Background and Objectives: Despite the growing amount of new research, the pathophysiology of glaucoma remains unclear. The aim of this study was to determine the relationship between intracranial pressure (ICP), ocular blood flow and structural optic nerve parameters. Materials and Methods: A prospective clinical study was conducted involving 24 patients with open-angle glaucoma and 25 healthy controls. Routine clinical examination was performed. Swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA) images were taken (DRI-OCT Triton, Topcon). The vessel density (VD) values of the ONH were calculated around the optic nerve head (ONH). An orbital Doppler device (Vittamed 205, Kaunas, Lithuania) was used for non-invasive ICP measurements. Color Doppler imaging (CDI) (Mindray M7, Shenzhen, China) was used for retrobulbar blood flow measurements in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs). Results: ICP was 8.35 ± 2.8 mmHg in the glaucoma group and 8.45 ± 3.19 mmHg in the control group (p = 0.907). In the glaucoma group, the VD of the superficial vascular plexus in the inferior-nasal (NI) sector of the ONH showed a correlation with ICP (r = 0.451, p = 0.05). In contrast, the control group exhibited weaker correlations. CRA peak systolic velocity (PSV) demonstrated significant moderate correlations with VD in multiple retinal layers, including the avascular retina layer in the temporal (T) sector (r = 0.637, p = 0.001). Conclusions: Lower ICP was significantly associated with the lower VD of the superficial plexus layer in the inferior-nasal sector in the glaucoma group, with the control group exhibiting weaker correlations in all sectors. Further longitudinal studies with larger sample sizes are needed to establish associations between intracranial pressure, ocular blood flow and ONH parameters.

Background and Objectives: Normal-tension glaucoma (NTG) is a subtype of primary open-angle glaucoma characterized by progressive optic nerve damage despite intraocular pressure (IOP) remaining within the normal range. The underlying pathophysiology of NTG remains incompletely understood, and its diagnosis is often delayed due to the lack of a definitive screening tool. This study aimed to evaluate differences in intracranial pressure pulse wave amplitude recorded from closed eyelids between NTG patients and control subjects using a novel non-invasive monitoring technology. Materials and Methods: A cross-sectional observational study was conducted, enrolling NTG patients and age-matched controls. Intracranial pressure pulse wave signals were recorded from closed eyelids using the ’Archimedes’ 02 device, which employs a highly sensitive digital pressure sensor and hydromechanical coupling for signal transmission. The amplitude of recorded intracranial pressure pulse waves was analyzed and compared between groups. Statistical analyses were performed using IBM SPSS Statistics 30.0, with significance set at p < 0.05. Results: A total of 140 participants were enrolled, including 68 NTG patients and 72 controls. After applying exclusion criteria, 63 NTG patients and 68 controls were included in the final analysis. The median intracranial pressure pulse wave amplitude was significantly higher in NTG patients (0.1326 a.u.) than in controls (0.0889 a.u.), with p = 0.01. Conclusions: These findings suggest that intracranial pressure pulse wave monitoring may serve as a potential biomarker for NTG. Further studies are needed to determine the diagnostic accuracy, sensitivity, and specificity of this technology for NTG detection.