Normal Tension Glaucoma

Summary of Evidence

Lowering intraocular pressure may be beneficial in patients with NTG who are at risk of disease progression.(CNTGS, 1998) {Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998 Oct;126(4):487-97.}

Low-pressure glaucoma patients treated with brimonidine 0.2% who do not develop ocular allergy are less likely to have field progression than patients treated with timolol 0.5%.(LPGTS, 2011) {Krupin T, Liebmann JM, Greenfield DS, Ritch R, Gardiner S; Low-Pressure Glaucoma Study Group. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol. 2011 Apr;151(4):671-81.}

Evidence

1. General Principles

1.1 Lower intraocular pressure

Clinical Trial

1998 CNTGS study group

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1998
Clinical Trial

Lowering intraocular pressure may be beneficial in patients with NTG who are at risk of disease progression {Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998 Oct;126(4):487-97.}

Randomized controlled trial of intervention ( Systemic carbonic anhydrase inhibitor/trabeculectomy) vs observation in fellow eye in Normal tension glaucoma (140 patients)
Findings:
- There was a significantly higher rate of glaucomatous optic disc progression or visual field loss in the control (35%) vs treated (12%) eyes
- Of 34 cataracts developed during the study, 11 (14%) occurred in the control group and 23 (38%) in the treated group, with the highest incidence in those whose treatment included filtration surgery.

2. Medical treatment

Main article: Chapter 3.11 Medical treatment of Glaucoma

Clinical Trial

2011 Krupin et.al. (LPGTS)

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2011
Clinical Trial

Low-pressure glaucoma patients treated with brimonidine 0.2% who do not develop ocular allergy are less likely to have field progression than patients treated with timolol 0.5% {Krupin T, Liebmann JM, Greenfield DS, Ritch R, Gardiner S; Low-Pressure Glaucoma Study Group. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol. 2011 Apr;151(4):671-81.}

Randomized controlled trial of brimonidine vs timolol in NTG (178 patients)
Findings:
- There was decreased visual field progression in brimonidine-treated (9.1%) than timolol-treated patients (39.2%)
- Mean IOP was similar for both groups throughout follow up
- More brimonidine treated patients discontinued study participation due to adverse effects

References

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