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

Abstract

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.

Does Intracranial Pressure Influence the Development of Glaucoma?

“…It is not clear that the control subjects underwent LP around the same time period as the glaucoma patients, and techniques likely changed. 13,14,41 The OP was normal in both groups with a difference in means ranging from 2 to 3.8 mm Hg. This may be statistically different, but the question is whether this is clinically significant or not.…”

“…It is not clear that the control subjects underwent LP around the same time period as the glaucoma patients, and techniques likely changed. 13,14,41…”

“…Studies Supporting the Pro Side and the Arguments Against Them: Humans Three articles from the Mayo Clinic have used similar methodology using many of the same patients. Each article identified patients who underwent LP with OP at a single institution during 3 time periods, which can generally be broken up into an early, 13 middle, 13,14 and late 41 time period. Of those patients who had an LP, they compared the OP of those who did and did not have glaucoma.…”

“…As an aside, the late cohort with glaucoma did not have a lower OP than the control subjects. 41 The authors argue that this was likely due to sample size. Interestingly, among the late cohort, there were 29 glaucoma patients and 48 control subjects, 41 whereas there were 28 glaucoma patients and 49 control subjects in the middle cohort.…”

“…41 The authors argue that this was likely due to sample size. Interestingly, among the late cohort, there were 29 glaucoma patients and 48 control subjects, 41 whereas there were 28 glaucoma patients and 49 control subjects in the middle cohort. 13,14 I guess that 1 less control and 1 more glaucoma patient in the late group made the difference!…”