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MEDTECH How can you distinguish normal tension glaucoma from other forms of the disease in your practice?
As the clinical understanding of glaucoma evolves, distinguishing normal tension glaucoma (NTG) from other forms of the disease becomes a critical component of optometric practice. Key to this task is understanding the disorder’s unique risk factors and clinical presentations.
Key Points:
- Normal tension glaucoma (NTG) doesn’t show significant intraocular pressure (IOP) increases but exhibits the same optic nerve damage and visual field loss as primary open angle glaucoma (POAG).
- NTG accounts for up to 40% of patients with open angle glaucoma in the US.
- Risk factors for NTG include older age, being female, Japanese ancestry, family history of glaucoma, and genetic mutations.
- Poor blood flow and vascular dysfunction, including low blood pressure, reduced ocular perfusion pressure, migraine, and Raynaud phenomenon are significant risk factors for NTG.
- Secondary forms of glaucoma can masquerade as NTG, often misleading diagnosis.
Additional Points:
- Thinner central corneal thickness (CCT) is common in NTG patients and can give context to IOP measurements.
- NTG patients typically have a normal anterior chamber angle requiring direct viewing for accurate evaluation.
- Examination of the optic disc, optical coherence tomography (OCT) of the RNFL and ganglion cell layer (GCL), and visual field testing are vital in diagnosing and managing NTG.
Conclusion:
- Detecting NTG requires understanding its unique risk factors and presentations, and the use of thorough clinical testing and historical reviews to provide superior care.
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“Identifying normal tension glaucoma is no easy task, but clinicians who familiarize themselves with the disorder’s unique risk factors and presentations can stand out from others who fail to recognize the clinical significance of their findings.”
Ashley M. Speilburg, OD, associate professor of optometry at the Illinois College of Optometry
