Original article
Distribution of Retinal Layer Atrophy in Patients With Parkinson Disease and Association With Disease Severity and Duration

https://doi.org/10.1016/j.ajo.2013.09.028Get rights and content

Purpose

To evaluate the thickness of the 10 retinal layers in the paramacular area of Parkinson disease patients using a new segmentation technology of optical coherence tomography (OCT) to examine whether the thickness of specific layers predicts neurodegeneration or Parkinson disease severity.

Design

Observational prospective study.

Methods

Parkinson disease patients (n = 129) and age-matched healthy subjects (n = 129) were enrolled. The Spectralis OCT system was used to automatically segment all retinal layers in a parafoveal scan using the new segmentation application prototype. Mean thickness of each layer was calculated and compared between Parkinson disease patients and healthy subjects, and between Parkinson disease patients with disease durations of less than or at least 10 years. A correlation analysis was performed to evaluate the association between retinal layer thickness, duration of disease, and Parkinson disease severity. Logistic regression analysis was performed to determine the most sensitive layer for predicting axonal atrophy.

Results

Parkinson disease patients showed statistically significant reduced thickness in the retinal nerve fiber, ganglion cell, inner plexiform, and outer plexiform layers and increased thickness in the inner nuclear layer compared with healthy subjects (P < .05). The inner retinal layers were more affected in Parkinson disease patients with long disease duration. The ganglion cell layer thickness was inversely correlated with disease duration and Parkinson disease severity, and was predictive of axonal damage in Parkinson disease patients.

Conclusions

The segmentation application of the Spectralis OCT revealed retinal layer atrophy in Parkinson disease patients, especially in the inner layers of patients with long disease duration. Ganglion cell layer reduction was associated with increased axonal damage.

Section snippets

Patients and Methods

This was an observational, prospective, longitudinal study. The study and data accumulation were performed with approval from the Miguel Servet Hospital Institutional Review Board (IRB). The authors confirm that the study and data accumulation conformed to all country, federal, or state laws, and the study adhered to the tenets of the Declaration of Helsinki. Informed consent for the research was obtained from the patients or subjects.

Required inclusion criteria were as follows: best-corrected

Results

One hundred twenty-nine eyes from 129 Parkinson disease patients (72 men and 57 women) and 129 eyes of 129 healthy individuals (72 men and 57 women) were included in the study. Disease duration ranged from 1-24 years with a median of 8.40 years since diagnosis. The ages of the Parkinson disease patients ranged from 40-80 years (mean 68.75) and the ages of healthy subjects ranged from 40-89 years (mean 69.01). Mean intraocular pressure was 14.56 mm Hg in the Parkinson disease group and 14.35 mm

Discussion

A reduction of retinal ganglion cells leads to a corresponding decrease in retinal and RNFL thickness that can be detected in Parkinson disease patients using OCT.20, 21 Aaker and associates reported a statistically significant reduction in macular thickness in Parkinson disease patients compared with controls based on spectral-domain OCT, but they did not segment the retinal layers.22 Altintaş and associates demonstrated that Parkinson disease severity was related to alterations in foveal

Elena Garcia-Martin, PhD, received her medical degree from Salamanca University, followed by a fellowship at Miguel Servet University Hospital and completed a formation period at St Paul's Eye Unit Royal Liverpool University Hospital. In 2010, she finished her PhD with honors. She is working in Neuro-Ophthalmology and external ocular diseases at Miguel Servet University Hospital. She had been engaged in numerous research related-activities and developing projects either in medical or basis

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    Elena Garcia-Martin, PhD, received her medical degree from Salamanca University, followed by a fellowship at Miguel Servet University Hospital and completed a formation period at St Paul's Eye Unit Royal Liverpool University Hospital. In 2010, she finished her PhD with honors. She is working in Neuro-Ophthalmology and external ocular diseases at Miguel Servet University Hospital. She had been engaged in numerous research related-activities and developing projects either in medical or basis science research.

    Luis E. Pablo, PhD, is a Professor of Ophthalmology and Optics at Zaragoza University in Spain. He completed his residency in ophthalmology in 1994. His areas of research interest are clinical and experimental glaucoma. Currently, Dr Pablo is Vice-Secretary-General of the Spanish Glaucoma Society and head of the Department of Ophthalmology at Miguel Servet University Hospital, Zaragoza, Spain.

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