Characteristics of Normal Tension Glaucoma Referrals at a Tertiary Care Center and Factors Associated with Unilateral versus Bilateral Disease

Fahd Yazdanie,1 Jeffrey R Sims,1 Stephanie Ying,2 Poonam Misra,3 Manjool Shah,1,4 Joseph F Panarelli1 1Department of Ophthalmology, NYU Langone Health, New York, NY, USA; 2Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 3Department of Ophthalmology, Manhattan Eye, Ear & Throat Hospital, Northwell Health, New York, NY, USA; 4Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USACorrespondence: Joseph F Panarelli, Department of Ophthalmology, NYU Langone Health, 222 E. 41st St, 4th Floor, New York, NY, 10017, USA, Tel +1 347-302-4326, Email [email protected]: To determine the characteristics of normal tension glaucoma referrals at a tertiary care center and risk factors associated with unilateral versus bilateral disease.Patients and Methods: Medical records were reviewed of patients who were referred to a single glaucoma provider at a tertiary care center and were given a presumptive diagnosis of normal tension glaucoma (NTG) between the years 2018 and 2021. Data collected included demographics, medical and family history, ophthalmic history, ophthalmic examination findings, neuro-ophthalmology referrals, and magnetic resonance imaging (MRI) results.Results: A total of 98 patients were included in this study. The majority of patients (82%) had bilateral disease at initial presentation. Most patients (65%) had a history of systemic disease, including hypertension (32%), cardiovascular disease (19%), diabetes (12%), obstructive sleep apnea (10%), or orthostatic hypotension (4%). Conditions associated with vascular dysregulation were identified in 24% of patients. Sixty six percent of patients had a family history of glaucoma, while nearly half (49%) were myopic. Of patients with unilateral disease, 39% had workup or consideration of other neuro-ophthalmic diagnoses compared to 13% of patients with bilateral disease (P = 0.01).Conclusion: Patients referred for NTG commonly present with disc changes in both eyes. Clinicians should assess for the presence of systemic diseases associated with vascular dysregulation, myopia, and a family history of glaucoma. Patients with unilateral disease consistent with NTG may benefit from additional workup including neuroimaging or a neuro-ophthalmic evaluation.Keywords: normal tension glaucoma, intraocular pressure, optic neuropathy, myopia, masquerading