Normal Tension glaucoma (NTG) capsule

✅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 ).