Retinal neurodegeneration exhibits etiology-specific spatial architectures: POAG showed global pRNFL and GCL thinning with compressed sectoral range, whereas AD and CAS showed preserved global pRNFL with temporal vulnerability, and intraeye spatial heterogeneity metrics (particularly pRNFL Max-Min difference) may help distinguish glaucomatous from nonglaucomatous conditions pending external validation.
The multicenter cross-sectional study compared inner retinal OCT measures across 1380 participants in four groups.
POAG showed profound global thinning of both pRNFL and macular GCL.
POAG was characterized by compression of the pRNFL sectoral thickness range, whereas AD and CAS maintained or increased pRNFL spatial variability.
AD showed selective temporal pRNFL thinning without significant macular GCL thinning.
CAS showed generalized macular GCL thinning together with temporal pRNFL vulnerability.
The pRNFL Max-Min difference showed high apparent discrimination of POAG from healthy controls, AD, and CAS, outperforming conventional global thickness metrics.
Retinal neurodegeneration exhibits etiology-specific spatial architectures, and spatial heterogeneity metrics may help differentiate glaucomatous from nonglaucomatous conditions.
This study used eye scans (optical coherence tomography) to compare the inner retina in people with glaucoma, Alzheimer's disease, and narrowing of the carotid artery, along with healthy people. It included 1380 participants across multiple centers. The researchers looked not just at average thickness of the nerve fiber and ganglion cell layers, but at how thickness varied across different regions of the same eye. People with glaucoma had marked thinning overall and a flattened pattern of regional variation in the nerve fiber layer. People with Alzheimer's disease and carotid stenosis kept normal overall nerve fiber thickness but showed thinning in the temporal (side toward the temple) region; carotid stenosis also showed thinning of the macular ganglion cell layer. A measure of the difference between the thickest and thinnest nerve fiber regions appeared to separate glaucoma from the other groups better than overall thickness. This research suggests that the spatial pattern of retinal thinning, and not just how thin the retina is, may help tell glaucoma apart from brain-related or blood-flow-related conditions. However, the authors note the results need confirmation in independent groups and in early-stage disease before they could be considered useful in clinical practice.
Qiu S, Cao L, Zhang J, Zhao N, Hu X, Wu B, et al.. (2026). Spatial Signatures of Retinal Neurodegeneration in Glaucoma, Alzheimer's Disease, and Carotid Stenosis.. Translational vision science & technology. https://doi.org/10.1167/tvst.15.10.38