Newly Discovered Dua's Layer has role in Glaucoma

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Yes, if you Google a diagram of corneal layers this image is the first to
come up.  No, it is no longer correct.  Not even Google can keep up!  via 
Remember when we all thought the cornea was just five layers thick?  These were simpler times, when diagrams were neatly organized and mnemonic devices were memorized -- the ancient history of pre-June 2013.  That was when Professor Harminder Dua of the University of Nottingham first published his discovery of a layer just 15 microns thick between the corneal stroma and Descemet's Membrane which he named Dua's layer.  The thin corneal layer is surprisingly tough, able to withstand up to 2 bars of pressure.  Due to it's properties, it has been used as a guidepost for surgeons in corneal transplants, banking on the toughness of Dua's layer to determine the depth of their incisions.

Dua's layer has also been implicated in corneal hydrops, a condition where fluid rushes into the layers of the cornea causing pain and sudden vision loss, most commonly in keratoconus.  A tear is Dua's layer appears to be the cause of corneal hydrops and the fluid that rushes into the stromal layers to cause so much damage.

But what else since its' discovery has Dua's layer done for optometry? In just a short amount of time, Professor Dua's research has revealed that the trabecular meshwork is really an extension of Dua's layer.  The trabecular meshwork is one of the most important tissues of concern in treating glaucoma, a disease of the eye that can result in permanent blindness.  Trabecular meshwork is a tissue in the anterior chamber of the eye through which aqueous humor passes to be drained out of the eye via Schlemm's canal.  If the fluid gets backed up, pressure will spike inside the eye, which can be high enough to kill nerve fibers at the back of the eye (glaucoma is a disease of optic nerve death). Many of today's best treatments for glaucoma work on increasing outflow of the aqueous humor fluid through the trabecular meshwork -- making that drainage occur faster and more effectively.

Just a year ago, none of us knew Dua's layer existed, and now we have learned that it extends to form the trabecular meshwork, a tissue that we all actively utilize in eyecare for glaucoma treatments.  It is amazing to think how much there still is to learn about the eye, and how much our knowledge changes every year.  I will keep you posted on every amazing detail on this blog, and I am never at a shortage of material with how even our understanding of basic eye anatomy is changing from year to year!

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