The glaucoma theory updated

The natural history of splinter haemorrhages on the optic disc is an argument in favour of the belief that the glaucomatous process starts in the small vessels of the papilla. The probable existence of factors in the aqueous, whose generation depend on the state of oxygenation in the posterior parts of the eye and which affect the outflow resistance, supports the idea that the pressure increase is a secondary effect. Reduced perfusion by increased IOP or reduced blood pressure etc. is likely to accelerate a process already begun in the papilla.