The Eye and the Brain: Photonic Devices in Neuro-Ophthalmology

Photonic imaging technologies have profoundly transformed neuro-ophthalmic diagnostics by enabling non-invasive visualization of neurodegenerative processes at the retinal level. This review examines how advanced light-based modalities provide unprecedented insights into the structural, physiologic, and biologic relationships between the eye and brain in conditions such as optic neuritis, multiple sclerosis, and glaucoma. Optical coherence tomography has emerged as an essential tool for quantifying thinning of the retinal nerve fiber layer and ganglion cell layer, serving as reliable biomarkers of axonal loss and disease progression across multiple sclerosis subtypes and optic neuropathies. Detection of apoptosing retinal cells imaging enables real-time visualization of retinal ganglion cell apoptosis preceding irreversible structural damage, offering a critical window for early intervention in various neurodegenerative conditions, in particular, glaucoma. Two-photon microscopy with adaptive optics enables subcellular-resolution imaging of retinal neurons, microvascular dynamics, and inflammatory processes in vivo, facilitating the characterization of neurodegenerative mechanisms at unprecedented spatial scales and redefining neuro-ophthalmology by positioning the retina as an accessible extension of the central nervous system. This review critically examines how established and investigational photonic imaging modalities may support earlier disease detection, longitudinal monitoring, and biomarker development in neuro-ophthalmic and neurodegenerative disorders, with potential implications for more timely and targeted management strategies.