近年来,眼科人工智能(artificial intelligence,AI)迅猛发展,眼底影像因易获取及其丰富的生物信息成为研究热点,眼底影像的AI分析在眼底影像分析中的应用不断深入、拓展。目前,关于糖尿病性视网膜病变(diabetic retinopathy,DR)、年龄相关性黄斑变性(age-related macular degeneration,AMD)、青光眼等常见眼底疾病的临床筛查、诊断和预测已有较多AI研究,相关成果已逐步应用于临床实践。除眼科疾病以外,探究眼底特征与全身各种疾病之间的关系并据此研发AI诊断系统已经成为当下的又一热门研究领域。AI应用于眼底影像分析将改善医疗资源紧缺、诊断效率低下的情况,为多种疾病的筛查和诊断开辟“新赛道”。未来眼底影像AI分析的研究应着眼于多种眼底疾病的智能性、全面性诊断,对复杂性疾病进行综合性的辅助诊断;注重整合标准化、高质量的数据资源,提高算法性能、设计贴合临床的研究方案。
In recent years, artificial intelligence (AI) in ophthalmology has developed rapidly. Fundus image has become a research hotspot due to its easy access and rich biological information. The application of AI analysis in fundus image is under continuous development and exploration. At present, there have been many AI studies on clinical screening, diagnosis and prediction of common fundus diseases such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma, and related achievements have been gradually applied in clinical practice. In addition to ophthalmic diseases, exploring the relationship between fundus features and various diseases and developing AI diagnostic systems based on this has become another popular research field. The application of AI in fundus image analysis will improve the shortage of medical resources and low diagnostic efficiency, and open up a “new track” for screening and diagnosis of various diseases. In the future, research on AI analysis of fundus image should focus on the intelligent and comprehensive diagnosis of multiple fundus diseases, and comprehensive auxiliary diagnosis of complex diseases, and lays emphasis on the integration of standardized and high-quality data resources, improve algorithm performance, and design clinically appropriate research program.
视网膜是中枢神经系统的一部分。在胚胎起源上,视网膜和大脑均由神经管发育而来。因此,许多发生在大脑的神经退行性疾病往往会同时累及视网膜。而神经退行性疾病过程中相关的特征性病理改变,如病理性蛋白聚集和神经血管单元破坏也常能在视网膜组织中被检测到。在一些神经退行性疾病中,眼部的病理改变甚至在临床症状出现之前就已发生;其次视网膜易于观察且局部治疗操作便捷,因此近年来视网膜在中枢神经退行性疾病发病机制研究、早期诊断和新型治疗方式探究等方面备受关注。该文对常见神经退行性疾病的眼部病理改变进行综述,旨在为大脑和视网膜神经退行疾病的发病机制、诊断以及治疗研究提供新的见解。
The retina is a part of the central nervous system. Developmentally, both retina and brain are derived from the neural tube. Therefore, many neurodegenerative diseases that occur in the brain tend to involve both the retina. In the process of neurodegenerative diseases, related characteristic pathological changes, such as pathological protein aggregation, neurovascular unit impairment can often be detected in retinal tissue. In some neurodegenerative diseases, pathological changes in the eye occur even before clinical symptoms appear. In addition, the retina are easy to observe and local treatments are convenient. In recent years, the manifestations of the retina have attracted much attention in the study of pathogenesis, early diagnosis, and new treatments of systemic central neurodegenerative diseases. In this way, this article reviews the ocular pathological changes of common neurodegenerative diseases, aiming to provide new insights into the pathogenesis, diagnosis, and treatment of brain and retinal neurodegenerative diseases.
帕金森病(Parkinson’s disease, PD)作为仅次于阿尔茨海默病的第二大神经退行性疾病,其眼部表现近年来逐渐成为跨学科研究热点。以往医生多关注运动迟缓、静止性震颤和肌强直等PD典型症状,但大量临床研究表明,眼睑异常、眼球运动障碍、视觉功能异常等眼部表现不仅普遍存在于PD患者中,更可能在典型运动症状出现前就已显现。长期以来,这些眼部症状因其他症状的掩盖往往被忽视,进一步降低了患者的生活质量。本综述系统梳理PD患者眼部表现的三大方面:首先,眼睑异常方面,PD患者瞬目频率降低,61.1%患者出现干眼症状,导致PD患者的生活质量进一步下降。其次,眼球运动障碍表现为特征性的阶梯式方波急跳、集合功能减退以及反向扫视错误率增加,其中反向扫视潜伏期延长对步态冻结的发生具有预测价值。最后,视觉功能障碍方面,PD患者可出现视敏度下降、色觉异常、对比敏感度受损和视幻觉。影像学检查观察到视网膜神经节细胞层变薄,伴随视网膜微血管密度降低,这些结构性改变与PD患者的视觉功能障碍有关,作为生物标志物具有独特潜力。神经内科-眼科联合诊疗模式不仅有助于PD的早期诊断和预后评估,更有助于临床医生全面理解PD的疾病机制和表现,为未来诊疗策略的优化提供客观依据。
Parkinson’s disease (PD), the second most common neurodegenerative disorder after Alzheimer’s disease, has increasingly garnered interdisciplinary research attention due to its ocular manifestations. While the classical triad of motor symptoms—bradykinesia, resting tremor, and rigidity—remains the diagnostic hallmark, accumulating clinical evidence indicates that ocular abnormalities, including eyelid dysfunction, oculomotor disturbances, and visual impairments, are not only prevalent in PD patients but may also precede the onset of typical motor symptoms. Historically overlooked due to masking by other clinical features, these ocular manifestations contribute to the deterioration of patients' quality of life. This review systematically examines PD-related ocular abnormalities across three key domains: First, eyelid dysfunction manifests as reduced blink frequency, with 61.1% of PD patients reporting dry eye symptoms, further exacerbating their life quality impairment. Second, oculomotor disturbances are characterized by staircase-pattern square-wave jerks, convergence insufficiency, and increased error rates in antisaccade tasks, with prolonged antisaccade latency serving as a predictive marker for freezing of gait. Third, visual dysfunction encompasses diminished visual acuity, dyschromatopsia, impaired contrast sensitivity, and visual hallucinations. Imaging studies reveal structural alterations such as retinal ganglion cell layer thinning and reduced retinal microvascular density, which correlate with visual deficits and hold promise as potential biomarkers. The establishment of a neuro-ophthalmological collaborative framework not only facilitates early PD diagnosis and prognostic assessment but also enhances clinicians' comprehensive understanding of disease mechanisms. Such an approach provides an objective foundation for optimizing future therapeutic strategies.