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    Taking a closer look at low-tension glaucoma risk factors, treatment guidelines

    Many patients can get IOP under control—but some still at risk

    Take home: A reasonable goal for patients with low-tension glaucoma patients is an IOP that is 30% below the untreated baseline. However, some patients will continue to progress and may require single-digit target IOP goals.


    Low-tension glaucoma is not such a distinct disorder that its pathogenesis differs from primary open-angle glaucoma. Instead, it represents a multifactorial disease entity along a continuum of IOP measurements, said David S. Greenfield, MD, professor of ophthalmology, co-director, Glaucoma Service, and director, Glaucoma Fellowship, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.

    Despite its many names—low-tension glaucoma, normal-tension glaucoma, low-pressure glaucoma, pseudoglaucoma, and soft glaucoma—patients can go blind without proper treatment and monitoring, Dr. Greenfield said.

    The well-known Normal Tension Glaucoma Study provided valuable clinical pearls regarding low-tension glaucoma treatment, Dr. Greenfield said. This included the importance of confirming suspected visual field progression, examining for optic disc hemorrhages, inquiring about migraines, and realizing that not all patients will continue to progress. The study also revealed that a target intraocular pressure (IOP) 30% below the untreated baseline is achievable and will prevent progression in about 80% of patients.

    “Twenty percent of patients will continue to progress despite low IOP targets,” Dr. Greenfield said. Clinicians should also be aware of the Low-Pressure Glaucoma Treatment Study (LoGTS), in which eyes randomized to brimonidine 0.2% were less likely to exhibit visual field progression and optic disc hemorrhage than eyes receiving timolol 0.5%. These findings occurred despite similar IOP levels in both groups during the course of the study.

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