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Editors Selection IGR 9-4

Anatomical Structures: Lamina cribrosa displacement I

Comment by Crawford Downs on:

54334 Posterior displacement of the lamina cribrosa in glaucoma: in vivo interindividual and intereye comparisons, Furlanetto RL; Park SC; Damle UJ et al., Investigative Ophthalmology and Visual Science, 2013; 54: 4836-4842

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Optic nerve head (ONH) biomechanics likely plays an important role in the development and progression of glaucoma, but it is not well understood. Active, progressive posterior remodeling of the lamina cribrosa has been previously hypothesized to underlie glaucomatous ONH cupping in a recent review paper (Exp Eye Res 2011; 93: 133-140. PMC3026919). Furlanetto and colleagues performed a masked, cross-sectional in vivo imaging study of single eyes from 47 open-angle glaucoma patients and 57 normal patients, as well as both eyes from 57 patients with unilateral glaucoma. Each eye's ONH was SD-OCT imaged using EDI, and the position of the anterior surface of the lamina within Bruch's membrane opening was measured in 11 equally-spaced horizontal B-scans. The study has two very important findings in terms of intra- and inter-subject comparisons and the effects of glaucoma on laminar position. First, the mean and maximum depth of the anterior laminar surface relative to Bruch's membrane opening was significantly greater in the glaucoma eyes compared to normal control eyes from different subjects, controlled for age, IOP, vertical disc diameter, and disc ovality index.

chronic, IOP-induced, posterior remodeling of the lamina cribrosa underlies at least some portion of the characteristic optic disc cupping typical of glaucoma

This result held for all 11 B-scans, which indicates that this is a widespread phenomenon that affects both the central and mid-peripheral lamina. This cross-sectional result does not show progressive posterior remodeling of the lamina present in the glaucoma eyes, as posterior laminar position could be an existing risk factor for disease. However, in asymmetric glaucoma patients, the anterior laminar surface was significantly more posterior (mean and maximum) in the glaucoma eye than the contralateral eye with no VF defect. Taken together, these results support the notion that chronic, IOP-induced, posterior remodeling of the lamina cribrosa underlies at least some portion of the characteristic optic disc cupping typical of glaucoma.

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