Optic Nerve Deformity as a Possible Contributor to Optic Neuropathy

The pathophysiology of most common forms of acquired optic neuropathy is mysterious, and even increasingly so. For example, elevated IOP is no longer part of the definition of primary open angle glaucoma (POAG). Most cases of normal tension glaucoma (NTG) worldwide are not associate with elevated intraocular pressure (IOP), and progressive vision loss often continues during therapy despite normal or subnormal IOP. But IOP is considered the only modifiable "risk factor" for POAG, so patients are aggressively treated medically and surgically to reduce IOP. The strong association with advancing age, axial myopia, and peripapillary atrophy is unexplained.