Glaucoma is a progressive optic neuropathy characterized by a particular pattern of optic disc changes and visual field loss. It has traditionally been considered a disease limited to the eye. However, the retina and optic nerve are part of the central nervous system and we now know that retinal ganglion cell loss in glaucoma is associated with damage in the central nervous system including the lateral geniculate nucleus and visual cortex.1,2 In addition, the trans-lamina cribrosa pressure difference and gradient as well as the stasis of cerebrospinal fluid (CSF) in the peripapillary area have been implicated in the pathogenesis of glaucoma.3–7
This supplement represents the proceedings of the 18th annual Optic Nerve Rescue and Restoration Think Tank, sponsored by The Glaucoma Foundation, entitled ‘Glaucoma and the Central Nervous System’ and held in New York, NY, September 16-17, 2011. The goal of The Glaucoma Foundation Think Tank is to explore areas of future medical or scientific interest by involving clinician-scientists, researchers in glaucoma, researchers in other areas of ophthalmology, and potential collaborators currently not involved in vision research in order to promote innovation and to identify important areas for future research and funding. Potential applications to eye disease with particular attention to prevention and reversal of blindness are our ultimate focus.
Ocular hypotensive therapy, which is the only approved form of glaucoma treatment, can slow disease progression but is often insufficient to stop further visual loss.8 Experts’ opinions described in this article on the relevant anatomy, physiology, and pathology of the central nervous system and cerebrospinal fluid dynamics shed light on the development of the diagnostics and therapeutics of glaucoma as a degenerative disease of the central nervous system.
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2. Gupta N, Yücel YH.Glaucoma as a neurodegenerative disease.Curr Opin Ophthalmol.2007;18:110–114.
3. Yablonski M, Ritch R, Pokorny KS.Effect of decreased intracranial pressure on optic disc.Invest. Ophthalmol Vis Sci.1979;18Suppl165.
4. Berdahl JP, Allingham RR, Johnson DH.Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma.Ophthalmology.2008;115:763–768.
5. Ren R, Jonas JB, Tian G, et al..Cerebrospinal fluid pressure in glaucoma: a prospective study.Ophthalmology.2010;117:259–266.
6. Jaggi GP, Miller NR, Flammer J, et al..Optic nerve sheath diameter in normal-tension glaucoma patients.Br J Ophthalmol.2012;96:53–56.
7. Killer HE, Miller NR, Flammer J, et al..Cerebrospinal fluid exchange in the optic nerve in normal-tension glaucoma.Br J Ophthalmol.2012;96:544–548.
8. Leske MC, Heijl A, Hussein M, et al..Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial.Arch Ophthalmol.2003;121:48–56.