Visual function in Alzheimer’s disease: current understanding and potential mechanisms behind visual impairment

Abstract

Alzheimer’s disease (AD) is the leading cause of dementia worldwide and is becoming one of the most morbid diseases of this century. Recently, ocular research in AD has gained significance, as the eye, due to its close relationship with the brain, can reflect the presence of neurological disorders. Several studies have reported alterations in various ocular structures in AD, ranging from tear fluid to the retina. These changes, particularly in the retina and the optic nerve, along with cerebral atrophy affecting visual brain areas, may lead to visual dysfunctions. This narrative review summarizes and critically examines current evidence on these impairments and explores their possible underlying mechanisms. A decrease in visual acuity, contrast sensitivity, and color vision has been observed, primarily associated with retinal ganglion cell loss or damage. Furthermore, alterations in the visual field, ocular motility, and visual perception have been recorded, mainly resulting from cortical changes. These optical parameters frequently correlate with patients’ cognitive status. In conclusion, these findings highlight the importance of developing strategies to preserve visual function in these patients, helping to prevent further deterioration in their quality of life, and emphasize the potential of visual function assessment as a tool for diagnosis or predicting AD progression.