43 EyeWorld Asia Pacific | June 2024 About the Physicians Marlene Moster, MD | Professor of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania | marlenemoster@gmail.com Pradeep Ramulu, MD, PhD | Chief, Division of Glaucoma, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland | pramulu@jhmi.edu Relevant Disclosures Moster: None Ramulu: Perfuse Therapeutics This article originally appeared in the March 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Although studies have shown that normal tension glaucoma (NTG) accounts for up to 70% of primary open-angle glaucoma (POAG) in China, with a population prevalence of 1%, NTG patients were actually not commonly seen in clinical practice. Misdiagnosis may lead to an overestimation of the prevalence of NTG. Before diagnosing NTG, it is necessary to exclude other optic nerve-related diseases first, such as congenital optic nerve abnormalities, Leber hereditary optic neuropathy, ischemic optic neuropathy, nutritional and toxic optic neuropathy, etc. Secondly, it is important to differentiate NTG from high tension glaucoma (HTG). Many hospitals in China are available to monitor 24-hour intraocular pressure (IOP), where doctors or nurses use the Icare tonometer to measure the dynamic changes in patients’ IOP, including nighttime IOP. Compared with patients’ own measurements using the home tomometer, measurements carried out by professional healthcare providers are more accurate and reliable. In some patients who show well-controlled IOP but progressing defects of visual field, a 24-hour IOP monitoring might reveal elevated nighttime IOP. We are working with mechanics experts to design and develop a new wearable corneal contact intraocular pressure ASIA-PACIFIC PERSPECTIVES Yao Ke, MD Zhejiang University Eye Hospital Eye Center, Second Affiliated Hospital Zhejiang University School of Medicine 1 Xihu Blvd., Hangzhou, China xlren@zju.edu.cn monitoring device, hoping to record dynamic changes of IOP more conveniently and accurately. It is also necessary to pay attention to probable past history of high IOPrelated glaucomatous optic nerve damage. For example, in patients with medication history of corticosteroid, IOP may appear to be normal with drug withdrawal, but glaucomatous optic nerve damage might be recognized. I completely agree with the opinions of the three professors. The treatment for NTG primarily focuses on lowering IOP. The preferred initial approach is to lower IOP by 30% from the baseline using IOP-lowering medications. If pharmaceutical treatments fail to delay disease progression, surgical treatments should be considered to further lower IOP to 8-12mmHg. The choice of surgical approach for NTG is indeed very difficult. Personally, I strongly agree with Dr. Moster’s viewpoint and would choose the XEN Gel implantation or Phaco combined with iStent implantation, rather than trabeculectomy that might carry more complications. Editors’ note: Prof. Yao Ke disclosed no relevant financial interests. Reference: 1. Zhao J, Solano MM, Oldenburg CE, Liu T, Wang Y, Wang N, Lin SC. Prevalence of Normal-Tension Glaucoma in the Chinese Population: A Systematic Review and MetaAnalysis. Am J Ophthalmol. 2019; 199:101-110. doi: 10.1016/j.ajo.2018.10.017. 2. Killer HE, Pircher A. Normal tension glaucoma: review of current understanding and mechanisms of the pathogenesis. Eye (Lond). 2018 May;32(5):924-930. doi: 10.1038/ s41433-018-0042-2. GLAUCOMA
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