Schematic Illustration of Normal Anatomy and Neurodegenerative Changes Associated With Glaucomatous Optic Neuropathy: A, The optic disc is composed of neural, vascular, and connective tissues. The convergence of the axons of retinal ganglion (RG) cells at the optic disc creates the neuroretinal rim; the rim surrounds the cup, a central shallow depression in the optic disc. Retinal ganglion cell axons exit the eye through the lamina cribrosa (LC), forming the optic nerve, and travel to the left and right lateral geniculate nucleus, the thalamic relay nuclei for vision.

B, Glaucomatous optic neuropathy involves damage and remodeling of the optic disc tissues and LC that lead to vision loss. With elevated intraocular pressure, the LC is posteriorly displaced and thinned, leading to deepening of the cup and narrowing of the rim. Distortions within the LC may initiate or contribute to the blockade of axonal transport of neurotrophic factors within the RG cell axons followed by apoptotic degeneration of the RG cells. Strain placed on this region also causes molecular and functional changes to the resident cell population in the optic nerve (eg, astrocytes, microglia), remodeling of the extracellular matrix, alterations of the microcirculation and to shrinkage and atrophy of target relay neurons in the lateral geniculate nucleus. | Weinreb, R. N., Aung, T., & Medeiros, F. A. (2014). The pathophysiology and treatment of
: a review. JAMA, 311(18), 1901–1911. https://doi.org/10.1001/jama.2014.3192

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