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We read with great interest the article entitled “Ocular blood flow and cerebrospinal fluid pressure in glaucoma” by Promelle et al. (1). The authors review the most recent research on alterations in ocular blood flow and/or cerebrospinal fluid (CSF) flow in glaucoma. They state that blood–CSF flow interactions may be involved in glaucoma, and also note that “the CSF’s behavior is supposedly linked to blood pulsatility.” We fully agree with this notion, as we believe that the vascular system could play a role in the pathogenesis of glaucoma through a mechanical interplay with the CSF circulation.

Dilated Virchow-Robin spaces in primary open-angle glaucoma: a biomarker of glymphatic waste clearance dysfunction?