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Morphometric analyses of the visual pathway in macular degeneration

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Introduction: Central retinal lesions caused by macular degeneration result in depriving visual pathway structures of activity. This, in turn, could result in anatomical and functional changes of visual pathway structures. If such changes in the visual pathway structures remain permanent they could limit the success of future treatments that aim to restore retinal function, such as retinal implants and a stem-cell-derived retinal epithelium. In a multi-centre study, we asked the question whether macular degeneration, both juvenile macular degeneration (JMD) and age-related macular degeneration (AMD), is associated with volumetric changes of visual pathway structures, and if there is any relationship between visual function, such as visual acuity, and the volume of the visual pathway structures. Methods: High-resolution anatomical magnetic resonance imaging (MRI) data were obtained in participants with either JMD or AMD, as well as in age-matched healthy controls. We separated the visual pathway structures from the rest of the brain in T1 MRI volumes. Voxel-based morphometry (VBM) was used to evaluate statistically the volumetric differences between patients and age-matched controls. Results: Comparison of patients with controls shows a lower volume of the LGB in both patient groups. Comparison of white matter between the groups revealed volumetric reductions in the optic radiations of the patients. Also in the grey matter in the visual cortex, the volume is reduced in patients compared to controls. All effects were visible in both the JMD and the AMD group. Results were most clear in the JMD group. Discussion and conclusion: Our main finding is that there is volumetric loss in the LGB and in the white matter of the visual pathways in macular degeneration. Our findings that there is also a decrease in grey matter in the visual cortex, complements previous studies. Further investigation of changes in the visual pathway structures in macular degeneration is needed, for a better understanding of the structure-function relationship in macular degeneration.

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