Detection of retinal changes with optical coherence tomography angiography in mild cognitive impairment and Alzheimer’s disease patients: A meta-analysis

OBJECTIVE: To assess retinal microvascular network impairments in the eyes of mild cognitive impairment (MCI) and Alzheimer’s disease (AD) patients with optical coherence tomography angiography (OCTA). DESIGN: Systematic review and meta-analysis. METHODS: A literature search was conducted in the PubMed and EMBASE databases to identify relevant studies detecting retinal microvascular attenuation among AD, MCI patients and cognitively healthy controls (HCs) by OCTA. Data were extracted by Review Manager V.5.4 and Stata V.14.0. RESULTS: Eight investigations were included in this meta-analysis, with 150 AD patients, 195 MCI patients and 226 HCs were eligible for meta-analysis. Evidence based on these studies demonstrated that there was a significantly decreased vessel density (VD) of the Optovue group in superficial capillary plexus (SCP): WMD = -2.26, 95% CI: -3.98 to -0.55, p = 0.01; in deep capillary plexus (DCP): WMD = -3.40, 95% CI: -5.99 to -0.81, p = 0.01, VD of the Zeiss group in SCP:WMD = -0.91, 95% CI: -1.79 to -0.02, p = 0.05 and an enlarged fovea avascular zone (FAZ):WMD = 0.06, 95% CI: 0.01 to 0.11, P = 0.02 in OCTA measurements of MCI patients. Additionally, in OCTA measurements of AD patients, there was a significantly decreased VD in the SCP: WMD = -1.88, 95% CI: -2.7 to -1.07, p<0.00001. In contrast, there was no significant decrease in DCP nor enlargement of FAZ in AD patients. CONCLUSION: Retinal microvascular alternations could be optimally screened in MCI patients detected by OCTA, which could be a warning sign of relative changes in the MCI before progressing to AD. Retinal microvasculature changes worth further investigation in larger scale clinical trials.