Normal-pressure glaucoma (JNC) leads to damage to the optic nerve disc and visual field defects, while maintaining the intraocular pressure within the statistical norm. What are the causes and symptoms of normal pressure glaucoma? How is the treatment going?

Normal-pressure glaucoma (JNC)is also known as low-pressure glaucoma. Identifying this disease entity and distinguishing between high-pressure and normal-pressure glaucoma is arbitrary and only indicates that the correct value of the intraocular pressure does not exclude glaucomatous damage to the optic nerve and loss of vision in its course.

Risk factors for developing normal pressure glaucoma

Intraocular pressure is one of the risk factors for the development of glaucoma, but in this type of glaucoma, other factors seem to play a more important role that are not yet fully understood. The most important of them are local vascular disorders, resulting from the tendency to constrict peripheral blood vessels. Such spasm may occur in the course of migraine headaches, Raynaud's disease, ischemic vascular disease, or autoimmune disease. Patients with this type of glaucoma often complain of freezing hands and feet and low blood pressure. This type of glaucoma is most common in the elderly, but it can also occur in middle-aged patients who are extremely vulnerable to stress and often unable to cope with it properly. Women suffer twice as often. It seems that recurrent vascularization disorders of the optic nerve make this nerve susceptible to damage even at normal intraocular pressure.

Glaucoma - what are its symptoms?

Examination of the patient

When examining a patient with normal-pressure glaucoma, an ophthalmologist finds a normal intraocular pressure of less than 22 mm Hg, damage to the optic nerve, and sometimes small, flame-like ecchymoses at the nerve disc. Visual field defects are often closer to the center and deeper than in high pressure glaucoma, and therefore may be more hazardous to your vision. In some patients, the changes in the field of view may not enlarge, but the usual form of glaucoma isdiagnosed very late, when the nerve damage is already large, and very advanced changes in the field of vision and cause significant visual impairment.

The patient needs to undergo detailed ophthalmic examinations, including intraocular pressure tests with an applanation tonometer at different times of the day, assess the anterior segment of the eye, assess the anterior chamber angle using a gonioscope or laser tomograph, assess the fundus, laser tomography of the optic nerve, layers nerve fibers and ganglion cells of the retina and perform visual field examination in the FDT Matrix technology.

In young people with symptoms of vascular spasm (freezing hands and feet), it is worth considering examining the blood vessels in the fingertips (capillaroscopy).

Treatment of normal pressure glaucoma

Treatment of this type of glaucoma is indicated when the condition of the optic nerve worsens and the defects in the visual field become larger and larger. Although the intraocular pressure is normal, it has been proven that the most effective treatment for this disease is to lower the pressure in the eyes even more by up to 30%. For this purpose, anti-glaucoma medications in eye drops and laser treatments are used. If, despite the pressure reduction, glaucoma still progresses and the field of vision deteriorates, then an anti-glaucoma surgery should be considered.

With a significant drop in blood pressure in patients treated for arterial hypertension, it may be recommended to reduce the evening dose of antihypertensive drugs under the supervision of a cardiologist.

About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, Warsaw

Dr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.

Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.

In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.

For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.

He is the author or co-author of numerous publications inscientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).

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Eye diseases and vision disorders