Reassessment of the Collaborative Normal-Tension Glaucoma Study: Statistical Evidence and Implications for Current Management

The potential treatment benefit reported in CNTGS depended largely on post hoc analytical modifications, whereas the original ITT analysis did not support a statistically significant effect of IOP reduction. These findings highlight the importance of transparent survival analysis methods and strict adherence to ITT principles in future NTG trials. Well-designed prospective studies that avoid immortal time bias and model treatment-related events appropriately are needed to clarify the true role of IOP reduction on NTG management.