Brain involvement in glaucoma: advanced neuroimaging for understanding and monitoring a new target for therapy

On the basis of a large body of experimental data the notion that glaucoma damages retinal ganglion cells and central areas of the visual system has been put forward. The mechanisms underlying glaucomatous involvement of the central areas are not known: the most likely hypothesis is that this event is the result of an anterograde transynaptic neurodegeneration triggered by ganglion cells' death. However, it is possible that in some cases it may be the consequence of a neurodegenerative disease of the central nervous system. In any event, novel mechanisms leading to cell demise might be implicated. The development of powerful neuroimaging techniques in conjunction with sophisticated analysis has recently provided compelling support to the involvement of central stations of the visual pathway in patients suffering of glaucoma. Diffusion Tensor-MRI allows the central damage associated with glaucoma to be assessed and therapeutic efficacy of novel neuroprotective interventions to be quantified.

227Highlights► Brain involvement strengthens the notion that glaucoma is a complex neurological disease. ► Brain damage in glaucoma can be the result of a transynaptic diffusion triggered by ganglion cell death. ► In some cases glaucoma may be consequent to a neurodegenerative process initiated in the CNS. ► Advanced neuroimaging will assist in the translation of novel therapeutics into the clinic.