Demyelination and trans synaptic degenerative changes in the visual pathway in glaucoma

Neurodegenerative disorders are characterised by irreversible neuronal loss, to which the exact mechanism remains unknown. One feature of neurodegenerative disease; Trans Synaptic degeneration (TSD) plays a key role in many CNS diseases such as Alzheimer's disease, Multiple Sclerosis and Optic Neuritis. Diffusion Tensor Magnetic Resonance Imaging (DTMRI) allows us to measure and visualise the orientation and anisotropy of MRI parameters in vivo. These measurable parameters can be used to characterise tissue integrity in the brain and white matter and thus show microstructural changes that are occurring throughout the disease process. This study looks to investigate which MRI parameters are measuring demyelination and whether demyelination is the initial pathological change that is occurring in glaucoma. These aims will be addressed in two phases, firstly a meta - analysis will be conducted in order to identify which MRI parameter /s is directly measuring demyelination and axonal loss. Followed by a comprehensive analysis comparing adjusted retinal nerve fibre layer (RNFL) thickness and MRI parameter values in the visual pathway in glaucoma patients. The clinical study will therefore allow us to identify which MRI parameter/s recognized from phase 1 are directly responsible for micro structural changes that are seen.