Posture-dependent collapse of the optic nerve subarachnoid space: A combined MRI and modeling study

Petter Holmlund*, Karen Helene Støverud, Anders Wåhlin, Urban Wiklund, Jan Malm, Gauti Jóhannesson, Anders Eklund

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: We hypothesize that a collapse of the optic nerve subarachnoid space (ONSAS) in the upright posture may protect the eyes from large translamina cribrosa pressure differences (TLCPD) believed to play a role in various optic nerve diseases (e.g., glaucoma). In this study, we combined magnetic resonance imaging (MRI) and mathematical modeling to investigate this potential ONSAS collapse and its effects on the TLCPD.

Methods: First, we performed MRI on six healthy volunteers in 6° head-down tilt (HDT) and 13° head-up tilt (HUT) to assess changes in ONSAS volume (measured from the eye to the optic canal) with changes in posture. The volume change reflects optic nerve sheath (ONS) distensibility. Second, we used the MRI data and mathematical modeling to simulate ONSAS pressure and the potential ONSAS collapse in a 90° upright posture.

Results: The MRI showed a 33% decrease in ONSAS volume from the HDT to HUT (P < 0.001). In the upright posture, the simulations predicted an ONSAS collapse 25 mm behind lamina cribrosa, disrupting the pressure communication between the ONSAS and the intracranial subarachnoid space. The collapse reduced the simulated postural increase in TLCPD by roughly 1 mm Hg, although this reduction was highly sensitive to ONS distensibility, varying between 0 and 4.8 mm Hg when varying the distensibility by ± 1 SD.

Conclusions: The ONSAS volume along the optic nerve is posture dependent. The simulations supported the hypothesized ONSAS collapse in the upright posture and showed that even small changes in ONS stiffness/distensibility may affect the TLCPD.

Original languageEnglish
Article number26
Pages (from-to)26
JournalInvestigative Ophthalmology and Visual Science
Issue number4
Publication statusPublished - Apr 2021

Bibliographical note

Supported by the Swedish National Space Board (Grant no. 193/17), Swedish Foundation for Strategic Research, the Knut and Alice Wallenberg Foundation, and the Swedish Society for Medical Research.

Publisher Copyright:
© 2021 The Authors

Other keywords

  • Glaucoma
  • Glymphatics
  • Optic nerve subarachnoid space
  • Posture
  • Translaminar pressure
  • Models, Theoretical
  • Optic Nerve/diagnostic imaging
  • Subarachnoid Space/diagnostic imaging
  • Humans
  • Middle Aged
  • Magnetic Resonance Imaging/methods
  • Male
  • Head-Down Tilt/physiology
  • Healthy Volunteers
  • Optic Nerve Diseases/diagnosis
  • Female
  • Intracranial Pressure/physiology


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