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Structural and functional brain changes beyond visual system in patients with advanced glaucoma.

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Primary open-angle glaucoma (POAG) is linked to widespread brain neurodegeneration, not just visual pathways. This study found brain atrophy and altered white matter integrity in POAG patients, suggesting it

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Radiology

Background:

  • Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
  • The hypothesis that POAG involves widespread neurodegeneration beyond the visual system requires investigation.

Purpose of the Study:

  • To test the hypothesis of spreading neurodegeneration in the brain in patients with POAG.
  • To investigate structural and functional brain changes in advanced POAG using multimodal MRI.

Main Methods:

  • Multimodal MRI scans were performed on 13 advanced POAG patients and 12 age-matched normal controls (NC).
  • Whole-brain explorative voxelwise analyses were conducted to assess white matter (WM) integrity and grey matter (GM) atrophy.
  • Functional connectivity (FC) was analyzed across various brain networks.

Main Results:

  • POAG patients exhibited altered WM tract integrity (decreased fractional anisotropy, increased diffusivities) in both visual and nonvisual pathways.
  • Brain atrophy was observed in visual cortex and distant GM regions (frontoparietal cortex, hippocampi, cerebellar cortex).
  • Decreased FC was found in visual, working memory, and dorsal attention networks, with increased FC in visual and executive networks.

Conclusions:

  • POAG is associated with widespread neurodegeneration affecting both structural integrity and functional connectivity throughout the brain.
  • Abnormalities in POAG correlate with visual field parameters, highlighting clinical relevance.
  • POAG should be considered a systemic neurodegenerative condition rather than solely an eye disorder.