Laminar Cribrosa In Ocular Hypertension And Primary Open-Angle Glaucoma: A Comparative Review

Abstract

The pathophysiology and development of glaucomatous ocular neuropathies are significantly influenced by the lamina cribrosa (LC), a sieve-like structure located within the optic nerve head. This comparative review explores the structural and biomechanical distinctions of the LC in ocular hypertension (OHT) and primary open-angle glaucoma (POAG), two closely related conditions marked by elevated intraocular pressure (IOP). While both conditions share pressure-related stressors, emerging evidence highlights significant differences in LC morphology, deformation, vascular perfusion, and mechanical compliance.In POAG, the LC demonstrates thinning, increased posterior displacement, and a high posterior bowing index, often accompanied by marked vascular dropout and reduced stiffness, indicating compromised tissue resilience. These alterations correlate strongly with retinal nerve fiber layer (RNFL) loss and visual field progression. Conversely, eyes with OHT generally maintain a thicker, more structurally stable LC, with preserved vascular perfusion and greater biomechanical resistance to IOP-induced deformation, factors that may explain the typically non-progressive course of OHT.High-resolution in vivo evaluation of the LC has been made possible by developments in imaging methods like swept-source OCT (SS-OCT) and enhanced-depth imaging optical coherence tomography (EDI-OCT), which have allowed for risk profiling and deeper clinical insights into disease causes. By synthesizing recent literature, this review underscores the LC's diagnostic and prognostic potential as a biomarker and advocates for future longitudinal and translational research focused on LC-targeted interventions. The stratification of patients and the creation of more individualized treatment plans for the treatment of glaucoma can both benefit from an understanding of these variations.