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What If ....

Over a five-day period in early June, I was able to travel to Orlando, Florida to present at Vision Expo East, one of the first large meetings post-COVID to bring the eye care industry back together. I then traveled to Cleveland, Ohio to give six hours of continuing education at the East West Summer Bash. It was definitely energizing to be back in person with colleagues after spending countless hours interacting online. Part of that last leg of the trip was having dinner with a colleague where we caught up on all things, one of which was his ninety some year-old grandma who, while living in some arthritic pain, was not experiencing any dementia thankfully.

It made me think of my own grandparents who have all passed, but that emotional
connection we all have with family. My grandma on my dad’s side in particular, had a fairly aggressive decline in her health due to diabetes, exacerbated by dementia. I was fairly certain she had a tractional retinal detachment in one eye – I can still picture her dining room table with oral medications left untaken.

Practically every disease state starts as a loss of homeostasis. With Alzheimer’s, there is calcium dysregulation along with accumulation of amyloid-β into senile plaques, forming approximately 15 to 25 years prior to the onset of cognitive decline.1 Cassava Sciences is not only developing a simple, yet sensitive diagnostic blood test to detect Alzheimer’s, but also plans to launch pivotal phase 3 trials by the end of 2021 for its oral medication simufilam.

As eye care practitioners, we have the distinct privilege to care for patients from birth until old age. Oftentimes, we get more than one touchpoint per year which is typically more than the primary care physician. A very recent paper showed that patients with
Alzheimer’s disease had more retinal roughness than age matched patients.2 Roughness was also associated with thinning of other retinal layers and decline in visual acuity.

A term I learned for the very first time is the glymphatic system which is the system or process by which cerebrospinal fluid (CSF) moves through channels formed by glia, cleansing the brain of harmful waste. The fascinating part is that the flow of fluid during
deep sleep is vital to clearing amyloid-β and tau proteins.3 Memory consolidation happens in this process. This activity in the brain now makes sense in how the ganglion cells of the nerve fiber layer that are bathed in CSF in the retrobulbar space can be
affected in Alzheimer’s.

During this time, I know the population at large is far more conscious of their own personal health and that of others. I encourage us all to take proactive measures to have the future in mind when we make decisions today. Living by example and telling stories
of a shared experience will only bring us closer to one another. There’s always someone that needs hope.

Justin Kwan, OD, FAAO

References are published in CRO Journal.