{"id":6939,"date":"2020-07-09T19:55:28","date_gmt":"2020-07-09T19:55:28","guid":{"rendered":"https:\/\/www.optometrists.org\/?page_id=6939"},"modified":"2021-07-19T07:00:26","modified_gmt":"2021-07-19T07:00:26","slug":"normal-tension-glaucoma","status":"publish","type":"page","link":"https:\/\/www.optometrists.org\/general-practice-optometry\/guide-to-eye-conditions\/glaucoma-guide\/glaucoma-faqs\/normal-tension-glaucoma\/","title":{"rendered":"Normal Tension Glaucoma"},"content":{"rendered":"<h2><b>What is normal tension glaucoma (NTG)?<\/b><\/h2>\n<p>Glaucoma is the name for a group of ocular diseases that occur as a result of:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">High <a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/guide-to-eye-exams\/why-is-eye-pressure-important\/\">eye pressure<\/a><\/li>\n<li style=\"font-weight: 400;\">Optic nerve damage<\/li>\n<li style=\"font-weight: 400;\">Loss of vision<\/li>\n<\/ul>\n<p>There are four main types of glaucoma that affect adults: <a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/eye-conditions\/glaucoma-guide\/glaucoma-faqs\/what-is-open-angle-glaucoma\/\">Primary open angle glaucoma<\/a>, <a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/eye-conditions\/glaucoma-guide\/glaucoma-faqs\/what-is-angle-closure-glaucoma\/\">primary angle closure glaucoma<\/a>, normal tension glaucoma, and secondary glaucoma.<\/p>\n<p>Each type of glaucoma causes vision loss as a result of damage to the optic nerve. In most cases, this is due to a drainage problem within the anterior angle of the eye that does not allow the aqueous humor (ocular fluid) to effectively flow out of the eye.<\/p>\n<p>The buildup of fluid in the eye causes increased pressure within the eye (intraocular pressure, IOP) which pushes on the optic nerve, and consequently, with time, causes damage to the nerve. Any damage to the optic nerve will result in partial or complete, permanent, vision loss.<\/p>\n<p><b>Normal tension glaucoma (NTG) is a form of open angle glaucoma, that occurs as a result of optic nerve damage, even when the pressure within the eye is within a normal range (12-22 mm Hg).<\/b><\/p>\n<p><em>Normal tension glaucoma, also called normal-pressure glaucoma, accounts for approximately 30-40% of all glaucoma cases.<\/em><\/p>\n<p>Normal tension glaucoma occurs gradually over time, with consistent IOP levels below 21 mm Hg, causing optic nerve head \u2018cupping\u2019, thinning of the fiber layer of the retinal nerve, and functional vision loss.<\/p>\n<h2><b>\u2018The silent thief of sight\u2019<\/b><\/h2>\n<p>Normal tension glaucoma, being a form of open angle glaucoma, is often referred to as \u2018the silent thief of sight\u2019 because by the time the disease is detected, a large amount of irreversible damage to the optic nerve has already occurred, causing permanent vision loss.<\/p>\n<p>Similar to open angle glaucoma, NTG generally does not present with any symptoms in its early stages. Over time, as the optic nerve becomes more damaged, your peripheral vision will be affected, and you may notice blind spots or the inability to see something out of the corner of your eye.<\/p>\n<p>As the disease progresses, it will continue to damage more nerve fibers of the optic nerve, and if uncontrolled, can result in tunnel vision\u2014\u00a0a condition in which you can only see straight ahead, as if you are looking through a paper tube.<\/p>\n<p>Eventually, if uncontrolled, your central vision will be affected as well, causing a total loss of vision.<\/p>\n<p><b>Symptoms of NTG may include:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\">Reduced vision<\/li>\n<li style=\"font-weight: 400;\">Loss of peripheral vision<\/li>\n<li style=\"font-weight: 400;\">Bulging or swollen cornea<\/li>\n<li style=\"font-weight: 400;\">Pupil dilation that doesn\u2019t change with light adjustments<\/li>\n<li style=\"font-weight: 400;\">Redness in the white (sclera) of the eye<\/li>\n<li style=\"font-weight: 400;\">Nausea<\/li>\n<\/ul>\n<p>If you experience any of these symptoms <a href=\"https:\/\/www.optometrists.org\/practice-search\/\"><strong>contact an eye doctor near you<\/strong><\/a>.<\/p>\n<p><strong>SEE RELATED:<\/strong> <a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/eye-conditions\/glaucoma-guide\/glaucoma-faqs\/what-is-angle-closure-glaucoma\/\">What Is Angle Closure Glaucoma?<\/a><\/p>\n\n\t<div class=\"practice-search-widget\">\n\t\t<h3>Find an eye doctor near you<\/h3>\n\t\t\n\t<form class=\"practice-search-form practice-search-form-widget\" action=\"https:\/\/www.optometrists.org\/practice-search\/results\/\" method=\"get\">\n\n\t\t<input type=\"hidden\" name=\"distance\" value=\"100\" class=\"practice-search-distance\">\n\t\t<input type=\"hidden\" name=\"page\" class=\"practice-search-page\">\n\t\t<input type=\"hidden\" name=\"address_latitude\"><input type=\"hidden\" name=\"address_longitude\">\n\n\t\t<input type=\"text\" name=\"address\" class=\"practice-search-address\" placeholder=\"City, Surburb or Address\" value=\"\">\n\n\t\t\n\t\t\t<input type=\"hidden\" name=\"distance\" value=\"100\" class=\"practice-search-distance\">\n\n\t\t\n\n\t\t<button type=\"submit\" class=\"practice-search-button\">\n\t\t\t\t\t\t\t\t\t<svg width=\"19\" height=\"19\" viewBox=\"0 0 19 19\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M10.6796 0.130005C9.15708 0.130059 7.66615 0.5646 6.38198 1.38258C5.09781 2.20057 4.07373 3.36803 3.43004 4.74783C2.78634 6.12763 2.54976 7.66246 2.74808 9.17205C2.9464 10.6816 3.57139 12.1033 4.54964 13.27L0.729639 17.08C0.6364 17.1732 0.562439 17.2839 0.511979 17.4058C0.461519 17.5276 0.435547 17.6581 0.435547 17.79C0.435547 17.9219 0.461519 18.0524 0.511979 18.1743C0.562439 18.2961 0.6364 18.4068 0.729639 18.5C0.917942 18.6883 1.17334 18.7941 1.43964 18.7941C1.5715 18.7941 1.70207 18.7681 1.82389 18.7177C1.94571 18.6672 2.0564 18.5932 2.14964 18.5L5.99964 14.62C7.35406 15.6038 8.98566 16.1324 10.6596 16.13C12.7814 16.13 14.8162 15.2871 16.3165 13.7869C17.8168 12.2866 18.6596 10.2517 18.6596 8.13C18.6596 6.00827 17.8168 3.97344 16.3165 2.47315C14.8162 0.97286 12.7814 0.130005 10.6596 0.130005H10.6796ZM10.6796 14.13C9.49295 14.13 8.33291 13.7781 7.34622 13.1188C6.35952 12.4595 5.59049 11.5225 5.13636 10.4261C4.68224 9.32975 4.56342 8.12335 4.79493 6.95946C5.02644 5.79558 5.59788 4.72648 6.437 3.88736C7.27611 3.04825 8.34521 2.4768 9.5091 2.24529C10.673 2.01378 11.8794 2.1326 12.9757 2.58673C14.0721 3.04085 15.0092 3.80989 15.6685 4.79658C16.3277 5.78328 16.6796 6.94332 16.6796 8.13C16.6796 9.7213 16.0475 11.2474 14.9223 12.3726C13.7971 13.4979 12.2709 14.13 10.6796 14.13Z\" fill=\"#fff\"\/><\/svg>\n\t\t\t\t\t<\/button>\n\n\t\t<button type=\"button\" class=\"practice-search-use-my-location\">\n\t\t\tSearch near me\n\t\t<\/button>\n\n\n\t<\/form>\n\n\n\n\t\t<\/div>\n\n\t\n<h2><b>Who is at risk for NTG?<\/b><\/h2>\n<p>The cause of normal tension glaucoma has yet to be discovered, scientists continue to search for answers.<\/p>\n<p>However, certain factors have been associated with a higher risk of NTG:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">Family history of NTG<\/li>\n<li style=\"font-weight: 400;\">Asian descent<\/li>\n<li style=\"font-weight: 400;\">History of systemic heart disease such as irregular heart rhythm<\/li>\n<\/ul>\n<h2><b>How is NTG diagnosed?<\/b><\/h2>\n<p>Normal tension glaucoma is diagnosed during a comprehensive eye exam. Your eye doctor will examine the health of your optic nerve by looking for signs of damage, using the following tests:<\/p>\n<p><b>Tonometry<\/b> calculates your IOP based on your eye\u2019s response to a puff of air.<\/p>\n<p><b>Tonometer or tonopen <\/b>is a tool used to obtain another measure of your IOP. During this test, your eyes will be numbed so that your doctor can gently touch the surface of your eye with either a tonometer or tonopen.<\/p>\n<p><a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/guide-to-eye-exams\/eye-exams\/what-is-an-oct-eye-exam\/\"><b>An optical coherence tomography (OCT) scan<\/b><\/a> is a non-invasive, diagnostic tool that uses a laser to provide color-coded, cross sectional images of the retina and optic nerve.<\/p>\n<p><a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/guide-to-eye-exams\/eye-exams\/visual-field-testing\/\"><b>A visual field test<\/b> <\/a>produces a computerized map of your visual field and measures the range of your peripheral vision. Your eye doctor will use this test to check for any areas of vision loss that may be caused by optic nerve damage. Loss of peripheral vision that may not even be noticeable to the patient, may be the first sign to indicate optic nerve damage.<\/p>\n<p><b>Optic disc examination<\/b> involves a thorough evaluation of the surface of the optic nerves, to examine the quality of the margin, or neuroretinal rim, and optic disc cup.<\/p>\n<p>Your eye doctor may examine your optic disc with direct ophthalmoscopy, a slit lamp, optic disc photography, or through digital imaging devices.<\/p>\n<p><b>Examination of anterior angle (<\/b><b>gonioscopy)<\/b> enables a thorough evaluation of the anterior angle.<\/p>\n<p>This determines if the angle is open or closed, and can detect the presence of abnormal blood vessels, adhesions, or damage from previous eye trauma.<\/p>\n<p>During this test, a special contact lens prism will be placed on the surface of your eye to enable a clear view of your anterior angle and drainage system.<\/p>\n<p><strong>Please note:<\/strong> It is important to inform your doctor of any other general health problems you may be experiencing, as well as any medication that you take on a regular basis. Normal-tension glaucoma can occur with blood vessel problems that cause low blood pressure, migraine headaches, or cold hands and feet.<\/p>\n<h2><b>How is NTG treated?<\/b><\/h2>\n<p>Normal tension glaucoma is generally treated the same way as open angle glaucoma\u2014 by reducing the IOP to an even lower level than normal. This is usually accomplished through anti-glaucoma eye drops, laser treatments, or surgery.<\/p>\n<h3><b>Anti-glaucoma eye drops<\/b><\/h3>\n<p><em>Most cases of NTG can be controlled with eye drops.<\/em><\/p>\n<p>Each type of eye drop works in a different manner, in order to effectively control IOP.<\/p>\n<p><b>Different types of anti-glaucoma eye drops:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><b>Prostaglandins <\/b>relax the muscles in the eyes to allow better fluid drainage, reducing build-up of IOP.<\/li>\n<li style=\"font-weight: 400;\"><b>Beta-blockers<\/b> decrease the <i>amount <\/i>of ocular fluid production and are typically prescribed in combination with prostaglandins.<\/li>\n<li style=\"font-weight: 400;\"><b>Alpha-adrenergic agonists<\/b> decrease the <i>rate <\/i>of fluid production. They may be prescribed in combination with other anti-glaucoma eye drops.<\/li>\n<li style=\"font-weight: 400;\"><b>Carbonic anhydrase inhibitors<\/b> decrease the <i>rate <\/i>of fluid production, and are generally prescribed in combination with other anti-glaucoma eye drops.<\/li>\n<li style=\"font-weight: 400;\"><b>Epinephrine <\/b>decreases the rate of fluid production, while increasing its outflow from the eye.<\/li>\n<li style=\"font-weight: 400;\"><b>Hyperosmotic agents <\/b>are used in emergencies, for patients with a severely high IOP that must be reduced immediately before permanent damage occurs. They reduce IOP by lowering ocular fluid volume.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.optometrists.org\/practice-search\/\"><strong>Contact an eye doctor near you<\/strong><\/a> to find out which eye drops can help treat your NTG.<\/p>\n<h3><b>Laser surgery<\/b><\/h3>\n<p>Laser surgery may be recommended for some patients with NTG. During a laser procedure, the surgeon creates different avenues to increase fluid drainage, and reduce IOP.<\/p>\n<p><b>Selective laser trabeculoplasty (SLT) is <\/b><b>the most frequently performed laser surgery for open angle glaucoma and NTG.<\/b> This laser procedure stimulates a biochemical change that improves the fluid drainage from the eye.<\/p>\n<p>Selective laser trabeculoplasty effectively lowers IOP by 20 to 30 percent, and has been proven just as effective as anti-glaucoma eye drops. Improved IOP after an SLT treatment has been shown in about 80 percent of patients, and may last 3 to 5 years. This laser surgery can also be repeated if needed.<\/p>\n<h3><b>Minimally invasive glaucoma surgery (MIGS)<\/b><\/h3>\n<p>Minimally invasive glaucoma surgery (MIGS) uses <i>microscopic tools<\/i> <i>and devices<\/i> during the surgical procedure to lower the risk of surgical complications.<\/p>\n<p><b>Micro trabeculectomies<\/b><\/p>\n<p>Micro trabeculectomies involve implanting a microscopic tubeinto the eye to enable proper fluid drainage through the anterior angle.<\/p>\n<p><i>The iStent is the most frequently performed MIGS procedure for the treatment of mild to moderate open angle glaucoma and NTG.<\/i><\/p>\n<p>The iStent procedure is generally combined with cataract surgery, and improves IOP levels by creating a bypass through the anterior angle to improve the outflow of fluid from the eye\u2014 through its natural drainage system.<\/p>\n<h3><b>Glaucoma filtration surgery<\/b><\/h3>\n<p><i>This type of surgery is recommended for mild to moderate stages of glaucoma, if eye drops and laser surgery have not been effective in lowering IOP levels.\u00a0<\/i><\/p>\n<p>During this procedure, a small piece of the eye\u2019s wall is removed, in order to create a new pathway for the fluid to drain through\u2014thereby lowering IOP levels.<\/p>\n<h2><b>When to see your doctor<\/b><\/h2>\n<p>Normal tension glaucoma can cause permanent damage to your optic nerve and result in irreversible vision loss.<\/p>\n<p><strong>LEARN MORE:\u00a0<\/strong>\u00a0<a href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/eye-conditions\/\">Guide to Eye Conditions<\/a><\/p>\n<p><a href=\"https:\/\/www.optometrists.org\/practice-search\/\"><strong>Schedule an eye exam with an eye doctor<\/strong><\/a> to detect any signs of optic nerve damage, <i>before <\/i>your vision is affected. If you have noticed any changes to your vision, schedule an appointment with your eye doctor as soon as possible.<\/p>\n<p><i>Early detection of NTG will facilitate earlier treatment\u2014 thereby reducing vision loss, and preserving vision.<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is normal tension glaucoma (NTG)? Glaucoma is the name for a group of ocular diseases that occur as a result of: High eye pressure<\/p>\n","protected":false},"author":4,"featured_media":6940,"parent":6884,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-article.php","meta":{"footnotes":""},"categories":[],"tags":[84,156,216,204,302,241,136],"class_list":["post-6939","page","type-page","status-publish","has-post-thumbnail","hentry","tag-adults","tag-blurry","tag-disease","tag-eye-drops","tag-eye-pressure","tag-glaucoma","tag-vision-problem"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Normal Tension Glaucoma - Optometrists.org<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.optometrists.org\/general-practice-optometry\/guide-to-eye-conditions\/glaucoma-guide\/glaucoma-faqs\/normal-tension-glaucoma\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Normal Tension Glaucoma - Optometrists.org\" \/>\n<meta property=\"og:description\" content=\"What is normal tension glaucoma (NTG)? 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