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In acute, subacute as well as chronic settings, decreased FD seems to be associated with stroke. A significant association was found between decreased FD and neurodegenerative disease, mainly addressing cognitive impairment (CI) and dementia. We performed a narrative synthesis and produced summary tables of findings of included papers because methodological heterogeneity precluded a meta-analysis. Results: Twenty-one studies were included for qualitative synthesis. Wherever possible, level of evidence (LOE) has been assessed by means of the Oxford Centre for Evidence-based Medicine Level of Evidence classification. Articles have been included based upon their relevance. Methods: A literature search was conducted, following the PRISMA Statement 2009 criteria, in four large bibliographic databases (Pubmed, Embase, Web Of Science and Cochrane Library) up to 12 October 2019. In this review, the potential of this retinal vessel metric to serve as a biomarker in neurodegeneration and stroke will be explored. Changes in FD could reflect subtle changes in the cerebral vasculature that correspond to preclinical stages of neurodegenerative diseases.

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Fractal dimension (FD) reflects the overall complexity of the retinal vasculature. Offering a “window to the brain,” the transparent eye enables non-invasive imaging of these changes in retinal structure and vasculature. Retinal alterations in particular can serve as surrogates for cerebral changes. Introduction: Ocular manifestations in several neurological pathologies accentuate the strong relationship between the eye and the brain. 4Centre of Environmental Sciences, Hasselt University, Diepenbeek, Belgium.3Health Unit, VITO (Flemish Institute for Technological Research), Mol, Belgium.2Research Group Ophthalmology, Biomedical Science Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.1Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium.Sophie Lemmens 1,2,3 *, Astrid Devulder 1,2, Karel Van Keer 1,2, Johan Bierkens 3, Patrick De Boever 3,4 and Ingeborg Stalmans 1,2

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Ultra fractal duplicate file