Single-digit IOP in Patients with NTG Associated with Reduction in VF Progression

Clinicians should use caution when dealing with eyes with NTG that are more prone to hypotony, such as high myopes or vitrectomized eyes. Frequent follow-up visits in patients in danger of progressing after trabeculectomy with antimetabolite drugs are suggested. Photo: World Glaucoma Association. Click image to enlarge. A significant proportion of patients with normal-tension glaucoma (NTG) continues to experience visual field (VF) deterioration despite optimized pharmacological treatment, which raises the question of whether more aggressive intraocular pressure (IOP) reduction, specifically to single-digit levels, offers additional benefits. Researchers in Portugal recently performed a systematic review and meta-analysis of nine observational studies to evaluate the efficacy and safety of further lowering IOP to single-digit levels in treated patients with progressive NTG. They found that achieving single-digit IOP levels was associated with a significant reduction in visual field progression rates.However, the researchers noted that a balance between efficacy and safety should be considered, as aggressive IOP reduction is also associated with a higher risk of hypotony-related complications. They found that postoperative hypotony was relatively frequent but generally transient and did not appear to have a significant impact on long-term visual acuity.The meta-analysis, which was published in Acta Ophthalmologica, analyzed 270 eyes overall. Trabeculectomy was performed across all nine studies. One study compared trabeculectomy with prostaglandin analogs.On average, IOP decreased from 14.77mm Hg preoperatively to 9.82mm Hg postoperatively, reflecting a mean reduction of 33.65%. This reduction slowed glaucoma progression, which was indicated by a change in the mean VF mean deviation (MD) slope from -0.91dB/year preoperatively to -0.25dB/year postoperatively. The meta-analysis showed a significant change in VF MD slope following trabeculectomy, with a pooled mean difference of 0.59dB/year.“Despite achieving and maintaining postoperative mean IOP levels below 10mmHg, VF progression was not completely halted, with a mean postoperative MD slope of -0.25dB/year,” the study authors wrote in their paper. “Although this rate represents a marked improvement compared to preoperative progression, it still seems to be significantly different from zero, indicating residual disease activity even under single-digit IOP levels.”This systematic review could potentially demonstrate that treatment success is not only determined by the ability to lower IOP to single-digit levels but also by its capacity to sustain this reduction over time. For this reason, the researchers suggested that future evidence should focus on both the efficacy of IOP reduction and the sustainability of this approach.Click here for the journal source. Araújo-Azevedo B, Ferreira-da-Silva R, Barbosa-Breda J. The efficacy and safety of reducing intraocular pressure to single-digit levels in normal-tension glaucoma: a systematic review and meta-analysis.  Acta Ophthalmol. March 20, 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.