New insights into blindness; mechanical fatigue of optic nerve head in glaucomatous optic neuropathy

A common cause of blindness worldwide is glaucoma. It is characterized by visual field loss which is caused by optic nerve damage leading to glaucomatous optic neuropathy (GON). Modelling of GON development may be helpful for designing strategies to decelerate the rate of GON progression and prevent GON development at early stages. Attempts to complete the modelling of GON development continue. In this paper, it was speculated that the modelling could be more completed through a biomechanical point of view. GON may result from the mechanical fatigue effects of radial tensile stress (TS), caused by intra-ocular pressure (IOP), on the optic nerve head (ONH). The mechanical fatigue rate is influenced by patient’s age, the maximum and minimum magnitude of IOP, the amplitude of IOP and TS fluctuations, the ONH geometry, scleral thickness and biomechanical properties of the sclera, particularly the peripapillary part, and the axial length of the globe. Based on this model, more efficient strategies can be developed to augment the ONH and decelerate the progression of glaucomatous optic nerve damage, and even screen high-risk individuals at early stages.