JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Results
Discussion
Disclosures
Acknowledgements
Materials
References
Automatic Translation
Medicine

Utilizando imagens da retina para estudar a demência

Published: November 06, 2017
doi:
10.3791/56137
, , , , , , ,
1Department of Ophthalmology and Visual Sciences,The Chinese University of Hong Kong, 2Department of Medicine & Therapeutics,The Chinese University of Hong Kong, 3Therese Pei Fong Chow Research Centre for Prevention of Dementia,The Chinese University of Hong Kong, 4Gerald Choa Neuroscience Centre,The Chinese University of Hong Kong, 5Memory Aging and Cognition Centre,National University Health System, 6Department of Pharmacology,National University of Singapore, 7Singapore Eye Research Institute,Singapore National Eye Centre, 8Duke-NUS Medical School,National University of Singapore

Summary

A retina partes proeminentes semelhanças com o cérebro e, portanto, representa uma janela única para estudar vasculatura e estrutura neuronal no cérebro de forma não-invasiva. Este protocolo descreve um método para estudar a demência usando técnicas de imagem da retina. Esse método potencialmente pode ajudar no diagnóstico e avaliação de riscos de demência.

Abstract

A retina oferece uma única “janela” para estudar processos fisiopatológicos da demência no cérebro, pois é uma extensão do sistema nervoso central (SNC) e partes proeminentes semelhanças com o cérebro em termos de origem embriológica, características anatômicas e Propriedades fisiológicas.  Estrutura vascular e neuronal na retina pode agora ser retina visualizada facilmente e de forma não-invasiva usando técnicas de imagem, incluindo a fotografia de fundo e tomografia de coerência óptica (OCT) e quantificado usando semi-automática programas de análise assistida por computador. Estudando as associações entre alterações vasculares e neuronais na retina e demência poderia melhorar a nossa compreensão da demência e, potencialmente, ajudar no diagnóstico e avaliação de riscos.  Este protocolo visa descrever um método de quantificar e analisar a vasculatura da retina e estrutura neuronal, que são potencialmente associados com demência. Este protocolo também fornece exemplos de alterações da retina em indivíduos com demência e discute questões técnicas e limitações atuais da imagem na retina.

Introduction

Devido ao aumento da expectativa de vida, demência tornou-se um problema médico principal, contribuindo para o social significativo e saúde econômica globalmente sobrecarregar-1,2,3,4,5. Hoje, uma pessoa nos Estados Unidos desenvolve a doença de Alzheimer (AD), a forma mais comum de demência, cada 66 s6. Estima-se que até ao ano 2050, 115 milhões de pessoas serão afetadas pelo AD7.

A retina oferece uma exclusiva “janela” para estudar a demência devido a suas propriedades anatômicas e fisiológicas semelhantes com o cérebro. Em termos de vascularização, a retina arteríolas e vênulas, medindo 100 a 300 µm de diâmetro, compartilham características semelhantes, com pequenos vasos cerebrais, tais como arteríolas fim sem anastomoses, função de barreira e autoregulação8, 9. em termos de estrutura neuronal, células da retina ganglionar (RGCs) compartilham Propriedades típicas com neurônios no sistema nervoso central (SNC) 10. As RGCs proeminente são conectadas com o cérebro como eles formam os nervo óptico e projeto sinais visuais da retina para os núcleos geniculados laterais e o colículo superior. O nervo óptico, semelhante a muitas fibras neuronais no SNC, é mielinizado por oligodendrócitos e é ensheathed em camadas na meninge. Nomeadamente, um insulto para o nervo óptico pode resultar em respostas semelhantes observadas em outros axônios do CNS, tais como retrógrada e anterógrada degeneração do axônio, formação de cicatriz, destruição de mielina, degeneração secundária e um nível anormal de neurotrophic fatores e neurotransmissores11,12,13,14. O aparecimento de sintomas visuais em alguns pacientes AD também pode ser explicado pelas associações robustas entre a retina e o cérebro de15,16. Como resultado, tem sido sugerido que a retina pode refletir os processos patológicos da demência no cérebro e imagem retinal pode ser usada para estudar a demência.

A vasculatura da retina e estrutura neuronal agora podem ser visualizadas não invasiva, usando técnicas de imagem da retina. Por exemplo, fotografias da retina do fundo podem ser capturadas usando câmeras do fundo e características da vasculatura da retina (por exemplo, navio calibre, tortuosidade e fractal dimensão) podem então ser quantificadas usando análise assistida por computador programas. Além disso, os parâmetros da estrutura da retina neuronal (tais como a espessura da camada plexiforme de gânglio célula-interna [GC-IPL] e camada retinal da fibra do nervo [RNFL]) também podem ser medidos usando a tomografia de coerência óptica (OCT) e quantificados usando o built-in algoritmos de análise.

Tendo em conta a importância da imagem na retina para estudar a demência, o presente protocolo visa descrever um método de imagem e analisando a vasculatura da retina e estrutura neuronal na vivo usando técnicas de imagem da retina. Este protocolo também fornece exemplos de alterações da retina em indivíduos com demência e discute questões técnicas e limitações atuais da imagem na retina.

Protocol

todos os métodos descritos aqui foram aprovados por um Comitê de ética de pesquisa clínica local em Hong Kong. Nota: para manter a simplicidade, o equipamento listado na Tabela de materiais é usado para ilustrar os procedimentos de imagem da retina e posterior análise. Medição de parâmetros vasculares da retina é ilustrada usando a Singapura I navio avaliação programa (Shiva) 17 (versão 4.0, Nacional Universidade de Singapura, Singapura)…

Representative Results

Figura 10: Um exemplo para mostrar as diferenças na vasculatura da retina entre um sujeito normal e um assunto AD. Quando comparado com o assunto normal, fotografia do fundo do sujeito AD mostrou mais estreitos calibres de navio (CRAE da zona B, 116.4 µm vs 156.4 µm; CRVE da zona B, 186.9 µm vs 207,5 µm; CRAE da zona C, 138.5 µm …

Discussion

Este protocolo descreve os procedimentos de quantificar as alterações neuronais e vasculares no retina na vivo. Como a retina compartilha semelhante origem embriológica, características anatômicas e fisiológicas Propriedades com o cérebro, essas alterações na retina podem refletir alterações similares da vasculatura e estrutura neuronal no cérebro.

Como mostrado na Figura 10 e tabela 1, o assunto AD mostrou diminuição da emb…

Disclosures

The authors have nothing to disclose.

Acknowledgements

Sobre laços financeiros potenciais, o autor Tien Y. Wong é um co-inventor do programa Cingapura I navio avaliação (Shiva) usado neste artigo.

Materials

Non-mydriatic Retinal Camera  Topcon, Inc, Tokyo, Japan TRC 50DX  N/A
Singapore I Vessel Assessment Program National University of Singapore Version 4.0 N/A
CIRRUS HD-OCT  Carl Zeiss Meditec, Inc, Dublin, CA Model 4000 N/A
Mydriatic Agents  N/A N/A Prepared from 1% tropicamide and 2.5% phenylephrine hydrochloride
DOWNLOAD MATERIALS LIST

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Retinal ImagingDementiaAlzheimer’s DiseaseBiomarkersVascular ChangesNeuronal ChangesFundus CameraPupil DilationImage CaptureOptic DiscRetinaComputer-assisted Analysis
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Chan, V. T., Tso, T. H., Tang, F., Tham, C., Mok, V., Chen, C., Wong, T. Y., Cheung, C. Y. Using Retinal Imaging to Study Dementia. J. Vis. Exp. (129), e56137, doi:10.3791/56137 (2017).
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