Neurodegeneration in the brain – before or after the retina?

Summary: Brain imaging is a big-data science. Functional techniques in particular generate a large amount of information about visual processing but this is rarely systematically compiled to be relevant to eye disease. Functional brain imaging has indicated that the visual cortex can regain some visual function following gene therapy for an inherited retinal condition (Leber Congenital Amaurosis). However,the changes in visual cortical processing occurring as a consequence of field loss are not well understood. We review the use of MRI in examining this problem and identify the key questions to consider when designing interventional trials for inherited retinal disease causing field loss. It is now accepted that there is a greater level of neuroplasticity in the adult brain than previously thought, opening the possibility of incorporating therapeutic techniques specifically targeting the visual cortex if necessary. It is therefore critical to establish baseline changes in visual cortex structure and function caused by retinal disease in order to understand the potential interactions when developing treatments inthe future