NTG Patients May Require More Frequent Monitoring, Study Says

Establishing a baseline, critical in all glaucoma cases, is especially important in NTG given the greater likelihood of fluctuations. Photo: Andrew Rixon, OD. Click image to enlarge. A recent study from South Korea has linked a number of factors—thinner baseline retinal nerve fiber thickness (RNFLT), lower baseline and mean intraocular pressure (IOP) and greater IOP fluctuation—to greater long-term visual field variability in patients with normal-tension glaucoma.Normal-pressure glaucoma differs from other forms of glaucoma in that it causes optic nerve damage and vision loss despite eye pressure remaining within a normal range. As the authors explained in the study, “Because NTG progresses without an elevated IOP, structural and functional monitoring, particularly through VF testing, plays a critical role in disease management.”Researchers performed a retrospective analysis on the medical records of 77 patients (114 eyes) with normal-tension glaucoma. Patients’ mean age was 58.96 and all were initially examined for visual acuity, central corneal thickness (mean 553.3) and axial length (mean 24.84). The study excluded anyone 18 years old or younger or with a “history of ocular trauma or intraocular surgery except for uncomplicated cataract extraction surgery, retinal or neurological diseases affecting vision or VFs, media opacities and other optic neuropathies unrelated to glaucoma.”After the duration of the study, patients were followed up with for an average of 7.98 years. Throughout the study and its subsequent follow-up period, the researchers found that “a thinner baseline RNFLT was significantly associated with greater long-term VF variability,” as well as being associated with functional vision decline, and that "insufficient structural reserve is thought to contribute to greater instability in VF measurements.”The researchers noted that this study “was intentionally designed to address an important limitation by restricting the study population to treatment-naïve NTG patients with baseline IOP ≤21mm Hg.” In addition, they “excluded eyes exposed to elevated IOP or prior treatment, thereby isolating disease-related functional instability inherent to NTG.”The paper concludes with the researchers emphasizing that “VF variability in NTG reflects intrinsic structural susceptibility rather than pressure elevation alone” and advising clinicians to incorporate RNFL measurements into clinical decision making to improve individualized management for each patient.Click here for the journal source. Lee S, Moon S, Kim E, et al. Factors associated with long-term visual field variability in patients with normal-tension glaucoma. J Ophthalmol. January 23, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.