Normal-tension glaucoma (Low-tension glaucoma)
- PMID: 21150042
- PMCID: PMC3038511
- DOI: 10.4103/0301-4738.73695
Normal-tension glaucoma (Low-tension glaucoma)
Abstract
Glaucoma is now considered an abnormal physiology in the optic nerve head that interacts with the level of intraocular pressure (IOP), with the degree and rate of damage depending on the IOP and presumably the degree of abnormal physiology. Diagnosis of normal-tension glaucoma (NTG), defined as glaucoma without a clearly abnormal IOP, depends on recognizing symptoms and signs associated with optic nerve vulnerability, in addition to absence of other explanations for disc abnormality and visual field loss. Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, migraine headache with aura, and the like), or a family history of glaucoma. Possibly relevant, is a history of hemodynamic crisis, arterial obstructive disease, or sleep apnea. Neurological evaluation with imaging is needed only for atypical cases or ones that progress unexpectedly. Management follows the same principle of other chronic glaucomas, to lower the IOP by a substantial amount, enough to prevent disabling visual loss. However, many NTG cases are non-progressive. Therefore, it may often be wise in mild cases to determine whether the case is progressive and the rate of progression before deciding on how aggressivene to be with therapy. Efforts at neuroprotection and improvement in blood flow have not yet been shown effective.
Conflict of interest statement
Similar articles
-
Influence of intraocular pressure reduction on progression of normal-tension glaucoma with myopic tilted disc and associated risk factors.Jpn J Ophthalmol. 2017 May;61(3):230-236. doi: 10.1007/s10384-017-0508-y. Epub 2017 Mar 9. Jpn J Ophthalmol. 2017. PMID: 28280945
-
Eyes with Suspicious Appearance of the Optic Disc and Normal Intraocular Pressure: Using Clinical and Epidemiological Characteristics to Differentiate Those with and without Glaucoma.PLoS One. 2016 Jul 19;11(7):e0158983. doi: 10.1371/journal.pone.0158983. eCollection 2016. PLoS One. 2016. PMID: 27433805 Free PMC article.
-
Comparison of the Progression of High- and Low-tension Glaucoma as Determined by Two Different Criteria.Korean J Ophthalmol. 2016 Feb;30(1):40-7. doi: 10.3341/kjo.2016.30.1.40. Epub 2016 Jan 21. Korean J Ophthalmol. 2016. PMID: 26865802 Free PMC article.
-
[Aiming for zero blindness].Nippon Ganka Gakkai Zasshi. 2015 Mar;119(3):168-93; discussion 194. Nippon Ganka Gakkai Zasshi. 2015. PMID: 25854109 Review. Japanese.
-
[A challenge to primary open-angle glaucoma including normal-pressure. Clinical problems and their scientific solution].Nippon Ganka Gakkai Zasshi. 2012 Mar;116(3):233-67; discussion 268. Nippon Ganka Gakkai Zasshi. 2012. PMID: 22568103 Review. Japanese.
Cited by
-
Glaucoma Patients Have a Lower Abundance of Butyrate-Producing Taxa in the Gut.Invest Ophthalmol Vis Sci. 2024 Feb 1;65(2):7. doi: 10.1167/iovs.65.2.7. Invest Ophthalmol Vis Sci. 2024. PMID: 38315494 Free PMC article.
-
Role of ocular blood flow in normal tension glaucoma.Adv Ophthalmol Pract Res. 2022 Feb 16;2(1):100036. doi: 10.1016/j.aopr.2022.100036. eCollection 2022 May-Jun. Adv Ophthalmol Pract Res. 2022. PMID: 37846223 Free PMC article. Review.
-
Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases.Graefes Arch Clin Exp Ophthalmol. 2023 Dec;261(12):3569-3579. doi: 10.1007/s00417-023-06163-5. Epub 2023 Jul 11. Graefes Arch Clin Exp Ophthalmol. 2023. PMID: 37432451 Free PMC article.
-
Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis.Eye (Lond). 2023 Oct;37(15):3065-3083. doi: 10.1038/s41433-023-02471-6. Epub 2023 Mar 28. Eye (Lond). 2023. PMID: 36977937 Review.
-
Corneal Endothelial Cell Density in Normal Tension Glaucoma Compared to Healthy Controls.J Clin Med. 2022 Jun 18;11(12):3515. doi: 10.3390/jcm11123515. J Clin Med. 2022. PMID: 35743585 Free PMC article.
References
-
- Anderson DR. The management of elevated intraocular pressure with normal optic discs and visual fields: I. The disk-field status as a risk predictor. Surv Ophthalmol. 1977;21:479–89. - PubMed
-
- Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. The Ocular Hypertension Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120:701–13. - PubMed
-
- Anderson DR. Glaucoma, capillaries, and pericytes: 1. Blood flow regulation. Ophthalmologica. 1996;210:257–62. - PubMed
-
- Mozaffarieh M, Flammer J. Chapter 5. London: Current Medical Group; 2008. Pocket Reference to Ocular Blood Flow and Glaucomatous Optic Atrophy.
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous