Retinal Vascular Imaging in Vascular Cognitive Impairment: Current and Future Perspectives

Abstract

Vascular cognitive disorders are heterogeneous and increasingly recognized entities with intricate correlation to neurodegenerative conditions. Retinal vascular analysis is a noninvasive approach to study cerebrovascular pathology, with promise to assist particularly during early disease phases. In this article, we have systematically summarized the current understanding, potential applications, and inevitable limitations of retinal vascular imaging in patients with vascular cognitive impairment. In addition, future directions in the field with support from automated technology using deep learning methods and their existing challenges are emphasized.

Sectoral segmentation of retinal amyloid imaging in subjects with cognitive decline

“…The retinas derived from AD patients are hallmarked by an array of pathologies that mirror the disease in the brain, characterized not only by Aβ deposits, but also phosphorylated tau, vasculopathy, inflammation, and neurodegeneration 7–16,32,36,37 . We translated the RAI in clinical studies as a safe and non‐invasive tool for retinal curcumin‐labeled Aβ plaque imaging, with the potential of early detection of a pathological biomarker of AD 7,13 .…”

Vascular contributions to cognitive impairment and dementia (VCID): A report from the 2018 National Heart, Lung, and Blood Institute and National Institute of Neurological Disorders and Stroke Workshop

“…Novel cerebral spinal fluid (CSF) biomarkers for BBB breakdown, such as soluble platelet‐derived growth factor receptor‐β, 50 and imaging methods such as dynamic contrast enhanced MRI, hold promise in measuring BBB permeability in humans 52,53 . Additionally, a multimodal imaging study highlighted vascular dysfunction as a potential upstream trigger of late‐onset AD in a multimodal imaging study, 54 highlighting the potential of using vascular function and dysfunction tests that could be measured outside the brain, such as a retinal vascular imaging exam 55 . It is important to validate these biomarkers to better understand the correlation between local and systemic clinical manifestations as well as the correlation between their utility and interpretation in animal models and humans.…”

GWAS of Retinal Vessel Tortuosity Identifies 173 Novel Loci Revealing Genes and Pathways Associated with Vascular Pathomechanics and Cardiometabolic Diseases

“…The fundus is of interest beyond the field of ophthalmology, since pathological changes in the retinal vessels often reflect those in the microvasculature of other organs. Indeed, based on the homology between the microvasculature in the retina and that found in other organs, retinal analysis has the potential of becoming a powerful screening tool for diseases elsewhere in the body, notably the brain 1,2,3,4,5 , kidney 6,7 and ear 8 . The retinal microvasculature can therefore provide signs of systemic disease, including increased risk of diabetes 9,10,11,12 , obesity 13 and cardiovascular disease (CVD) 14,15,16,17,18 , specifically stroke 16,19,19,20,21 , coronary heart disease 22 , coronary artery disease 23 , hypertension 11,24,25,20,26,27,28,29,30,31,32,33,34 , atherosclerosis 19,20,35 and myocardial infarction 36,37 .…”