Feasibility Study for Longitudinal Retinal Imaging in the Anti‐Amyloid Treatment in Asymptomatic Alzheimer’s Disease (A4) Trial

Background Alterations to the retina manifest in patients diagnosed with neurodegenerative diseases such as Alzheimer’s disease (AD). Retinal imaging techniques open the possibility for non‐invasive evaluation of AD pathology. Clinically AD diagnosed patients exhibit retinal spots that may be amyloid deposits. Few studies monitoring preclinical individuals exist, limiting the assessment of the feasibility of retinal imaging as a biomarker for early‐stage AD risk detection. Method We compared extent and distribution of retinal fluorescent spots and cerebral amyloid in clinically normal individuals who screened positive for high amyloid levels through positron emission tomography (PET) from the Anti‐Amyloid Treatment in Asymptomatic Alzheimer Disease (A4) as well as a companion cohort of individuals who exhibited low levels of amyloid PET in the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) study. We quantified the number of curcumin‐positive fluorescent retinal spots from participants from both studies to determine retinal amyloid deposition at baseline. Result Participants from the A4 trial exhibited a greater number of retinal spots compared to those from the LEARN study. We report a positive correlation between retinal spots and brain amyloid, as measured by the standardized uptake value ratio (SUVr). Conclusion The results of this study support the use of retinal fundus imaging for and assessing relationships with brain amyloid PET SUVr. Further work is needed to determine the nature of retinal spots and their relationship with actual amyloid plaques cross‐sectionally and longitudinally.