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. Author manuscript; available in PMC: 2009 Nov 16.
Published in final edited form as: J Glaucoma. 2008 Jun–Jul;17(4):318–328. doi: 10.1097/IJG.0b013e31815a343b

Figure 2. Whether, Over the Course of a Lifetime, an Eye Demonstrates the “Neuropathy of Aging” or the Neuropathy of Glaucoma Lies in ONH Susceptibility.

Figure 2

For a given ONH, IOP generates low or high levels of stress depending upon the 3D architecture (geometry) of the ONH connective tissues (size and shape of the canal, thickness of the lamina and sclera) - (Susceptibility 1). Some ONHs will have relatively low stress at high IOP (d). Others will have high stress at low IOP (e). Whether a given level of IOP-related stress is physiologic or patho-physiologic depends upon the ONH's microenvironment (Susceptibility 2). Strong connective tissues, a robust blood supply and stable astrocytes and glia increase the chance of Normal ONH Aging (right – bottom). While the existence of a neuropathy of aging is controversial, the difference between “normal” age-related axon loss (if it is shown to exist) and the development of glaucomatous damage is a matter of ONH susceptibility. Reprinted with permission from Burgoyne, et al64).