To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population.

A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m²) + 0.16 diastolic blood pressure (mm Hg) - 0.18 age (years) - 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure.

The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively ( p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower ( p < 0.001; beta: -0.12; B: -2.306; 95% confidence interval [CI]: -2.717, -1.895) in OAG group than in non-glaucomatous group and the mean TLCPD was distributed higher ( p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively.

Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.