NTG Designed for iPhone 11 Case, Heavy-Duty Tough Rugged Lightweight Slim Shockproof Protective Case for iPhone 11 6.1 Inch, Black

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Galassi F, Giambene B, Varriale R. Systemic vascular dysregulation and retrobulbar hemodynamics in normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2011;52:4467–71. In the case of NTG, detailed differential diagnostics should be performed before establishing the diagnosis because optic disc cupping is not pathognomonic for glaucoma. Glaucoma with previously or periodically increased IOP needs to be excluded (pigmentary glaucoma and steroid or inflammatory glaucoma, also the cases with wide daily fluctuations in IOP). Excavated disc may be observed in the course of ischemic neuropathy, inherited anomalies, and compressive neuropathy [ 7]. The distinction between NTG and the last of these conditions is crucial because it excludes underlying life-threatening conditions. Flammer J, Orgul S, Costa VP, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002;21:359–93.

Tarasoff-Conway JM, Carare RO, Osorio RS, et al. Clearance systems in the brain-implications for Alzheimer disease. Nat Rev Neurol. 2015;11:457–70. Mojon DS, Hess CW, Goldblum D, et al. High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology. 1999;106:1009–12. Choi J, Kim KH, Jeong J, Cho HS, Lee CH, Kook MS. Circadian fluctuation of mean ocular perfusion pressure is a consistent risk factor for normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2007;48(1):104–11.

Are the visual field defects different in NTG and HTG?

Cellini M, Possati GL, Profazio V, Sbrocca M, Caramazza N, Caramazza R. Color doppler imaging and plasma levels of endothelin-1 in low-tension glaucoma. Acta Ophthalmol Scand Suppl. 1997;224:11–3. Wostyn P, De Groot V, Van Dam D, Audenaert K, De Deyn PP. Senescent changes in cerebrospinal fluid circulatory physiology and their role in the pathogenesis of normal-tension glaucoma. Am J Ophthalmol. 2013;156:5–14. Caprioli J, Sears M, Spaeth GL. Comparison of visual field defects in normal-tension glaucoma and high-tension glaucoma. Am J Ophthalmol. 1986;102:402–4.

NTG is caused by impaired CSF circulation in the subarachnoid space of the optic nerve and this results in a toxic damage to the nerve. Luo XG, Chiu K, Lau FH, Lee VW, Yung KK, So KF. The selective vulnerability of retinal ganglion cells in rat chronic ocular hypertension model at early phase. Cell Mol Neurobiol. 2009;29:1143–51. King D, Drance SM, Douglas G, Schulzer M, Wijsman K. Comparison of visual field defects in normal-tension glaucoma and high-tension glaucoma. Am J Ophthalmol. 1986;101:204–7.

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All patients meeting the inclusion criteria who agreed to participate in the research had MRI scans performed on the brain and both orbits with a 1.5-Tesla Magnetic Resonance Scanner (Optima 360, GE Healthcare). The scans were carefully evaluated by experienced neuroradiologists (RP, BS). Any pathology found was classified as either possibly interfering with the glaucoma diagnosis or not significant. The patient’s serial mean BP, especially in the lower limbs (mean value, 125/70 mmHg), ruled out the possibility of systemic hypotension. Thyroid and coagulation abnormalities and autoimmune disease and inflammatory disease were excluded by normal thyroid-stimulating hormone (TSH), T4, prothrombin time (PT), partial thromboplastin time (PTT), bleeding time (BT), and negative anticardiolipin antibody, as well as other immunologic study and normal vascular biopsy. The findings of the patient’s brain magnetic resonance imaging (MRI) were normal, as was his carotid vascular study. Primary diagnosis Stowell C, Burgoyne CF, Tamm ER, Ethier CR. Biomechanical aspects of axonal damage in glaucoma: A brief review. Exp Eye Res. 2017;157:13–9.