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BioMed Research International
Volume 2017, Article ID 5123148, 7 pages
Review Article

The Glymphatic Hypothesis of Glaucoma: A Unifying Concept Incorporating Vascular, Biomechanical, and Biochemical Aspects of the Disease

1Department of Psychiatry, PC Sint-Amandus, Beernem, Belgium
2Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium
3Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Department of Biomedical Sciences, Antwerp, Belgium
4Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
5Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
6Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland
7Department of Neurology and Memory Clinic, Middelheim General Hospital (ZNA), Antwerp, Belgium

Correspondence should be addressed to Peter Wostyn; eb.tenyks@retep.nytsow

Received 20 May 2017; Accepted 1 August 2017; Published 29 August 2017

Academic Editor: John H. Zhang

Copyright © 2017 Peter Wostyn et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The pathophysiology of primary open-angle glaucoma is still largely unknown, although a joint contribution of vascular, biomechanical, and biochemical factors is widely acknowledged. Since glaucoma is a leading cause of irreversible blindness worldwide, exploring its underlying pathophysiological mechanisms is extremely important and challenging. Evidence from recent studies appears supportive of the hypothesis that a “glymphatic system” exists in the eye and optic nerve, analogous to the described “glymphatic system” in the brain. As discussed in the present paper, elucidation of a glymphatic clearance pathway in the eye could provide a new unifying hypothesis of glaucoma that can incorporate many aspects of the vascular, biomechanical, and biochemical theories of the disease. It should be stressed, however, that the few research data currently available cannot be considered as proof of the existence of an “ocular glymphatic system” and that much more studies are needed to validate this possibility. Even though nothing conclusive can yet be said, the recent reports suggesting a paravascular transport system in the eye and optic nerve are encouraging and, if confirmed, may offer new perspectives for the development of novel diagnostic and therapeutic strategies for this devastating disorder.