Estimated trans‐lamina cribrosa pressure difference versus intraocular pressure as biomarker for open‐angle glaucoma. The Beijing Eye Study 2011

Abstract

ABSTRACT.Purpose: To examine whether an estimated trans-lamina cribrosa pressure difference (TLCPD) better than intraocular pressure (IOP) correlated with markers for glaucoma. Results: In the non-glaucomatous population, mean TLCPD was 5.8 AE 4.1 mmHg and mean estimated CSFP was 8.9 AE 3.7 mmHg. IOP was higher (p = 0.008), CSFP was lower (p < 0.001), and TLCPD was (p < 0.001) higher in the glaucoma group than in the non-glaucomatous group. The intergroup difference was highest for TLCPD (2.1 mmHg) followed by CSFP (1.7 mmHg) and IOP (0.4 mmHg). Open-angle glaucoma (OAG) was associated with higher TLCPD [p < 0.001; odds ratio (OR): 1.14; 95% confidence intervals (CI): 1.08, 1.19] but not with IOP (p = 0.22; OR: 0.96; 95% CI: 0.89, 1.03). In contrast, angle-closure glaucoma (ACG) was associated with higher IOP (p = 0.03; B: 0.14; OR: 1.15; 95% CI: 1.01, 1.30) but not with TLCPD (p = 0.98), after adjustment for age and anterior chamber depth. Retinal nerve fibre layer thickness was associated with lower TLCPD (p = 0.036) but not with IOP (p = 0.96), after adjusting for gender, age, region of habitation, optic disc area and refractive error. Neuroretinal area and volume were associated with smaller TLCPD (p = 0.002, and p < 0.001, respectively), after adjusting for gender, optic disc area and refractive error, but not with IOP (p = 0.43 and p = 0.25, resp.). Conclusions: In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of OAG.

Translamina Cribrosa Pressure Difference as Potential Element in the Pathogenesis of Glaucomatous Optic Neuropathy

“…Interestingly, ocular hypertensive study participants had significantly higher estimated CSFP values than normal individuals. 49 Parallel to these findings, a smaller neuroretinal rim area was associated with lower body mass index in the Beijing Eye Study and the Central India Eye and Medical Study. 50,51 Considering body mass index as a surrogate for CSFP, these findings also support the hypothesis of an association between low CSFP and glaucomatous optic neuropathy.…”

Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data

“…Numerous ophthalmologic studies, mostly from the Beijing Eye Study, have recently been published using an estimated CSFP from a formula derived from clinical data. [9][10][11][12]14,15 Because translaminar pressure differential has been recognized as an important risk factor in glaucoma and as a key variable in ocular hypertension, there has been increasing interest in studying CSFP in the context of these ophthalmologic diseases. Due to the invasive nature of testing CSFP, noninvasive measures are desirable.…”

“…An equation excluding radiographic measurements that was derived from this set, but not described in the literature, determined an ICC of 0.71, still indicating a strong correlation between predicted and actual CSFP. [9][10][11][12][13][14][15] To determine the accuracy or generalizability of this formulaic derivation of CSFP, we examined a large, retrospective dataset compiled from the Mayo Clinic electronic medical records (EMRs).…”

Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma

“…9 Similar differences were found in the Singapore Indian Eye Study 40 and the Beijing Eye Study. 41 All of these results indicate that, although NTG pressures are not as high as POAG ones, IOP still plays an important role in the pathogenesis of NTG. These data in fact provide the basis for the currently preferred IOP-lowering treatment for NTG eyes to slow progression.…”

“…72,[74][75][76] Low intracranial pressure in the context of normal IOP levels might in fact lead to an abnormally large translaminar cribrosa pressure difference, thereby increasing the probability of glaucomatous damage. Jonas et al, 41 utilizing data from the Beijing Eye Study, reported that translaminar pressure difference (calculated with body mass index, diastolic blood pressure, and age) showed a better correlation with the extent of glaucomatous damage than did IOP, indicating its potential role as a biomarker for open-angle glaucoma. However, the relationship between translaminar pressure difference and glaucoma is complex and can be affected by various factors such as body mass index, body position, blood pressure, and displaced lamina cribrosa.…”