Estimated cerebrospinal fluid pressure and trans-lamina cribrosa pressure difference in open angle glaucoma. The Korea National Health and Nutrition Examination Survey 2009-2012

Background/AimsTo evaluate the association between strabismus and primary open-angle glaucoma (POAG) in a representative Korean population.MethodsA total of 11 114 participants aged 20 years or older in the Korea National Health and Nutrition Examination Survey database for the years 2010 through 2011 were reviewed. A standardised protocol was used to interview every participant and to perform comprehensive ophthalmic examinations. Glaucoma diagnosis was based on fundus photography and frequency-doubling technology perimetry results, according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Ocular alignment was evaluated using the alternate prism and cover test, and clinically significant horizontal strabismus was defined as exodeviation of ≥15 prism dioptres (PD) and esodeviation of ≥10 PD. Univariate and multivariate regression analyses were used to evaluate the potential risk factors for POAG.ResultsIn the Korean population, subjects with clinically significant esodeviation had a much higher prevalence of POAG (12.32%) than those without clinically significant esodeviation (3.14%, p=0.016). After adjusting for age and intraocular pressure, clinically significant esodeviation was independently associated with POAG (OR 7.61, p=0.002).ConclusionEsodeviation was independently associated with POAG in the Korean population. This could be the result of, at least in part, ocular-adduction-induced greater strain on the temporal optic nerve head and peripapillary tissues, which makes eyes with esodeviation more vulnerable to POAG.

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Three-Decade Evaluation of Cerebrospinal Fluid Pressure in Open-Angle Glaucoma at a Tertiary Care Center

Journal of Ophthalmology ◽

10.1155/2020/7487329 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Catherine G. Knier ◽

David Fleischman ◽

David O. Hodge ◽

John P. Berdahl ◽

Michael P. Fautsch

Keyword(s):

Cerebrospinal Fluid ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Care Center ◽

Tertiary Care ◽

Fluid Pressure ◽

Normal Tension Glaucoma ◽

Cerebrospinal Fluid Pressure ◽

Open Angle ◽

Study Results

Elevated intraocular pressure (IOP) is the most prevalent risk factor for primary open-angle glaucoma. However, IOP alone does not fully describe a mechanical basis for disease in patients with normal tension glaucoma or primary open-angle glaucoma. The translaminar pressure difference (TLPD) theory proposes that the pressure gradient generated by the difference of IOP and cerebrospinal fluid pressure (CSFp) acting at the level of the optic nerve can lead to cupping and glaucoma when IOP is higher than normal and/or CSFp is lower than normal. The study results to date have generally supported the TLPD theory; however, varying methods, populations, and sample sizes make it difficult to compare results. To further assess whether there is an association between low CSFp and open-angle glaucoma, 30 years of clinical data that assess 96,543 lumbar punctures were analyzed. Patients with open-angle glaucoma showed a significantly lower CSFp than randomly selected normal control patients (9.9 ± 3 mm·Hg (n = 86) versus 12.1 ± 3.6 mm·Hg (n = 114), p < 0.001 ) following adjustment for age and sex. This retrospective study provides strong evidence for an association between open-angle glaucoma and low CSFp.

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