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REVIEW
Year : 2022  |  Volume : 17  |  Issue : 5  |  Page : 937-947

Glymphatic imaging and modulation of the optic nerve


1 Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, NY, USA
2 Department of Ophthalmology; Department of Radiology; Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health; Center for Neural Science, College of Arts and Science, New York University, New York, NY, USA

Correspondence Address:
Kevin C Chan
Department of Ophthalmology; Department of Radiology; Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health; Center for Neural Science, College of Arts and Science, New York University, New York, NY
USA
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Source of Support: This work was supported by National Institutes of Health, No. R01-EY028125; BrightFocus Foundation, No. G2019103; Feldstein Medical Foundation; Research to Prevent Blindness/Stavros Niarchos Foundation International Research Collaborators Award; and an unrestricted grant from Research to Prevent Blindness to NYU Langone Health Department of Ophthalmology (to KCC), Conflict of Interest: None


DOI: 10.4103/1673-5374.324829

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Optic nerve health is essential for proper function of the visual system. However, the pathophysiology of certain neurodegenerative disease processes affecting the optic nerve, such as glaucoma, is not fully understood. Recently, it was hypothesized that a lack of proper clearance of neurotoxins contributes to neurodegenerative diseases. The ability to clear metabolic waste is essential for tissue homeostasis in mammals, including humans. While the brain lacks the traditional lymphatic drainage system identified in other anatomical regions, there is growing evidence of a glymphatic system in the central nervous system, which structurally includes the optic nerve. Named to acknowledge the supportive role of astroglial cells, this perivascular fluid drainage system is essential to remove toxic metabolites from the central nervous system. Herein, we review existing literature describing the physiology and dysfunction of the glymphatic system specifically as it relates to the optic nerve. We summarize key imaging studies demonstrating the existence of a glymphatic system in the optic nerves of wild-type rodents, aquaporin 4-null rodents, and humans; glymphatic imaging studies in diseases where the optic nerve is impaired; and current evidence regarding pharmacological and lifestyle interventions that may help promote glymphatic function to improve optic nerve health. We conclude by highlighting future research directions that could be applied to improve imaging detection and guide therapeutic interventions for diseases affecting the optic nerve.


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