NTG treatment plan similar to POAG management

San Francisco - Results from the Collaborative Normal Tension Glaucoma Study provided the first and still best evidence that lowering IOP by 30% in patients with normal-tension glaucoma (NTG) does prevent or slow the progression of glaucomatous visual field loss, said Donald L. Budenz, MD, MPH, associate professor, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.

In developing a treatment plan for the patient with NTG, Dr. Budenz said that he first assesses IOP at different times of the day in order to establish the baseline level that will be used to set a target. Treatment is usually initiated with a prostaglandin analogue and aims to lower IOP by at least 30%, although a more aggressive goal may be pursued if the patient has already sustained significant glaucomatous damage.

“A prostaglandin is my drug of first choice in this condition because it has the potential to reach the target IOP with single-agent therapy and so it provides cost and compliance benefits for the patient. Theoretically, a prostaglandin can also lower IOP below episcleral venous pressure, which may be needed in patients with NTG,” he said.

If prostaglandin monotherapy is ineffective, he adds a second medication, choosing from among a topical carbonic anhydrase inhibitor, beta-blocker or alpha-agonist, turns to selective laser trabeculoplasty as needed to reach the IOP goal, and proceeds to trabeculectomy with an antifibrotic agent as a last resort.