinsonian Syndromes: A Narrative Review

“…Regarding potential confounding factors among patients' groups, it is noteworthy that patients with a history of ophthalmologic pathologies, including age-related macular degeneration, previous intraocular surgery, glaucomatous optic neuropathy, and diabetic retinopathy, among others, were excluded [9,[20][21][22]24]. When participants' age is concerned, the vast majority of the included studies reported no significant age difference between patients' groups and matched healthy controls; thus, age-related decreases in OCT parameters were not observed [9,19,20,[22][23][24]. In the study by Alkabie et al, it was demonstrated that patients with PSP were significantly older when compared with both the group with PD and control subjects [21].…”

“…The first group consisted of three studies focusing on the differentiation between patients with typical (PD) and atypical Parkinsonism (PSP, MSA, and CBS) based on retinal parameters, as assessed with OCT [9,19,20]. The second group comprised three studies investigating the retinal morphology and its potential role in distinguishing patients with PD versus patients with PSP [21][22][23]. Finally, one study explored the value of retinal parameters through OCT in a setting of dementia associated with the presence of Lewy bodies or Parkinson's disease [24] Records identified through the…”

“…The researchers exhibited significant differences between the two groups of patients, with a thicker mean average RNFL and a higher mean macular volume among patients with PD than a group with PSP. Notably, it was observed that a minimum GCIPL thickness cut-off value of 69 µm seems able to distinguish PSP from PD with high sensitivity and specificity values [23].…”