PURPOSE: To compare the parameters measured with the ocular response analyzer (ORA; Reichert Inc., Depew, NY, USA) between normal control subjects and patients with normal tension glaucoma (NTG) and to investigate clinical usefulness of ORA. METHODS: Intraocular pressure (IOP) and central corneal thickness (CCT) were measured using the Goldmann applanation tonometer (GAT) in 100 eyes of 100 normal subjects and 100 eyes of 100 NTG patients. Four types of ORA parameters, corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated IOP (IOPg), and corneal-compensated IOP (IOPcc) were also measured. RESULTS: The mean CH values were 11.2 mm Hg and 10.3 mm Hg and the mean CRF values were 10.8 mm Hg and 9.9 mm Hg in the normal subjects group and the NTG group, respectively. Mean CH and CRF were significantly lower in NTG patients (p < 0.001) and the IOPcc were higher than normal subjects (p = 0.004). IOPg was in agreement with the GAT IOP (ICC = 0.811) and IOPcc was not correlated with CCT. The cut-off value of 'IOPcc - IOPg' as the diagnostic standard parameter was -0.05 mm Hg (sensitivity; 76%, specificity; 55%). CONCLUSIONS: IOPg measurements were similar to GAT IOP, and other ORA parameters (CH, CRF, IOPcc) were significantly different between normal subjects and NTG patients. Consequently, the difference of IOPcc and IOPg could be a useful parameter in NTG diagnosis.
Diagnosis ; Humans ; Intraocular Pressure ; Low Tension Glaucoma* ; Sensitivity and Specificity

PURPOSE: To evaluate the variation of 24-hours blood pressure in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). METHODS: Thirty patients with NTG, 30 patients with POAG, and 30 normal controls were enrolled in this study. Each subjects underwent 24-hours ambulatory blood pressure monitoring. The variation of each parameter and difference among NTG, POAG, and control groups were compared. RESULTS: The lowest diastolic blood pressure (DBP) and the lowest mean arterial blood pressure (MAP) were significantly lower in the NTG group(51.9+/-11.3 mmHg and 66.9+/-13.1 mmHg) than in the POAG group(60.0+/-11.4 mmHg and 77.8+/-16.8 mmHg, p=0.048 and 0.024) and the control group(60.1+/-10.5 mmHg and 77.4+/-13.3 mmHg, p=0.047 and 0.031) during nighttime. More patients showed a lowest MAP less than 60 mmHg in the NTG group(8 patients, 27%) than in the POAG group(2 patients, 7%) and the control group(2 subjects, 7%, p=0.038 each). In addition, a decrease of more than 15% in DBP was more frequent in NTG group(17 patients, 57%) than in the POAG group(9 patients, 30%) and the control group(9 subjects, 30%, p=0.037 each). CONCLUSIONS: Nocturnal reduction in blood pressure may play an important role in the pathogenesis of NTG in some patients. Therefore, nighttime blood pressure should be considered as an important reference factor in diagnosis and treatment of NTG.
Arterial Pressure ; Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Diagnosis ; Glaucoma, Open-Angle* ; Humans ; Low Tension Glaucoma*

As accommodation and repeated tonometry were known to change the level of intraocular pressure, sometimes they may give a misleading indication for the diagnosis and management of early glaucoma, ocular hypertension and low tension glaucoma. The object of this study was to investigate the effects of accommodation and repeated tonometry on intraocular pressure in Korean adults. Repeated tonometry was performed on 120 normal Korean eyes with visual acuity of 20/20 or more under controlled condition of accommodation and relaxation using Goldmann applanation tonometry and Schiotz tonometry. The results were as follows: 1. In repeated Goldmann applanation tonometry, a statistically significant reduction in mean intraocular pressure was produced during accommodation but not during relaxation. The maximum reduction of 3.25mmHg was produced during four minutes of accommodation and significant reduction of 2.01 mmHg was shown in first one minute of accommodation. 2. In repeated Schiotz tonometry, a statistically significant reduction in mean intraocular pressure was produced during accommodation but not during relaxation. The maximum reduction of 3.71mmHg was produced during four minutes of accommodation and significant reduction of 2.39 mmHg was shown in first one minute of accommodation.
Adult* ; Diagnosis ; Glaucoma ; Humans ; Intraocular Pressure ; Low Tension Glaucoma ; Manometry* ; Ocular Hypertension ; Relaxation ; Visual Acuity

PURPOSE: We have evaluated the mutations of the OPTN gene, which has been reported to be associated with the normal tension glaucoma (NTG). METHODS: The OPTN gene was analyzed in 53 patients with NTG and 40 normal subjects. Genomic DNA was extracted from the blood samples of each patients, exon 5 and exon 6 of the OPTN gene were amplified by PCR and DNA sequencing was performed. RESULTS: No mutation was found in normal subjects. But three kinds of point mutation (G412A, C459T in exon 5, G577C in exon 6) were found in 7 patients with NTG. CONCLUSIONS: We report the novel point mutations of OPTN gene in NTG patients. This shows the possibility of diagnosis of NTG by detecting the mutation of OPTN gene.
Diagnosis ; DNA ; Exons ; Glaucoma* ; Humans ; Low Tension Glaucoma ; Point Mutation ; Polymerase Chain Reaction ; Sequence Analysis, DNA

PURPOSE: To determine the effect of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) and diagnosis of glaucoma on the resultant reclassification of patients as having primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), or ocular hypertension (OHT). METHODS: Intraocular pressure (Goldmann applanation tonometry) and visual field test (Humphrey 24-2) were measured in 22 eyes of 23 patients with OHT, 20 eyes of 20 patients with POAG, 31 eyes of 31 patients with NTG, 27 eyes of 27 control subjects. CCT was measured and used to obtain a corrected value for the IOP and to reclassify the type of glaucoma. RESULTS: There was no significant difference in CCT between controls and patients with POAG, but the CCT in the group with NTG was significantly lower than that in the control group (p=0.012), and the CCT in the group with OHT was significantly higher than in controls (p=0.002). Correcting IOP for corneal thickness, 22.58% of patients with NTG could be reclassified as having POAG, and 56.52% of the patients with OHT as normal. CONCLUSIONS: Underestimation of the IOP in patients with POAG who have thin cornea may lead to a misdiagnosis of NTG, while overestimation of the IOP in normal subjects who have thick cornea may lead to a misdiagnosis of OHT. We suggest that CCT must be considered in diagnosis of glaucoma.
Cornea ; Diagnosis* ; Diagnostic Errors ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Low Tension Glaucoma ; Ocular Hypertension ; Visual Field Tests

PURPOSE: This study was performed to evaluate the validity of optical coherence tomography 3000 (OCT3) in the diagnosis of normal tension glaucoma (NTG). METHODS: One-hundred and eighty eyes with NTG or glaucomatous optic disc changes by direct ophthalmoscope and 51 normal eyes were included. Mean deviation (MD) and pattern standard deviation (PSD) were acquired by the Humphrey visual field analyzer. Mean retinal nerve fiber layer (RNFL) thickness was measured by OCT3. We analyzed the relationships between MD and mean RNFL thickness, PSD, and mean RNFL thickness. We also analyzed differences in the change of mean RNFL thickness according to the change of visual field defect progression. RESULTS: MD and PSD were proportional to the mean RNFL thickness, using the Pearson correlation coefficient: 0.418 (p=0.001) and -0.397 (p=0.002), respectively. There was a significant decrease in the mean RNFL thickness according to the visual field defect severity. Particular, the RNFL thickness of the superior and inferior quadrants were significantly decreased in the severe visual field defect groups. The difference between the mean RNFL thicknesses in pre-perimetric glaucoma between the normal eye and early glaucoma groups was not statistically significant. CONCLUSIONS: The mean RNFL thickness measured by OCT3 could be considered as valid parameter for the diagnosis of NTG. For early diagnosis of glaucoma, however, visual field test must be considered with OCT3.
Diagnosis ; Early Diagnosis ; Glaucoma ; Low Tension Glaucoma* ; Nerve Fibers* ; Ophthalmoscopes ; Retinaldehyde* ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields*

PURPOSE: To investigate the effects of a delay in finger temperature recovery rate on the hand cold provocation test (HCPT) and a nocturnal dip greater than 10% (dipper) on the progression of glaucomatous visual field (VF) defects in open-angle glaucoma patients when the intraocular pressure (IOP) was well controlled lower than the target pressure. METHODS: 30 patients (58 eyes) with normal tension glaucoma (NTG) and 13 patients (24 eyes) with primary open angle glaucoma, and 12 normal controls (24 eyes) were retrospectively enrolled in this study. We performed HCPT, 24 hour ambulatory blood pressure monitoring (24-hr ABPM), Goldmann applanation tonometer measurements, and VF tests on all subjects. The delay in finger temperature recovery rate was defined as a delay longer than 15% of the mean finger temperature of normal controls over 2 intervals among 5, 10, 15, and 20 minutes after the immersion of cold water. We examined the relationships among the delay in finger temperature recovery rate, dipper, and the progression of glaucomatous VF defects. RESULTS: The finger temperature recovery rate in NTG patients was significantly delayed more than that of normal controls at 5, 10, and 15 minutes after the immersion. The delay in finger temperature recovery rate significantly correlated with dipper in NTG patients. Glaucomatous VF defects were significantly progressed in the presence of dipper in NTG patients. Delay in finger temperature recovery rate was significantly related to the progression of glaucomatous VF defects in NTG patients. In the binary logistic regression test, delay in finger temperature recovery rate was the only factor that was strongly related to the progression of glaucomatous visual field in NTG patients. CONCLUSIONS: When glaucomatous VF defects progressed despite the IOP being well controlled, 24-hr ABPM and HCPT for detecting vascular dysregulation might be helpful for diagnosis and treatment of glaucoma.
Blood Pressure Monitoring, Ambulatory ; Diagnosis ; Fingers* ; Glaucoma* ; Glaucoma, Open-Angle ; Hand ; Humans ; Immersion ; Intraocular Pressure ; Logistic Models ; Low Tension Glaucoma ; Retrospective Studies ; Visual Fields ; Water

PURPOSE: The purpose of this study was to investigate the association between normal-tension glaucoma (NTG) and allergic rhinitis in a population-based setting using data from the Korea National Health and Nutrition Exam Survey (2010–2012). METHODS: The authors selected a total of 8,614 participants aged 40 years and older for this study. All participants completed an ophthalmic examination required for diagnosis of NTG based on the International Society for Geographical and Epidemiological Ophthalmology criteria. An interview regarding nasal symptoms was also performed. The included participants were classified into NTG (n = 604) and control (n = 8,010) groups. The authors compared the groups in terms of prevalence of allergic rhinitis and identified risk factors of NTG. RESULTS: In NTG patients, allergic rhinitis prevalence was 29.1% (176/604), which was significantly higher than that of the control group (25.0%, 2,000/8,010; p = 0.023). There were significant associations between NTG and allergic rhinitis (odds ratio [OR]= 1.34, 95% confidence interval [CI] = 1.12–1.62, p = 0.002), even after adjusting for potential confounders (age, sex, diabetes, hypertension, number, of family members, household income quartile, frequency of eating out, and smoking status). In particular, patients with NTG aged 60–69 years, those aged 70–79 years, and those who were male had significantly higher ORs for prior allergic rhinitis compared with control subjects (OR = 1.62, 95% CI = 1.16–2.26, p = 0.005; OR = 1.52, 95% CI = 1.06–2.18, p = 0.024; and OR = 1.42, 95% CI = 1.10–1.83, p = 0.007, respectively). CONCLUSIONS: This study showed a significant association between NTG incidence and allergic rhinitis, especially in males and elderly patients (>60 years of age). These results suggested that allergic rhinitis may have a potential role in the development of NTG. Therefore, ophthalmologists and allergic rhinitis patients should remain vigilant to this potential risk factor.
Aged ; Diagnosis ; Eating ; Family Characteristics ; Glaucoma ; Humans ; Hypertension ; Incidence ; Korea ; Low Tension Glaucoma ; Male ; Ophthalmology ; Prevalence ; Rhinitis, Allergic ; Risk Factors ; Smoke ; Smoking

PURPOSE: We compared the abilities of Stratus optical coherence tomography (OCT), Heidelberg retinal tomography (HRT) and standard automated perimetry (SAP) to detect the progression of normal tension glaucoma (NTG) in patients whose eyes displayed localized retinal nerve fiber layer (RNFL) defect enlargements. METHODS: One hundred four NTG patients were selected who met the selection criteria: a localized RNFL defect visible on red-free fundus photography, a minimum of five years of follow-up, and a minimum of five reliable SAP, Stratus OCT and HRT tests. Tests which detected progression at any visit during the 5-year follow-up were identified, and patients were further classified according to the state of the glaucoma using the mean deviation (MD) of SAP. For each test, the overall rates of change were calculated for parameters that differed significantly between patients with and without NTG progression. RESULTS: Forty-seven (45%) out of 104 eyes displayed progression that could be detected by red-free fundus photography. Progression was detected in 27 (57%) eyes using SAP, 19 (40%) eyes using OCT, and 17 (36%) eyes using HRT. In early NTG, SAP detected progression in 44% of eyes, and this increased to 70% in advanced NTG. In contrast, OCT and HRT detected progression in 50 and 7% of eyes during early NTG, but only 30 and 0% of eyes in advanced NTG, respectively. Among several parameters, the rates of change that differed significantly between patients with and without progression were the MD of SAP (p = 0.013), and the inferior RNFL thickness (p = 0.041) and average RNFL thickness (p = 0.032) determined by OCT. CONCLUSIONS: SAP had a higher detection rate of NTG progression than other tests, especially in patients with advanced glaucoma, when we defined progression as the enlargement of a localized RNFL defect. The rates of change of the MD of SAP, inferior RNFL thickness, and average RNFL thickness differed between NTG patients with and without progression.
Disease Progression ; Female ; Humans ; Intraocular Pressure/*physiology ; Low Tension Glaucoma/*diagnosis/physiopathology ; Male ; Middle Aged ; Retina/*pathology ; Tomography, Optical Coherence/*methods ; Visual Field Tests/*methods ; Visual Fields/*physiology

PURPOSE: To investigate the risk factors for initial central scotoma (ICS) compared with initial peripheral scotoma (IPS) in normal-tension glaucoma (NTG). METHODS: Fifty-six NTG patients (56 eyes) with an ICS and 103 NTG patients (103 eyes) with an IPS were included. Retrospectively, the differences were assessed between the two groups for baseline characteristics, ocular factors, systemic factors, and lifestyle factors. Also, the mean deviation of visual field was compared between the two groups. RESULTS: Patients from both ICS and IPS groups were of similar age, gender, family history of glaucoma, and follow-up periods. Frequency of disc hemorrhage was significantly higher among patients with ICS than in patients with IPS. Moreover, systemic risk factors such as hypotension, migraine, Raynaud's phenomenon, and snoring were more prevalent in the ICS group than in the IPS group. There were no statistical differences in lifestyle risk factors such as smoking or body mass index. Pattern standard deviation was significantly greater in the ICS group than in the IPS group, but the mean deviation was similar between the two groups. CONCLUSIONS: NTG Patients with ICS and IPS have different profiles of risk factors and clinical characteristics. This suggests that the pattern of initial visual field loss may be useful to identify patients at higher risk of central field loss.
Female ; Humans ; Incidence ; *Intraocular Pressure ; Low Tension Glaucoma/*complications/diagnosis/physiopathology ; Male ; Middle Aged ; Optic Disk/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment/*methods ; Risk Factors ; Scotoma/diagnosis/*epidemiology/etiology ; Visual Fields/*physiology