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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US Preventive Services Task Force - Screening for glaucoma: recommendation statement [15]
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American Academy of Ophthalmology - Primary open-angle glaucoma [16]
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American Optometric Association - Comprehensive adult eye and vision examination [17]
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.
Consultations
Neurophthalmologist consultation can be ordered to rule out compressive optic neuropathy (as indicated).
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.
Activity
No restrictions on activity are indicated.
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] :
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Abnormal anticardiolipin antibody level
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Higher mean intraocular pressure (IOP) at follow up
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Higher baseline age
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Female sex
