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    Growing attention turns to cerebrospinal fluid pressure in glaucoma

    Potential correlation explored as POAG cases appear at age when CSFp is reduced

    Elevated intraocular pressure (IOP) has long been recognized to play a role in glaucoma, and data from population-based studies demonstrate that blood pressure, possibly through an effect on ocular perfusion pressure, may influence open-angle glaucoma risk.

    Recently, evidence has been accumulating to support the theory that cerebrospinal fluid pressure (CSFp) is also important in primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG), and the relationship has potential implications for clinical practice, said R. Rand Allingham, MD.

    “We will need a noninvasive method to measure CSFp. With that information, we will be able to assess the role of CSFp in its contribution to the translaminar pressure gradient (the difference between IOP and CSFp) and begin considering this as a new therapeutic target,” said Dr. Allingham, Richard and Kit Barkhouser Distinguished Professor, Duke University Eye Center, Durham, NC, and principal clinician scientist, National University of Singapore.

    To enlarge image, click here.

    The idea that CSFp is important in glaucoma is reasonable from an anatomic perspective recognizing that the lamina cribosa is the structure that separates the cerebrospinal fluid space from another pressurized fluid compartment, the aqueous humor, within the eye. Increasing evidence suggests there is normally a physiologic balance between CSFp and IOP.

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