Glaucoma - a new understanding

[Sorshup]

As I read the reports people post, of progression despite treatment, why do I have NTG etc I read up more and more and think. And through internet searching I have found an answer.

You probably know that the nerves leave the eye, and blood vessels pass through, the sieve-like lamina cribrosa (the optic disc, in illustrations). Inevitably this thin structure is weak and if it distorts by being hollowed, cupped, or swollen, everything passing through suffers, So why does this distortion occur? We are told that the pressure in the eye causes it. But this explains neither why some people with high pressures don't develop glaucomatous damage yet others within the normal range do (the NTG classification).

The answer largely depends on the balance between the eye pressure and that of the brain fluid, because the latter circulates all the way down to the lamina cribrosa. So arises the term "trans lamina pressure gradient' - TLPG. To maintain health the pressure of the brain fluid, ICP, is usually no more than 3mmHg lower than the IOP. If the former goes down, as it does naturally with age - calamity! And similarly if the IOP goes too high - calamity! So if someone's ICP is lower than average the eye will suffer despite the IOP being in the normal range - NTG. If both ICP and IOP are higher than normal but the TLPG remains minimal no damage occurs. So if your glaucoma is progressing despite good IOP control it could be that your ICP is low. Unfortunately measurement and management of ICP is not easy and so we return to the only thing that can be manipulated, by medication or surgery, is the IOP. I am ignoring completely, here, evrything else such as neuroprotection with medication , diet or supplement, just introducing the influence and importance of TLPG.

[AlfredV]

I've never heard about this before but it sounds sensible. Thank you. I know that ophthalmologists can measure optic disc cupping (it's in my notes but they have never discussed it with me). I wonder if that could act as a surrogate marker for the pressure difference?

[Sparr0w-hawk]

This is really good and informative. Explains lots. Stopped long term yoga practice and meditation which likely acts on the ICP. Right exercise helps and age is not a friend. Reminds one that young at heart always helps. Where can one learn more about ICP? Would it be connected to pineal gland?

[Sorshup in reply to Sparr0w-hawk]

Thanks AlfredV and Sparrow-hawk. Yes, keep delving the internet as well as grilling the doctors when you see them ! And today i researched ICP control to find that if it is considered to be high a 30 degree elevation of the upper body for sleeping can reduce it by 3mmHg just as exactly the same approach can reduce nocturnal IOP by, wait for it.......3mmHg ! So the elevated sleeping idea for glaucoma will achieve nothing from the TLPG aspect !

[Beecalmed]

Thanks Sorshup! That’s really interesting reading.

Have you found anything relating to TLPG and retinal haemorrhages? Research I read suggested that in NTG subjects the bleeds appeared in many subjects to proceed a period of nerve damage & sight loss with a lead in of 18 months from the bleed on average. I’d be interested to know more about this.

I suffer from bleeds regularly but recently had a period of time with none. I’d like to know why they stopped in case it’s something I can continue to do to stop them.

I ask because the retinal bleeds have started again. The only change I noted in my life since the bleeds appeared again is severe mental &/or physical stress. It would seem I need to disconnect my para central nervous system if I want to stop my Glaucoma progression. 🤔

[VerdiG]

That all sounds interesting although a bit beyond my comprehension. I have never been convinced that it’s all down to eye pressures. I have NTG and vision loss always happens during/after periods of stress. I definately will never give up meditation, as it’s the one thing that keeps me stress free and feeling positive.