Relationships between multimodal ocular imaging and white matter hyperintensity volume.

Area of Science:

• Ophthalmology
• Neurology
• Radiology

Background:

• White matter hyperintensities (WMH) are key markers of cerebral small vessel disease, linked to stroke, cognitive decline, and mortality.
• Current MRI assessments for WMH are costly and impractical for large-scale monitoring.
• Ocular imaging offers a non-invasive alternative due to shared microvascular characteristics between the retina and brain.

Purpose of the Study:

• To explore associations between multimodal ocular imaging biomarkers and WMH volume.
• To enable earlier, non-invasive detection of cerebral small vessel disease.
• To investigate lobe-specific WMH and multimodal biomarkers.

Main Methods:

• 761 participants underwent ophthalmic (OCT, fundus photography) and neuroimaging (MRI) evaluations.
• Ocular metrics included macular retinal nerve fiber layer (mRNFL), macular ganglion cell-inner plexiform layer (mGCIPL), central retinal arteriolar equivalent (CRAE), and arteriole/venular ratio (AVR).
• Generalized linear regression models analyzed associations between ocular biomarkers and WMH volume, adjusting for demographics and vascular risk factors.

Main Results:

• Thinner mGCIPL and macular ganglion cell complex (mGCC) associated with greater WMH volume in total brain, temporal, and occipital lobes.
• Reduced macular inner nuclear layer (mINL) correlated with larger WMH in the total brain and specific lobes.
• Smaller AVR, narrower CRAE, wider CRVE, lower fractal dimension (FD), and wider global vein width were linked to increased WMH volume, particularly in the occipital lobe. Associations were stronger in females.

Conclusions:

• OCT and fundus photography parameters are independently associated with WMH volume.
• These ocular parameters show potential as biomarkers for early detection and monitoring of WMH.
• Multimodal ocular imaging may facilitate precise identification and surveillance of white matter alterations.