The results of MRI exploration of glaucoma patients: what are the benefits?

After 13 years of glaucoma exploration using MRI at 1.5 and 3 Tesla, we have deduced that there is no specific characteristic between the different forms of this disease, which is manifested by a slowly progressing degenerative optical neuropathy, predominant from front to back (with volume of the optic nerve head always greater than the distal portions of the 2nd neurone, chiasma, and optic tract), interspersed with clinical flare-ups that are recognized by an intense localized hypersignal (frequently from the apex progressing along the canal). Visual tract involvement is always bilateral, even in cases where symptoms are exclusively unilateral (asymmetry can be observed in these cases). The discordance between (i) the severity of axon reduction and (ii) the signs of injury already present at the time when MRI is performed and the relative preservation of visual function argues for encephalic disease with visual involvement. Its delayed discovery makes treatment, even with neuroprotectors, less effective and points toward the need for implementing directed genetic prevention studies, as a first step to more effectively assessing the therapies available.