Novel Risk Factors for Glaucoma

CEREBROSPINAL FLUID PRESSURE Evidence supports the association of low cerebrospinal fluid (CSF) pressure with the prevalence of glaucoma, particularly with respect to normal-tension glaucoma (NTG). The most robust study comes from Tongren Hospital in Beijing, China, in which patients with both high-tension and normal-tension open-angle glaucoma as well as healthy controls underwent lumbar punctures.1 Their CSF and translaminar (IOP minus the CSF pressure) pressures were compared. Those diagnosed with NTG had significantly lower CSF pressures than patients with high-tension open-angle glaucoma and control subjects. Furthermore, the translaminar pressure was significantly higher in the NTG group than in the control group. Although these findings help clinicians to understand the mechanistic aspects of glaucoma’s development, the clinical applications are limited because there is no clinically safe method of elevating CSF pressure, even if that were shown to prevent glaucomatous progression.