Low-Tension Glaucoma Treatment & Management

Updated: Sep 20, 2018
  • Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

In low-tension glaucoma (LTG), the aim of IOP-lowering medications is for a reduction of at least 30%.

Also see the following clinical guideline summaries:

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Surgical Care

Argon laser trabeculoplasty (ALT): This procedure may have minimal effect because the intraocular pressure (IOP) is already in the reference range.

Selective laser trabeculoplasty (SLT): SLT targets pigment-producing cells in the trabecular meshwork with less tissue destruction and scarring compared with ALT.

Trabeculectomy: If medical therapy is ineffective, adjunctive antimetabolite therapy likely is needed for postoperative IOP to be in the single digits. A higher risk of hypotony and endophthalmitis exists when targeting extremely low pressures that may be needed to retard or prevent progression of field loss.

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Consultations

Neurophthalmologist consultation can be ordered to rule out compressive optic neuropathy (as indicated).

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Diet

An increase in salt intake may be recommended if the patient's diastolic blood pressure is significantly lower than the systolic blood pressure (ie, >70 mm Hg). However, controversy exists regarding this recommendation. Exercise caution in those patients with vascular or cardiac disease.

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Activity

No restrictions on activity are indicated.

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Long-Term Monitoring

After obtaining baseline optic disc photos and/or analysis and visual fields, patients should receive regular follow-up care (eg, at least every 6 months) to monitor for progression of field loss and optic nerve tissue in low-tension glaucoma (LTG).

Evaluate risk factors for defective visual-field progression linked to the following 4 independent predictive factors determined by the Canadian Glaucoma Study [22] :

  • Abnormal anticardiolipin antibody level

  • Higher mean intraocular pressure (IOP) at follow up

  • Higher baseline age

  • Female sex

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