Ocular and Systemic Risk Factors and Correlation with Glaucomatous Damage in Normal Tension Glaucoma

Background Normal tension glaucoma (NTG) is a clinical entity that poses a diagnostic and therapeutic challenge. The study elaborates ocular and systemic risk factors of NTG in the South Indian population. It determines the correlation between risk factors and severity of glaucomatous damage. Methods This descriptive study was done on 81 eyes of 41 patients. A brief history of hypertension, heart disease, migraine, and family history of glaucoma were noted. The parameters measured include blood pressure, lipid profile, visual acuity, refraction, intraocular pressure (IOP) by applanation tonometry, diurnal variation, slit lamp biomicroscopy, central corneal thickness (CCT), and perimetry (Humphrey 24-2). Results The mean age was 51.75 years. There was female predilection (63.41%). Thirteen patients (32.5%) had hypertension, five (12.5%) had migraine, and seven had hyperlipidemia (17.5%). Perfusion pressure demonstrated a negative correlation value of -0.319 (rho value) with visual field defects (p<0.05) and -0.266 (rho value) with glaucomatous cupping (p=0.093). The IOP varied from 10 mmHg to 19 mmHg with a mean of 15.34. The average CCT was 522.06±36.09 microns. Neuroretinal rim thinning was seen in 12 eyes (14.8%), polar notching in six eyes (7.4%), and peripapillary atrophy in 20 eyes (24.6%). Two eyes (2.4%) had splinter hemorrhage at disc margin. A lower value of CCT was associated with lower IOP, a weak positive correlation (r value 0.121). Optic disc cupping is strongly associated with severity of field defects, r value 0.743, (p<0.00). Conclusion Normal tension glaucoma is common in females. Hypertension and lower diastolic perfusion pressure are important risk factors. Lower CCT is associated with lower IOP (applanation tonometry). Optic disc cupping and diastolic perfusion pressure strongly correlate with severity of visual field defects.