Mechanical environment of the optic nerve head in glaucoma

The optic nerve head (ONH) is of particular interest from a biomechanical perspective because it is a weak spot within an otherwise strong corneo-scleral envelope. The lamina cribrosa provides structural and functional support to the retinal ganglion cell axons as they pass from the relatively high-pressure environment in the eye to a low-pressure region in the retrobulbar cerebrospinal space. To protect the retinal ganglion cell axons within this unique environment, the lamina cribrosa in higher primates has developed into a complex structure composed of a three-dimensional network of flexible beams of connective tissue. The ONH is nourished by the short posterior ciliary arteries, which penetrate the immediate peripapillary sclera to feed capillaries contained within the laminar beams. This intrascleral and intralaminar vasculature is unique in that it is encased in load-bearing connective tissue, either within the scleral wall adjacent to the lamina cribrosa, or within the laminar beams themselves. Glaucoma is a multifactorial disease, and we believe that biomechanics not only determines the mechanical environment in the ONH, but also mediates IOP-related reductions in blood flow and cellular responses through various pathways. Our current understanding of the mechanical environment of the ONH is described, with particular emphasis on the influence of biomechanics in glaucoma.