{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:28:10Z","timestamp":1787218090754,"version":"build-2736575974"},"reference-count":10,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81230029"],"award-info":[{"award-number":["81230029"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82301196"],"award-info":[{"award-number":["82301196"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Capital\u2019s Funds for Health Improvement and Research Brain Major Disease Research Program","award":["CFH-BRAIN:2024-2-1021"],"award-info":[{"award-number":["CFH-BRAIN:2024-2-1021"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,2,23]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>The imbalance between intraocular pressure (IOP) and intracranial pressure (ICP) is a recognised contributor to optic nerve (ON) injury. Clinically, the translaminar pressure difference is often simplistically interpreted as the direct subtraction of ON cerebrospinal fluid pressure (ON \u2013 CSFp) from IOP. While finite element analyses suggest that the transition between these two pressure compartments is neither abrupt nor uniform, instead forming a spatially graded finite transition zone, this concept remains unconfirmed from a fluid dynamics perspective. Given the inability to directly measure intraneural pressure in vivo, we modelled the ON as a continuous fluid medium. Using a mathematical approach, we visually illustrate how IOP and ON\u2013CSFp interact to generate spatially varying intraneural hydrostatic pressure gradients. Our results show that these gradients assume a three-dimensional conical configuration. Elevation of IOP or reduction of ON\u2013CSFp expands this conical gradient field, contributing to ON injury, whereas elevation of ICP produces an inverted conical gradient. The steepest gradients occur in the peripheral region posterior to the lamina cribrosa, rendering this area most vulnerable to damage. This study challenges the clinical oversimplification that pressure difference is equivalent to a mere subtraction of two values. It thereby improves clinicians\u2019 understanding of the biomechanical mechanisms underlying IOP and ICP imbalance-related ON injury. Importantly, it also highlights the often-overlooked phenomenon of intraneural pressure gradients, extending beyond the conventional focus on the translaminar pressure gradient alone.<\/jats:p>","DOI":"10.1136\/bjo-2025-328354","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:20:19Z","timestamp":1776273619000},"page":"1048-1050","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Optic nerve intraneural pressure trend under intraocular\u2013intracranial pressure effects"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7705-7943","authenticated-orcid":false,"given":"Yuan","family":"Xie","sequence":"first","affiliation":[{"name":"Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zekun","family":"Li","sequence":"additional","affiliation":[{"name":"Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wu","sequence":"additional","affiliation":[{"name":"Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Institute of Ophthalmology, Beijing Tongren Hospital,Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0566-9879","authenticated-orcid":false,"given":"Kaiwen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Institute of Ophthalmology, Beijing Tongren Hospital,Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Shao","sequence":"additional","affiliation":[{"name":"Beijing Institute of Ophthalmology, Beijing Tongren Hospital,Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingyan","family":"Mao","sequence":"additional","affiliation":[{"name":"Beijing Institute of Ophthalmology, Beijing Tongren Hospital,Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Cheng","sequence":"additional","affiliation":[{"name":"Xi\u2019an No.1 Hospital, Xi\u2019an, Shaanxi Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3175-0344","authenticated-orcid":false,"given":"Xiaofei","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8933-4482","authenticated-orcid":false,"given":"Ningli","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China"},{"name":"Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China"},{"name":"Beijing Institute of Ophthalmology, Beijing Tongren Hospital,Capital Medical University, Beijing, 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