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Introduction. Extreme dippers are patients with a nocturnal fall of blood pressure (BP) of more than 20%, dippers have normal diurnal rhythm and decrease of BP of 10-15%, while patients with a nocturnal BP fall of less than 10% are considered to be non-dippers. Objective. The aim of this study was to compare 24-hour ambulatory BP monitoring results of normaltension glaucoma (NTG) patients with NTG suspects, as well as to determine whether NTG patients are more prone to daytime/nighttime systemic arterial BP and heart rate oscillations in comparison to NTG suspects. Methods. This was a prospective, cross-sectional and observational study of 57 hypertensive patients (39 female and 18 male), all examined at the Eye and the Cardiology Clinic, Clinical Center of Serbia in Belgrade, between November 2011 and March 2012. Before 24-hour ambulatory BP monitoring, complete ophthalmological examination was performed (intraocular pressure was measured with both Goldmann applanation and dynamic contour tonometer, as well as with computerized perimetry and Heidelberg retinal tomography). Results. There was no statistically significant difference between NTG patients and NTG suspects both in systolic daytime (131.86-141.81 mmHg, SD=±14.92 vs. 129.67-141.83 mmHg, SD=±13; p=0.53) and nighttime measurements (117.1-129.7 mmHg, SD=±18.96 vs. 112.11-127.59 mmHg, SD=±16.53; p=0.53) as well as diastolic daytime (74.55-80.37 mmHg, SD=±8.72 vs. 75.19-82.41 mmHg, SD=±7.72; p=0.58) and nighttime measurements (65.66-71.48 mmHg, SD=±8.73 vs. 67.12-73.78 mmHg, SD=±7.11; p=0.34). There was no statistically significant difference between NTG patients and NTG suspects in heart rate during the day (72.73-76.36 beats per minute [bpm], SD=±5.44 vs. 72.15-76.45 bpm, SD=±4.59; p=0.43) nor during the night (64.4-71.9 bpm, SD=±6.74 vs. 68.02-72.48 bpm, SD=±4.76; p=0.11). Conclusion. No statistically significant difference was found between NTG patients and NTG suspects in regard to their systolic and diastolic BP measured both during daytime and nighttime. NTG patients had lower nocturnal BP fall (both systolic and diastolic) than NTG suspects.

Abstract: Purpose: To investigate the cerebrospinal fluid (CSF) dynamics along the entire optic nerve (ON) in patients with normal‐tension glaucoma (NTG). Methods: Retrospective analysis of computed tomographic (CT) cisternographies in Caucasian patients with NTG. Fifty‐six patients (99 of 112 eyes) fulfilled the diagnostic criteria of NTG and underwent CT‐cisternography. Twelve subjects without NTG (24 eyes) served as controls. Contrast‐loaded cerebrospinal fluid (CLCSF) density measurements in Hounsfield units (HU) were performed at four defined regions along the ON and in the basal cistern. Results: In NTG patients, the mean density CLCSF in the bulbar segment measured 76 ± 49 HU right and 88 ± 74 HU left, in the mid‐orbital segment 117 ± 92 HU right and 119 ± 73 HU left, in the intracanalicular ON portion 209 ± 88 HU right and 216 ± 101 HU left, in the intracranial ON portion 290 ± 106 HU right and 286 ± 118 HU left and in the basal cistern 517 ± 213 HU. The distribution of CLCSF along the ON showed a statistically significant reduction in the intraorbital ON segments in NTG patients compared to controls without NTG with the far largest difference within the retrobulbar segment (−150 HU right and −117 HU left; right: p < 0.001, left: p < 0.001). Conclusion: This study demonstrates a gradual reduction in CLCSF towards the retrobulbar segment in NTG, while in controls without NTG, no reduction in CLCSF was measured within the orbital segments. Impaired CSF dynamics along the ON may contribute to the pathophysiology of NTG. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the retinal radial peripapillary capillary (RPC) network in normal-tension glaucoma (NTG) and nonarteritic anterior ischemic optic neuropathy (NAION) eyes using optical coherence tomography angiography (OCTA). Material and Methods: Twenty-two patients with NTG, 22 patients with unilateral chronic NAION, and 23 age-matched controls were enrolled. Patients underwent OCTA to obtain en face angiograms of the peripapillary region. The main outcome measures were as follows: (1) the whole en face image perfusion density (WPD) and (2) the circumpapillary perfusion density (CPD). Results: Mean ± SD age was 66.3 ± 7.0 years in the NTG group, 68.1 ± 4.3 years in the NAION group, and 63.9 ± 7.0 years in the control group (p > 0.05 for all the comparisons). The visual field mean defect (MD) was worse in patients than in controls (p < 0.0001), but did not differ between NTG and NAION (−9.6 ± 2.6 dB and −8.2 ± 2.6 dB, respectively). The WPD was 0.41 ± 0.04 in the NTG group (p < 0.0001 in comparison with healthy subjects and NAION patients), 0.46 ± 0.04 in the NAION group (p < 0.0001 in comparison with the control group), and 0.56 ± 0.03 in the control group. The CPD was significantly reduced in both NTG (0.48 ± 0.04, p < 0.0001) and NAION eyes (0.52 ± 0.05, p < 0.0001), after comparison to control eyes (0.59 ± 0.03). Moreover, the CPD was significantly lower in NTG than in NAION eyes (p = 0.006). Conclusions: OCTA documented a reduction of the peripapillary perfusion in NTG and unilateral NAION. In presence of similar functional damage, the lower perfusion densities in NTG may indicate greater vascular alterations in chronic compared to acute ischemic optic neuropathies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine and compare the changes in the retinal vasculature in eyes with high-tension glaucoma (HTG) or normal-tension glaucoma (NTG).Methods: The right eyes of 43 HTG subjects, 33 NTG subjects, and 51 age- and sex-matched normal subjects were included in this cross-sectional study. Signals were projected from the internal limiting membrane to retinal pigment epithelium. The retinal perfused vessel densities in the peripapillary and parafoveal regions were measured automatically with optic coherence tomography angiography and the split-spectrum amplitude-decorrelation angiography algorithm.Results: Compared with normal eyes, glaucomatous eyes had a smaller retinal nerve fibre layer (RNFL) thickness, smaller full parafoveal retinal thickness, and lower retinal perfused vessel density (PVD) in the peripapillary and parafoveal regions (all P < 0.01). The visual field, RNFL and retinal thicknesses, and PVD in the parafoveal region in the HTG eyes were similar to those in the NTG eyes. However, the NTG eyes had a significantly lower mean PVD than the HTG eyes in the peripapillary region. When the different sectors of the peripapillary region were studied, the difference was still significant in most sectors (all P < 0.05), except the inferotemporal sector (P = 0.676).Conclusions: The retinal perfused vessel density is significantly reduced in HTG and NTG eyes, and more prominently in the peripapillary region in NTG eyes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To investigate whether there are differences in retinal oxygen saturation in upper and lower visual field hemispheres in primary open‐angle glaucoma (POAG) and in normal‐tension glaucoma (NTG). Methods: This study enrolled POAG and NTG patients exhibiting differences between the upper and lower total deviation (TD) that were either more than 10 or <5 dB. Retinal oxygen saturation measurements in these patients with glaucoma were performed by a non‐invasive spectrophotometric retinal oximeter. The Student's t‐test was used for statistical analysis. Results: Evaluations of the worse and better hemifields in the patients with POAG who exhibited differences in the upper and lower hemifield TD that was <5 dB (n = 25) showed that there were no statistically significant differences for the retinal venous saturation of oxygen (SaO2). However, there was a higher mean SaO2 in the worse (57.0 ± 7.5%) versus the better (54.3 ± 7.0%) hemifield in the patients with NTG (n = 22; p = 0.007). Evaluations of the patients with more than a 10‐dB difference in the upper and lower hemifield TD showed statistically significant differences for the retinal venous SaO2 in the venous vessels between the POAG (n = 19) and the NTG (n = 26) patients. Conclusion: Although there was no significant difference in retinal SaO2 in the venules between the better and worse hemifield when the difference between the better and worse hemifield in the patients with POAG was <5 dB, there was a higher SaO2 in the venous vessels in the worse hemifield in the patients with NTG. [ABSTRACT FROM AUTHOR]

Purpose: There are multiple reports of the role of corneal hysteresis (CH) as an independent risk factor for the diagnosis and risk of progression of normal-tension glaucoma (NTG). Our study measured CH with the Ocular Response Analyzer (ORA) in patients with intraocular pressure (IOP) <21 mmHg to investigate if a low CH would identify NTG in this Asianbased practice. Methods: This was a prospective cross-sectional study of patients who underwent routine eye examination during 2016 in a private practice in Honolulu, Hawaii, where most patients are Asian. Inclusion criteria are: 1) $65 years 2) IOP <21 (compensated IOP by ORA), and 3) CH values <10 using ORA as measured by a single experienced technician. Exclusion criteria are: 1) sight-limiting ocular or corneal disease that would preclude accurate measurements for the purposes of the study. 2) Any patient who had difficulty in being tested with the ORA. 3) Patients who had any history of any type of glaucoma. All patients that met the inclusion criteria underwent fundus photography to measure cup-to-disc ratio and cup-to-disc asymmetry and also had central corneal thickness measured. Thickness of the retina nerve fiber layer was measured by ocular coherence tomography. The eyes with an average retina nerve fiber layer thickness less than 80 µm were classified as possible NTG and were scheduled for a visual field test. The field examination was considered valid only if the fixation, false positives, and false negatives were within the acceptable range. Patient demographics and data on preexisting diseases were collected including age, sex, coexisting medical conditions, and previous intraocular surgery. Those with thinning of retina nerve fiber layer on optical coherence tomography had a Humphrey visual field test to confirm the diagnosis of glaucoma. Results: Seventy-six eyes of 46 patients that met the eligibility criteria were included in the study. Twenty-one previously undiagnosed eyes were confirmed as having NTG, which corresponds to an incidence of 27.6%. Conclusion: CH measurement is a valuable test to assist in early diagnosis of NTG, especially in the elderly Asian population. With an established diagnosis, aggressive early treatments medically or surgically to further lower IOP can prevent irreversible blindness, which can severely impact the patient's family and socioeconomic status. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To study the long‐term outcome of deep sclerectomy with and without mitomycin‐C (MMC) in patients with normal‐tension glaucoma (NTG). Methods: We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non‐MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra‐ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits. Results: A total of 37 patients were enrolled, 15 in the MMC and 22 in the non‐MMC group. The median (range) follow‐up was 7.9 (1.0–9.0) years, with a drop‐out of three (8%) patients. The preoperative IOP was 15 (11–21) mmHg in the MMC and 15 (10–19) mmHg in the non‐MMC group. At the last 6‐ to 9‐year follow‐up, IOP was significantly reduced to 9 (2–13) mmHg (p = 0.002) and 10 (5–13) mmHg (p < 0.001). The overall (groups combined) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p = 0.48 and p = 0.25). Goniopuncture was performed in 87% and 100% of eyes in the MMC and non‐MMC groups (p = 0.14). Needling with MMC injection was performed 0 (0–1) times in the MMC group and 0.5 (0–4) times in the non‐MMC group (p = 0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma. Conclusion: In NTG, long‐term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight‐threatening complications. [ABSTRACT FROM AUTHOR]

Purpose To assess the associations between vascular and metabolic comorbidities and the prevalence of open-angle glaucoma ( OAG) with low-teen and high-teen intraocular pressure ( IOP) in Korea. Methods Cross-sectional data from the Korean National Health and Nutrition Examination Survey from 2008 to 2012 were analysed. Participants diagnosed with OAG with normal IOP were further classified into low-teen IOP ( IOP ≤ 15 mmHg) and high-teen IOP (15 mmHg < IOP ≤ 21 mmHg) groups. Using multiple logistic regression analyses, the associations between vascular and metabolic comorbidities and the prevalence of glaucoma were investigated for the low- and high-teen IOP groups. Results The prevalences of hypertension, hyperlipidemia, ischaemic heart disease, stroke and metabolic syndrome were significantly higher among subjects with low-teen OAG compared with normal subjects, while only the prevalences of hypertension and stroke were higher among subjects with high-teen OAG compared with normal subjects. In multivariate logistic regression models adjusted for confounding factors, low-teen OAG was significantly associated with hypertension ( OR, 1.68; 95% CI, 1.30-2.18), hyperlipidemia ( OR, 1.49; 95% CI, 1.07-2.08), ischaemic heart disease ( OR, 1.83; 95% CI, 1.07-3.11), stroke ( OR, 1.91; 95% CI, 1.12-3.25) and metabolic syndrome ( OR, 1.46; 95% CI, 1.12-1.90). High-teen OAG was only associated with stroke ( OR, 2.58; 95% CI, 1.20-5.53). Conclusion Various vascular and metabolic comorbidities were significantly associated with low-teen OAG, but not with high-teen OAG. These data support the hypothesis that vascular factors play a more significant role in the pathogenesis of OAG with low-teen baseline IOP. [ABSTRACT FROM AUTHOR]

Purpose: To compare optic disc topography in eyes in three intraocular pressure (IOP) groups of <15 mmHg, 15-20 mmHg, and ≥21 mmHg using spectral domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy, adjusting for the degree of damage, as measured by retinal nerve fiber layer (RNFL) thickness and average visual field loss. Methods: A total of 184 eyes of 112 patients with primary open-angle glaucoma were recruited into groups based on baseline untreated intraocular pressure (IOP) of <15 mmHg (normal-tension glaucoma [NTG], very low), 15-20 mmHg (NTG, medium), or ≥21 mmHg (high-tension glaucoma [HTG]). Patients underwent scanning laser ophthalmoscopy, SD-OCT, and Humphrey visual field testing. Univariate and multivariate models were created, accounting for degree of retinal ganglion cell (RGC) loss by either OCT RNFL thickness or visual field mean deviation (MD). Results: Univariate and multivariate analyses demonstrated no morphological differences in HRT or OCT parameters among IOP groups that met Bonferroni-corrected statistical significance when using either MD or OCT RNFL as the damage criterion ( p < 0.0063). The mean cup depth was shallower for the IOP <15 mmHg group than the IOP ≥21 mmHg group ( p < 0.05) for both MD ( p < 0.011) and OCT RNFL ( p < 0.014). Conclusion: Normal-tension and high-tension glaucoma are not distinguishable by optic nerve head topography with HRT and OCT when the degree of damage by Humphrey visual field testing is taken into account. [ABSTRACT FROM AUTHOR]

Purpose: We conducted a prospective study in patients with normal-tension glaucoma (NTG) who received either isopropyl unoprostone or latanoprost. We compared the drugs in terms of their effects on intraocular pressure (IOP) and visual field loss progression over a 3-year period. Study design: Prospective, randomized controlled study. Methods: We enrolled 48 patients with newly diagnosed NTG at Kanazawa University Hospital. Eligible patients were randomly allocated (1:1) to receive either unoprostone or latanoprost ophthalmic solutions. The primary outcomes were IOP changes and visual field deterioration within 36 months. Visual field changes were analyzed: the cumulative survival rates were calculated in terms of mean deviation, pattern standard deviation, and total deviation of the upper or lower hemi-visual field, each visual field sector, and guided progression analysis. In addition, we evaluated the progression of glaucomatous optic disc changes using fundus photography and confocal scanning laser ophthalmoscopy. Results: The mean pretreatment IOP was 15.0±2.4 mmHg in the Unoprostone group and 15.2±1.9 mmHg in the Latanoprost group. The mean IOP during the treatment period was 13.7±2.3 mmHg in the Unoprostone group and 13.0±1.8 mmHg in the Latanoprost group. In both groups, the IOP decreased significantly (p=0.001) from baseline after treatment. The posttreatment IOP values were significantly lower in the Latanoprost group than in the Unoprostone group (p=0.023). Regarding the 3-year cumulative survival rate of visual field loss progression, there were no significant differences between groups in any parameters of the visual field or guided progression analysis. There were no significant differences between groups in disc changes. Conclusions: No significant differences were found between groups with regard to the visual field and structural progression in patients with NTG, although unoprostone was less effective than latanoprost in lowering the IOP. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of filtering surgery using the EX-PRESS device on intraocular pressure (IOP), flare count, anterior chamber (AC) depth, and the corneal endothelium in primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG). Patients and methods: The study comprised 63 consecutive patients with POAG or NTG. They underwent complete ophthalmologic examinations, including measurement of visual acuity (VA), IOP, flare count, AC depth, and cell density of the corneal endothelium (CE). Two outcomes were used for surgical success: outcome 1 was defined as a ≥20% reduction in the IOP from the preoperative value, with an IOP ≥ 5 mmHg but ≤18 mmHg, and outcome 2 was defined as a ≥20% reduction in the IOP, with an IOP ≥ 5 mmHg but ≤15 mmHg. Results: The IOP significantly decreased from 17.7 preoperatively to 12.4 mmHg postoperatively ( P < 0.0001). The success rates for outcome 1 at 24 months were 81.3 and 46.7% for POAG and NTG, respectively ( P = 0.0065); the corresponding success rates for outcome 2 were 79.4 and 46.7% ( P = 0.0120). The flare count significantly increased on postoperative day 1 ( P = 0.0002) but recovered to insignificant levels by day 3 ( P = 0.0686). A transient decrease in AC depth was observed by 4 weeks after surgery ( P = 0.0017). The CE changed from 2529 preoperatively to 2428/mm at 24 months ( P = 0.0089). Conclusion: The advantage of filtering surgery using the EX-PRESS device includes reduced inflammation, and the disadvantages include loss of the CE and reduced effectiveness of NTG. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of surgical or medical reduction of intraocular pressure (IOP) on progressive normal-tension glaucoma followed up over 15 years. Methods: Sixty eyes of 60 patients were divided into 3 intervention groups: group 1 (trabeculectomy, n = 17); group 2 (IOP reduction rate ≥15% with prostaglandin analogs, n = 24); and group 3 (IOP reduction rate <15% with prostaglandin analogs, n = 19). The preintervention and postintervention mean deviation (MD) slopes and IOP were compared. Factors associated with the rate of visual field progression were identified by multiple regression analysis. Results: The mean follow-up was 19.8 years. In group 1, the preintervention and postintervention IOPs were 14.7 ± 1.3 and 9.1 ± 2.0 mmHg, respectively ( P < .001, 38% reduction). The MD slope decreased significantly after trabeculectomy (−0.86 ± 0.51 versus −0.19 ± 0.20 dB/y; P < .001). In group 2, the preintervention and postintervention IOPs were 14.7 ± 1.5 and 11.7 ± 1.2 mmHg, respectively ( P < 0.001, 20% reduction), with significant differences in the MD slope (−0.52 ± 0.37 versus −0.31 ± 0.30 dB/y; P = .019). In group 3, the preintervention and postintervention IOPs were 14.4 ± 1.8 and 13.2 ± 1.6 mmHg, respectively ( P < 0.001, 8% reduction), with no differences in the MD slope (−0.40 ± 0.27 versus −0.50 ± 0.65 dB/y; P > .05). Multiple regression analysis showed that the average IOP, IOP reduction rate, and preintervention MD slope were related to the extent of the postintervention reduction in the MD slope. The difference in the preintervention and postintervention MD slopes significantly correlated with the rate of IOP reduction ( r = 0.559, P < .001). Conclusions: A pressure-dependent maintenance effect of the visual field was confirmed in progressive normal-tension glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the associations between endothelin-1 (ET-1) and macrophage chemoattractant protein-1 (MCP-1) levels and visual field (VF) progression in normal-tension glaucoma (NTG). Methods: We conducted a prospective, longitudinal study in 71 patients with NTG. Blood samples from all subjects were assayed for ET-1 and MCP-1 concentrations, and baseline ophthalmic examinations, including the VF, were performed. Baseline data were compared with follow-up data over 3 years. Results: After 3 years of follow-up, 14 of the 71 patients showed VF progression, and the systemic MCP-1 level was significantly associated with VF progression (r= 0.318,p= 0.007). Multiple regression analysis showed that VF progression was significantly associated with MCP-1 (odds ratio, OR = 1.021, 95% CI = 1.003–1.040;p= 0.020) and optic disc hemorrhage (ODH; OR = 1.573; 95% CI = 1.140–2.170;p= 0.023). Conclusions: Systemic MCP-1 levels were associated with VF progression in patients with NTG. [ABSTRACT FROM AUTHOR]

Glaucoma can cause progressive, irreversible vision loss if it is not promptly and properly diagnosed and treated. While the disease is typically managed by ophthalmology specialists, its wide prevalence means that primary care providers should have a fundamental understanding of glaucoma and its treatment, since the medications employed against it can have a wide array of systemic adverse effects. In addition, many common systemic medications can have adverse effects on the progression of glaucoma. This article discusses the basic principles of glaucoma, several of the most common forms of the disease, and its treatment. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the influence of intraocular pressure (IOP) reduction on progression of normal-tension glaucoma (NTG) with myopic tilted disc and to demonstrate the associated risk factors. Methods: The medical records on 109 eyes of 109 NTG patients with myopic tilted discs who were followed up for more than 5 years and treated with topical medications were reviewed. Glaucoma progression was defined according to either structural or functional deterioration. Patients were divided into tertile groups according to the percent IOP reduction from the baseline, and the cumulative probability of NTG nonprogression of the upper- and lower-tertile groups was compared using Kaplan-Meier survival analysis. The multivariate Cox proportional hazards model was used to identify the risk factors for glaucoma progression. Results: Forty-nine of 109 eyes (45.0%) showed glaucoma progression after the average follow-up period of 7.55 ± 1.79 years. The Kaplan-Meier analysis revealed a greater cumulative probability of nonprogression for the upper-tertile group (percent IOP reduction >20.9%) than for the lower-tertile group (percent IOP reduction<12.9%; P = 0.016). The Cox proportional hazards model indicated that presence of disc hemorrhage was a factor associated with glaucoma progression (HR = 3.664; P = 0.001). Conclusions: Lower-percent reduction in IOP was associated with NTG progression in eyes with myopic tilted discs, and the presence of disc hemorrhage was a risk factor for NTG progression. [ABSTRACT FROM AUTHOR]

Purpose: The association of central retinal vein occlusion (CRVO) with primary open-angle glaucoma (POAG) or ocular hypertension has been reported, and lowering intraocular pressure (IOP) helps to improve the retinal circulation in eyes with CRVO. However, the clinical features of CRVOs with normal-tension glaucoma (NTG) are not well known. Therefore, we investigated Japanese CRVO patients with NTG. Methods: We retrospectively investigated 234 CRVO patients over 5 years, with follow-ups of more than 12 months, and evaluated the prevalence of glaucoma. Results: Of the 234 CRVO patients, 18 (7.7%) were diagnosed with NTGs (n = 10) or POAGs (n = 8). Seven POAG (87.5%) and 3 NTG (30%) patients had systemic hypertension. At the initial CRVO evaluation, 6 NTGs showed a significantly increased IOP; mean IOP was 13.3 mm Hg before CRVO, 16.2 mm Hg at CRVO, and 13.5 mm Hg at the final visit. Conclusions: The proportion of NTGs with systemic hypertension was low. IOP of NTG patients was significantly elevated at the initial CRVO evaluation, even in the presence of anti-glaucoma drugs. [ABSTRACT FROM AUTHOR]

Purpose: To report on the optic canal cross-sectional area (OCA) in Caucasian patients with normal-tension glaucoma (NTG) compared with Caucasian control subjects without known optic nerve (ON) diseases. Methods: Retrospective analysis of computed tomographic images of the cranium and orbits in 56 NTG patients (30 females and 26 males; 99 of 112 eyes; mean age 67.7 ± 11.1 years). Fifty-six age- and gender-matched subjects (mean age: 68.0 ± 11.2 years) without known ON diseases served as controls. The OCA at the orbital opening was measured in square millimeters by using the tool "freehand." Statistical analysis was performed by using the independent two-tailed t-test. Results: The mean orbital opening OCA in NTGs measured 14.5 ± 3.5 mm2 (right OCA: 14.4 ± 3.6 mm2, left OCA: 14.5 ± 3.4 mm2) and in controls measured 18.3 ± 2.6 mm2 (right OCA: 18.5 ± 2.7 mm2, left OCA: 18.1 ± 2.5 mm2). The difference between NTG and controls was statistically significant (p < 0.000 for the right OCA, p < 0.000 for the left OCA). Conclusion: This study demonstrates narrower OCAs in Caucasian NTG patients compared with Caucasian control subjects without known ON diseases. Narrower OCAs might contribute to a discontinuity of the cerebrospinal fluid flow between the intracranial and orbital subarachnoid space in NTG patients. This might have an influence onto the pathophysiology in NTG. [ABSTRACT FROM AUTHOR]

Glaucomatous optic neuropathy is the most commonly acquired optic neuropathy encountered in clinical practice. It is the second leading cause of blindness globally, after cataracts, but it presents a greater public health challenge than cataracts, because the blindness it causes is irreversible. It has pathogenesis still largely unknown and no established cure. Alterations in serum antibody profiles, upregulation, and downregulation have been described, but it still remains elusive if the autoantibodies seen in glaucoma are an epiphenomenon or causative. Hypertension, diabetes, and hearing disorders also are associated. This review is a glaucoma update with focus about the recent advances in the last 15 years. [ABSTRACT FROM AUTHOR]

Purpose To measure the juxtapapillary choroidal thickness in eyes with normal-tension glaucoma ( NTG) and to compare it with healthy eyes. Methods Twelve radial B-scan images of the optic nerve head ( ONH) were obtained from 96 patients with NTG and 48 healthy subjects matched by age using swept-source ( SS) optical coherence tomography ( OCT). The juxtapapillary choroidal thickness was defined as the average choroidal thickness within 500 μm from the border tissue of Elschnig. Choroidal thinning in patients with NTG was assessed by calculating the relative choroidal thickness, defined as the ratio of the measured juxtapapillary choroidal thickness in each meridian to the corresponding value in age-matched healthy controls. Retinal nerve fibre layer ( RNFL) damage as reflected by circumpapillary RNFL thickness (measured using spectral-domain OCT) was also assessed. Results The juxtapapillary choroid was significantly thinner in NTG eyes than in healthy control eyes in the inferotemporal and superotemporal sectors. The relative choroidal thinning was topographically associated with the hemispheric location of dominant RNFL damage. The average juxtapapillary choroidal thickness was not associated with either the global RNFL thickness or the visual field mean deviation. Age and untreated intraocular pressure were significantly associated with the juxtapapillary choroidal thickness in NTG eyes in both univariate and multivariate analyses (all p < 0.05). Conclusions Decreased microvascular circulation in the ONH as a result of juxtapapillary choroidal thinning could be an important part of the pathogenesis of optic nerve damage in NTG. [ABSTRACT FROM AUTHOR]

Glaucoma is one of the main causes of irreversible blindness in the world. The most common form, primary open-angle glaucoma, is an optic neuropathy that is characterized by a progressive loss of retinal ganglion cells and their axons, leading to structural changes in the optic nerve head and associated visual field defects. Elevated intraocular pressure remains the most important modifiable risk factor for primary open-angle glaucoma. However, a significant proportion of patients develop glaucomatous damage in the absence of increased intraocular pressure, a condition known as normal-tension glaucoma (NTG). The pathophysiology underlying NTG remains unclear. Several studies have revealed that vascular and cerebrospinal fluid (CSF) factors may play significant roles in the development of NTG. Vascular failure caused by functional or structural abnormalities, and compartmentation of the optic nerve subarachnoid space with disturbed CSF dynamics have been shown to be associated with NTG. In the present article, based on the concept of the glymphatic system and observations in patients with NTG, we hypothesize that failure of fluid transport via the glymphatic pathway in the optic nerve may be involved in the pathogenesis of some if not many cases of NTG. According to this hypothesis, vascular and CSF factors may share reduced glymphatic transport and perivascular waste clearance in the optic nerve as a final common pathway leading to the development of NTG. In addition, we speculate that some cases of NTG may reflect glymphatic dysfunction in natural brain aging and central nervous system diseases, such as Alzheimer's disease. Clearly, further studies are needed to gain additional insight into the relative contribution of these factors and conditions to reduced glymphatic transport in the optic nerve., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Wostyn and Killer.)

Background: In randomized, controlled trials of open-angle glaucoma (OAG) or ocular hypertension (OHT), bimatoprost 0.01 % improved tolerability while retaining the intraocular pressure (IOP)-lowering efficacy of bimatoprost 0.03 %. Given geographic/racial differences in glaucoma presentation, the APPEAL study assessed the occurrence and severity of hyperemia produced by bimatoprost 0.01 %, and its efficacy, in the Taiwanese clinical setting.Methods: In this multicenter, open-label, observational study, treatment-naïve and previously treated patients with OHT or OAG received once-daily bimatoprost 0.01 % for 12 weeks. Hyperemia (primary endpoint) was graded at baseline, week 6, and week 12 using a photonumeric scale (0, +0.5, +1, +2, +3), grouped (≤ +1, none to mild; ≥ +2, moderate to severe), and reported as unchanged from baseline, improved, or worsened. IOP assessments followed the same schedule. Supplemental efficacy analyses were conducted based on previous therapies.Results: The intent-to-treat population (N = 312) included treatment-naïve (13.5 %) and previously treated (86.5 %) patients; mean age was 53.3 years. At baseline, 46.3 % of previously treated patients were receiving prostaglandin analog (PGA) monotherapy. At week 12, 91.2 %, 5.9 %, and 2.9 % of treatment-naïve patients exhibited unchanged, worsened, and improved hyperemia from baseline, respectively; 77.9 %, 12.9 %, and 9.2 % of previously treated patients showed no change, worsening, and improvement, respectively. There were no statistically significant shifts in hyperemia severity in either group, or in subgroups based on previous use of any PGA, any non-PGA, latanoprost, or travoprost monotherapies. In treatment-naïve patients, mean IOP reduction from baseline (18.0 ± 3.8 mm Hg) was 3.6 mm Hg at week 12 (P < 0.0001); 83.3 % had baseline IOP ≤ 21 mm Hg. In previously treated patients, mean additional IOP reduction from baseline (17.8 ± 3.9 mm Hg) was 2.6 mm Hg (P < 0.0001); similar results were observed in patient subgroups based on previous therapies.Conclusions: In the Taiwanese clinical setting, bimatoprost 0.01 % provided significant IOP lowering in treatment-naïve patients (regardless of baseline IOP) and previously treated patients (even those with relatively low IOP on other therapies), while causing no significant changes in hyperemia from baseline.Trial Registration: Clinicaltrials.gov NCT01814761 . Registered 18 March 2013. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the effects of a dorzolamide-timolol fixed combination (DTFC) on intraocular pressure (IOP), heart rate (HR), blood pressure (BP), ocular perfusion pressure (OPP), and diastolic ocular perfusion pressure (DOPP) in patients with normal-tension glaucoma (NTG). Methods: A prospective, interventional, single-blind, single-center study was conducted. Newly diagnosed NTG patients that had not been treated with a glaucoma medication in the most recent 4 weeks were included. Patients were examined at baseline (without medication) and week 4 (under medication). Baseline IOP, HR, systolic and diastolic BP, OPP, and DOPP were measured at 8 am, 12 pm, and 4 pm. At week 4, IOP, HR, systolic and diastolic BP, OPP, and DOPP were measured at 10 am and 8 pm as well. Results: After 4 weeks of DTFC treatment, IOP was significantly reduced at all time points (1.6-2.6 mmHg, P < 0.001), and the average IOP reduction was 14.4 %. HR and systolic BP showed no statistically significant difference at all time points; however, diastolic BP was decreased significantly at 12 pm and 4 pm ( P = 0.004 and 0.001). OPP and DOPP showed no statistical significant difference after DTFC. Conclusions: DTFC has favorable effects on IOP and can be used without concerns of DOPP in patients with NTG. [ABSTRACT FROM AUTHOR]

Purpose To compare the in vivo lamina cribrosa position in patients with normal-tension glaucoma ( NTG) and high-tension glaucoma ( HTG). Methods The comparative cross-sectional study included three age- and sex-matched groups: 26 eyes of 26 NTG patients, 26 eyes of 26 HTG patients and 25 eyes of 25 healthy controls. Serial horizontal B-scan images of the optic nerve head were obtained from each eye using enhanced depth imaging optical coherence tomography. Mean and maximum lamina cribrosa depths were measured in 11 equally spaced horizontal B-scans. Statistical analysis was conducted to compare lamina cribrosa depth among the three groups and to correlate lamina cribrosa depth with age, retinal nerve fibre layer ( RNFL) thickness and visual field ( VF) mean deviation ( MD). The area under the receiver operating characteristic curve ( AUC) for lamina cribrosa depth was calculated. Results Mean and maximum lamina cribrosa depths were significantly greater in HTG than in NTG eyes, and in NTG than in normal eyes in all 11 scans (all p < 0.05). The AUCs of the averaged mean and averaged maximum lamina cribrosa depths in HTG eyes (0.977 and 0.988, respectively) were significantly greater than those in NTG eyes (0.735 and 0.765, respectively; both p < 0.01). Lamina cribrosa depth was found to have a negative correlation with age in HTG eyes; however, the same association was not found in NTG or controls. Neither RNFL thickness nor VF MD was significantly correlated with lamina cribrosa depth in each group. Conclusions The lamina cribrosa is more posteriorly located in HTG than in NTG eyes, as well as in NTG eyes compared with healthy controls. The lamina cribrosa depth can help differentiate HTG from normal eyes, but it does not reach a good level of diagnostic accuracy for detecting NTG. [ABSTRACT FROM AUTHOR]

Purpose Elevated intra-ocular pressure ( IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. Method Prospective, cross-sectional, case-control hospital-based study. Patients with primary open-angle glaucoma ( POAG), normal-tension glaucoma ( NTG), ocular hypertension ( OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. Results A total of 614 subjects (291 males) were recruited between March and December 2013 ( POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p < 0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. Conclusions The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare the intraocular pressure (IOP) reduction efficacy and safety between the ophthalmic solutions 0.005% latanoprost (Lat) and 0.0015% tafluprost (Taf) in Japanese patients with normal-tension glaucoma (NTG). Methods: In this randomized nonmasked study, we prospectively enrolled 30 Japanese NTG patients who had used Lat monotherapy for more than 4 weeks, and randomly divided them into the following two groups: 1) Lat-to-Taf group (LT group) and 2) Taf-to-Lat group (TL group). At the beginning of the study, both groups were switched from initial Lat to Lat or Taf for 12 weeks, and then switched over to the other drug (crossover) for 12 additional weeks. At 0, 4, 12, 16, and 24 weeks, we evaluated each patient's IOP, conjunctival injection, and corneal epitheliopathy score, and at 0, 12, and 24 weeks, we evaluated their eyelash changes and pigmentation of the eyelids and irises. Results: The mean IOP of the LT group (15 eyes) was 10.5, 10.6, and 11.1 mmHg, at 0, 12, and 24 weeks, respectively, whereas that of the TL group (15 eyes) was 11.7, 11.1, and 10.5 mmHg at 0, 12, and 24 weeks, respectively. No significant differences were found between the two groups and in the intragroup comparisons. Moreover, no significant differences were found between Lat and Taf in regard to the conjunctival injection score and corneal epitheliopathy score. Eyelash changes and eyelid and iris pigmentation were similar in both groups. Conclusion: The findings of this study show that Lat and Taf have equivalent efficacy and safety in Japanese patients with NTG. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the relationship between visual field (VF) progression and baseline refraction in Japanese patients with primary open-angle glaucoma (POAG) including normaltension glaucoma. Patients and methods: In this retrospective study, the subjects were patients with POAG who had undergone VF tests at least ten times with a Humphrey Field Analyzer (Swedish interactive thresholding algorithm standard, Central 30-2 program). VF progression was defined as a significantly negative value of mean deviation (MD) slope at the final VF test. Multivariate logistic regression models were applied to detect an association between MD slope deterioration and baseline refraction. Results: A total of 156 eyes of 156 patients were included in this analysis. Significant deterioration of MD slope was observed in 70 eyes of 70 patients (44.9%), whereas no significant deterioration was evident in 86 eyes of 86 patients (55.1%). The eyes with VF progression had significantly higher baseline refraction compared to those without apparent VF progression (-1.9±3.8 diopter [D] vs -3.5±3.4 D, P=0.0048) (mean ± standard deviation). When subject eyes were classified into four groups by the level of baseline refraction applying spherical equivalent (SE): no myopia (SE > -1D), mild myopia (-1D = SE > -3D), moderate myopia (-3D = SE > -6D), and severe myopia (-6D = SE), the Cochran-Armitage trend analysis showed a decreasing trend in the proportion of MD slope deterioration with increasing severity of myopia (P=0.0002). The multivariate analysis revealed that baseline refraction (P=0.0108, odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.25) and intraocular pressure reduction rate (P=0.0150, OR: 0.97, 95% CI: 0.94-0.99) had a significant association with MD slope deterioration. Conclusion: In the current analysis of Japanese patients with POAG, baseline refraction was a factor significantly associated with MD slope deterioration as well as intraocular pressure reduction rate. When baseline refraction was classified into four groups, MD slope in myopia groups was less deteriorated as compared to those in the emmetropic/hyperopic group. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the discrimination capabilities of macular and peripapillary retinal nerve fiber layer (pRNFL) thickness parameters as measured using spectral domain optical coherence tomography (SD-OCT) between primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG).Methods: A total of 90 subjects were enrolled: 30 healthy subjects, 30 subjects with POAG and 30 subjects with NTG, consecutively. Retinal nerve fiber layer thickness, macular thickness and volume measurements were obtained with circular and radial SD-OCT scans. All parameters were compared between groups using an analysis of variance test. Areas under receiver-operating characteristic (AROC) curves with sensitivities at specificities greater than or equal to 90 per cent were generated to compare discrimination capabilities of various parameters between POAG and NTG.Results: Macular thickness and volume measurements were the highest in normal subjects, followed by NTG and POAG (p < 0.05). Average retinal nerve fiber layer thickness had perfect discrimination for normal-POAG (AROC: 1.000; sensitivity: 100 per cent) and near perfect discrimination for normal-NTG (AROC: 0.979; sensitivity: 93 per cent) as well as NTG-POAG pairs (AROC: 0.900; sensitivity: 60 per cent). Inferior outer macular thickness (IOMT) and total volume were the best macular thickness and volume parameters having similar AROCs and sensitivities between normal and POAG (IOMT, AROC: 0.987; sensitivity: 92 per cent and total volume, AROC: 0.997; sensitivity: 97 per cent), normal and NTG (IOMT, AROC: 0.862, sensitivity: 47 per cent and total volume, AROC: 0.898, sensitivity: 67 per cent) and also between NTG and POAG (IOMT, AROC: 0.910, sensitivity: 53 per cent and total volume, AROC: 0.922, sensitivity: 77 per cent). In each comparison group, there was no statistically significant difference in AROCs between average retinal nerve fiber layer and inferior outer macular thickness, as well as total volume.Conclusions: The macular parameters offer comparable performance to pRNFL parameters for the discrimination of NTG and POAG. Average retinal nerve fiber layer thickness, total macular volume and inferior outer macular thickness were the best SD-OCT parameters with superior discriminating capabilities. [ABSTRACT FROM AUTHOR]

Background: To investigate the incidence and risk factors of glaucoma in normal-tension glaucoma (NTG) suspect patients who had been lost-to-follow-up for at least 24 months.Methods: Seventy-two eyes of 72 NTG suspect patients who returned to the hospital after at least 24 months of follow-up loss were enrolled in this study between January 2009 and June 2013. The data were collected retrospectively. The incidence of glaucoma was investigated using a comprehensive glaucoma evaluation in lost-to-follow-up NTG suspect patients. The patients were classified into the glaucoma group, who developed glaucoma during the study period, and the glaucoma suspect group, who did not, to analyse the risk factors for glaucoma.Results: The number of patients who developed glaucoma was 7 (9.7 %) out of the 72 NTG suspect patients who had been mean lost-to-follow-up for 44 months. The rate of progression from suspected to glaucoma was 2.6 %/year. In the glaucoma group, the baseline intraocular pressure (IOP) was 18.43 ± 2.44 mmHg, and the average retinal nerve fiber layer (RNFL) thickness was 78.14 ± 7.60 μm; in the glaucoma suspect group, the baseline IOP was 14.95 ± 2.47 mmHg, and the average RNFL thickness was 92.55 ± 7.65 μm. The study results showed that the glaucoma group had higher baseline IOP and a thinner average RNFL (p = 0.003; p < 0.001). The results of the multivariable logistic regression analysis showed that the risk factors for glaucoma were high baseline IOP (OR = 1.63; p = 0.037) and a thin average RNFL (OR = 0.841; p = 0.004).Conclusions: The incidence of glaucoma in the lost-to-follow-up NTG suspect patients was 9.7 % for approximately 44 months, at a rate of 2.6 %/year. The risk factors for glaucoma in these patients were high baseline IOP and a thin average RNFL. [ABSTRACT FROM AUTHOR]

Purpose: To compare the therapeutic efficacy and safety of brimonidine/timolol fixed-combination (BTFC) and 0.5 % timolol ophthalmic solution in normal-tension glaucoma (NTG) patients. Methods: This was a multi-institution, randomized, active-controlled, open-label, parallel-group study. After a full ophthalmic and glaucoma examination, a total of 110 NTG patients-55 undergoing therapy with BTFC and 55 0.5 %, with timolol-participated in this study. Among them, 1 failed to meet the inclusion/exclusion criteria, 10 revoked their consent to participate in the study, 3 had adverse reactions, and 1 had a drug adherence rate of less than 70 %. Ultimately, a total of 95 patients-48 in the BTFC group and 47 in the 0.5 % timolol group-completed the study. The study visits took place at baseline and at 4 and 12 weeks. Diurnal IOP was measured at 9 a.m., 11 a.m., and 5 p.m. during the baseline visit and the visit at 12 weeks after eye-drop instillation. At each follow-up visit, compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the investigators. Results: The average difference in IOP change measured at 11 a.m. 12 weeks after administration between the two groups was 2.10 ± 2.59 mmHg. The BTFC group had a better IOP-lowering effect at all time points than did the 0.5 % timolol group. The ratio of patients whose average IOP had decreased by >20 % after 4 and 12 weeks was 50 and 56 % in the BTFC group, respectively, whereas it was 29.41 and 23.53 % in the 0.5 % timolol group, respectively ( p = 0.034, <0.001). Conclusions: BTFC has a superior IOP-lowering effect than 0.5 % timolol in NTG patients. [ABSTRACT FROM AUTHOR]

Background/aim: To evaluate, in vivo, the optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in patients with normal-tension glaucoma (NTG) and those with Alzheimer disease (AD) in comparison with healthy subjects. Materials and methods: This cross-sectional study included 18 patients with NTG, 20 with AD, and 20 control subjects. An ophthalmologic examination and OCT scans of both eyes were performed in all patients. Results: There was a significant reduction in peripapillary RNFL thickness and macular GCC thickness and a significant increase in the global loss volume (GLV) rate in both the NTG and AD patients when compared to the control subjects (P = 0.004, P = 0.006, P < 0.001, respectively). The statistical evaluation showed no difference in any RNFL or GCC parameters between the AD and NTG groups (P > 0.05). There was a negative correlation between disease duration and average RNFL and GCC thicknesses (r = -0.350, P = 0.027 and r = -0.471, P = 0.002, respectively) and a positive correlation between duration and GLV (r = 0.427, P = 0.006) in the AD group. Conclusion: The average RNFL thickness, GCC thickness, and GLV rates may help in the diagnosis of AD as an additional examination and may provide some important clues about the duration of the disease. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the relationship between intraocular pressure (IOP) and the progression of visual field defects in Japanese primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) patients. Patients and methods: The subjects of the study were patients undergoing treatment for POAG or NTG who had performed visual field tests at least ten times with a Humphrey field analyzer (Swedish interactive thresholding algorithm standard, C30-2 program). The progression of visual field defects was defined by a significantly negative value of the mean deviation slope at the final visual field test during the follow-up period. The relationships between the progression of visual field defects and IOP, as well as other clinical factors, were retrospectively analyzed. Results: A total of 156 eyes of 156 patients were included in the analysis. Significant progression of visual field defects was observed in 70 eyes of 70 patients (44.9%), while no significant progression was evident in 86 eyes of 86 patients (55.1%). The eyes with visual field defect progression had significantly lower baseline IOP (P<0.05), as well as significantly lower IOP reduction rate (P<0.01). The standard deviation of IOP values during follow-up was significantly greater in the eyes with visual field defect progression than in eyes without (P<0.05). Conclusion: Reducing IOP is thought to be useful for Japanese POAG or NTG patients to suppress the progression of visual field defects. In NTG, IOP management should take into account not only achieving the target IOP, but also minimizing the fluctuation of IOP during follow-up period. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical characteristics of patients with normal-tension glaucoma and the effect of the cardiovascular findings on the progression of the glaucoma. Materials and Methods: The medical records of 80 eyes of 40 normal-tension glaucoma patients (25 women, 15 men) with typical glaucomatous optic disc and/or visual field changes and no recorded intraocular pressure >21 mmHg, who were treated with topical medications, were reviewed. Normal-tension glaucoma progression was defined by either structural (optic disc or retinal nerve fibre layer) or functional (visual field) deterioration. Results: The average follow-up period was 5.1±4.06 years, and 15 of 40 patients (37.5%) showed the normal-tension glaucoma progression. There were 25 stable patients (62.5%). Mean intraocular pressure measured higher in the progressed patients (14.53±3.27 mmHg) than stable patients (14.18±2.94 mmHg), but it was not statistically different between the groups (p=0.638). The disc size was bigger in progressed patients (2.16±0.25 μm) than stable patients (1.99±0.39 μm), (p=0.05). The age, central corneal thickness, visual field examination findings and the mean retinal nerve fiber layer at the initial examination were similar between progressed and stable patients (p>0.05). The diastolic fluctuations in progressed patients was higher than stable group (p=0.041) and progressed patients' diastolic blood pressure measures at night were lower than stable patients (p=0.032). Conclusion: Despite relatively similar intraocular pressure and visual field examination findings between progressed and stable patients, cardiovascular systemic examination should be kept in mind in the cases with normal-tension glaucoma when especially progression of the disease occur in their follow ups. [ABSTRACT FROM AUTHOR]

Background: There are limited data concerning the optic disc topography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients living in Southeast Asian countries. This study aims to compare optic disc parameters in patients with NTG and POAG in Malaysia and to discuss the results in comparison with studies of NTG and POAG in other Asian countries. Methods: This prospective cross-sectional study was performed in two hospitals with glaucoma service in Malaysia from 2010 to 2012. Seventy-seven patients of Malay ethnicity were enrolled in this study, including 32 NTG patients and 45 POAG patients. Using the Heidelberg Retinal Tomograph III, we measured optic disc area, cup area, rim area, cup volume, rim volume, cupto- disc area ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area. Results: The eyes for NTG patients had significantly larger optic disc areas (2.65 [standard deviation, 0.41] vs 2.40 [standard deviation, 0.36] mm2, respectively; P=0.006) and cup areas (1.54 [standard deviation, 0.43] vs 1.32 [standard deviation, 0.40] mm2, respectively; P=0.027) compared with the eyes of POAG patients. Comparison of the other parameters between the two groups revealed no significant difference (P=0.050). The moderate and severe NTG patients showed significantly deeper cups and larger disc and cup areas when compared with the moderate and severe POAG patients (P=0.050). Conclusion: The NTG patients in this study have notably larger optic disc and cup areas than the POAG patients. Our observations are consistent with those reported in studies of NTG and POAG patients in Korea. The deeper cups and larger disc and cup areas may serve as indicators of severity when comparing NTG with POAG. However, these findings require verification with IOP and visual field results. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the risk and risk factors for newly developed visual impairment in treated patients with normal-tension glaucoma (NTG) followed up on for 10 years. Methods: Patients with NTG, who did not have visual impairment at the initial diagnosis and had undergone intraocular pressure (IOP)-lowering treatment for more than 7 years, were included on the basis of a retrospective chart review. Visual impairment was defined as either low vision (0.05 [20/400] ≤ visual acuity (VA) <0.3 [20/60] and/or 10 degrees ≤ central visual field (VF) <20 degrees) or blindness (VA <0.05 [20/400] and/or central VF <10 degrees) by World Health Organization (WHO) criteria. To investigate the risk and risk factors for newly developed visual impairment, Kaplan. Meier survival analysis and generalized linear mixed effects models were utilized. Results: During the 10.8 years mean follow-up period, 20 eyes of 16 patients were diagnosed as visual impairment (12 eyes as low vision, 8 as blindness) among 623 eyes of 411 patients. The cumulative risk of visual impairment in at least one eye was 2.8% at 10 years and 8.7% at 15 years. The risk factors for visual impairment from treated NTG were worse VF mean deviation (MD) at diagnosis and longer follow-up period. Conclusion: The risk of newly developed visual impairment in the treated patients with NTG was relatively low. Worse VF MD at diagnosis and longer follow-up period were associated with development of visual impairment. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether normal-tension glaucoma (NTG) is associated with metabolic syndrome and to evaluate which components of metabolic syndrome are related to NTG. Methods: This study included 18240 participants who underwent health check-ups including fundus photography and intraocular pressure measurements. For NTG diagnosis, all participants with findings suggestive of glaucoma completed a further glaucoma evaluation, including applanation tonometry, gonioscopy and standard automated perimetry. The National Cholesterol Education Program Adult Treatment Panel III guideline was used to characterize metabolic syndrome. Results: Of the 18240 participants, 3635 (19.9%) had metabolic syndrome and 300 (1.6%) were diagnosed with NTG. The prevalence of NTG was 1.5% in subjects without metabolic syndrome and 2.1% in subjects with metabolic syndrome. The presence of metabolic syndrome was not significantly associated with NTG (p = 0.067). There were significant associations of NTG with hypertension and impaired glucose tolerance (IGT) among the individual components of metabolic syndrome (OR, 1.53; 95% CI, 1.20-1.94; p = 0.001 and OR, 1.47; 95% CI, 1.12-1.94; p = 0.006). NTG was positively associated with the number of metabolic syndrome components (OR, 1.10; p = 0.040). Multivariable analysis showed the prevalence of NTG to be significantly higher in participants aged between 50 and 70 years relative to those aged 40 to 50 years, male gender, participants with higher baseline intraocular pressure, hypertension and IGT. Conclusions: Of the metabolic syndrome components, hypertension and IGT contributed to an increased risk of NTG. These findings suggest that metabolic syndrome components may play a role in the pathogenesis of NTG. [ABSTRACT FROM AUTHOR]

Purpose To compare the outcome of deep sclerectomy ( DS) with and without mitomycin-C ( MMC) in patients with normal-tension glaucoma ( NTG). Methods We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; mean ± SD; 64 ± 7 years) who underwent DS with a collagen implant. Patients were randomized to the MMC and non- MMC groups. Subconjunctival MMC (0.4 mg/ml for 3 min) was used intraoperatively in 15 of 37 eyes. We defined total success as 25% reduction in intraocular pressure ( IOP) without medication. Follow-up time was 12 months. Results The mean preoperative IOP was significantly reduced from 15.2 ± 2.8 mmHg to 9.3 ± 2.7 (p < 0.001) in the MMC group after 12-month follow-up and from 15.1 ± 2.9 mmHg to 11.8 ± 2.0 (p < 0.001) in the non- MMC group. At 12 months, the mean IOP was significantly lower in the MMC group (p = 0.003) compared with the non- MMC group. Total success was achieved in 10 of 15 eyes (67%) in MMC group and in nine of 22 eyes (41%) in non- MMC group (p = 0.12). The number of glaucoma medications was decreased from 2.2 ± 0.8 to 0.5 ± 1.2 in MMC group (p = 0.001) and from 2.6 ± 1.0 to 0.5 ± 0.7 in non- MMC group (p < 0.001). Goniopuncture was performed in seven eyes (47%) in the MMC group, compared with 16 eyes (73%) in the non- MMC group (p = 0.13). IOP < 10 mmHg was achieved in seven of 15 eyes in the MMC group and in two of 22 in the non- MMC group (p = 0.009). Complication rate was low, and no difference between groups was evident. Conclusion Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG. Intraoperative use of MMC results in lower postoperative IOP 12-month postoperatively without increased rate of complications. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the longitudinal changes in the central retinal vessel diameter in asymmetric progressive normal-tension glaucoma (NTG) patients. Methods: This study included 27 patients with bilateral NTG without any systemic vascular disease who showed glaucomatous progression in one eye at the mean follow-up of 24.3 months (range, 18-29 months). Progression was determined by the development of new retinal nerve fiber layer (RNFL) defects or widening of pre-existing defects on red-free RNFL photographs. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were measured at baseline and at the mean follow-up of 24.3 months. We classified the eyes of each patient as either progressed or stable eyes, and compared the differences and changes in the CRAE and CRVE. Results: No significant inter-eye difference was observed at baseline in the mean CRAE (167.5 ± 22.2 μm vs. 168.2 ± 15.5 μm, p = 0.809) and in the mean CRVE (276.3 ± 18.2 μm vs. 281.6 ± 21.9 μm, p = 0.267) between the progressed and stable eyes. There were significant changes in CRAE in the progressed eyes between baseline and 2 years after baseline (from 167.5 ± 22.2 μm to 146.9 ± 18.0 μm, p < 0.0001), but there were no significant changes in the stable eyes (from 168.2 ± 15.5 μm to 167.5 ± 14.8 μm, p = 0.084). Conclusions: In our series of NTG patients with asymmetric progression, central retinal artery diameter decreased over time in the progressed eyes, whereas no significant decrease in the central retinal artery diameter was seen in the stable eyes. [ABSTRACT FROM AUTHOR]

Since glaucoma is a progressive and irreversible optic neuropathy, accurate screening and/or early diagnosis is critical in preventing permanent vision loss. Recently, optical coherence tomography (OCT) has become an accurate diagnostic tool to observe and extract the thickness of the retinal nerve fiber layer (RNFL), which closely reflects the nerve damage caused by glaucoma. However, OCT is less accessible than fundus photography due to higher cost and expertise required for operation. Though widely used, fundus photography is effective for early glaucoma detection only when used by experts with extensive training. Here, we introduce a deep learning-based approach to predict the RNFL thickness around optic disc regions in fundus photography for glaucoma screening. The proposed deep learning model is based on a convolutional neural network (CNN) and utilizes images taken with fundus photography and with RNFL thickness measured with OCT for model training and validation. Using a dataset acquired from normal tension glaucoma (NTG) patients, the trained model can estimate RNFL thicknesses in 12 optic disc regions from fundus photos. Using intuitive thickness labels to identify localized damage of the optic nerve head and then estimating regional RNFL thicknesses from fundus images, we determine that screening for glaucoma could achieve 92% sensitivity and 86.9% specificity. Receiver operating characteristic (ROC) analysis results for specificity of 80% demonstrate that use of the localized mean over superior and inferior regions reaches 90.7% sensitivity, whereas 71.2% sensitivity is reached using the global RNFL thicknesses for specificity at 80%. This demonstrates that the new approach of using regional RNFL thicknesses in fundus images holds good promise as a potential screening technique for early stage of glaucoma.