August 2016
Volume 57, Issue 10
Open Access
Letters to the Editor  |   August 2016
Peripapillary Suprachoroidal Cavitation, Parapapillary Gamma Zone and Optic Disc Rotation Due to the Biomechanics of the Optic Nerve Dura Mater
Author Affiliations & Notes
  • Jost B. Jonas
    Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany;
    Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, and Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China;
  • Yi Dai
    Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China;
    Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China; and the
  • Songhomitra Panda-Jonas
    Augenpraxis Seegartenklinik, Heidelberg, Germany.
Investigative Ophthalmology & Visual Science August 2016, Vol.57, 4373. doi:10.1167/iovs.16-19885
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      Jost B. Jonas, Yi Dai, Songhomitra Panda-Jonas; Peripapillary Suprachoroidal Cavitation, Parapapillary Gamma Zone and Optic Disc Rotation Due to the Biomechanics of the Optic Nerve Dura Mater. Invest. Ophthalmol. Vis. Sci. 2016;57(10):4373. doi: 10.1167/iovs.16-19885.

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      © ARVO (1962-2015); The Authors (2016-present)

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It was with great interest that we read the article by Wang and colleagues,1 in which they formed a biomechanical model of the optic nerve head and calculated that the optic nerve head strains following a lateral eye movement of 13° were as high as or higher than those resulting from an intraocular pressure of 50 mm Hg. This example may show the importance of the biomechanics of the optic nerve dura mater for the physiology and pathophysiology of the optic nerve head. To cite an example, peripapillary suprachoroidal cavitations found in highly myopic eyes with a prevalence of approximately 17% are usually located in the inferior peripapillary region.2,3 They are associated with an optic disc rotation around the vertical axis and high axial myopia. The fact that the pull of the optic nerve dura mater may exert traction on the temporal and inferior peripapillary sclera has been discussed.4 This traction may be stronger on the temporal optic nerve head side than on its nasal side, as the optic nerve dura mater originates in the nasal upper region of the orbit. Subsequently, the pull may be most marked in eyes with a longer axial diameter (i.e., highly myopic eye) in adduction. These reflections fit well with the model described by Wang et al.1 in their study. We would therefore like to ask Dr. Wang and associates1 whether their model could also explain the forces exerted by the optic nerve dura mater pull on the temporal peripapillary sclera and peripapillary scleral flange, also including the development and enlargement of parapapillary gamma zone and increasing vertical optic disc rotation in highly myopic eyes. 
References
Wang X, Rumpel H, Lim WEH, et al. Finite element analysis predicts large optic nerve head strains during horizontal eye movements. Invest Ophthalmol Vis Sci. 2016; 57: 2452–2462.
Spaide RF, Akiba M, Ohno-Matsui K. Evaluation of peripapillary intrachoroidal cavitation with swept source and enhanced depth imaging optical coherence tomography. Retina. 2012; 32: 1037–1044.
You QS, Peng XY, Chen CX, Xu L, Jonas JB. Peripapillary intrachoroidal cavitations. The Beijing Eye Study. PLoS One. 2013; 8: e78743.
Dai Y, Jonas JB, Ling Z, Wang X, Sun X. Unilateral peripapillary intrachoroidal cavitation and optic disc rotation. Retina. 2015; 35: 655–659.
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