Vascular Risk Factors in Normal-Tension Glaucoma

A practical approach to evaluating patients with progressive disease despite controlled IOP.

Ciera D. Johnson; Rachel Chapman, MD; Samantha Goldburg, MD; and Mary Qiu, MD

Glaucoma Today

Key Takeaways For patients with normal-tension glaucoma (NTG) whose disease continues to progress despite adequate IOP control, it is worth considering whether vascular risk factors are contributing to their optic nerve vulnerability. After confirming an NTG diagnosis, use a targeted vascular history to identify whether the patient may benefit from additional systemic evaluation, coordinate care with the patient's medical team, and continue to prioritize IOP reduction for NTG management. Evaluating vascular risk factors may improve understanding of disease progression and the overall health of patients with NTG. A familiar clinical scenario in glaucoma practice is the patient with normal-tension glaucoma (NTG) whose disease continues to progress despite seemingly adequate IOP control. The instinct is often to pursue an even lower target IOP. Although IOP reduction remains the only intervention proven to slow disease progression,1 it is worth considering whether another factor could be contributing to the patient’s optic nerve vulnerability. NTG accounts for a substantial proportion of primary open-angle glaucoma (POAG) cases worldwide, representing approximately 30% to 40% of POAG cases in Western populations and an even greater proportion in East Asian populations.2,3 The condition is characterized by progressive optic neuropathy despite untreated IOPs within a statistically normal range. Although IOP lowering remains the cornerstone of disease management, many patients continue to demonstrate structural or functional progression even after achieving their target pressures.4,5 This observation has prompted increasing interest in factors beyond IOP that may influence disease susceptibility and progression. Among these, vascular dysfunction has received considerable attention. Proposed contributors include nocturnal hypotension, impaired vascular autoregulation, obstructive sleep apnea (OSA), vasospastic disorders, and other systemic conditions that may reduce optic nerve perfusion.6,7 Although these associations are supported by a growing body of observational evidence, it remains unclear whether identifying or treating these conditions alters the course of NTG.

Inherited Retinal Disease in a Young Patient

Blurred central vision, lesions, and macular dystrophy lead to this diagnosis.

Eric Robertson, Osama Said, OD

Modern Optometry

Designing a Successful Front Office

Thoughtful planning is essential.

Alan Winig

Retina Today

Opening an independent practice brings the freedom to shape it according to your vision, values, and standards of care. Ownership also expands your role beyond that of a clinician to that of an entrepreneur and CEO, and it creates opportunities to build long-term wealth. The primary asset is the ophthalmology practice itself, and a second potential asset is the real estate the practice occupies. Choosing to purchase your office building rather than lease space creates an additional investment and a future source of passive income. Owner-occupied real estate is common in our industry and can be a smart financial strategy when feasible. Once you have selected a location, thoughtful space planning becomes essential. One of the most important elements of office design is patient flow (ie, how patients move through the space and how efficiently they can complete their visit). Maximizing throughput without making your patients feel rushed creates a better experience for both them and your staff. Ophthalmology practices serve a large elderly population, and many of these individuals have mobility limitations or move slowly. The office layout should be intuitive, easy to navigate, and designed to minimize unnecessary walking.