Retinal assessment in 143 patients with white matter lesions: the potential of OCTA as an evaluation tool

Abstract

Background: The retina is a simple window to reflect the changes of brain nerves. The aim of this study was to investigate the association between retinal status and white matter lesions (WMLs) in 143 patients aged 50-80 years, utilizing Optical Coherence Tomography Angiography (OCTA) and the Fazekas Visual Scale for assessment.

Methods: A total of 143 subjects underwent MRI scanning to assess the degree of WMLs using the Fazekas scale. Retinal imaging was conducted utilizing OCTA. Multivariate logistic regression analysis was employed to determine the odds ratios and 95% confidence intervals associated with the Fazekas score for each factor. The relationship between cognitive function and various OCTA parameters was assessed using quadratic and cubic simulation curve models. Data following a normal distribution are presented as means, while non-normally distributed data are reported as medians. Qualitative data are expressed as percentages.

Results: As Fazekas grades increased, ILM-IPL thickness (OR = 3.267, OR = 8.436), vessel density in the parafoveal region of the macula, retinal vessel densities (OR = 2.058, OR = 2.363), and RNFL thickness significantly reduced (p < 0.05). With increasing Fazekas scores, the bilateral foveal avascular zone showed a significant increase (OR = 0.362, OR = 0.458) (p < 0.05). Retinal thickness and vascular density were negatively correlated with WMLs, and positively correlated with cognitive function (p < 0.05).

Conclusion: The severity of WMLs increases as retinal thickness and vascular density decrease. OCTA examination has a degree of role in screening for WMLs caused by cerebral microvascular disease. Its effectiveness in screening early asymptomatic individuals or those with mild cognitive impairment is somewhat limited.

Keywords: cerebral small vessel diseases; cognitive dysfunction; fundus oculi; retina; white matter.

Figure 1

The relationship between Moca score and ILM-IPL thickness (SPSS Statistics 26 IBM); A: Moca score and right eye ILM-IPL thickness; B: Moca score and left eye ILM-IPL thickness; MoCA: Monterey Cognitive Assessment Scale; ILM: Internal limiting membrane; IPL: Inner plexiform layer.

Figure 2

The relationship between Moca score and vascular density of SCP and DCP (SPSS Statistics 26 IBM); A: Moca score and right eye vascular density of SCP; B: Moca score and left eye vascular density of SCP; C: Moca score and right eye vascular density of DCP; D: Moca score and left eye vascular density of DCP; MoCA: Monterey Cognitive Assessment Scale; SCP: Superficial capillary plexus; DCP, Deep capillary plexus.

Figure 3

The relationship between Moca score and vascular density and RNFL thickness (SPSS Statistics 26 IBM); A: Moca score and right eye NI RNFL thickness; B: Moca score and right eye SN RNFL thickness; C: Moca score and right eye ST vascular density; D: Moca score and right eye NS vascular density; MoCA: Monterey Cognitive Assessment Scale; RNFL: Retinal nerve fiber layer.

Figure 4

The relationship between Moca score and FAZ (SPSS Statistics 26 IBM); A: Moca score and right eye FAZ; B: Moca score and left eye FAZ; MoCA: Monterey Cognitive Assessment Scale; FAZ: Foveal avascular zone.

Figure 5

Magnetic Resonance Imaging T2-FLAIR characteristic images of white matter lesions (indicated by the red arrow) in a Fazekas grade 2 subject, along with retinal thickness and vascular density data obtained via Optical Coherence Tomography Angiography (Images from the same subject); A, B: Diagram of white matter lesions; C: Retinal thickness measurement diagram; D:Diagram of vascular density measurement.