Associations Between Retinal Artery/Vein Occlusions and Risk of Vascular Dementia

In this study published in the Journal of Alzheimer's Disease, Dr. Cecilia Lee and her co-authors investigated whether retinal artery and retinal vein occlusions are risk factors for developing dementia. Retinal vascular occlusions are associated with aging and can reflect systemic vascular changes related to diseases like hypertension and cardiovascular disease, changes that may also be occurring in the brain. Vascular pathology is already known to be an important risk factor for Alzheimer's disease and related dementias. Dr. Lee wondered if retinal vascular occlusion might be a harbinger for problems with cognition down the line.

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Understanding the Brain through Aging Eyes

In this Viewpoint article published in the journal Advances in Geriatric Medicine and Research, Dr. Cecilia Lee discusses the ways in which the eye, specifically the retina, can provide valuable information about the aging brain and dementia. The eye and the brain share the same embryologic origins and undergo similar changes as we age. One reason that it is challenging to develop treatments for neurodegenerative diseases associated with aging such as Alzheimer's disease is that it is very difficult to examine brain tissue while a person is living. The retina, however, can be visualized easily and non-invasively in an ophthalmology clinic or doctor's office, and can provide interesting clues about disease processes in the brain. This review explores the recent developments in retinal imaging technology and what we know to date about various retinal pathological changes that correlate with Alzheimer's disease. The authors also review what we hope to discover going forward, such as understanding how changes in the retina correlate with Alzheimer's disease progression, and if they can be detected before cognitive decline occurs. These potential biomarkers in the retina may be used to monitor disease progression when evaluating potential therapies in clinical trials, for example. Since there is no known treatment for Alzheimer's disease, the hope is that the retina may provide new insights into the mechanisms of aging and related pathological processes that will lead to the development of interventions to halt or prevent Alzheimer's disease and dementia.

Blazes M, Lee CS. Understanding the Brain through Aging Eyes. Adv Geriatr Med Res. 2021;3(2):e210008. doi: 10.20900/agmr20210008.

Multicenter, Head-to-Head, Real-World Validation Study of Seven Automated Artificial Intelligence Diabetic Retinopathy Screening Systems

In this article published in the journal Diabetes Care, Dr. Aaron Lee and his co-authors put diabetic retinopathy screening algorithms to the test in the real world, evaluating them on retinal images from nearly 24,000 veterans who sought diabetic retinopathy screening at two Veterans Affairs health care systems (Seattle and Atlanta). These screening algorithms are designed to check patients who might be at risk for retinopathy, a potential complication of diabetes that can lead to blindness if left untreated. Based on performance in clinical trials, one of these algorithms is approved for use in the US, and several others are in clinical use in other countries. Dr. Lee wanted to know how well they worked outside of the clinical trial setting, however, when faced with real world data from a diverse group of patients in a variety of clinical settings.

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Exploring a Structural Basis for Delayed Rod-Mediated Dark Adaptation in Age-Related Macular Degeneration Via Deep Learning

In this study, Dr. Aaron Lee, Dr. Cecilia Lee and their co-authors used a unique artificial intelligence approach for identifying novel anatomic biomarkers in the retinas of patients with age-related macular degeneration. Patients with this condition can progressively lose their central vision, and there are still no effective treatments for the more common dry (non exudative) form of the disease. Delayed rod-mediated dark adaptation is the method through which the retina recovers after a stimulus of bright light, and this process can be measured as a function of time to help predict which patients are at risk for age-related macular degeneration and vision loss. The authors wanted to take advantage of the increasingly advanced retinal imaging technology available to search for structural changes in the retina that might be associated with dark adaptation dysfunction, to better understand the cellular and structural pathology that occurs early the in age-related macular degeneration disease process.

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Minimum data set for SD‐OCT retinal imaging and analysis from the Atlas of Retinal Imaging in Alzheimer's Study

In this article, a group of authors representing 16 different institutions (including our own Dr. Cecilia Lee) have laid out a framework for standardization of retinal imaging data collection for Alzheimer's disease biomarker research studies. Many labs are doing research in this area, but they often use different imaging modalities and protocols, making it challenging to compare data between studies. Because these studies often have small numbers of subjects by necessity, standardizing data collection will also enable researchers to collect data into a larger database, allowing them to observe larger trends in the data.

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