Aqueous Humor Outflow Structure and Function Imaging At the Bench and Bedside: A Review

Area of Science:

• Ophthalmology and visual sciences
• Glaucoma research
• Anterior segment eye anatomy

Background:

• Glaucoma research is increasingly focused on the anterior segment due to new imaging and surgical advancements.
• Traditional research on the trabecular meshwork has expanded to encompass the entire aqueous humor outflow (AHO) pathway.
• Understanding the structure and function of the AHO pathway is critical for glaucoma management.

Purpose of the Study:

• To review the historical basis and current methodologies for studying the anterior segment and AHO in glaucoma.
• To discuss structural and functional assessment techniques for the AHO pathway.
• To explore the clinical implications of distal outflow resistance and segmental AHO.

Main Methods:

• Review of historical pathological approaches and modern imaging tools like two-photon microscopy and optical coherence tomography for structural assessment.
• Description of non-real-time and real-time techniques, including aqueous angiography, for functional assessment of AHO.
• Discussion of research integrating structural and functional data to understand AHO in normal and diseased eyes.

Main Results:

• Novel imaging modalities and angle-based surgical treatments are driving new focus in anterior segment glaucoma research.
• AHO investigation is now divided into structural and functional assessments, utilizing diverse methodologies.
• Research highlights the importance of distal outflow resistance and segmental AHO in clinical applications.

Conclusions:

• Developing an improved structure: function relationship for the AHO pathway is key to advancing glaucoma understanding and therapeutics.
• Bridging bench-side research with clinical applications will lead to better treatments for anterior segment diseases.
• Enhanced understanding of the AHO pathway promises improved therapeutic strategies for glaucoma.