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Title: | Systematic Review on Fractal Dimension of the Retinal Vasculature in Neurodegeneration and Stroke: Assessment of a Potential Biomarker | Authors: | Lemmens, Sophie Devulder, Astrid Van Keer, Karel Bierkens, Johan DE BOEVER, Patrick Stalmans, Ingeborg |
Issue Date: | 2020 | Publisher: | FRONTIERS MEDIA SA | Source: | Frontiers in Neuroscience, 14 (Art N° 16) | Abstract: | Introduction: Ocular manifestations in several neurological pathologies accentuate the strong relationship between the eye and the brain. Retinal alterations in particular can serve as surrogates for cerebral changes. Offering a "window to the brain," the transparent eye enables non-invasive imaging of these changes in retinal structure and vasculature. Fractal dimension (FD) reflects the overall complexity of the retinal vasculature. Changes in FD could reflect subtle changes in the cerebral vasculature that correspond to preclinical stages of neurodegenerative diseases. In this review, the potential of this retinal vessel metric to serve as a biomarker in neurodegeneration and stroke will be explored. Methods: A literature search was conducted, following the PRISMA Statement 2009 criteria, in four large bibliographic databases (Pubmed, Embase, Web Of Science and Cochrane Library) up to 12 October 2019. Articles have been included based upon their relevance. Wherever possible, level of evidence (LOE) has been assessed by means of the Oxford Centre for Evidence-based Medicine Level of Evidence classification. Results: Twenty-one studies were included for qualitative synthesis. We performed a narrative synthesis and produced summary tables of findings of included papers because methodological heterogeneity precluded a meta-analysis. A significant association was found between decreased FD and neurodegenerative disease, mainly addressing cognitive impairment (CI) and dementia. In acute, subacute as well as chronic settings, decreased FD seems to be associated with stroke. Differences in FD between subtypes of ischemic stroke remain unclear. Conclusions: This review provides a summary of the scientific literature regarding the association between retinal FD and neurodegenerative disease and stroke. Central pathology is associated with a decreased FD, as a measure of microvascular network complexity. As retinal FD reflects the global integrity of the cerebral microvasculature, it is an attractive parameter to explore. Despite obvious concerns, mainly due to a lack of methodological standardization, retinal FD remains a promising non-invasive and low-cost diagnostic biomarker for neurodegenerative and cerebrovascular disease. Before FD can be implemented in clinic as a diagnostic biomarker, the research community should strive for uniformization and standardization. | Notes: | Lemmens, S (reprint author), Univ Hosp UZ Leuven, Dept Ophthalmol, Leuven, Belgium.; Lemmens, S (reprint author), Katholieke Univ Leuven, Dept Neurosci, Biomed Sci Grp, Res Grp Ophthalmol, Leuven, Belgium.; Lemmens, S (reprint author), VITO Flemish Inst Technol Res, Hlth Unit, Mol, Belgium. sophie.1.lemmens@uzleuven.be |
Other: | Lemmens, S (reprint author), Univ Hosp UZ Leuven, Dept Ophthalmol, Leuven, Belgium, Katholieke Univ Leuven, Dept Neurosci, Biomed Sci Grp, Res Grp Ophthalmol, Leuven, Belgium, VITO Flemish Inst Technol Res, Hlth Unit, Mol, Belgium. sophie.1.lemmens@uzleuven.be | Keywords: | fractal dimension;retina;brain;neurodegeneration;cognitive impairment;Alzheimer's disease;stroke;cerebral small vessel disease | Document URI: | http://hdl.handle.net/1942/30773 | e-ISSN: | 1662-453X | DOI: | 10.3389/fnins.2020.00016 | ISI #: | WOS:000514382000001 | Rights: | 2020 Lemmens, Devulder, Van Keer, Bierkens, De Boever and Stalmans. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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