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Normal Tension Glaucoma (NTG)

ISN Guide to Eye Involvement: Dr. Liz Irvin

Dr. Liz IrvinHello, I am Dr. Liz Irvin, your ISN Guide to Eye Involvement. In addition to helping Dr. C. Stephen Foster develop resources for this section of the ISN website, I am happy to try to respond to questions that you may have or to redirect you to resources that may be helpful. Email liz-irvin@sclero.org.
Overview
NTG and Scleroderma
Symptoms and Diagnosis
Treatments

Normal Tension Glaucoma (NTG) Overview

Regular glaucoma is when the optic nerve is damaged by high pressure inside of the eye. It can cause permanent vision loss. Normal Tension Glaucoma (NTG) is when the optic nerve is damaged even though the pressure inside of the eye is normal. (Also see: Scleroderma Eye Involvement, What is Scleroderma?, Types of Scleroderma, Systemic Sclerosis and Sjogren's Syndrome)
What is Glaucoma? Glaucoma is a group of eye diseases that gradually steals sight without warning and often without symptoms. Glaucoma Research Foundation.
Normal-Tension Glaucoma. Normal-tension glaucoma (also called low-tension glaucoma) is a unique condition in which optic nerve damage and vision loss have occurred despite a normal pressure inside the eye. Although its cause is not completely understood, normal-tension glaucoma is generally believed to occur either because of an unusually fragile optic nerve that can be damaged despite a normal pressure inside the eye or because of reduced blood flow to the optic nerve. WebMD.
The case for autoimmunity in glaucoma. This review provides a critical assessment of the potential role for autoimmunity as an initiating or exacerbating etiology (cause) in some patients with glaucoma. Wax MB. (PubMed) Exp Eye Res. 2010 Aug 27.
Type Abnormalities in Patients with Systemic Sclerosis. In the two groups under study, intraocular pressure was measured within normal limits. However, glaucomatous type abnormalities were more frequent in patients with SSc compared to the control group. Such abnormalities may be atributed to the vasculopathy that is observed in patients with SSc, affecting therefore and the vessels of the optic disc. A.A. Drosos. [FRI0347] EULAR 2006.

Normal Tension Glaucoma and and Systemic Sclerosis (Scleroderma)

A significant increase of normal tension glaucoma (NTG) has been discovered in patients with systemic scleroderma. In a 2003 study of 88 scleroderma patients in France, 10 of the patients were found to have NTG, compared to none of the controls.
Vasospastic individuals demonstrate significant similarity to glaucoma patients as revealed by gene expression profiling in circulating leukocytes. This result indicates a potential predisposition of vasospastic individuals to glaucomatous optic nerve atrophy. The targeted expression profiles might be further considered for early/predictive glaucoma diagnosis. Molecular Vision, Nov 2009. (Also see: Raynaud's)
Ocular Glaucomatous Abnormalities and Systemic Sclerosis (Scleroderma)
Increased prevalence of ocular glaucomatous abnormalities in systemic sclerosis. Ocular abnormalities suggesting glaucomatous neuropathy without ocular hypertension were dramatically more prevalent in patients with SSc. These abnormalities seem to be mild but justify long term follow up. They are consistent with the vascular pathogenic hypothesis for NTG (normal tension glaucoma). PubMed. Ann Rheum Dis. 2004 Oct;63(10):1276-8.

Symptoms and Diagnosis of Normal Tension Glaucoma

Symptoms of Normal Tension Glaucoma. Regular eye examinations with an ophthalmologist are important to screen for optic nerve damage and vision loss despite a normal eye pressure. eMedicine.

Treatments of Normal Tension Glaucoma

Effect of sex hormones on experimental autoimmune uveoretinitis (EAU). The data support the hypothesis that sex hormones may affect autoimmune diseases by inducing changes in the cytokine balance. This suggests that sex hormone therapy could be considered as an adjunct to anti-inflammatory agents to treat ocular autoimmune diseases in humans. PubMed. Immunol Invest. 2003 Nov;32(4):259-73.
Retinal findings in systemic sclerosis: a comparison with nailfold capillaroscopic patterns. Retinal abnormalities are often seen in patients with SSc and they may reflect the vascular changes characteristic of SSc. However, retinal changes may differ in quality from the changes of nailfold capillaries. PubMed. Ann Rheum Dis 2003 Mar;62(3):204-7. (Also see: Types of Scleroderma)
 
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