Diagnostic value of MRI microstructure in primary open-angle glaucoma

Primary open-angle glaucoma (POAG) is a neurodegenerative disease affecting the visual pathway. This study aimed to evaluate the diagnostic value of MRI-based microstructural parameters in POAG. This retrospective study included patients who underwent MRI examinations between December 2022 and December 2024. Participants were divided into primary open-angle glaucoma and healthy control groups based on comprehensive ophthalmic examinations, including the presence of RNFL defects and glaucomatous visual field defects. All participants received visual field tests, ocular structural assessments (including IOP, AL, CCT, RNFL thickness, and VCDR), and MRI scans to obtain microstructural parameters (FA and MD of the optic tracts and radiations, plus height and volume of the LGN). The final analysis included 102 POAG patients and 187 healthy controls. MRI parameters revealed significantly lower FA values in OT (0.37 ± 0.04 vs 0.39 ± 0.05, P = 0.002) and OR (0.51 ± 0.05 vs 0.53 ± 0.04, P = 0.006), higher MD values in OT (11.78 ± 1.52 vs 10.63 ± 1.66, P < 0.001) and OR (8.73 ± 0.94 vs 8.41 ± 0.58, P = 0.002), and reduced LGN height (3.81 ± 0.42 vs 4.24 ± 0.34, P < 0.001) and volume (115.36 ± 13.52 vs 125.54 ± 10.75, P < 0.001) in POAG patients. The multivariate model combining MRI parameters showed excellent diagnostic performance with an AUC of 0.886. MRI-based microstructural parameters of the central visual pathway exhibited notable changes in primary open-angle glaucoma and provided valuable diagnostic information, especially when used in multivariate models.