Also called low-tension or normal-pressure glaucoma, in normal-tension glaucoma the optic nerve is damaged even though the pressure in the eye is not very high.

Doctors do not know why some people’s optic nerves are damaged even though they have almost normal pressure levels.

Those at higher risk for this form of glaucoma are:

• people with a family history of normal-tension glaucoma
• people of Japanese ancestry
• people with a history of systemic heart disease such as irregular heart rhythm.

How is Normal-tension Glaucoma Different?

Glaucoma is a group of eye diseases that usually share common traits, such as high eye pressure, damage to the optic nerve and gradual sight loss. Most kinds of glaucoma involve elevated eye pressure.

Normal-tension glaucoma (NTG), also known as low tension or normal pressure glaucoma, is a form of glaucoma in which damage occurs to the optic nerve without eye pressure exceeding the normal range. In general, a “normal” pressure range is between 12-21 mm Hg.

What Causes Normal-tension Glaucoma?

The causes of NTG are still unknown. For some reason, the optic nerve is susceptible to damage from even the normal amount of eye pressure. Researchers continue to examine why some optic nerves are damaged by these relatively low eye pressure levels.

How is Normal-tension Glaucoma Diagnosed?

NTG is diagnosed by observing the optic nerve for signs of damage. This can be done in one of two ways.

In one procedure, an instrument called an ophthalmoscope is held close to the eye. In a darkened room, the light from the ophthalmoscope allows the doctor to look through the pupil and examine the shape and color of the optic nerve. A nerve that is cupped or is not a healthy pink color is a cause for concern.

A second procedure is the visual field test. This test produces a map of the patient’s complete field of vision. Using this test, the doctor can check for any areas of sight loss that may be caused by damage to the optic nerve. This would appear as slight changes in the person’s vision occurring anywhere from near the center to the edge of the field of vision. These changes are not necessarily noticeable to the patient.

How is Normal-tension Glaucoma Treated?

Since so little is known about why normal eye pressure damages some eyes, most doctors treat normal tension glaucoma by reducing the eye pressure as low as possible using medications, laser treatments and conventional surgery.

Article by Douglas R. Anderson, MD. Last reviewed and updated on August 5, 2022.

Douglas R. Anderson, MD

Dr. Anderson is Professor emeritus of Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute.