While the exact cause of glaucoma remains a mystery, recent studies suggest a (neurodegenerative) process that extends to the brain. This enigmatic disease does not limit itself to ocular damage but affects the entire visual pathway. Gracitelli and colleagues contributed further and found that cortical brain changes are correlated with functional and structural ocular parameters. Is it time to add MRI to our glaucoma work-ups?
Ordering an MRI is certainly not justified or cost effective for glaucoma diagnosis and management, but further research may determine other markers that can be used for a fraction of the cost.
Neuroprotective drugs could be an important way to preserve the optic nerve and brain function. When do cortical changes occur? While brain damage seems to occur early in the disease, future studies will attempt to understand the exact relationship. Is there atrophy in an area that is no longer needed due to decreased ocular function? Is it a simultaneous neurodegeneration across the visual pathway or does brain damage actually precede optic nerve damage? If it is the latter, it may be useful to selectively employ MRIs in those hard-to-diagnose cases. Time, and more studies, will tell.
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