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Glaucoma as a cause of optic nerve abnormalities on magnetic resonance imaging

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Abstract

Background/objectives

To report a series of patients with glaucoma and optic nerve abnormalities on magnetic resonance imaging (MRI) in at least one-eye, and to determine whether these findings correlate with the severity of glaucoma.

Patients and methods

Retrospective study of all patients who underwent a brain/orbits MRI without and with contrast at our institution between 07/1/2019-6/30/2022. Patients with optic nerve T2-hyperintensity and/or MRI optic nerve atrophy in at least one-eye and a diagnosis of isolated glaucoma in at least one-eye were included. Demographic information, glaucoma clinical characteristics, glaucoma severity parameters, and MRI indication were collected.

Results

Fifty-six patients (112 eyes) (age 65 years-old [range 26–88]; 70% male) had isolated bilateral glaucoma with at least one-eye MRI optic nerve abnormality. The indication for MRI was atypical/asymmetric glaucoma in 91% of patients. Of the 112 eyes, 23 had optic nerve T2-hyperintensity alone; 33 had both optic nerve T2-hyperintensity and MRI optic nerve atrophy; 34 had MRI optic nerve atrophy alone; and 22 did not have abnormal optic nerve MRI-findings. None had optic nerve enhancement. A statistically significant association between optic nerve T2-hyperintensity or MRI optic nerve atrophy and glaucoma severity parameters was found.

Conclusions

Glaucoma is a clinical diagnosis and MRI brain is usually not required, except in atypical or asymmetric cases. Optic nerve T2-hyperintensity and MRI optic nerve atrophy are nonspecific MRI-findings that can be found in severe glaucomatous optic nerves and should not systematically prompt investigations for another cause of optic neuropathy.

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Fig. 1: Abnormal ON radiologic findings on MRI of the brain and orbits.

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Data availability

The data that support the findings of this study are available from the corresponding author, VB, upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA

    Rasha Mosleh, Fernando Labella Álvarez, Walid Bouthour, Michael Dattilo, Beau B. Bruce, Nancy J. Newman & Valerie Biousse

  2. The Goldschleger Eye Institute, The Sheba Medical Center, Tel Hashomer, Israel

    Rasha Mosleh

  3. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Amit M. Saindane

  4. Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Amit M. Saindane & Nancy J. Newman

  5. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Beau B. Bruce

  6. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Beau B. Bruce, Nancy J. Newman & Valerie Biousse

Authors
  1. Rasha Mosleh
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  2. Fernando Labella Álvarez
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  3. Walid Bouthour
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  4. Amit M. Saindane
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  5. Michael Dattilo
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  6. Beau B. Bruce
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  7. Nancy J. Newman
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  8. Valerie Biousse
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Contributions

RM, FL, WB, VB, NJN, MD were responsible for designing the review protocol, writing the protocol and report, conducting the search, screening potentially eligible studies, extracting and analysing data, interpreting results, updating reference lists and creating tables. AS was responsible for reviewing all MRI studies; he contributed to writing the report, extracting and analysing data. BBB conducted the statistical analyses and contributed to the design of the review protocol, and writing the report.

Corresponding author

Correspondence to Valerie Biousse.

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Competing interests

No relevant conflicting relationship exists for any author. This work was supported in part by the National Institutes of Health’s National Eye Institute’s core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine) and by a departmental grant from Research to Prevent Blindness (New York, NY). VB is consultant for GenSight Biologics and Neuro-phoenix, and receives research support from GenSight Biologics. NJN is consultant for GenSight Biologics, Santhera/Chiesi, Stoke, Avidity, Neurophth and Neurophoenix; receives research support from GenSight Biologics and Santhera/Chiesi; is a participant in educational webinars sponsored by WebMD-Global Medscape. BBB is a consultant for Bayer. FL received a research grant from Fundación Alfonso Martín Escudero, Madrid, Spain, for clinical research in neuro-ophthalmology. WB received a scholarship from Geneva University Hospitals, Geneva, Switzerland.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study was presented in part at the North American Neuro-Ophthalmology Society Annual Meeting in Orlando, FL in March 2023.

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Mosleh, R., Labella Álvarez, F., Bouthour, W. et al. Glaucoma as a cause of optic nerve abnormalities on magnetic resonance imaging. Eye (2024). https://doi.org/10.1038/s41433-024-02964-y

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