The management of normal tension glaucoma

OBJECTIVE: To outline the difficulties in making management decisions associated with normal tension glaucoma. To suggest treatment strategies according to the clinical presentation of the disease. METHOD: Literature review and findings based on clinical experience. CONCLUSIONS: The treatment of normal tension glaucoma involves many difficult decisions including whether to intervene and, if so, when and how to treat. Providing the patient with information is essential to gain co-operation and confidence. At present, the treatment objectives are to prevent further visual field loss by reduction of intraocular pressure by 30 per cent or more. This may be achieved by using medical or surgical regimens. Recently, there has been emphasis on the use of neuroprotective drugs that may act independently of the effect of intraocular pressure lowering. The balance between protecting vision and iatrogenic damage is not always easy.