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To assess associations of the trans-lamina cribrosa pressure difference TLCPD with glaucomatous optic neuropathy.


The population-based Central India Eye and Medical Study included 4711 subjects. Based on a previous study with lumbar cerebrospinal fluid pressure CSFP measurements, CSFP was calculated as CSFPmmHg = 0.44 Body Mass Indexkg-m2+0.16 Diastolic Blood PressuremmHg−0.18×AgeYears −1.91. TLCPD was IOP–CSFP.


Mean TLCPD was 3.64±4.25 mm Hg in the non-glaucomatous population and 9.65±8.17 mmHg in the glaucomatous group. In multivariate analysis, TLCPD was associated with older age P<0.001; standardized coefficient beta:0.53; regression coefficient B:0.18; 95% confidence interval CI:0.17, 0.18, lower body mass index P<0.001; beta: −0.28; B: −0.36; 95%CI: −0.38, −0.31, lower diastolic blood pressure P<0.001; beta: −0.31; B: −0.12; 95%CI: −0.13, −0.11, higher pulse P<0.001; beta:0.05; B:0.02; 95%CI:0.01,0.2, lower body height P = 0.02; beta: −0.02; B: −0.01; 95%CI: −0.02,0.00, higher educational level P<0.001; beta:0.04; B:0.15; 95%CI:0.09,0.22, higher cholesterol blood concentrations P<0.001; beta:0.04; B:0.01; 95%CI:0.01,0.01, longer axial length P = 0.006; beta:0.03; B:0.14; 95%CI:0.04,0.24, thicker central cornea P<0.001; beta:0.15; B:0.02; 95%CI:0.02,0.02, higher corneal refractive power P<0.001; beta:0.07; B:0.18; 95%CI:0.13,0.23 and presence of glaucomatous optic neuropathy P<0.001; beta:0.11; B:3.43; 95%CI:2.96,3.99. Differences between glaucomatous subjects and non-glaucomatous subjects in CSFP were more pronounced for open-angle glaucoma OAG than for angle-closure glaucoma ACG 3.0 mmHg versus 1.8 mmHg, while differences between glaucomatous subjects and non-glaucomatous subjects in IOP were higher for ACG than for OAG 8.5 mmHg versus 3.0 mmHg. Presence of OAG was significantly associated with TLCPD P<0.001; OR:1.24; 95%CI:1.19,1.29 but not with IOP P = 0.08; OR:0.96; 95%CI:0.91,1.00. Prevalence of ACG was significantly associated with IOP P = 0.04; OR:1.19; 95%CI:1.01,1.40 but not with TLCPD P = 0.92.


In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of open-angle glaucoma.

Author: Jost B. Jonas , Vinay Nangia , Ningli Wang, Karishma Bhate, Prabhat Nangia, Purna Nangia, Diya Yang, Xiaobin Xie, Songhomitra Pan



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