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Editors Selection IGR 15-1

Anatomical Structures: Age-related laminar insertion variations

Comment by Claude Burgoyne on:

51223 Human lamina cribrosa insertion and age, Sigal IA; Flanagan JG; Lathrop KL et al., Investigative Ophthalmology and Visual Science, 2012; 53: 6870-6879

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In this report, Sigal and co-authors report an analysis of the effect of age on the amount and percent of the lamina cribrosa that inserts into the pia mater rather than the sclera in 21 human cadaver eyes from 11 individuals. This issue is of clinical interest for the following reasons. Firstly, laminar insertion migration from the sclera into the pia mater is a central component of early optic nerve head change in the monkey experimental glaucoma model and progresses in magnitude and extent through moderate and severe damage. Secondly, if this phenomenon occurs in human glaucoma, its peripheral location within the neural canal allows it to potentially contribute to the mechanisms of NFL hemorrhage, excavation and retinal ganglion cell axon insult. Thirdly, if the mechanisms of optic nerve head aging and glaucomatous damage overlap, one would hypothesize (as do the authors) that the amount and proportion of the lamina cribrosa insertion into the pia mater might increase with age. However, the authors report that the fraction of LC inserting into the pia mater (2.2% to 29.6%) had a significant decrease with age (p = 0.049), which resulted from a non-significant increase in the total area of LC insertion (p = 0.41) and a non-significant decrease in the area of LC insertion into the pia mater (p = 0.55). The strength of the report is the rigor of the eye-specific measurements (relative to previous human cadaver eye studies) and the intelligence with which the findings are discussed. Its weaknesses are for the most part well discussed by the authors. However, the small number of included individuals (n = 11, ages 47, 65, 70, 76, 77, 79, 83, 84 (n = 2), 88 and 91) effectively makes this a study of nine individuals between the ages of 70 and 91. To answer questions about aging and lamina insertion position requires a characterization of laminar insertion position across all ages. The results of this study suggest a trend towards less laminar insertion into the pia mater with age in aged patients. It may be the case that the results of this study will hold when laminar insertion geometry is robustly characterized in young, young adult, adult and aged human eyes. However, human cadaver eyes from young patients are difficult to obtain. SDOCT attempts to clinically characterize anterior and posterior laminar insertion anatomy may eventually allow this issue to be resolved and should be undertaken.

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