Optic nerve head biomechanics in aging and disease

- Nontechnical review focused on educating the reader in optic nerve head biomechanics.
- Focus on how mechanical forces and the resulting deformations are distributed in the posterior pole and ONH (biomechanics) and how the ONH responds to IOP as a structural system.
- Focus on how the living system responds to those deformations (mechanobiology).
- Discuss the biomechanical basis for IOP-driven changes in connective tissues, blood flow, and cellular responses.
- Use glaucoma as the primary framework to present the important aspects of ONH biomechanics in aging and disease.

This nontechnical review is focused upon educating the reader on optic nerve head biomechanics in both aging and disease along two main themes: what is known about how mechanical forces and the resulting deformations are distributed in the posterior pole and ONH (biomechanics) and what is known about how the living system responds to those deformations (mechanobiology). We focus on how ONH responds to IOP elevations as a structural system, insofar as the acute mechanical response of the lamina cribrosa is confounded with the responses of the peripapillary sclera, prelaminar neural tissues, and retrolaminar optic nerve. We discuss the biomechanical basis for IOP-driven changes in connective tissues, blood flow, and cellular responses. We use glaucoma as the primary framework to present the important aspects of ONH biomechanics in aging and disease, as ONH biomechanics, aging, and the posterior pole extracellular matrix (ECM) are thought to be centrally involved in glaucoma susceptibility, onset and progression.