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]

“Only half of the patients who present with normal-tension glaucoma will progress over a period of 5 to 7 years. This brings up the question as to whether treatment should always be started on everyone who presents with glaucoma,” he said. Dr. [healio.com]

• 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]

  Splinter hemorrhages are reported more frequently in NTG, but may also be seen in uncontrolled POAG. [13] Hemorrhages may simply indicate poor control and thus are more frequent in NTG in which substantial lowering of pressure is more difficult to achieve [ijo.in]

  Splinter hemorrhages are common, and glaucomatous cupping and visual defects are frequent. • Cardiac arrhythmia • Blood dyscrasias • Severe anemia • Polycythemia vera • Hyperviscosity syndromes • Increased platelet adhesiveness • Vascular dysregulation [reviewofophthalmology.com]

  Splinter hemorrhages are seen more commonly in NTG, but may also be found in POAG. [40] Hemorrhages may simply indicate poor control. Although the optic nerve head may be larger in NTG than in POAG, glaucomatous cupping is comparable. [jovr.org]

• Blurred Vision

  These include: Changes in blood pressure Migraine headaches Blurred vision Stinging or itchy eyes We encourage you to see a specialist right away if you are experiencing the symptoms above. [willseye.org]

  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]

• Retinal Pigmentation

  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]

  A region of absent retinal pigment epithelium (RPE) is more often seen as a crescent or halo at the disc border in NTG than in high-pressure glaucoma or normal eyes. [ijo.in]

  pigment epithelium  13.8 to 28.0% in NTG Soares AS, Artes PH, Andreou P, Leblanc RP, Chauhan BC, Nicolela MT. [slideshare.net]

  Introduction Primary open angle glaucoma (POAG) is a chronic optic neuropathy in which raised intraocular pressure (IOP) results in damage at the optic nerve head, reduced retinal nerve fibre layer thickness and subsequent death of retinal ganglion cells [macfarlaneoptometrist.com.au]

[…] 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]

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]

Workup An evaluation to determine whether a patient has NTG should be done with a thorough history-taking. [aao.org]

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]

• 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]

  As a result, low OPP could lead to ischemic changes in the optic nerve head and glaucomatous visual field defect progression. [hindawi.com]

  Ischemic changes in brain magnetic resonance imaging are more common in these patients [ 17, 55 ]. [journals.plos.org]

Nifedipine and acetazolamide treatment seemed to show no advantage over no-treatment in our patients. [ncbi.nlm.nih.gov]

Treatment to lower IOP 30% reduces the risk of disease progression by 66%, but observation without treatment may be warranted in some patients with early-stage glaucomatous optic neuropathy. [scholars.northwestern.edu]

What are the Treatment Options? That treatment of NTG is similar to that of primary open-angle glaucoma—the only proven therapy is to lower eye pressure. [brightfocus.org]

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]

Clinical data about the disease, such as the rate of glaucomatous visual field defect progression and risk factors for disease progression, might be helpful to clinicians to estimate prognosis and devise treatment regimens. [hindawi.com]

Blood pressure variability and cardiovascular prognosis. Many expectations but limited data. Hell J Cardiol. 2017;58:465–7. 6. [nature.com]

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]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Glaucoma Signs: Alternate Possible Explanations Misleading Ocular Conditions Etiologies that can result in visual field loss Etiologies that can predispose to glaucoma progression at normal IOPs • A large physiologic cup. [reviewofophthalmology.com]

The etiology is poorly understood, but whatever it is, the level of IOP seems to determine whether the etiologic factors will lead to glaucomatous damage or not. [ijo.in]

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]

Although estimates vary widely between studies, taken together, epidemiologic studies suggest that throughout the world, NTG represents perhaps 50% or more of all open-angle glaucoma. The more we look, the more we find, Dr. Park said. [eyeworld.org]

In a large epidemiologic study assessing the prevalence of glaucoma, it was found that an estimated 30 percent of patients diagnosed with OAG had NTG (3)(4), and Asian populations appear to be particularly prone to NTG; the Japanese Tajimi study cited [theophthalmologist.com]

Synthesizes a classical approach to the glaucomas-based on seven earlier editions spanning over 40 years-with the most up-to-date evidence-based and epidemiologically-derived classifications and outcomes.Coherently correlates with authoritative consensus [books.google.com]

Reviewed on 3/9/2018 References Medically reviewed by William Baer, MD; Board Certified Ophthalmology REFERENCES: "Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis" UpToDate.com "Angle-closure glaucoma" UpToDate.com [emedicinehealth.com]

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]

This video discusses the three main types of glaucoma—open-angle glaucoma, closed-angle glaucoma, and normal-tension glaucoma, as well as the pathophysiology, diagnosis, and treatment. [youtube.com]

Glaucoma Pathophysiology Glaucoma Causes [news-medical.net]

Ninth Annual Meeting of the American Glaucoma Society Amelia Island, Florida, on February 18-20, 1999 by: Greg Skuta Symposium Autonomic Innervation and Microcirculation in the Eye - Implication for Glaucoma Pathophysiology, February 26-27, 1999 in Erlangen [e-igr.com]

Can You Prevent It? Unfortunately, you can't prevent glaucoma. But blindness from the condition can often be prevented if it's diagnosed and treated early. So keep up with your regular eye exams done by an ophthalmologist. Pagination [webmd.com]

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]

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]

However, if a case seems typical and likely to progress, initiation of treatment would be prudent in order to prevent functional vision loss. [macfarlaneoptometrist.com.au]