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    Glaucoma may not be the disease you think it is

    Growing evidence supports IOP, CSF pressure differential

    Take-home message: Clinicians continue to explore the relationship between IOP and cerebrospinal fluid pressure in glaucoma.

    Sioux Falls, SD—Most ophthalmologists learned that glaucoma is a disease of elevated IOP. There is a good possibility it is something else entirely.

    “We know that IOP matters in glaucoma, but perhaps the pressure differential across the cornea—which is what we measure in IOP—is only a surrogate for the pressure differential that really matters,” said John P. Berdahl, MD.

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    “What matters is the pressure across the optic nerve head, the pressure gradient between the eye and the cerebrospinal fluid (CSF) 500 μm across the lamina cribrosa,” said Dr. Berdahl, of Vance Thompson Vision, Sioux Falls, SD. “There is growing evidence to support the idea that glaucoma is not a one-pressure disease, IOP, but a two-pressure disease, the difference between IOP and CSF pressure.”

    More Glaucoma: Visit the Glaucoma 360 homepage!

    Exploring the concept

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