ARVO 2025: Multimodal retinal imaging in asymptomatic APOE ε4 carriers, noncarriers, and Alzheimer Disease

At ARVO 2025, in Salt Lake City, Utah, Alex Choi discussed his poster on APOE carrier genetic status and its relation to Alzheimer disease as well as changes of the retina that might reflect early signs leading to an earlier diagnosis of the disease

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Alex Choi:

Hi, my name is Alex Choi. I am a second-year medical student at the Duke University School of Medicine. And yeah, to kind of briefly explain my project. I was looking at APOE carrier genetic status and how that relates to Alzheimer disease and the changes of the retina that might reflect early signs that can lead to an earlier diagnosis of the disease. And so we looked at people who were non-carriers of APOE ε4, meaning that they had no alleles. People who were also carriers having one or two alleles, and then people who were symptomatic for Alzheimer disease. In terms of the methods, we looked at OCT and OCTA imaging, and we did some statistics to ensure that they were adjusted for age and sex during the analysis as well. And so in summary, we found that the microvascular changes, namely the perfusion and vessel densities in the carriers and non-carriers tended to be higher than the ones in the Alzheimer's disease group. Meaning that as disease progression happens through the Alzheimer's disease spectrum, we kind of see a decrease in the microvascular densities in the retina.

On the other hand, we saw that the peripapillary capillary perfusion density was actually higher in the Alzheimer disease group, and we actually think that might be a response to kind of the hypoxia that might be induced as a result of the amyloid pathology happening in the Alzheimer disease group. And so that was kind of an interesting finding as well. So in summary, we found that the carriers of the APOE ε4 allel changes similar in the retina to symptomatic Alzheimer disease patients, which is interesting. And we think that some of these microvascular changes might precede the more kind of macro-level structural changes that happen in the retina in these carrier populations.

And lastly, we think that this parapapillary capillary perfusion density variable might be kind of a symptomatic biomarker to indicate progression to kind of a symptomatic Alzheimer disease state. This particular project was kind of a snapshot, so it was kind of a cross-sectional study. But the next step, actually, for me, is kind of to look at longitudinal changes, to see whether we can see these changes kind of happen over time, across kind of the same patients. And so that would be something interesting. So we actually did some surveys looking at whether people would want to know about an early diagnosis of Alzheimer, and more than half of people said that they would. And so we actually think that this is applicable kind of to everybody, or people who kind of go into these routine eye screenings get their eyes checked annually. Maybe this would be kind of an easy way to indicate early changes that might be leading to Alzheimer disease. And so anybody with, like, a family history of Alzheimer disease, anybody who would maybe want to know and kind of plan for earlier lifestyle changes, I think.