AOA 2024: Uncovering the ocular connection in neurodegenerative diseases

With family history and lifestyle risk playing a role in neurodegenerative disease development, spotting cognitive changes early can make a significant impact on patient quality of life. Erin Draper, OD, FAAO, and Christopher Kuc, OD, FAAO, outline their talk from the AOA Optometry's Meeting that highlighted the important role eye care providers can play in catching biomarkers early through routine eye exams.

Video transcript

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

Erin Draper, OD, FAAO:

Hi, I'm Erin Draper. I'm associate professor at the Pennsylvania College of Optometry (PCO).

Chris Kuc, OD, FAAO:

I'm Chris Kuc, I'm in private practice at Medical Optometry America in Newtown Square, Pennsylvania. Our talk stems around neurodegenerative disease, and sort of bringing that topic to optometric practice and a lot of the connections that exist between the eye and the brain. We're kind of an odd pair because I'm in private practice and Dr. Draper's in academia at PCO in the neuro department. So we thought: Well, if we give a talk that focused on practical approach and applications to these patients, you know, it's a topic that's come to prominence in the media, in the news, and our patients want to know about it. And from a practical perspective, I like to educate my patients, especially lifestyle and things we can do to avoid these kind of problems later in life. And Dr. Draper focuses more of her practice specifically on neuro, so I thought, "Boy, this could be a good topic."

Draper:

Right, so we were trying to focus on looking at the anatomy connections between the eye and the brain. And another thing being that we as optometrist now have more tools in our toolkit that really look at the brain, like our OCT, and other ancillary testing visual fields or whatnot. So we're actually measuring and looking at brain and when we talk about neurodegenerative disease, it's about atrophy in the brain. And we're seeing this very similar atrophy in the eye. So what we then [have been] discovering over the past decade or so is that the eye is going to be a really great place for looking for biomarkers for really detecting early neurodegenerative disease, because our goal is to detect it early, get the treatments in early, improve the quality of life of these patients. And we have a large role to play in that. And Chris really talked a lot about [how he] can talk to his patients and really educates them on what they can do to help prevent [neurodegenerative disease], some of the lifestyle modifications and things like that. So I know in your practice, you talked a lot about a few things and I think you share some of those things that you find important to educate those patients on.

Kuc:

Sure, yeah. You know, a lot of these patients may know they have risk, they know they have family history. That said, lifestyle's a talk that's very easy for optometrists. We're used to giving it for dry eye, diabetes, macular degeneration. So the the topics kind of come naturally to us, as it relates to neurodegenerative problems. Similar things; our health system in America, 18% of the GDP is spent on health care. So if you have one of the highest costs and unhealthiest patients, so our western lifestyle is the problem. So inflammation is what we're trying to counter. But the lifestyle changes, things like exercise, supplements like omega-3s that are looked at now — we're comfortable talking about those for dry eye — they also apply to all the other chronic diseases. But again, controlling underlying disease, exercise, diet. Specifically, they've looked at the Mediterranean style diet, they've looked at a think called the MIND diet, which applies those Mediterranean style principles with hypertensive style diet, combine those two, and that's worked really well for patients with Alzheimer's, dementia. So having these discussions for patients that may be healthy or have a family history is important to have. We can intervene early and get our patients thinking about changing their health by exercise, diet, and lifestyle changes, they may have less complications down the road. So optometry is predominantly a profession that sees a lot of healthy people. But we do have patients that actually have the disease. So you know, once they're diagnosed, and we know they have Alzheimer's or one of the neurodegenerative diseases, we have to be able to offer practical approaches to help these patients in predominantly vision and addressing their visual concerns. But it could be low vision, it could be filters, could be text-to-speech devices. There's a lot of things we can offer our patients that really improve the quality of life for these patients.

Draper:

So patients that we bring this up with are ones that maybe have a family history, or maybe we're seeing some abnormalities on the eye exam that aren't matching with other things. I say, "Could this be a neurodegenerative disease factor involved in here?" As we said, neurodegenerative disease is neurons atrophy, glaucoma, and many other eye disease are like that. But if I don't think it's truly that and I think this could be neurodegenerative disease, I have this conversation with them that you know, maybe I'll say, "Any issues with your memory? Any other motor issues? Any other neurological concerns that you have?" And if they do, I'm thinking, maybe they should talk to a neurologist. Maybe there's some other testing other than the eye exam that we should be exploring that could explain the cause of the issues you are having. So that's kind of where I kind of start the conversation with my patients, just based on their history, and also based on do I see any abnormalities of the exam that aren't matching up [unintelligable] in terms of patients.

Kuc:

Oh, I think people for the most part are pretty open to the idea. Whether they apply those principles to their life, that's a whole other story. But the whole topic itself is really, really interesting and one thing that we haven't really mentioned yet is technology that we have in our offices now is what they're studying. So, you know, OCT, ERG, VEP, SAKAB, different tracking devices that are out there, visual field tests. These are things that we have at our disposal, we're comfortable using it for glaucoma and monitoring those images for diabetics and macular degeneration. That's part of our regular everyday practice now, but how do we apply those tests to patients that actually have neurodegenerative disease? And can we detect abnormalities that we can directly connect to those diseases and the fact of the matter is we can now, but how can we get those patients earlier? And that's where the interest comes. So the health system in general is looking for ways to identify these patients before they start to have the cognitive decline. And the puzzle is not all put together just yet. But if we're on top of it, and we're part of that picture, I think optometry really can play a key role in being able to deliver great care to patients.

Draper:

The key takeaways from our talk, our purpose of giving it, is really just making optometrists aware of the role that they play with patients that either have neurodegenerative disease or are at risk for developing neurodegenerative disease, and realizing that we're part of the health care team to get them that early intervention and also being part of seeing where we're going in the future. So we have these tools in our office that are going to be really great biomarkers for the future in working with neurologists. Being parts of clinical trials even, and that we're being part of the team that's ... going to treat these patients by getting them diagnosed early and being a part of the team. So I think for me, that's a big takeaway that we can be aware of. In addition, as you said, making sure that the patients have the education of what they can do between ... what changes can they make in their life? What changes can they make in their lifestyle? Increasing their exercise, changing their diet, and the great health benefit that will essentially come from that. Particularly if they have a family history of dementia or other neurodegenerative disease.