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Normal-tension glaucoma: is it different from primary open-angle glaucoma?

Shields, M Bruce

Current Opinion in Ophthalmology: March 2008 - Volume 19 - Issue 2 - p 85–88
doi: 10.1097/ICU.0b013e3282f3919b
Glaucoma: Edited by Donald L. Budenz

Purpose of review Normal-tension glaucoma (NTG) is a common form of open-angle glaucoma throughout the world, and yet there are many unanswered questions regarding both the mechanisms of the optic neuropathy and the treatment of these patients. The present review considers how recent literature advances our understanding of both the mechanisms of glaucomatous damage and the treatment of patients with NTG.

Recent findings The main theme in the current literature continues to be that NTG and primary open-angle glaucoma (POAG) represent a continuum of open-angle glaucomas, in which a certain level of intraocular pressure (IOP) is the predominant causative risk factor in POAG, while additional IOP-independent factors take increasing importance in NTG. There is considerable overlap between the two conditions, however, and within the population of NTG patients there are subsets in which IOP, blood flow and other factors assume relative importance.

Summary In clinical practice, control of IOP remains the mainstay of managing NTG patients, but consideration must also be given to other factors, especially those that may influence perfusion of the optic nerve head. Treatment paradigms will likely change as researchers continue to investigate the mechanisms of glaucomatous optic neuropathy and search for IOP-independent neuroprotective agents.

Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to M. Bruce Shields, Department of Ophthalmology and Visual Science, Yale University School of Medicine, 40 Temple Street, New Haven, CT 06520, USA Tel: +1 203 785 7282; fax: +1 203 785 7694; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.