A Comment on the “Progression of Normal-tension Glaucoma After Ventriculoperitoneal Shunt to Decrease Cerebrospinal Fluid Pressure”. J Glaucoma. 2016;25:e50–e52

The translamina cribrosa gradient hypothesis descends from the demonstration that the intra-cranial pressure (ICP) is lower in primary open-angle glaucoma and normal tension glaucoma and higher in ocular hypertension compared with that observed in age-matched controls. On this basis, it has been suggested that ICP plays a crucial role in the development of glaucoma. We challanged this hypothesis by discussing an instructive case of shunted normal pressure hydrocephalus and glaucoma, which offered the unique opportunity to assess the occurrence of optic nerve damage in relation to delta pressure changes, assuming the valve-opening pressure as the maximum ICP proxy.