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Editors Selection IGR 24-4
Risk Factors: Risk factors for NTG progression
Comment by Yunhan Lee & Michael Kook on:
116720 Natural History and Risk Factors for Glaucoma Progression in Chinese Patients With Normal-Tension Glaucoma, Chen DF; Wang C; Si Y et al., Investigative Ophthalmology and Visual Science, 2024; 65: 28
While the Collaborative Normal Tension Glaucoma Study and Early Manifest Glaucoma Trial primarily focused on non-Asian populations,1,2 this study provides valuable insights into the progression of normal-tension glaucoma (NTG) in Chinese patients, addressing a knowledge gap regarding NTG in Asian cohorts. It complements prospective studies conducted in Japanese patients,3 enabling comparisons of regional differences within Asia. Unlike the Japanese study, this study identifies shorter axial length (AL) and younger age as distinctive contributors to NTG progression, offering a fresh perspective on NTG pathophysiology.
Identification of shorter AL as a risk factor for NTG progression
The identification of shorter AL as a risk factor for NTG progression is noteworthy. The authors suggest that this may result from crowded optic nerve head anatomy in shorter eyes, which increases mechanical stress and susceptibility to glaucomatous damage. Conversely, longer AL may offer protection against progression by minimizing IOP fluctuations4 and reducing mechanical strain on the lamina cribrosa. Unexpectedly, younger age was also associated with faster structural progression, in contrast to previous studies that linked older age to more rapid progression. The authors hypothesize that younger patients may lack the vascular adaptations seen in older individuals, such as elevated systolic blood pressure, which could help maintain optic nerve perfusion.
Interestingly, IOP fluctuation was not identified as a significant risk factor in this study, differing from findings in Japanese and other populations.3 The authors propose that the higher mean IOP observed in this cohort may overshadow the effects of IOP fluctuations. This suggests that mean IOP may play a more critical role in NTG progression in populations with relatively higher baseline IOPs.
This study highlights the complex interplay of AL and age in NTG progression. Further research is needed to validate these findings and determine whether these risk factors arise from universal mechanisms or are population specific. Overall, this study makes a significant contribution to understanding NTG in Asian populations and emphasizes the importance of individualized management strategies for NTG.
References
- Collaborative Normal-Tension Glaucoma Study Group. Natural history of normal-tension glaucoma. Am J Ophthalmol. 1998;126(4):487-497.
- Heijl A, Leske MC, Bengtsson B, Hyman L, Hussein M; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120(10):1268-1279.
- Nakazawa N, Tanaka K, Onodera H, et al. Factors associated with progression of Japanese open-angle glaucoma with lower normal intraocular pressure. Ophthalmology. 2018;125(11):1660-1668.
- Jeong DW, Kook MS, Lee KS, Lee JR, Han S. Circadian pattern of intraocular pressure fluctuation in young myopic eyes with open-angle glaucoma. Invest Ophthalmol Vis Sci. 2014;55(4);2148-2156.
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