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Low Tension Glaucoma


Presentation

  • We describe a case of a 68-year-old man, referred by his optometrist with suspected low-tension glaucoma, who presented with advanced cupped optic discs and field of vision loss that were subsequently found to be due to a giant prolactinoma.[ncbi.nlm.nih.gov]
  • Other factors must be present to explain these findings in low-tension glaucoma.[ncbi.nlm.nih.gov]
  • Headaches were present in 86% of elderly low-tension glaucoma patients (70 yr of age or older) but in only 64% of elderly normal subjects (P 0.04) and only 59% of elderly ocular hypertensive patients (P 0.02).[ncbi.nlm.nih.gov]
  • The purpose of the present study was to test this hypothesis by comparing three groups of patients matched for age and sex: 51 patients with LTG, 51 patients with open angle glaucoma (OAG) and 46 control patients.[ncbi.nlm.nih.gov]
  • We present nine case reports illustrating our thesis. Glaucomatous cupping and loss of visual field were progressing relentlessly at normal pressures in each case.[ncbi.nlm.nih.gov]
Splinter Hemorrhage
  • The presence of splinter hemorrhages at the optic disk (10% of affected eyes) or of systemic arterial hypertension (diastolic blood pressure greater than 100 mm Hg) was associated with progression of visual field defects.[ncbi.nlm.nih.gov]
  • 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,[ncbi.nlm.nih.gov]
Blurred Vision
  • If you do notice any symptoms, they might include blurred vision, or seeing rainbow-coloured circles around bright lights. Both eyes are usually affected, although it may be worse in one eye.[nhs.uk]
  • Side-effects from some eye drops may include a stinging sensation, red eyes, blurred vision, headaches, or changes in pulse, heartbeat or breathing.[umkelloggeye.org]
  • You should call your doctor immediately if you begin experiencing symptoms, such as severe pain, nausea, and blurred vision.[healthline.com]
  • Some early symptoms may include blurred vision, halos, mild headaches or eye pain.[arleoeye.com]
  • Eye drops may have the following side effects: stinging redness blurred vision headaches dry mouth slow heart rate difficulty breathing impotence Pills used to control glaucoma may sometimes cause: numbness and tingling of the hands and feet fatigue depression[huroneye.com]
Retinal Pigmentation
  • The trabecular meshwork, choroidal and optic nerve vasculature, retinal pigment epithelium, and photoreceptors were normal in appearance.[ncbi.nlm.nih.gov]
  • 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,[ncbi.nlm.nih.gov]
Aura
  • […] 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[ncbi.nlm.nih.gov]

Workup

  • A detailed workup including neuroimaging may be indicated in patients with decreased central visual acuity ( 20/40), patients under 50 years of age, individuals with visual field defects that respect the vertical rather than horizontal midline, and those[glaucomatoday.com]
  • Corneal Thickness Measurements in Normal-tension Glaucoma Workups: Is It Worth the Effort?. J Glaucoma. 2009 Apr 15 [Epub ahead of print]. Stewart WC, Reid KK. Incidence of systemic and ocular disease that may mimic low-tension glaucoma.[emedicine.medscape.com]
  • […] circulation and migraine. 10 In addition, studies have suggested an association of immune-related diseases with NTG, including an increased incidence of paraproteinemia and autoantibodies. 11 Clinical Evaluation The most important part of the diagnostic workup[reviewofophthalmology.com]
  • Workup An evaluation to determine whether a patient has NTG should be done with a thorough history-taking.[aao.org]
Ischemic Changes
  • However, diffuse cerebral small-vessel ischemic changes were found more in patients with low-tension glaucoma (n 8) than control patients (n 1) (P .0196).[ncbi.nlm.nih.gov]

Treatment

  • Nifedipine and acetazolamide treatment seemed to show no advantage over no-treatment in our patients.[ncbi.nlm.nih.gov]
  • However systolic and diastolic systemic arterial blood pressure measurements varied significantly after nifedipine treatment compared with baseline (p 0.05).[ncbi.nlm.nih.gov]
  • Seven of these eyes had diurnal curves performed pre- and two months postlaser treatment to measure the effect of ALT on diurnal pressure variation.[ncbi.nlm.nih.gov]
  • A group of 20 patients with LTG well-compensated by medical treatment underwent Color Doppler Imaging (CDI) of the ophthalmic artery and posterior ciliary arteries with peak systolic velocity (PSV) and Purcelot's index (PI) evaluation.[ncbi.nlm.nih.gov]
  • A mean reduction in the IOP was observed after medical treatment, and central corneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in the mHTG group.[ncbi.nlm.nih.gov]

Prognosis

  • No firm evidence was obtained to indicate that treatment of the low-tension glaucoma improved the prognosis of the ocular course.[ncbi.nlm.nih.gov]
  • . • Prognosis and therapy : • According to Collaborative Normal-Tension Glaucoma Study (CNTGS) • Goal - to achieve an lOP that is as low as possible, without the development of complications. • Aggressive reduction in IOP by 30% to reduce progressive[slideshare.net]
  • What Is the Prognosis for Normal-Tension Glaucoma? With early diagnosis and treatment, it's possible to prevent optic nerve damage and/or vision loss, if already present, may be slowed or stabilized.[emedicinehealth.com]

Etiology

  • If vascular disease is important in the etiology of low-tension glaucoma, then it must be localized or vasospastic since this study does not support the concept of a generalized vascular etiology, either of an atheromatous or hyperviscous nature, for[ncbi.nlm.nih.gov]
  • Because migraine is an ischemic disorder, its possible association with low-tension glaucoma has etiologic and therapeutic implications.[ncbi.nlm.nih.gov]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Obesity linked to lower risk of glaucoma in women Estrogen deficiency accelerates aging of the optic nerve Diagnosis Although there are other systemic factors of interest in the etiology of NTG, the current diagnosis only distinguishes it from POAG by[fiteyes.com]
  • This review provides a critical assessment of the potential role for autoimmunity as an initiating or exacerbating etiology (cause) in some patients with glaucoma. PubMed, Exp Eye Res, [2010]. Type Abnormalities in Patients with Systemic Sclerosis.[sclero.org]

Epidemiology

  • The epidemiological features of DH were studied in 58 low-tension glaucoma patients by examining them every one to four weeks from 6 to 32 months.[ncbi.nlm.nih.gov]
  • For example, 92% of Japanese patients from a cross-sectional epidemiologic study presented with this form of glaucoma. 3 RISK FACTORS IOP is currently the only modifiable risk factor for the development and progression of all types of glaucoma.[glaucomatoday.com]
  • Epidemiology Frequency United States Up to 15-25% of patients with POAG experience low-tension glaucoma.[emedicine.medscape.com]
  • Diagnosis : Normal Tension Glaucoma (NTG) EPIDEMIOLOGY 15-25% of patients with open angle glaucoma in the US have normal range IOP on single measurement On average, older than POAG patients Increased prevalence in Japan SIGNS IOP within normal range Progressive[webeye.ophth.uiowa.edu]
Sex distribution
Age distribution

Pathophysiology

  • Physiological and pathophysiological aspects of ocular blood flow and of microcirculation and hemorrheology will be considered and the significance of ocular vasospasm in low-tension glaucoma discussed.[ncbi.nlm.nih.gov]
  • Therefore, conjunctiva deserves careful analysis, because its accurate microscopic definition could help clarify the pathophysiology of aqueous outflow in glaucoma. 2011 The Authors.[ncbi.nlm.nih.gov]
  • Pathophysiology Low-tension glaucoma is an optic neuropathy with chronic loss of retinal ganglion cells (RGC) due to a genetic hypersensitivity to IOP. Low-tension glaucoma also is due to vascular factors, including vasospasm and ischemia.[emedicine.medscape.com]

Prevention

  • 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.[ncbi.nlm.nih.gov]
  • Sawada A, Kitazawa Y, Yamamoto T, et al: Prevention of visual field defect progression with brovincamine in eyes with normal-tension glaucoma. Ophthalmology 1996; 103:283-288.[webeye.ophth.uiowa.edu]
  • A Mediterranean diet helps. 9 portions of vegetables or fruit a day will also help to keep your retinal veins and macula healthy, and prevent cataract formation...9 a day (men) 7 (women) keeps the doctor away. BJO 16.[goodhopeeyeclinic.org.uk]
  • Progression of the disease can be managed and further deterioration of sight can be prevented if the condition is caught early.[ncbi.ie]
  • This helps lower the eye pressure and prevents further optic nerve damage and visual loss. Your doctor will discuss this possibility with you when other options are not preventing progressive damage.[huroneye.com]

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