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Normal-tension glaucoma is associated with cognitive impairment
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  • Published on: 22 June 2022
    Is impaired cerebrospinal fluid dynamics the link between dementia and normal-tension glaucoma ?
    • Hanspeter E Killer, Ophthalmologist Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland, Switzerland
    • Other Contributors:
      • Achmed Pircher, Ophthalmologist

    We like to congratulate Mullany et al. for their paper on normal-tension glaucoma is associated with cognitive impairment.1 To link normal-tension glaucoma (NTG) to cognitive impairment and therefore to a neurodegenerative process opens a new vista and research approach for glaucoma research. NTG indeed is an intriguing optic neuropathy that presents with a glaucomatous optic disc appearance and visual field loss similar to that seen in primary open angle glaucoma. The main risk factor for glaucoma however, increased intraocular pressure is missing.

    Unlike other cranial nerves the optic nerve is a white matter tract of the brain, enveloped in the meninges (dura, arachnoid and pia mater) and surrounded by cerebrospinal fluid (CSF) on its entire length. And CSF indeed may be the link that connects the neurodegenerative process leading to cognitive impairment and the glaucomatous optic neuropathy in NTG. Recent research demonstrated a relationship between decreased CSF flow, measured in the ventricles and the spinal cord, and cognitive deficit in the elderly.2 In NTG, impaired CSF dynamics was demonstrated with computer assisted cisternography in the subarachnoid space of the intraorbital optic nerve most pronounced in the bulbar region behind the eye globe.3 In a recent publication we found an elevated L-PGDS concentration in the subarachnoid space of the optic nerve in NTG patients with optic nerve sheath compartment syndrome that results in a reduced CSF turnover.4...

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    Conflict of Interest:
    None declared.