Real-world management patterns and outcomes in normal-tension glaucoma.

BACKGROUND/AIM: This study aimed to assess the clinical outcomes of normal-tension glaucoma (NTG) in real-world clinical practice, focusing on the clinical profile, pattern of treatment preferences, and visual field progression.

METHODS

A total of 875 eyes (476 patients) with NTG were included, with a mean age of 68 ± 10.6 years. Of these, 77 eyes had unilateral NTG and 399 had bilateral NTG. Ocular/systemic associations were recorded, and clinical variables, including the number of medications, intraocular pressure (IOP), and visual field parameters, were retrieved. Treatment options to achieve target IOP included topical medications (monotherapy or combination therapy) and surgical interventions. Visual field progression on guided progression analysis was available in 496 eyes with reliable data.

RESULTS

At baseline, 45% of eyes had severe glaucoma (mean deviation, MD = -13 ± 8.7 dB). While 92 eyes (including 5 unilateral NTG) were observed without medication, 783 eyes were on initiated on topical medications. At a mean follow-up of 32 ± 10.2 months, 22.2% of treated eyes showed visual field progression, compared to 10.8% in untreated eyes. The rate of progression in eyes that progressed was -2 ± 0.9 dB per year versus 0.2 ± 0.9 dB in stable eyes, P = 0.003. Multivariate analysis did not reveal any clinical or systemic association that predicted visual field progression.

CONCLUSION

This study highlights the challenges of treating NTG in real-world clinical practice, where 45% patients presented with severe glaucoma. The absence of identifiable factors for progression suggests the need to search for newer risk factors for halting NTG progression.