Browsing by Author "Agrawal, Rupesh"

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    Angioarchitectural alterations in the retina and choroid in frontotemporal dementia.
    (PloS one, 2024-01) Allen, Ariana; Robbins, Cason B; Joseph, Suzanna; Hemesat, Angela; Kundu, Anita; Ma, Justin P; Haystead, Alice; Winslow, Lauren; Agrawal, Rupesh; Johnson, Kim G; Bozoki, Andrea C; Stinnett, Sandra S; Grewal, Dilraj S; Fekrat, Sharon

    Objective

    Frontotemporal dementia (FTD) is a progressive neurodegenerative disorder that affects the frontal and temporal lobes of the brain, leading to cognitive decline and personality changes. The objective of this cross-sectional study was to characterize angioarchitectural changes in the retina and choroid of individuals with FTD compared to cognitively normal controls using optical coherence tomography (OCT) and OCT angiography (OCTA).

    Methods

    Cross-sectional comparison of patients with FTD and controls with normal cognition. All participants underwent Mini-Mental State Examination (MMSE) at the time of imaging. Outcome measures included OCT parameters: retinal nerve fiber layer (RNFL) thickness, ganglion cell layer-inner plexiform layer (GC-IPL) thickness, central subfield thickness (CST), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI); and OCTA superficial capillary plexus parameters: foveal avascular zone (FAZ) area, 3x3mm and 6x6mm macular perfusion density (PD) and vessel density (VD), 4.5x4.5mm peripapillary capillary perfusion density (CPD) and capillary flux index (CFI). Generalized estimating equation analysis was used to account for the inclusion of 2 eyes from the same participant.

    Results

    29 eyes of 19 patients with FTD and 85 eyes of 48 controls were analyzed. In FTD, 3x3mm macular PD (p = 0.02) and VD (p = 0.02) and CFI (p = 0.01) were reduced compared to controls. There was no difference in average 4.5x4.5mm CPD, RNFL thickness, GC-IPL thickness, CST, SFCT, CVI, FAZ, or 6x6mm VD or PD between FTD and controls (all p > 0.05); however, there was a trend toward lower macular 6x6mm PD and VD in patients with FTD.

    Conclusion

    Decline of peripapillary and macular OCT and OCTA parameters merit further investigation as potential biomarkers for FTD detection. Noninvasive retinal and choroidal imaging may hold promise for earlier detection, and future longitudinal studies will clarify their role in monitoring of FTD.
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    Choroidal Structural Analysis in Alzheimer's Disease, Mild Cognitive Impairment, and Cognitively Healthy Controls.
    (Am J Ophthalmol, 2020-10-08) Robbins, Cason B; Grewal, Dilraj S; Thompson, Atalie C; Powers, James H; Soundararajan, Srinath; Koo, Hui Yan; Yoon, Stephen P; Polascik, Bryce W; Liu, Andy; Agrawal, Rupesh; Fekrat, Sharon
    PURPOSE: To assess choroidal structural parameters in symptomatic Alzheimer's disease (AD), mild cognitive impairment (MCI), and cognitively healthy controls. DESIGN: Prospective cross-sectional study. METHODS: Setting: Outpatient neurological disorders clinic. STUDY POPULATION: One hundred and twelve eyes of 67 individuals with AD, 143 eyes of 74 individuals with MCI, and 248 eyes of 137 controls. Individuals with diabetes, glaucoma, or retinal pathology were excluded. OBSERVATION PROCEDURE: High-definition EDI foveal scans were obtained using Zeiss Cirrus HD-5000 AngioPlex (Carl Zeiss Meditec, Dublin, CA). Subfoveal choroidal thickness (SFCT) was measured by two masked graders with a third adjudicator. Total choroidal area (TCA), luminal area (LA), and choroidal vascularity index (CVI) were calculated after image binarization. MAIN OUTCOME MEASURES: Association of choroidal parameters with AD, MCI, or controls using generalized estimating equations, adjusted for age and sex. RESULTS: After adjustment for age, sex, and visual acuity, TCA was significantly greater in AD (ß 2.73, p = 0.001) and MCI (ß 4.38, p < 0.001) compared to controls, LA was significantly greater in AD (ß 1.68, p = 0.001) and MCI (ß 2.69, p < 0.001) compared to controls, and CVI was significantly lower in MCI (ß -0.58, p = 0.002) compared to controls. SFCT was similar among AD, MCI, and controls on multivariable analysis (p > 0.05). CONCLUSIONS: TCA, LA, and CVI may differ between individuals with AD, MCI, and healthy cognition, whereas SFCT may not differ between these groups. TCA, LA, and CVI deserve further study in individuals along the Alzheimer's continuum.
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    Differences in Retinal and Choroidal Microvasculature and Structure in Dementia With Lewy Bodies Compared With Normal Cognition.
    (Journal of vitreoretinal diseases, 2024-01) Joseph, Suzanna; Robbins, Cason B; Allen, Ariana; Haystead, Alice; Hemesath, Angela; Kundu, Anita; Ma, Justin P; Johnson, Kim G; Agrawal, Rupesh; Gunasan, Vithiya; Stinnett, Sandra S; Grewal, Dilraj S; Fekrat, Sharon
    Purpose: To evaluate the retinal and choroidal microvasculature and structure in individuals with dementia with Lewy bodies (DLB) compared with controls with normal cognition using optical coherence tomography (OCT) and OCT angiography (OCTA). Methods: An institutional review board-approved cross-sectional comparison of patients with DLB and cognitively normal controls was performed. The Cirrus HD-OCT 5000 with AngioPlex (Carl Zeiss Meditec) was used to obtain OCT and OCTA images. Results: Thirty-four eyes of 18 patients with DLB and 85 eyes of 48 cognitively normal patients were analyzed. The average capillary perfusion density (CPD) was higher in the DLB group than in the control group (P = .005). The average capillary flux index (CFI) and ganglion cell inner-plexiform layer (GC-IPL) thickness were lower in the DLB group than in the control group (P = .016 and P = .040, respectively). Conclusions: Patients with DLB had an increased peripapillary CPD, decreased peripapillary CFI, and attenuated GC-IPL thickness compared with those with normal cognition.
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    Retinal and Choroidal Changes in Men Compared with Women with Alzheimer's Disease: A Case-Control Study.
    (Ophthalmology science, 2022-03) Mirzania, Delaram; Thompson, Atalie C; Robbins, Cason B; Soundararajan, Srinath; Lee, Jia Min; Agrawal, Rupesh; Liu, Andy J; Johnson, Kim G; Grewal, Dilraj S; Fekrat, Sharon

    Purpose

    To evaluate differences in the retinal microvasculature and structure and choroidal structure among men and women with Alzheimer's disease (AD) compared with age-matched cognitively normal male and female controls.

    Design

    Case-control study of participants ≥ 50 years of age.

    Participants

    A total of 202 eyes of 139 subjects (101 cases and 101 controls).

    Methods

    All participants and controls underwent OCT and OCT angiography (OCTA), and parameters of subjects with AD were compared with those of cognitively normal controls.

    Main outcome measures

    The foveal avascular zone (FAZ) area, vessel density (VD), and perfusion density (PD) in the superficial capillary plexus within the 3- and 6-mm circle and ring using Early Treatment Diabetic Retinopathy Study (ETDRS) grid overlay on OCTA; central subfield thickness (CST), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, and choroidal vascularity index (CVI) on OCT.

    Results

    No significant sex differences in VD or PD were found in the AD or control cohorts; however, there were greater differences in VD and PD among AD female participants than AD male participants compared with their respective controls. The CST and FAZ area were not different between male and female AD participants. Among controls, men had a thicker CST (P < 0.001) and smaller FAZ area (P = 0.003) compared with women. The RNFL thickness, GCIPL thickness, and CVI were similar among male and female AD participants and controls.

    Conclusions

    There may be a loss of the physiologic sex-related differences in retinal structure and microvasculature in those with AD compared with controls. Further studies are needed to elucidate the pathophysiological basis for these findings.