Optic neuropathy is a broad umbrella term which includes optic atrophies due to various causes in which NFs are being atrophied or shrinking in size, but not totally vanishing. Glaucoma is also defined as an optic neuropathy implying that NFs are also being atrophied similar to non-glaucomatous optic atrophies (NGOA).
Question arises: if both NGOA and glaucomatous disc are optic atrophies then why are there distinctive morphological and histological differences in the NGOA and glaucomatous discs (GD)?
All the NGOAs are flat or non-excavated whereas GDs are excavated. Moreover, the histology of the NGOAs such as due to multiple sclerosis reveals that NFs are still visible and present though shrunken in size. In contrast, the histology of the end- stage GD reveals an empty bean-pot totally devoid of NFs. Where did entire NFs disappear?
The total disappearance of NFs in the end-stage glaucomatous disc can only be explained by their severance and not by their atrophy. Therefore, glaucoma may be not be an optic neuropathy but an optic axotomy.
Sir, I feel a cut nerve usually heals (sometimes by forming a neuroma and in other cases sprouting new fibers). However, if a nerve AND the ganglion cell are slowly compressed, there is degeneration of the nerve and not splitting. Since glaucoma is a slow, chronic, progressive neuropathy, the changes could reflect apoptosis
In glucoma there's pressure beginning in cribriform plate and then in advanced stages expands behind it.
Pressure leads to demylination and then axonal affection of retinal ganglion cells it is optic neuropathy
All the above defintions are correct , glaucoma defintion has never been straight forward , but over past decade there have been much discussion as to what is the corrcet defintion . From my own understanding, it is assocaited with optic neuropthay / and there is strong eviednce of retinal ganglion cell degeneration .
Yes Dr. Syed Husnain, although it is a big breakthrough in the field of Glaucoma, I agree with your hypothesis that it is an optic axotomy rather than present belief that it is optic neuropathy. I have read your research and am satisfied with your great discovery which will revolutionize the management of this important ophthalmic health problem in the world soon.
Dear Prof. Imtiaz, I feel very honored with your endorsement of optic axotomy in glaucoma – especially coming from a great ophthalmologist like yourself. Whatever the reason may be; the bottom line in glaucoma is that LC is sinking (already proven) with the result that nerve fibers are being stretched and broken at the scleral edge starting with the most peripheral NFs ( being deepest and closest to scleral edge) and ending with the most central in an orderly sequence in glaucoma. As a result of severance of NFs the RGCs are dying due to retrograde degeneration whereas neurons in the LGN due to Wallerian degeneration.
Researchers can test the optic axotomy hypothesis very easily.
All we need is to change the way we look at the glaucomatous disc- a gestalt switch. If we look at the glaucomatous disc in context of sinking LC and severance of NFs along with its vasculature then the every change in the glaucomatous disc will so obvious as we have never seen before. Progressive thinning of the RNFL and histology of end-stage glaucomatous disc – and empty crater devoid of NFs and its vasculature - is obvious proof of severance of NFs in glaucoma. glaucoma may not be an optic neuropathy. Please just give a try. Thanks
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