Intraocular and intracranial pressure in glaucoma patients taking acetazolamide

PONE-D-20-14239

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The manuscript is well organized, presented in intelligible fashion and written in standard English.

I understand this may not be so relevant to the objective of this study, however in Lines 139,150: the Blood Pressure measurement was done while the participants in Supine position with this device (Omron Model M6 Comfort,) and the instruction manual of that device states that the patient has to be in Chair with Back and arm being supported. So this can result in less accurate readings and in turn, less accurate understanding of the relationship between the AZZ and BP for example.

Also as mentioned it will be very helpful if we can have Glaucoma patients who are not on AZZ.

Reviewer #2: The authors applied a new noninvasive method to measure ICP longitudinally after acetazolamide (AAZ) treatment in glaucoma patients. By comparing the differential effect of AAZ on ICP and IOP reduction, the authors concluded that AAZ treatment may actually increase the trans-lamina cribrosa pressure difference at periods immediately after the treatment.

The manuscript is well-written and the analysis is rigourly conducted, despite acknowleged design limitations which are discussed in great detail by the authors. Although the study does not have a control patient group not taking AAZ, the longitudinal design including pre- and post-treatment measurements circumvents such drawback and still makes the analysis sound.

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Reviewer #1: Yes: Nayef K Alshammari

Reviewer #2: No