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However, IOP alone does not fully describe a mechanical basis for disease in patients with normal tension glaucoma or primary open-angle glaucoma. The translaminar pressure difference (TLPD) theory proposes that the pressure gradient generated by the difference of IOP and cerebrospinal fluid pressure (CSFp) acting at the level of the optic nerve can lead to cupping and glaucoma when IOP is higher than normal and\/or CSFp is lower than normal. The study results to date have generally supported the TLPD theory; however, varying methods, populations, and sample sizes make it difficult to compare results. To further assess whether there is an association between low CSFp and open-angle glaucoma, 30 years of clinical data that assess 96,543 lumbar punctures were analyzed. Patients with open-angle glaucoma showed a significantly lower CSFp than randomly selected normal control patients (9.9\u2009\u00b1\u20093\u2009mm\u00b7Hg (n\u2009=\u200986) versus 12.1\u2009\u00b1\u20093.6\u2009mm\u00b7Hg (n\u2009=\u2009114), <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>&lt;<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>) following adjustment for age and sex. This retrospective study provides strong evidence for an association between open-angle glaucoma and low CSFp.<\/jats:p>","DOI":"10.1155\/2020\/7487329","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T01:05:07Z","timestamp":1605143107000},"page":"1-8","source":"Crossref","is-referenced-by-count":5,"title":["Three-Decade Evaluation of Cerebrospinal Fluid Pressure in Open-Angle Glaucoma at a Tertiary Care Center"],"prefix":"10.1155","volume":"2020","author":[{"given":"Catherine G.","family":"Knier","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA"},{"name":"Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Fleischman","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David O.","family":"Hodge","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Jacksonville, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Berdahl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Vance Thompson Vision, Sioux Falls, SD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9115-2485","authenticated-orcid":true,"given":"Michael P.","family":"Fautsch","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3192"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1007\/bf00181776"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/s0161-6420(04)00665-7"},{"issue":"6","key":"4","first-page":"1163","article-title":"The influence of cerebrospinal fluid pressure on the lamina cribrosa tissue pressure gradient","volume":"36","author":"W. 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