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We present a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway. Even though uncommon, compression of the anterior visual pathway is an important...
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Purpose:
The aim of the study was to compare the diagnostic ability of macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness in high-tension glaucoma (HTG) and low-tension glaucoma (LTG).
Patients and methods:
Glaucoma was defined as glaucomatous optic neuropathy and reproducible visual field defects....
Glaucoma is a chronic optic neuropathy characterized by progressive damage to the optic nerve, death of retinal ganglion cells and ultimately visual field loss. It is one of the leading causes of irreversible loss of vision worldwide. The most important trigger of glaucomatous damage is elevated eye pressure, and the current standard approach in gl...
Main objective:
The thinning of prelaminar tissue and prelamina cupping is known to occur by ischemia, as we see in anterior ischemic optic neuropathy. Since normal tension glaucoma (NTG) is thought to be more related to vascular factor than in primary open-angle glaucoma (POAG), we hypothesized that prelamina thinning may occur prominently in NTG...
This study addresses the prevalence and clinical presentation of patients with primary open angle glaucoma (POAG) in the greater Accra metropolitan area.
This is a retrospective case series of 455 patients (813 eyes) at the Emmanuel Eye Clinic. Patients were diagnosed from May 2008 to Nov 2011. The definition of POAG conformed to the International...
Importance: Normal-tension glaucoma (NTG) is a common cause of vision loss. Objective: To investigate the role of TANK binding kinase 1 (TBK1) gene duplications in NTG to gain insights into the causes of glaucoma that occurs at low intraocular pressure (IOP). Design, Setting, and Participants: In this multicenter case-control study, we investigated...
Citations
... Glaucoma is a characteristic progressive optic neuropathy that may be associated with elevated intraocular pressure (IOP) or with normal IOP, the latter referred to as normal tension glaucoma (NTG) [1]. Since IOP is normal in such patients, the diagnosis of NTG requires careful consideration of masquerading (glaucoma-like) optic neuropathies including neurological etiologies [2]. However, differentiating NTG from neurological causes of optic disc cupping and visual deficits remains a challenge. ...
Purpose. We describe a patient with normal tension glaucoma (NTG) of several years whose management was complicated by the presence of a giant internal carotid-ophthalmic artery aneurysm. Observations. A 72-year-old woman presented to our glaucoma clinic with accelerated deterioration of her vision in her left eye (OS) over a 1-month period. Her ophthalmic history was most notable for bilateral NTG diagnosed 3 years prior which had been treated with several laser trabeculoplasty OS and topical bimatoprost 0.01% eye drops in both eyes (OU). Upon evaluation, her visual acuity OS had worsened, and visual field (VF) testing showed extensive progressive losses temporally and pericentrally OS over a year with stable IOP measurements and no neurological complaints. Given her atypical NTG progression, she was referred for an urgent neurological evaluation which revealed an unruptured giant left internal carotid-ophthalmic aneurysm. Following the successful treatment of the aneurysm with platinum coils, she continued to demonstrate additional bilateral ophthalmic changes including further progression of VF loss and RNFL thinning OS>OD on follow-up. Conclusion and Importance. Overall, this report describes a unique complication in the management of a patient with chronic bilateral NTG in the form of a giant internal carotid-ophthalmic aneurysm. Moreover, it highlights the need for clinicians to maintain a degree of suspicion for compressive lesions of the optic nerve when presented with atypical progression of VFs and/or visual acuity loss in glaucomatous patients.
... Patients with intracranial tumors have been reported to have normal IOP but glaucomatous-like optic discs. [3][4][5][6] Studies show that the neuroradiological presence of a mass lesion in patients diagnosed with glaucoma varies from 0 to 14.2%. 2,7 While part of the possible work-up, routine neuroimaging is not recommended for patients with presumed NTG, because of the low yield of intracranial pathological detection. ...
... 2,8 Instead of imaging studies, the pattern of the visual field defect can be a diagnostic clue to identify the intracranial etiology if optic disc neuroretinal rim pallor is absent in examinations. 6 Studies show that visual field defects related to vertical alignment are significantly associated with compressive intracranial pathology. 2,6 This is an important clinical finding in isolated or coexisting intracranial masses and glaucoma, where the diagnosis of brain lesions may be overlooked. ...
... 6 Studies show that visual field defects related to vertical alignment are significantly associated with compressive intracranial pathology. 2,6 This is an important clinical finding in isolated or coexisting intracranial masses and glaucoma, where the diagnosis of brain lesions may be overlooked. Therefore, a detailed record of visual field pattern changes is crucial. ...
When non-glaucomatous disease with disc cupping mimics normal-tension glaucoma (NTG), diagnosis is challenging. The typical optic disc features of glaucomatous disease are often subjective, and often overlap with disc changes in compressive intracranial lesions. Ancillary diagnostic testing such as retinal nerve fiber layer (RNFL) analysis and visual field testing can elevate the index of suspicion of an underlying non-glaucomatous process. We present a case of a nonfunctional macroadenoma coexisting with NTG, although it is unclear if the concurrent brain lesion aggravated or caused it. This case highlights the diagnostic challenge of recognizing optic cupping and non-matching abnormalities in the visual field from a coexisting intracranial lesion, even in the absence of other neurological signs.
... Compressive optic neuropathy (CON) caused by sellar tumors often exhibits visual impairment as the main and the first symptom. It causes visual field defect, optic disc pallor, retinal nerve fiber loss, and even the enlargement of the cup [1,2]. These clinical manifestations sometimes overlap with that of glaucomatous optic neuropathy (GON), leading to diagnosis confusion [3][4][5]. ...
... Nevertheless, the vertical C/D ratio of the CON eyes was also larger than that of controls with statistical significance. Cupping of the optic nerve head, which is widely recognized as a typical sign of glaucoma, can also be found in CON [1,2,4,5]. Because of the similar disc appearance, diagnostic confusion of the two conditions was not uncommon even for experienced ophthalmologists [3]. ...
Purpose
To compare the patterns of retinal microvasculature change in the peripapillary and macular region between compressive optic neuropathy (CON) and glaucomatous optic neuropathy (GON), and to assess the ability of optical coherence tomography angiography (OCTA) in differentiating the two conditions.
Methods
This cross-sectional study included 108 participants (108 eyes), 36 with CON, 36 with GON, and 36 healthy controls. The CON and GON eyes were matched by the average peripapillary retinal nerve fiber layer (pRNFL) thickness (1:1). Optical coherence tomography (OCT) and OCTA were performed to compare the structural and vascular change of the peripapillary and macular region between groups.
Results
Both CON and GON eyes showed more severe structural and vascular damage than the control eyes. The CON eyes had lower pRNFL thickness than the GON eyes in the temporal and nasal quadrants, and thicker pRNFL thickness in the inferior quadrant. The average GCC thickness did not differ between the two groups. The peripapillary vessel density of the CON group was significantly higher in the inferior sectors than that of the GON group. In the macular region, the CON group had significantly higher vessel density in the whole image, the temporal sector in parafovea region, and the temporal, superior, and inferior sectors in perifovea region.
Conclusion
To a similar degree of structural damage, CON had less retinal vascular impairment than GON, especially in the macular region, and the significance of the finding needs further evaluation.
... Glaucoma is one of the optic neuropathy disorders characterized by the progressive degeneration of retinal ganglion cells (RGC), which eventually lead to cupping of the optic disc and decreased visual field. 1 Glaucoma is also closely related to an increase in intraocular pressure caused by the damage of trabecular meshwork (TBM), which results in optic nerve damage, characterized by the loss of retinal ganglion cells. 2,3 Globally, in 2020, more than 76 million people are suffering from glaucoma, and it is expected to increase to 111.8 million people by 2040. ...
Glaucoma is an optic neuropathy disease that causes cupping of the optic disc and decreased visual field. Glaucoma is still the second leading cause of blindness globally, with a worldwide prevalence of more than 76 million people in 2020. However, no therapy can cure glaucoma completely, especially when optic nerve damage has occurred. Available treatments only play a role in keeping the intraocular pressure stable This research aims to determine the potential use of modified stem cell therapy to treat intraocular damage in glaucoma cases. Literature research was conducted by involving seven online databases, namely Pubmed, ScienceDirect®, Proquest, EBSCOhost®, SAGE®, Clinicalkey®, and Scopus, published between 2010-2020 with the keywords stem cells; therapy; glaucoma; optic nerve. Six articles were selected, and out of the six articles, all writings were experimental research. The entire literature states that modified stem cell therapy has the potential as a therapeutic option in treating intraocular damage in patients with glaucoma. Based on the systematic literature review that has been carried out, it is known that stem cell therapy has the potential to be a therapeutic option in treating glaucoma cases. Much more research is needed to assess the effectiveness of modified stem cell therapy in managing intraocular damage due to glaucoma.
... We confirmed that fast progression of VF or worsening of best corrected visual acuity (BCVA) are the most important signs in prompting magnetic resonance (MR) scans, in contrast to young age and unilateral involvement. Choudhari presented a series of six patients receiving treatment for normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) who were finally found to have optic neuropathy secondary to compression of anterior visual pathways (Choudhari et al., 2011) [4]. Since misdiagnosing is common and successful diagnostic process of all forms of optic neuropathy for comprehensive ophthalmologist is not realistic, Ahmed advocates routine neuroimaging to avoid diagnostic delay [5]. ...
... We confirmed that fast progression of VF or worsening of best corrected visual acuity (BCVA) are the most important signs in prompting magnetic resonance (MR) scans, in contrast to young age and unilateral involvement. Choudhari presented a series of six patients receiving treatment for normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) who were finally found to have optic neuropathy secondary to compression of anterior visual pathways (Choudhari et al., 2011) [4]. Since misdiagnosing is common and successful diagnostic process of all forms of optic neuropathy for comprehensive ophthalmologist is not realistic, Ahmed advocates routine neuroimaging to avoid diagnostic delay [5]. ...
The aim of this paper is to report clinically various cases of intracranial tumors in patients referred to glaucoma clinic for consultation. The secondary aim was to increase the awareness of intracranial tumors in atypical cases of glaucoma. We present the retrospective analysis of five patients referred to glaucoma clinic for consultation. Due to atypical course of the disease, in addition to standard glaucoma examinations, all patients had a neurologic full visual field, color vision, and MRI done. In all patients, intracranial malignancies were found, some patients underwent surgery of the lesions with consecutive clinical improvements. Interestingly, in some patients, coexisting glaucoma was diagnosed. Patients were selected deliberately to present a wide spectrum of possible clinical scenarios when glaucoma may be complicated by intracranial tumors. Sometimes, the relevance of intracranial tumors with respect to their influence on the clinical picture of the optic nerve cannot be established. To conclude, in the “atypical cases of glaucoma” the assessment of the optic nerve may indicate the necessity of neuroimaging in differential diagnostics.
... Compressive optic neuropathies causing cupping have been observed in patients with pituitary adenomas, 6,7,[16][17][18][19][20] aneurysms, [21][22][23][24] craniopharyngiomas 19,25 and meningiomas. 16,17,19,26,27 Bianchi-Marzoli et al 28 performed a masked measurement of the optic discs of 29 patients with compressive optic neuropathies and 20 age-matched controls. ...
... Compressive optic neuropathies causing cupping have been observed in patients with pituitary adenomas, 6,7,[16][17][18][19][20] aneurysms, [21][22][23][24] craniopharyngiomas 19,25 and meningiomas. 16,17,19,26,27 Bianchi-Marzoli et al 28 performed a masked measurement of the optic discs of 29 patients with compressive optic neuropathies and 20 age-matched controls. ...
... Compressive optic neuropathies causing cupping have been observed in patients with pituitary adenomas, 6,7,[16][17][18][19][20] aneurysms, [21][22][23][24] craniopharyngiomas 19,25 and meningiomas. 16,17,19,26,27 Bianchi-Marzoli et al 28 performed a masked measurement of the optic discs of 29 patients with compressive optic neuropathies and 20 age-matched controls. This study found a significantly larger cup-to-disc ratio (0.37) for eyes with compressive optic neuropathies than for control eyes (0.10). ...
Optic nerve cupping or enlargement of the cup-to-disc ratio is widely recognized as a feature of glaucoma, however it may also occur in non-glaucomatous optic neuropathies. The most well-recognized non-glaucomatous optic neuropathies that cause cupping include compressive optic neuropathies, arteritic anterior ischemic optic neuropathies, hereditary optic neuropathies, and optic neuritis. Cupping is thought to consist of two main components: prelaminar and laminar thinning. The former is a shallow form of cupping and related to loss of retinal ganglion cells, whereas the latter involves damage to the lamina cribrosa and peripapillary scleral connective tissue. Differentiating glaucomatous and non-glaucomatous optic nerve cupping remains challenging even for experienced observers. Classically, the optic nerve in non-glaucomatous causes has pallor of the neuroretinal rim, but the optic nerve should not be examined in isolation. The patient’s medical history, history of presenting illness, visual function (visual acuity, color vision and visual field testing) and ocular examination also need to be considered. Ancillary testing such as optical coherence tomography of the retinal nerve fiber layer and ganglion cell layer-inner plexiform layer may also be helpful in localizing the disease. In this review, we review the non-glaucomatous causes of cupping and provide an approach to evaluating a patient that presents with an enlarged cup-to-disc ratio.Keywords: optic disc cupping, misdiagnosis of glaucoma, nonglaucomatous cupping, differential diagnosis of glaucoma, optic disc pallor
... A brief review of literature and studies on when to do neuroimaging in a cupped disc with normal intraocular pressure, when to suspect a non-glaucomatous optic neuropathy, and diagnostic yield of these indicators is summarised in Table 1. [1][2][3] This case is intriguing as both the glaucomatous and neurological conditions were co-existing, increasing the complexity and none of these enlisted points could direct towards diagnosis. The clinching factor was history of headache, tinnitus and the peculiar appearance of the disc. ...
Differentiating glaucomatous and non-glaucomatous optic neuropathy can be challenging even to an experienced clinician and it is even more complex to identify early ophthalmic manifestation of neurological lesions when the optic nerve is already jeopardized by advanced glaucoma. This is a case of a patient with juvenile open-angle glaucoma with advanced glaucomatous cupping who developed an intracranial tuberculoma and subsequent obstructive hydrocephalus. Subtle edema identified in an almost totally damaged nerve, coupled with a history of headache and tinnitus, was the clinching factor prompting early treatment in the form of ventriculoperitoneal shunting and antituberculous therapy. Detailed history, systematic clinical exam, and appropriate imaging are imperative in reducing morbidity and sometimes mortality associated with these neurological conditions.
... Но, к сожалению НГ является одной из самых трудно диагностируемых нозологических форм открытоугольной глаукомы и как показал ретроспективный анализ литературы и клиническая практика, нередки случаи обнаружения аденомы гипофиза у пациентов с предполагаемой НГ [2,3,4,5,6,7,8,9,10,11]. По данным ряда авторов частота неверного диагностирования неглаукоматозной оптической нейропатии, развившейся вследствие компрессии аденомой гипофиза хиазмы и зрительного нерва составляет около 6,5-8% [6,11]. ...
... Но, к сожалению НГ является одной из самых трудно диагностируемых нозологических форм открытоугольной глаукомы и как показал ретроспективный анализ литературы и клиническая практика, нередки случаи обнаружения аденомы гипофиза у пациентов с предполагаемой НГ [2,3,4,5,6,7,8,9,10,11]. По данным ряда авторов частота неверного диагностирования неглаукоматозной оптической нейропатии, развившейся вследствие компрессии аденомой гипофиза хиазмы и зрительного нерва составляет около 6,5-8% [6,11]. ...
Цель: дифференциальная диагностика патологии зрения при макроаденоме гипофиза и нормотензивной глаукоме. Материал и методы: Под наблюдением находилась пациентка И., 59 лет с жалобами на снижение остроты зрения и выпадение поля зрения на левом глазу. В дополнение к стандартному офтальмологическому обследованию были произведены: оптическая когерентная томография (Stratus OCT 3000), экстракраниальная и транскраниальная ультразвуковая допплерография и магнитно–резонансная томография (МРТ) головного мозга. Результаты: Была обнаружена частичная атрофия зрительного нерва левого глаза, которая явилась следствием гормонально неактивной макроаденомы гипофиза размерами 3-29-26 мм с эндо-, супра- и параселлярным (левосторонним) ростом. Представленный клинический случай позволил расставить некоторые акценты в дифференциальной диагностике аденомы гипофиза и нормотензивной глаукомы. Выводы: На примере данного клинического случая хотелось бы подчеркнуть важность своевременного и сочетанного ведения специалистами узкого профиля (офтальмологами, невропатологами, эндокринологами и нейрохирургами) пациентов такого рода для ранней и точной диагностики, что может предотвратить высокий процент инвалидизации.
... Furthermore, the absence of rim pallor helps rule out other optic neuropathies (ischemic, infiltrative, traumatic, toxic, metabolic, and compressive) that could also result in retinal nerve fiber layer defects and arteriole narrowing, and which would necessitate a more through systemic workup, possibly including blood work and neuroimaging. [37][38][39] Baseline photos were taken to assist in monitoring for future structural progression 40 that would manifest as widening of the nerve fiber layer defects (locations of future progression and correlating visual field defects 41 ), increased rim thinning/ vessel baring/arteriole narrowing, increased parapapillary atrophy, and/or further nasalization of the central retinal vessel trunk. C Subjective evaluation of serial photos and objective imaging (OCT) are complementary structural evaluations used in concert with regular functional (visual field) assessment to monitor for progression. ...
Glaucoma is the leading cause of irreversible blindness worldwide and is projected to affect more than 79.6 million people by 2020, over 10% of whom will be bilaterally blind.1 This multifactorial progressive optic neuropathy causes characteristic retinal nerve fiber layer damage that will eventually lead to associated glaucomatous visual field defects if left untreated. Unfortunately, these visual field defects are difficult for the patient to detect until more advanced stages and, as a result, early glaucoma is usually asymptomatic.2 This paper presents a case that is consistent with population studies that suggest that as many as half of people with glaucoma are unaware that they have the disease.3
... C des lésions à la couche de fibres nerveuses rétiniennes et un rétrécissement de l'artériole, et qui nécessiteraient des examens systémiques plus poussés, comme des analyses sanguines et la neuroimagerie. [37][38][39] Des photos de référence ont été prises afin de contribuer à la surveillance de la progression structurelle 40 à l'avenir qui pourrait se manifester par un élargissement des lésions à la couche de fibres nerveuses (emplacements de la progression future et corrélation avec les lésions du champ visuel 41 ), une augmentation de l'épaississement de l'anneau, de la mise à vif des vaisseaux ou du rétrécissement de l'artériole, de l'atrophie parapapillaire ou une plus forte nasalisation du tronc des vaisseaux rétiniens centraux. ...
Le glaucome est la principale cause de cécité irréversible dans le monde et devrait toucher plus de 79,6 millions de personnes d’ici 2020, dont plus de 10 % seront atteintes de cécité bilatérale.1Cette neuropathie optique progressive multifactorielle provoque des lésions caractéristiques à la couche de fibres nerveuses rétiniennes qui finiront par entraîner des lacunes glaucomateuses du champ visuel s’ils ne sont pas traités. Malheureusement, ces lacunes du champ visuel sont difficiles à détecter pour le patient avant les stades plus avancés et, par conséquent, le glaucome précoce est habituellement asymptomatique.2Cet article présente un cas qui concorde avec les études des populations selon lesquelles jusqu’à la moitié des personnes atteintes de glaucome ne savent pas qu’elles ont contracté la maladie.3
