How do you approach the treatment of "normal tension glaucoma" and how do you discuss this with patients?

It highlights that glaucoma is probably not an eye pressure disease, but rather a vascular disease. As noted above, there is a genetic component clearly, but vasculopaths (DM, Sleep apnea, CVD, etc.) increase that risk with the same IOP.

I explain that what's "normal" or "low" for most people may in fact be too high for them, and we therefore need to lower their pressure below a target of 15, or 12, or 30% lower than baseline (depending on severity, baseline IOP, corneal thickness, status of other eye, etc). I tell them that patient...

Normal tension glaucoma (NTG) is one of the most challenging types of glaucoma to treat. These patients present with moderate/advanced VF loss, which may be progressive. Patients are made aware of the multifactorial nature of the disease (low body weight, low blood pressure, migraine, sleep apnea, d...

The recent trend for very tight control of blood pressure by the hypertension community ( SPRINT guidelines) has been widely and indiscriminately applied, adding another risk factor for glaucomatous field loss progression. The older the patient, the more the risk. The ubiquitous low salt diet plus d...