Abstract
ObjectivesWe hypothesized that a meta-analysis of existing studies may help to reveal significant changes on diffusion tensor imaging (DTI) in patients with glaucoma. Therefore, a meta-analysis was utilized to investigate the possibility that DTI can detect white matter damage in patients with glaucoma.MethodsThe study design and report adhered to the PRISMA Statement guidelines. DTI studies that compared glaucoma patients and controls were surveyed using PubMed, Web of Science and EMBASE (January 2008 to September 2013). Stata was used to analyze the decrease in fractional anisotropy (FA) and increase in mean diffusivity (MD) in the optic nerve and optic radiation in patients with glaucoma.ResultsEleven DTI studies were identified through a comprehensive literature search, and 10 independent DTI studies of glaucoma patients were eligible for the meta-analysis. A random effects model revealed a significant FA reduction in the optic nerve and optic radiation, as well as a significant MD increase in the tracts. A heterogeneity analysis suggested that FA may be related to glaucoma severity.ConclusionsOur findings revealed that the optic nerve and optic radiation were vulnerable regions in patients with glaucoma and that FA may be correlated with glaucoma severity and age. Furthermore, this study suggests that magnetic resonance imaging in patients with glaucoma may help to provide objective evidence to aid in the diagnosis and management of glaucoma.
Highlights
Glaucoma is the second most common cause of blindness in the world [1], and it currently affects approximately 90 million people worldwide [2,3]
Eight studies were included in the mean diffusivity (MD) analysis of the optic tracts and optic radiation, involving 192 individuals with glaucoma and 167
Eleven studies with a total of 202 glaucoma patients and 218 controls were included in the meta-analysis of the fractional anisotropy (FA) in the optic nerves, which revealed a significant FA decrease in glaucoma patients (SMD: 1.8960.34) with high heterogeneity (Figure 3)
Summary
Glaucoma is the second most common cause of blindness in the world [1], and it currently affects approximately 90 million people worldwide [2,3]. Glaucoma is believed to be an optic neuropathy characterized by loss of retinal ganglion cells correlated with visual field defects and alterations of the optic nerve [3]. Neuronal degeneration involving all parts of the central visual pathways has been documented at autopsy, and severe visual field losses have been observed in both eyes [9]. Diffusion tensor imaging (DTI) can quantitatively measure anterior visual pathway compression using fractional anisotropy (FA) and mean diffusivity (MD) [10]. An FA decrease and MD increase may indicate structural damage to the optic nerve axon in patients with glaucoma [11]
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