Normal-tension glaucoma: Current concepts and approaches-A review.
Leung Dexter Y L, Tham Clement C
AI Summary
Normal tension glaucoma involves complex vascular dysfunction and may be part of a broader small vessel disease spectrum, suggesting that managing vascular risk factors is crucial alongside IOP.
Abstract
Normal tension glaucoma (NTG) has remained a challenging disease. We review, from an epidemiological perspective, why we should redefine normality, act earlier at lower pre-treatment intraocular pressure (IOP) level, and the role of ocular perfusion pressures, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction. The correlation of silent cerebral infarcts (SCI) and NTG may indicate that NTG belongs to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium. Epidemiological studies also suggested that vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of SCI, SVD and glaucoma. Artificial intelligence with deep learning, may help predicting NTG progression from vascular geometry. Finally, we review latest evidence on the role of minimally-invasive glaucoma surgery, lasers, and newer drugs. We conclude that IOP is not the only modifiable risk factors as, many vascular risk factors are readily modifiable.
MeSH Terms
Shields Classification
Key Concepts5
Normal tension glaucoma (NTG) may belong to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium, as indicated by the correlation of silent cerebral infarcts (SCI) and NTG.
Vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of silent cerebral infarcts (SCI), small vessel disease (SVD), and glaucoma, as suggested by epidemiological studies.
Intraocular pressure (IOP) is not the only modifiable risk factor for normal tension glaucoma (NTG), as many vascular risk factors are readily modifiable.
The role of ocular perfusion pressures in normal tension glaucoma (NTG) should be considered, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction.
Artificial intelligence with deep learning may help predict normal tension glaucoma (NTG) progression from vascular geometry.
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