✅Normal Tension glaucoma (NTG) Definition
☝️VF and ON characteristic for glaucoma with reported normal IOP range )
✅Normal Tension glaucoma (NTG) What u have to know
✍️ although the IOP is most important modifiable risk factor, glaucoma is beyond high IOP and can even be diagnosed without.
✍️ optic disc (non or low) perfusion mainly underlies the NTG pathogenesis
✍️ relatively common missed diagnosis ( 1 for each 1000 patients) so optic disc exam is mandatory for routine examination ( undilated ) just take a look ( maybe vision-saving or even life- saving)
✍️ Risk factors including
☝️age ( old )
☝️sex ( F)
☝️ race( Asian esp Japanese)
☝️ thin cornea ( false low IOP reading)
☝️hypotension
☝️overtreatment of hypertension with beta blockers
☝️raynaud disease
☝️migraine
✍️ diagnosis:
☝️asymptomatically and accidentally discovered with characteristic VF ( deep and steep and close to fixation) and optic disc changes ( focal notching with disc haemorrhage )
✍️ most important life-saving DD
☝️ pituitary tumor ( mom of my own friend misdiagnosed for yrs as NTG until died from pituitary tumor )
✅ Normal Tension glaucoma (NTG) Other DD
☝️Long steroid therapy ( neglected history)
☝️ intermittently occluded angle ( gonioscopy is mandatory)
☝️ Burnt out PDS with reverse trabecular hyperpigmentation (up more than down)
✅Normal Tension glaucoma (NTG) the most important study
📖 CNTGS( collaborative NTG Study 📖
☝️Reduction of IOP 30% from pre-treatment values can slow the progression
☝️50% of untreated NTG don’t show progression in 5 yrs follow up ( VF and disc imaging)
☝️migraine, disc hage at diagnosis, female sex are high risk for progression
✅Normal Tension glaucoma (NTG) Regarding tttt
☝️PGs are drug of choice
☝️Alpha agonist ( brimonidine ) is superior to beta blockers ( timolol) regarding neuroprotection
☝️If u have to use beta blockers don’t prescribe it before sleeping as it decrease ON perfusion )
