Clinical Characteristics Of Retinal Changes In Morphology And Function Of Parkinson's Disease

Part ? Structural alterations of the retina in Parkinson's disease using spectral-domain optical coherence tomography Objective To observe the structural alterations of the retina in Parkinson's disease(PD).Method Fifty-three PD patients were enrolled in this case-control study.The patients included 35 males and 18 females,with the best corrected vision acuity(BCVA)?0.8.Forty-one health controls included 24 males and 17 females,with the best corrected vision acuity(BCVA)?1.0.All subjects were received general Ophthalmology examinations(including BCVA test,slit-lamp test,fundus examination),vision field,and spectral-domain optical coherence tomography(SD-OCT)test.Correlation analysis was used to analyze the retinal thickness and other factors,including age,duration,H-Y scores and UPDRS? scores.Results Both of the macular retinal thickness and macular volume were significantly thinner than the health controls(P=0.027,0.001,respectively).The average thickness of circumpapillary retinal nerve fiber layer(CP-RNFL)and the thickness of inferior RNFL were thinner than that of health controls(P=0.008,0.004);And the thickness of superior,nasal,temporal quadrant of CP-RNFL had no statistically difference(p=0.532,0.347,0.117).Correlation analysis showed that retinal thickness and CP-RNFL had no correlation with age,duration,H-Y scores or UPDRS? scores.Conclusions SD-OCT can detect the structural changes of the retina in PD patients,and the retinal thickness and volume are decreased,and the thickness of average and inferior CP-RNFL were obvious thinning.Part ? Characteristics of the multifocal electroretinogram in Parkinson's disease Objective To investigate the changes of multifocal electroretinogram(mf-ERG)in Parkinson's disease.Methods Fifty-three Parkinson's disease(PD)patients(106 eyes)and forty-one normal controls(eighty-two eyes)received mf-ERG examination and general Ophthalmology examinations including best corrected vision acuity,slit –lamp test,fundus examination,intraocular pressure,vision field test.Results The amplitude density of P1 wave in PD patients were dramatically decreased in ring 1 and ring2 compared with the normal controls(p=0.000,0.000,respectively).The latency of P1 wave in the ring 1,ring2 and ring3 were significantly higher than the control group(p=0.000,0.039,0.000,respectively).However,in both of the amplitude and implicit time of N1 wave,there were no statistically difference between the two groups.Conclusions The vision function has already decreased in PD patients,even before the vision acuity is normal.The mf-ERG test can find the changes of vision function in PD patients,which are the decrease of amplitude density of P1 and the latency of implicit times of P1 wave in some regions of the retina.Part ? Combination of multifocal electroretinogram and spectral-domain OCT can increase diagnostic efficacy of Parkinson's Disease Objective Retinal changes have been identified in morphology and function in Parkinson's disease(PD).However,controversial results suggest that it is incredible that only using single method on testing retinal change to evaluate Parkinson's disease.The aim of this study was to assess retinal changes and increase the diagnostic yield of Parkinson's disease with combination of multifocal electroretinogram(mf-ERG)and spectral domain optical coherence tomography(SD-OCT)examinations.Method Fifty-three PD patients and forty-one healthy controls were enrolled.Subjects were assessed for retinal function using mf-ERG and retinal structure using SD-OCT.Results The PD patients had a significantly decreased amplitude density of P1 in ring1 and ring2,and a delayed implicit time of P1 in ring1,ring2 and ring3.The macular retinal thickness,macular volume and average RNFL thickness were decreased in PD.The amplitude density of P1 was negatively correlated with mean deviation of visual field and positively correlated with macular volume.The AUC of combination of amplitude density of P1 in ring1 and mean deviation of visual field and macular volume to detect PD diagnosis was 0.944,and a combination of amplitude density of P1 in ring1 and macular volume revealed AUC of 0.921,which were both higher diagnostic valuation to discriminate PD patients.Conclusion Amplitude density of P1 combined with macular volume can get a high diagnostic effectiveness to discriminate between participants with or without PD.It indicates that a combination of mf-ERG and SD-OCT provides a good clinical biomarker for diagnosis of PD.Part ? Clinical Characteristics of Retinal Changes in morphology and function of Parkinson's Disease Patients with Different stages Objective Retinal changes have been identified in morphology and function in Parkinson's disease(PD).However,previous findings are not consistent.The aim of this study was to stratifiedly analyze the PD patients with differently clinical stages and find whether retinal morphologic and functional changes with different H-Y stages in PD patients have statistical difference.Method Fifty-three PD patients and forty-one healthy controls were enrolled.Subjects were assessed for retinal function using mf-ERG and retinal structure using SD-OCT. Among the 53 patients(106 eyes),the patients were divided into three groups according to H-Y scale,including 7 cases(14 eyes,6 males and 1 female)in H-Y 0-1.5 stage(Group B).Group C(H-Y 2-2.5 stage)had 36 patients(72 eyes,19 males and 17 females).Group D(H-Y 3 stage)had 10 patients(20 eyes,6 males and 4 females).And there were 41 cases(82 eyes,24 males and 17 female)in the healthy control group(Group A).Results There was no statistically significant difference between the four groups(Hp=0.480,2.630,0.885,7.248 p=0.923,0.452,0.829,0.064)between age,gender,intraocular pressure and best corrected vision acuity with Kruskal-Wallis test.And there were significant differences between the four groups and the PD subgroups in the mean deviation of visual field and UPDRSIII scores.(Hp=25.646,18.225,p<0.001,<0.001).In the mf-ERG test,the amplitude density of P1 wave in ring1 and ring2 were significantly different compared with the health control group,and no difference was found between the subgroups of PD patients.The results of SD-OCT test showed that the four parameters including macular retinal thickness,macular volume,p RNFL and i RNFL were significantly different between the PD group and HC group.And the further analysis suggested that all of the differences above appeared between the H-Y3 stage(Group D)and the HC group,yet there were no differences between HC group and H-Y0-1.5 stage(Group B)or H-Y2-2.5 stage(Group C).Conclusion PD patients with different stages Different stage is an important reason for the morphological and functional changes of retina in PD patients.SD-OCT and mf-ERG examination can detect the retinal changes in PD,however,the differences can't be found until in mid stage of PD patients(H-Y 3 stage).And in the early stages of PD patients(H-Y0-2.5 stage),the changes cannot be observed.