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Retinal imaging in Alzheimer’s disease
  1. Carol Y Cheung1,
  2. Vincent Mok2,
  3. Paul J Foster3,
  4. Emanuele Trucco4,
  5. Christopher Chen5,6,
  6. Tien Yin Wong7,8
  1. 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
  2. 2Gerald Choa Neuroscience Centre, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
  4. 4VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
  5. 5Pharmacology, National University Singapore Yong Loo Lin School of Medicine, Singapore
  6. 6Memory Aging and Cognition Centre, National University Health System, Singapore
  7. 7Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  8. 8Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Carol Y Cheung, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; carolcheung{at}


Identifying biomarkers of Alzheimer’s disease (AD) will accelerate the understanding of its pathophysiology, facilitate screening and risk stratification, and aid in developing new therapies. Developments in non-invasive retinal imaging technologies, including optical coherence tomography (OCT), OCT angiography and digital retinal photography, have provided a means to study neuronal and vascular structures in the retina in people with AD. Both qualitative and quantitative measurements from these retinal imaging technologies (eg, thinning of peripapillary retinal nerve fibre layer, inner retinal layer, and choroidal layer, reduced capillary density, abnormal vasodilatory response) have been shown to be associated with cognitive function impairment and risk of AD. The development of computer algorithms for respective retinal imaging methods has further enhanced the potential of retinal imaging as a viable tool for rapid, early detection and screening of AD. In this review, we present an update of current retinal imaging techniques and their potential applications in AD research. We also discuss the newer retinal imaging techniques and future directions in this expanding field.

  • Alzheimer's disease
  • image analysis
  • ophthalmology

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  • Contributors CYC, CPLHC and TYW conceptualised and designed the article. CYC drafted the article. CYC, VM, PJF, ET, CPLHC, TYW and CPLHC were responsible for revising it critically for important intellectual content. All authors approved this version to be published.

  • Funding CYC has received grant funding from the Health and Medical Research Fund, Hong Kong (Grant Number: 04153506) and Bright Focus Foundation (Reference Number: A2018093S). VM has received grant funding from SEEDS Foundation. PJF has received grant support for this work from The Richard Desmond Charitable Foundation via Fight for Sight, London, UK (Grant code 1965), The International Glaucoma Association, Ashford, UK and The Alcon Research Institute, Fort Worth, Texas, USA. CPLHC has received grant funding from the National Medical Research Council Singapore (NMRC/CG/NUHS/2010 and NMRC/CG/013/2013). ET has received grant funding from the EPSRC (M005976/1) and the NIHR Global Health Research Unit “INSPIRED” (16/136/102). TYW has received grant funding from the National Medical Research Council Singapore (NMRC/STaR/016/2013 and NMRC/OFLCG/001 c/2017) and Duke-NUS Medical School (DUKE-NUS/RSF/2014/0001).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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