Retinal and Choroidal Structure and Microvasculature in Dementia With Lewy Bodies and Alzheimer Disease

Purpose: To compare retinal and choroidal structural and microvascular imaging parameters between patients with dementia with Lewy bodies and those with Alzheimer disease using optical coherence tomography (OCT) and OCT angiography (OCTA). Methods: In this cross-sectional study, patients with dementia with Lewy bodies and those with Alzheimer disease underwent imaging with the Cirrus HD-5000 AngioPlex system (Carl Zeiss Meditec). OCT metrics included central subfield thickness, ganglion cell-inner plexiform layer thickness, retinal nerve fiber layer thickness, and choroidal vascularity index. Macular OCTA metrics included perfusion density, vessel density, and foveal avascular zone area. Peripapillary OCTA metrics included capillary perfusion density and capillary flux index. Generalized estimating equations adjusted for years of education were used to account for intereye correlation. Results: A total of 36 eyes from 20 patients with dementia with Lewy bodies and 42 eyes from 21 patients with Alzheimer disease were included. Compared with eyes from patients with Alzheimer disease, eyes from patients with dementia with Lewy bodies demonstrated significantly lower perfusion density and vessel density within the 3 × 3 mm Early Treatment Diabetic Retinopathy Study circle and ring ( P = .03-.04). Structural OCT and peripapillary OCTA metrics did not differ significantly between the groups. Conclusions: Compared with Alzheimer disease, dementia with Lewy bodies was associated with reduced macular perfusion density and vessel density on OCTA. These findings suggest disease-specific differences in the retinal microvasculature between dementia with Lewy bodies and Alzheimer disease.