Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

Yoon Kyung Kim; Undarmaa Tumurbaatar; Young-Hoon Ohn; Seung Joo Ha; Ka Hee Park

doi:10.3341/jkos.2016.57.9.1392

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Kim, Tumurbaatar, Ohn, Ha, and Park: Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

Original Article

J Korean Ophthalmol Soc 2016;57(9):1392-1399.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.9.1392

Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

Yoon Kyung Kim, MD¹, Undarmaa Tumurbaatar, MD¹, Young-Hoon Ohn, MD, PhD¹, Seung Joo Ha, MD, PhD², Ka Hee Park, MD¹

¹Department of Ophthalmology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

²Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Ka Hee Park, MD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Bucheon 14584, Korea Tel: 82-32-621-5424, Fax: 82-32-621-5018 E-mail: ophkh@schmc.ac.kr

Received 28 April 2016 Revised 23 June 2016 Accepted 2 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population.

Methods

A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m²) + 0.16 diastolic blood pressure (mm Hg) – 0.18 age (years) – 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure.

Results

The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively (p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower (p < 0.001; beta: −0.12; B: −2.306; 95% confidence interval [CI]: −2.717, −1.895) in OAG group than in nonglaucomatous group and the mean TLCPD was distributed higher (p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively.

Conclusions

Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.

Keywords: Cerebrospinal fluid pressure, Open-angle glaucoma, Trans-lamina cribrosa pressure difference

References

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Figure 1.

Distribution of estimated cerebrospinal fluid pressure. Estimated cerebrospinal fluid pressure (CSFP) was calculated after adjustment for glaucoma status, sex, log-transformed pulse, total cholesterol, log-transformed triglycerides, corneal refractive power, anterior chamber depth, vertical cup-to-ratio, and intraocular pressure.

Figure 2.

Distribution of estimated trans-lamina cribrosa pressure difference. Estimated trans-lamina cribrosa pressure difference (TLCPD) was calculated after adjustment for glaucoma status, sex, log-transformed pulse, corneal refractive power, anterior chamber depth, and vertical cup-to-disc ratio.

Table 1.

Characteristic per groups

Variable	Normal	Glaucoma suspect	Glaucoma	Total	Comparison (p-value^*)
By patient	N = 4,911	N = 895	N = 326	N = 6,132
Age (years)	50.8 ± 16.6	54.4 ± 15.7	65.5 ± 11.7	52.1 ± 16.6	<0.001^{1–2,1–3,2–3}
Sex (n, %)
Male	1,995 (40.6)	462 (51.6)	152 (46.6)	2,609 (42.5)	<0.001^1–2
Female	2,916 (59.4)	433 (48.4)	174 (53.4)	3,523 (57.5)
BMI (kg/m²)	23.7 ± 3.4	23.9 ± 3.2	23.7 ± 3.2	23.8 ± 3.4	0.510
Systolic BP (mm Hg)	119.3 ± 16.9	122.2 ± 18.1	126.6 ± 17.6	120.1 ± 17.2	<0.001^{1–2,1–3,2–3}
Diastolic BP (mm Hg)	75.6 ± 10.4	76.7 ± 10.3	75.0 ± 10.1	75.7 ± 10.4	0.004^1–2,2–3
Pulse (beats/15 sec)	17.6 ± 2.0	14.1 ± 3.0	17.5 ± 2.1	17.1 ± 2.6	<0.001^1–2,2–3
Total cholesterol (mg/dL)	189.7 ± 36.6	188.1 ± 35.7	190.2 ± 36.2	189.5 ± 36.5	0.468
HDL cholesterol (mg/dL)	51.8 ± 12.7	50.5 ± 12.6	48.4 ± 11.1	51.5 ± 12.6	<0.001^{1–2,1–3,2–3}
Triglycerides (mg/dL)	130.5 ± 130.9	137.1 ± 106.7	147.1 ± 81.0	132.3 ± 103.3	0.010^1–3
By eye	N = 9,149	N = 1,224	N = 428	N = 10,801
Corneal refractive power (diopter)	−0.8 ± 2.2	−0.7 ± 2.1	−0.7 ± 3.0	−0.8 ± 2.2	0.048
ACD	2.8 ± 0.5	2.7 ± 0.5	2.7 ± 0.6	2.8 ± 0.5	<0.001^1–3
Vertical CDR	0.3 ± 0.1	0.6 ± 0.1	0.7 ± 0.2	0.4 ± 0.1	<0.001^{1–2,1–3,2–3}
Horizontal CDR	0.3 ± 0.1	0.6 ± 0.1	0.6 ± 0.2	0.4 ± 0.1	<0.001^{1–2,1–3,2–3}
Estimated CSFP (mm Hg)	11.6 ± 3.7	11.2 ± 3.8	8.7 ± 3.3	11.4 ± 3.7	<0.001^{1–2,1–3,2–3}
IOP (mm Hg)	13.7 ± 2.7	14.2 ± 3.0	14.4 ± 3.4	13.8 ± 2.8	<0.001^1–2,1–3
TLCPD (mm Hg)	2.2 ± 4.4	3.0 ± 4.7	5.7 ± 4.4	2.4 ± 4.5	<0.001^{1–2,1–3,2–3}

Values are presented as mean ± SD unless otherwise indicated.

BMI = body mass index; BP = blood pressure; HDL = high-density lipoprotein; ACD = anterior chamber depth; CDR = cup-to-disc ratio; CSFP = cerebrospinal fluid pressure; IOP = intraocular pressure; TLCPD = trans-lamina cribrosa pressure difference.

^* p-values were calculated by analysis of variance (ANOVA) assuming unequal variance for continuous variables and Chi-square test for categorical variables. Posthoc comparison by Scheffe's method: i-j means that i-th group had significant differences (i, j = 1, 2, 3; Group 1 = Normal, Group 2 = Glaucoma suspect, Group 3 = Glaucoma).

Table 2.

Linear regression analysis for cerebrospinal fluid pressure

Variable	Univariable				Multivariable
Variable	B	95% CI	Beta	p-value	B	95% CI	Beta	p-value	VIF
Glaucoma suspect (vs. Normal)	−0.348	−0.566, −0.130	−0.030	0.002	0.241	−0.056, 0.538	0.022	0.111	0.000
Galucoma (vs. Normal)	−2.871	−3.226, −2.516	−0.151	<0.001	−2.306	−2.717, −1.895	−0.120	<0.001	2.594
Male (ref: Female)	0.869	0.728, 1.009	0.116	<0.001	0.870	0.730, 1.009	0.120	<0.001	1.093
Systolic BP (mm Hg)^*	−0.140	−0.646, 0.366	−0.005	0.588
Pulse (beats/15sec)^*	1.992	1.514, 2.469	0.082	<0.001	1.502	0.969, 2.035	0.063	<0.001	1.485
Total cholesterol (mg/dL)	0.004	0.002, 0.006	0.041	<0.001	0.003	0.001, 0.005	0.028	0.005	1.162
HDL cholesterol (mg/dL)	−0.003	−0.009, 0.002	−0.012	0.228
Triglycerides (mg/dL)^*	0.592	0.472, 0.712	0.095	<0.001	0.599	0.474, 0.724	0.098	<0.001	1.234
Corneal refractive power (diopter)	−0.579	−0.609, −0.549	−0.345	<0.001	−0.539	−0.569, −0.509	−0.337	<0.001	1.041
ACD	1.154	1.006, 1.032	0.146	<0.001	0.691	0.548, 0.835	0.089	<0.001	1.027
Vertical CDR	−2.578	−3.059, −2.097	−0.101	<0.001	−1.178	−1.832, −0.525	−0.048	<0.001	2.073
Horizontal CDR	−2.322	−2.817, −1.826	−0.088	<0.001
IOP (mm Hg)	0.086	0.061, 0.111	0.065	<0.001	0.034	0.009, 0.059	0.027	0.007	1.110

B = regression coefficient; CI = confidence interval; Beta = standardized regression coefficient; VIF = variance inflation factor; BP = blood pressure; HDL = high-density lipoprotein; ACD = anterior chamber depth; CDR = cup-to-disc ratio; IOP = intracular pressure.

^* Natural logarithmic transformations were performed before analysis.

Table 3.

Linear regression analysis trans-lamina cribrosa pressure difference

Variable	Univariable				Multivariable
Variable	B	95% CI	Beta	p-value	B	95% CI	Beta	p-value	VIF
Glaucoma suspect (vs. Normal)	0.798	0.533, 1.062	0.056	<0.001	1.349	0.977, 1.720	0.099	<0.001	0.000
Galucoma (vs. Normal)	3.537	3.107, 3.967	0.154	<0.001	2.776	2.264, 3.289	0.118	<0.001	2.579
Male (ref: Female)	−0.614	−0.785, −0.442	−0.067	<0.001	−0.740	−0.910, −0.570	−0.081	<0.001	1.018
Systolic BP (mm Hg)^*	2.257	1.644, 2.869	0.069	<0.001
Pulse (beats/15 sec)^*	2.090	1.509, 2.671	0.070	<0.001	4.604	3.964, 5.243	0.155	<0.001	1.362
Total cholesterol (mg/dL)	−0.001	−0.003, 0.002	−0.006	0.538
HDL cholesterol (mg/dL)	−0.008	−0.015, −0.002	−0.024	0.015
Triglycerides (mg/dL)^*	−0.100	−0.247, 0.047	−0.013	0.185
Corneal refractive power (diopter)	0.506	0.468, 0.543	0.248	<0.001	0.492	0.454, 0.530	0.244	<0.001	1.030
ACD	−1.134	−1.314, −0.954	−0.118	<0.001	−0.729	−0.909, −0.549	−0.076	<0.001	1.026
Vertical CDR	4.303	3.722, 4.884	0.138	<0.001	2.446	1.623, 3.268	0.080	<0.001	2.090
Horizontal CDR	3.903	3.304, 4.501	0.122	<0.001

^* Natural logarithmic transformations were performed before analysis.

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