The association between asymmetric stress distribution on the lamina cribrosa and glaucoma progression

Purpose: The purpose of this study was to assess the effect of ocular movements on the progression of glaucoma.

Methods: A total of 118 primary open-angle glaucoma patients were enrolled, comprising 71 patients in the progression group and 47 patients in the non-progression group. Utilizing three geometric parameters-axial length, optic disc radius, and optic cup deepening-a personalized virtual optic nerve head (ONH) model was designed. ONH biomechanical changes during ocular movement were simulated using a finite element analysis. Simulation results were analyzed and compared between the progression and non-progression groups.

Results: In both progression and non-progression groups, ONH strains significantly increased with increasing rotation angle. When the eye rotated by 10°, the stress on the anterior surface of the lamina cribrosa on the temporal side was significantly higher in the progression group compared to the non-progression group (16.19 ± 0.90 kPa vs. 13.24 ± 3.00 kPa, P < 0.001). The stress ratio, indicating asymmetric stress distribution, was higher in the progression group than in the non-progression group (0.56 ± 0.13 vs. 0.49 ± 0.19, P = 0.018). Stress ratio significantly increased with increasing optic disc radius (standardized β = 0.303, P < 0.001) and optic cup deepening (standardized β = 0.538, P < 0.001).

Conclusions: Asymmetric stress distribution with ocular movement was higher in the progression group. This asymmetry was associated with optic disc radius and optic cup deepening. Therefore, ocular movement may contribute to the progression of glaucoma, with ONH geometry playing a role.

Key messages: WHAT IS KNOWN : Ocular movement is considered one of the physical stress factors affecting the optic nerve head.

What is new: Ocular movement increased the strain on the optic nerve head and resulted in an asymmetric stress distribution on the lamina cribrosa surface. Asymmetric stress distribution on lamina cribrosa with ocular movement was higher in the glaucoma progression group and associated with optic disc radius and optic cup deepening.