Review ArticlesThe Influence of Translaminar Pressure Gradient and Intracranial Pressure in Glaucoma A ReviewPrice, David A. BS*; Harris, Alon MS, PhD, FARVO†; Siesky, Brent PhD†; Mathew, Sunu MBBS*Author Information *Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN †Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY All relationships listed above are pursuant to Indiana University and Icahn School of Medicine at Mount Sinai’s policies on outside activities. Disclosure: A.H.: receives remuneration from AdOM for serving as a consultant and a board member, and from Thea for a speaking engagement. He also holds an ownership interest in AdOM, Luseed, Oxymap, and QuLent. The authors declare no conflict of interest. Reprints: Alon Harris, MS, PhD, FARVO, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg 22-86, New York, NY 10029 (e-mail: firstname.lastname@example.org). Received October 29, 2019 Accepted November 25, 2019 Online date: December 4, 2019 Journal of Glaucoma: February 2020 - Volume 29 - Issue 2 - p 141-146 doi: 10.1097/IJG.0000000000001421 Buy Metrics Abstract 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. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.