title: An energy theory of glaucoma.
abstract: A radial array of fortified astrocytes (FASTs) is the load bearing structure of the rat optic nerve head (ONH). At the retinal end the ONH is suspended on a fluid filled extracellular space occupied by modified pigment cells which generate a glomerular-like formation of villi. We propose that regulation of fluid in and out of this space may contribute to buffering the normal fluctuations of intraocular pressure. The energy requirement for the fluid transfer process is provided by the dense vascularity of the ONH and is reflected in the giant mitochondria of the FASTs. We propose that glaucoma occurs when a maintained rise in pressure overwhelms the capacity of this regulatory system. Under these circumstances the FAST array becomes detached from its anchorage in the surrounding ONH sheath. Progressively driven backwards by the pressure, the FASTs degenerate. We propose that the degeneration of the FASTs is associated with ischemic damage caused by the backward stretching of their blood supply. Retraction of the FAST processes deprives the retinal ganglion cell axons of their energy support, resulting in axotomy. We consider that our previously observed rescue of axons and FASTs by transplantation of olfactory ensheathing cells is due to replacement of this lost energy source.
authors: Department of Brain Repair and Rehabilitation, Spinal Research Unit, UCL Institute of Neurology, London, United Kingdom.
authors: Ying
authors: Y
authors: Li
authors: Department of Brain Repair and Rehabilitation, Spinal Research Unit, UCL Institute of Neurology, London, United Kingdom.
authors: Daqing
authors: D
authors: Li
authors: Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing, China.
authors: Xi
authors: X
authors: Ying
authors: NIHR Biomedical Research Centre Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
authors: Peng T
authors: PT
authors: Khaw
authors: Department of Brain Repair and Rehabilitation, Spinal Research Unit, UCL Institute of Neurology, London, United Kingdom.
authors: Geoffrey
authors: G
authors: Raisman
mesh_terms: D000818:Animals; D001253:Astrocytes / Q000166:cytology / Q000378:metabolism / Q000473:pathology; D001369:Axons / Q000378:metabolism / Q000473:pathology; D004195:Disease Models, Animal; D005260:Female; D005901:Glaucoma / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D007429:Intraocular Pressure / Q000502:physiology; D008954:Models, Biological; D009389:Neovascularization, Pathologic / Q000378:metabolism / Q000473:pathology; D009900:Optic Nerve / Q000033:anatomy & histology / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D051381:Rats; D012160:Retina / Q000033:anatomy & histology / Q000378:metabolism / Q000473:pathology; D012162:Retinal Degeneration / Q000378:metabolism / Q000473:pathology; D014180:Transplantation
keywords: glia; intraocular pressure; olfactory ensheathing cells; optic nerve head; posterior ciliary artery