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Patient management individualized by presentation in normal tension glaucoma
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CORONADO, Calif. — Work-up in patients with normal tension glaucoma should be individualized according to their presentation, particularly when they are suspected of belonging to certain common subsets with non-IOP-dependent components of the disease, according to a speaker.
Martin B. Wax
“If you think that all normal tension glaucoma is the same and you only have one tool to treat it, I don’t think you’re doing the best for your patients,” Martin B. Wax, MD, said at the annual meeting of the American Glaucoma Society in a joint symposium with the North American Neuro-Ophthalmology Society. “My evaluation is tailored to what the patient presents and whether I think they fit into one of those subsets.”
Patients with vasospasm, ischemic disease, nocturnal hypotension and sleep apnea are among those whose presentations can be classified into subsets and worked up accordingly.
Calcium channel blockers may be a consideration for patients with vasospasm, he said, whereas patients with ischemic disease may benefit from statins or other cardiac medications.
“I think [nocturnal hypotension] is one of the most overlooked subsets for all of glaucoma,” Wax said, adding that it is easy to diagnose with home blood pressure monitoring and may be treatable by reducing blood pressure medication if the patient is overmedicated.
Sleep apnea, another well-known subset, may be treated with weight loss, continuous positive airway pressure or surgery, he said.
“Arm sleepers,” another subset of patients, can be given an eye shield, he said.
“You can do more for your patients if you can define that they meet certain qualifications that could be one of the defined subsets,” Wax said. – by Patricia Nale, ELS
Disclosure: Wax reports he is chief medical officer and executive vice president of PanOptica Pharmaceuticals.