Dr. Paul Foster

Eye Sign of Dementia Risk? Thinning of Retinal Nerve Fiber Layer

MedicalResearch.com Interview with:

Dr. Paul Foster

Dr. Foster

Paul Foster BMedSci(Hons) BMBS PhD FRCS(Ed) FRCOphth FRCS(Eng)
Professor of Glaucoma Studies & Ophthalmic Epidemiology
Research Theme Lead Integrative Epidemiology & Visual Function
UCL Institute of Ophthalmology & Moorfields Eye Hospital

MedicalResearch.com: What is the background for this study? 

Response:  Dementia is the medical challenge of the moment – increasingly common, adversely impacting quality of life for millions, and a great worry for all. Efforts to identify treatments or interventions rely on being able to identify those people at greatest risk. Our motivation was to help identify those people, primarily to aid in the development of treatments through clinical trials.

MedicalResearch.com:  What are the main findings?

Response:  We found that people in the lowest two quintiles of retinal nerve fibre layer thickness (RNFL) are around double the risk of having mild cognitive problems. There was a significantly greater proportion of people in the thinnest quintile who get new cognitive problems within 3 years, compared with those in the thickest quintile.

MedicalResearch.com: What should readers take away from your report?

Response: An eye examination should form part of any general medical examination. There is no systemic disease which does not have an eye sign. Retinal examination is particularly important as retinal morphometry (either of vessels or neuroretina) can identify risk of stroke, MI, hypertension, diabetes and dementia. These tests currently are limited to the research arena, but are likely to become available to general practitioners within 5 years.

If patients are found to have a thin RNFL, clinicians could use the opportunity to advise “healthy lifestyle” activities, promoting both physical and mental activity, and encouraging social interaction. There is a link between poorer vision and hearing and cognitive decline, so advising a hearing and vision assessment would be useful, optimizing of sight and vision are likely to pay dividends – interventions such as new glasses, cataract surgery or hearing aids etc.  Counselling 40% of the population over the age of 40 may provoke panic, so it is important to keep things in perspective, and offer constructive, practical advice to patients and the public.  Some drug treatments may be suitable: for background:

Dementia: timely diagnosis and early intervention  BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3029
(Published 16 June 2015)Cite this as: BMJ 2015;350:h3029 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We are working on calculations of the sensitivity and specificity (i.e. false negatives and false positives) of the eye/vision tests that may help identify increased risk of cognitive decline, to try to work out how widespread the offer of screening be.


Ko F, Muthy ZA, Gallacher J, et al. Association of Retinal Nerve Fiber Layer Thinning With Current and Future Cognitive DeclineA Study Using Optical Coherence TomographyJAMA Neurol. Published online June 25, 2018. doi:10.1001/jamaneurol.2018.1578

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Last Updated on June 25, 2018 by Marie Benz MD FAAD