Normal-tension glaucoma: Current concepts and approaches-A review

Area of Science:

• Ophthalmology
• Neurology
• Epidemiology

Background:

• Normal tension glaucoma (NTG) presents diagnostic and therapeutic challenges.
• Current management often focuses on intraocular pressure (IOP) reduction.
• The role of vascular factors in NTG pathogenesis is increasingly recognized.

Purpose of the Study:

• To review epidemiological evidence for redefining normality in NTG management.
• To explore the impact of ocular perfusion pressure and vascular health on NTG.
• To discuss the potential of artificial intelligence in predicting NTG progression.

Main Methods:

• Epidemiological review of NTG and associated vascular conditions.
• Analysis of ocular perfusion pressure, vascular autoregulation, and endothelial function.
• Exploration of vascular geometry, silent cerebral infarcts (SCI), and small vessel diseases (SVD).
• Review of emerging treatments including minimally-invasive glaucoma surgery, lasers, and novel drugs.

Main Results:

• NTG management may benefit from earlier intervention at lower pre-treatment IOP.
• Defective vascular autoregulation and endothelial dysfunction impact ocular perfusion.
• NTG shares pathological links with SVD, evidenced by correlations with SCI.
• Vascular geometry, such as fractal dimension, influences perfusion efficiency and disease occurrence.
• Artificial intelligence (AI) shows promise in predicting NTG progression using vascular geometry.

Conclusions:

• Intraocular pressure is not the sole modifiable risk factor for NTG.
• Vascular risk factors, including endothelial dysfunction and impaired autoregulation, are crucial and modifiable.
• A broader perspective encompassing vascular health is essential for effective NTG management.
• Future research should integrate vascular assessments and AI for personalized NTG treatment strategies.