Systemic Hemodynamics and Ocular Perfusion in Normal-Tension Glaucoma: Evaluation of Beta-Blocker Effect

To compare the effects of topical treatments with and without beta-blockers on diurnal and nocturnal intraocular pressure (IOP), systemic blood pressure (BP), and ocular perfusion pressure (OPP) in patients with normal-tension glaucoma (NTG).

NTG patients followed at the Glaucoma Unit of the Department of Ophthalmology, Sakarya University Training and Research Hospital between 2020 and 2025 were retrospectively analyzed. Patients receiving beta-blocker-containing therapy (Group 2, n = 21) and nonbeta-blocker therapy (Group 1, n = 18) were included. Twenty-four-hour IOP and systolic/diastolic BP (DBP) measurements were recorded, and OPP was calculated. Optical coherence tomography parameters and visual field tests were also evaluated.

Patients using beta-blockers had significantly lower diurnal and nocturnal systolic BP (SBP) compared to the nonbeta-blocker group (P₁= 0.012, P₂= 0.048). No significant differences were observed in DBP between groups during diurnal and nocturnal periods (P ₁= 0.126, P ₂= 0.255). There were no significant differences between groups in 24-h mean IOP values or IOP fluctuation (P ₁= 0.590, P ₂= 0.753). Diurnal OPP was significantly lower in the beta-blocker group, while nocturnal OPP did not differ between groups (P ₁= 0.012, P ₂= 0.258). Ganglion cell-inner plexiform layer thickness was higher in the nonbeta-blocker group (P = 0.012). No significant differences were observed in other structural or functional measurements (retinal nerve fiber layer, P = 0.599; mean deviation, P = 0.457; pattern standard deviation, P = 0.805).

In NTG patients, beta-blocker use reduces diurnal SBP and diurnal OPP but has no significant effect on 24-h IOP or nocturnal OPP. These findings support the critical role of systemic hemodynamics and ocular perfusion in NTG progression and suggest that beta-blockers should be monitored carefully for OPP effects, especially in normotensive patients.