The Influence of Translaminar Pressure Gradient and Intracranial Pressure in Glaucoma: A Review.

The current evidence associating intracranial pressure (ICP) with glaucoma, the translaminar pressure gradient hypothesis, and anatomic factors likely affecting the relationship between ICP and retrolaminar tissue pressure including the size of the optic canal and lamina cribrosa thickness are reviewed. In addition, the evidence of diurnal and positional variation on the translaminar pressure gradient, effects of glaucoma medications, evidence of ICP helping to maintain cerebrospinal fluid flow in the optic nerve to prevent glaucomatous damage, and the effect of intraocular pressure variation in glaucoma are also reviewed. We find that while low ICP is associated with glaucoma disease in most studies, evidence is mixed on how closely ICP matches retrolaminar tissue pressure, and it appears the relationship is affected by the size of the optic canal, thickness of the lamina cribrosa, and lymphatic outflow from the optic nerve. Future studies can likely strengthen associations by measuring and controlling for some of these factors.