Special Interview with Francesco Ruggeri: Exploring Retinal Optical Coherence Tomography (OCT) Biomarkers for Neurodegenerative Diseases
23 September 2025
Francesco Ruggeri is an assistant researcher in the Ophthalmology Department of the Faculty of Neuroscience, Mental Health, and Sensory Organs at the University of Rome Sapienza, where he is an Ophthalmology Specialist Trainee (PGY-3). He is currently working at the Hospital Foundation Adolphe De Rothschild in Paris. His research focuses on retinal imaging -particularly optical coherence tomography (OCT) - for the study of the ganglion cell layer (GCL) as a potential biomarker for neurodegenerative diseases. Recently, he published a thought-provoking review titled “The Role of the Ganglion Cell Layer as an OCT Biomarker in Neurodegenerative Diseases” in our journal Journal of Integrative Neuroscience (JIN), Volume 24, Issue 5. This review provides valuable insights into the use of retinal OCT imaging in neurodegenerative diseases and suggests promising perspectives for diagnosis and monitoring.
We’re glad to have the opportunity to speak with him. Here are some highlights from our exchange.
1. Could you briefly introduce your academic background and current research focus?
I am currently a third-year Ophthalmology resident at the University of Rome Sapienza. Over the past several years, I have developed a strong interest in retinal imaging, especially OCT. Last summer, I had the opportunity to work with Prof. Nadia Waheed at Tufts University in Boston. Together with collaborators at the New England Eye Center and the Massachusetts Institute of Technology, our project focused on advanced imaging and OCT analysis. Since May of this year, I have worked at the Retina Service of the Hospital Foundation de Rothschild in Paris under Prof. Aude Couturier. In addition to my work on the ganglion cell layer as a biomarker in neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and Multiple sclerosis, I am also currently involved in a research project on idiopathic neovascular membranes. This work aims to identify potential imaging biomarkers for diagnosis and treatment response prediction.
2. What motivated you to focus on the GCL rather than the more commonly studied retinal nerve fiber layer (RNFL)?
When I started exploring the link between retinal imaging and neurodegeneration, I quickly realized that most studies focused on the RNFL. While RNFL is a well-established biomarker, the measurements can be influenced by large retinal vessels in the peripapillary region, which may obscure or distort thickness values. The GCL, on the other hand, is free from these vascular artifacts and contains the cell bodies of retinal ganglion cells, making it a more direct marker of neuronal loss. This means that subtle neurodegenerative changes may appear more clearly in the GCL than in the RNFL. For me, it was both a scientific and a clinical decision: I wanted to work on a structure that could offer cleaner, more consistent measurements, and potentially reveal patterns that would otherwise remain hidden.
3. In Alzheimer’s disease, Parkinson’s disease, and Multiple sclerosis, GCL thinning shows different pathological features and distribution patterns. Do you think these differences could help in differential diagnosis or in predicting disease progression?
Yes, absolutely. One of the most interesting aspects of working on the GCL is seeing how each disease leaves its own “signature” on this layer.
In Alzheimer’s disease, thinning is often most pronounced in the central and temporal macular regions, and is strongly correlated with cognitive decline. In Parkinson’s disease, the pattern tends to be more focal, with greater loss in the inferior and inferotemporal sectors, sometimes mirroring the asymmetry of motor symptoms. In Multiple sclerosis, GCL thinning is frequently linked to episodes of optic neuritis and is correlated not only with visual function, but also with disability scores.
These specific patterns can help clinicians differentiate between conditions. When monitored over time, they can also provide valuable prognostic information about how the disease might evolve.
4. Did you encounter any unexpected results during the study? For example, were GCL changes in certain diseases more pronounced or more subtle than anticipated?
Yes. In Multiple sclerosis, we saw GCL thinning even in patients with no history of optic neuritis. That was surprising, because it suggests there could be silent, ongoing damage that OCT can pick up before it becomes clinically evident.
In Parkinson’s disease, thinning of the inferior retina was more marked than I expected. In some cases, it even mirrored the side of the body most affected by motor symptoms.
5. If GCL-OCT technology becomes widely adopted, how do you think it could transform current diagnostic workflows? What would be its greatest value for patients, clinicians, and healthcare systems?
GCL-OCT could really change the way we approach these patients. OCT is quick, non-invasive, and widely available, so adding GCL analysis could give us an extra layer of information without extra burden for the patient.
For clinicians, it would mean having an objective biomarker to support diagnosis and track progression. For patients, it would mean earlier detection and closer monitoring without the need for expensive or invasive tests. For healthcare systems, GCL-OCT is a relatively low-cost tool that could improve screening and follow-up, thereby reducing the long-term impact of advanced disease.
6. Do you plan to further explore this topic in future studies? Are there any upcoming clinical trials or technological innovations in the pipeline?
Yes. I would like to test GCL as a biomarker in larger, long-term studies, and work on standardizing OCT protocols so that results are comparable across centers. I am also interested in combining GCL analysis with other biomarkers, such as neurofilament light chain, Aβ, or tau, and in using new OCT technologies such as adaptive optics and AI-based segmentation. In parallel, I have been involved in research on OCT angiography scan patterns, including work comparing Raster and the novel Ammonite scan in diabetic patients that was recently presented at ARVO. This experience reinforced my interest in how technical advances in image acquisition can improve quality, reduce artifacts, and make OCT a more powerful tool for both research and clinical care.
7. What were the key factors that influenced your decision to publish this study in JIN?
This journal brings together the fields of neuroscience. Since our work sits right at that intersection, it felt like the right place to reach our target audience.
In this interview, Francesco Ruggeri not only shared his in-depth research on the retinal GCL, but also offered insights into future research directions and potential clinical applications. We are grateful to Ruggeri for his valuable contributions and look forward to his continued work in this field.
Article details: The Role of the Ganglion Cell Layer as an OCT Biomarker in Neurodegenerative Diseases