The Strain Response to Intraocular Pressure Increase in the Lamina Cribrosa of Control Subjects and Glaucoma Patients

Purpose: The purpose of this study was to measure biomechanical strains in the lamina cribrosa (LC) of living human eyes undergoing intraocular pressure (IOP) increase. Methods: Healthy control subjects and patients with glaucoma underwent optical coherence tomographic (OCT) imaging of the LC before and after wearing of swim goggles that increased IOP (57 image pairs, 39 persons). Digital volume correlation was used to measure biomechanical strains in optic nerve head tissue and change in depth of the anterior border of the LC. Results: The mean IOP increase in both glaucoma and control eyes was 7.1 millimeters of mercury (mm Hg) after application of the goggles. Among glaucoma eyes, strains that were significant were: contractile E zz (average = - 0.33%, P = 0.0005), contractile E 99 (average = - 0.23%, P = 0.03), E max (average = 0.83%, P < 0.0001), and [' max (average = 0.95%, P < 0.0001), whereas the average anterior LC depth (ALD) decreased by 2.39 mu m (anterior; P = 0.0002). In glaucoma eyes, shear strain Ez9 was greater with worse mean deviation (MD) and visual function index (P = 0.044 and P = 0.006, respectively, multivariate models). Strain compliance for Er9, Ez9, and E 99 all increased with greater MD worsening prior to imaging (P = 0.04, P = 0.007, and P = 0.03). Conclusions: LC strains were measurable 20 minutes after IOP increase, producing axial compression and greater peripheral strain than centrally. Some strain compliances were greater with worse existing visual field loss or with more progressive past field loss. Translational Relevance: Biomechanical strains are related to measures of glaucoma damage, supporting the hypothesis that optic nerve head biomechanical responses represent a noninvasive biomarker for glaucoma.