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Structural and functional changes in the retina in Parkinson’s disease
  1. Jordan N Alves1,
  2. Britta U Westner2,
  3. Andreas Højlund3,
  4. Rimona Sharon Weil4,5,6,
  5. Sarang S Dalal1
  1. 1 Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
  2. 2 Radboud University, Donders Institute for Brain, Cognition and Behaviours, Nijmegen, The Netherlands
  3. 3 Department of Linguistics, Cognitive Science & Semiotics, Aarhus University, Aarhus, Denmark
  4. 4 Dementia Research Centre, University College London, London, UK
  5. 5 Movement Disorders Consortium, University College London, London, UK
  6. 6 Wellcome Centre for Human Neuroimaging, University College London, London, UK
  1. Correspondence to Dr Jordan N Alves, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, 8000, Denmark; jordannicolasalves{at}


Parkinson’s disease is caused by degeneration of dopaminergic neurons, originating in the substantia nigra pars compacta and characterised by bradykinesia, rest tremor and rigidity. In addition, visual disorders and retinal abnormalities are often present and can be identified by decreased visual acuity, abnormal spatial contrast sensitivity or even difficulty in complex visual task completion. Because of their early onset in patients with de novo Parkinson’s disease, the anatomical retinal changes and electrophysiological modification could be valuable markers even at early stages of the disease. However, due to the concomitant occurrence of normal ageing, the relevance and specificity of these predictive values can be difficult to interpret. This review examines retinal dysfunction arising in Parkinson’s disease. We highlight the electrophysiological delays and decreased amplitude in the electroretinography recorded in patients and animal models. We relate this to coexisting anatomical changes such as retinal nerve fibre layer and macular thinning, measured using optical coherence tomography, and show that functional measures are more consistent overall than optical coherence-measured structural changes. We review the underlying chemical changes seen with loss of retinal dopaminergic neurons and the effect of levodopa treatment on the retina in Parkinson’s disease. Finally, we consider whether retinal abnormalities in Parkinson’s disease could have a role as potential markers of poorer outcomes and help stratify patients at early stages of the disease. We emphasise that retinal measures can be valuable, accessible and cost-effective methods in the early evaluation of Parkinson’s disease pathogenesis with potential for patient stratification.

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  • RSW and SSD contributed equally.

  • Contributors JNA conceived and wrote the first draft of the paper. All the coauthors participated equally in the conceptual idea for the article and critically reviewed and approved the final version of the paper. There are no other contributors.

  • Funding This work was supported by an ERC starting grant (ERC-StG-640448) to SSD. RSW is supported by a fellowship from the Wellcome Trust (205167/Z/16/Z). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript (AAM) version arising from this submission.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.