Diagnosing, managing normal-tension glaucoma requires sharp skills

NEW YORK — The diagnosis and management of normal-tension glaucoma is a challenge for clinicians, requiring a thoughtful and thorough approach, according to a glaucoma expert speaking here.

Eve J. Higginbotham, MD, delivered the keynote address on the nuances of diagnosing and treating normal-tension glaucoma here at the Ocular Surgery News Symposium.

“It’s imperative for us to keep our diagnostic skills as sharp as possible” in order to recognize normal-tension glaucoma, she said.

Dr. Higginbotham said a thorough medical history is needed to rule out the effects of previous corticosteroid use or trauma, among other factors. She also advised measuring corneal thickness, obtaining a diurnal IOP curve and performing blood work for patients who are suspects for normal-tension glaucoma.

Normal-tension glaucoma can be a challenge to treat, Dr. Higginbotham told attendees. One study in normal-tension glaucoma patients found that a 30% reduction in IOP might be protective, she said.

There is controversy as to whether normal-tension glaucoma should be considered a separate clinical entity or a subset of primary open-angle glaucoma, she said.

“Consider that IOP is a continuous variable, with no separation between normal and abnormal,” Dr. Higginbotham said.