Diagnosis and Monitoring of Low-Tension Glaucoma

Purpose: The purpose of this review is to discuss current ideas on the definition, pathophysiology, diagnosis, and management of low-tension glaucoma (LTG). Recent Findings: While previously considered a distinct entity, LTG may be a continuation of primary open angle glaucoma with intraocular pressures (IOPs) within the statistical range of “normal”. Vascular dynamics, sleep apnea, and intracranial pressure may play a role in patients with LTG. Summary: LTG remains a diagnosis of exclusion. A thorough medical history and possible blood work-up and neuroimaging may help exclude nutritional deficiencies, toxicities, and intracranial masses. Vasculature dysregulation may play a role in LTG and account for its association with certain systemic conditions. IOP lowering remains the mainstay treatment of LTG, with caution advised for topical beta-blocker medications. Non-IOP-lowering therapy, such as treating underlying systemic conditions potentially affecting ocular blood flow (e.g. hypotension, anemia, sleep apnea) and nutritional supplements (Ginkgo biloba and resveratrol), may be beneficial and are currently being studied.