Time to Eliminate “Normal Tension” in Primary Open-Angle Glaucoma

  • Diya Yang
  • Robert N. WeinrebEmail author
Part of the Advances in Visual Science and Eye Diseases book series (AVSED, volume 1)


Glaucoma affects more than 70 million people worldwide with approximately 10% being bilaterally blind. It is the leading cause of irreversible blindness in the world [1]. Primary open-angle glaucoma (POAG), perhaps the most common type of glaucoma, is an optic neuropathy characterized by an accelerated loss of retinal ganglion cells [2]. There is a characteristic excavated appearance of the optic disc associated with visual field loss.


  1. 1.
    Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901–11.CrossRefGoogle Scholar
  2. 2.
    Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711–20.CrossRefGoogle Scholar
  3. 3.
    Hollands H, Johnson D, Hollands S, Simel DL, Jinapriya D, Sharma S. Do findings on routine examination identify patients at risk for primary open-angle glaucoma? JAMA. 2013;309(19):2035–42.CrossRefGoogle Scholar
  4. 4.
    Lee BL, Bathija R, Weinreb RN. The definition of normal-tension glaucoma. J Glaucoma. 1998;7(6):366–71.CrossRefGoogle Scholar
  5. 5.
    Sommer A. Ocular hypertension and normal-tension glaucoma: time for banishment and burial. Arch Ophthalmol. 2011;129(6):785–7.CrossRefGoogle Scholar
  6. 6.
    Von Graefe A. Uber die iridectomie bei glaucoma und uber den glaucomatosen prozess. Graefes Arch Clin Exp Ophthalmol. 1857;3:456–65.CrossRefGoogle Scholar
  7. 7.
    Von Graefe A. Uber die glaucomatose Natur der “Amaurosen mit Sehnervenexkavation” und uber das Wesen und die Classification des Glaucoms. Graefe. Arch Ophthalmol. 1862;8:271.Google Scholar
  8. 8.
    Schiotz H. Ein neuer Tonometer: Tonometrie. Arch Augenheilkd. 1905;52:401.Google Scholar
  9. 9.
    Pickard R. Glaucoma and low tension disc cup enlargements. Br J Ophthalmol. 1931;15(6):323–33.CrossRefGoogle Scholar
  10. 10.
    Drance SM, Sweeney VP, Morgan RW, Feldman F. Studies of factors involved in the production of low tension glaucoma. Arch Ophthalmol. 1973;89(6):457–65.CrossRefGoogle Scholar
  11. 11.
    Drance SM, Morgan RW, Sweeney VP. Shock-induced optic neuropathy: a cause of nonprogressive glaucoma. N Engl J Med. 1973;288(8):392–5.CrossRefGoogle Scholar
  12. 12.
    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(2):204–7.CrossRefGoogle Scholar
  13. 13.
    Cartwright MJ, Anderson DR. Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma (low-tension glaucoma). Arch Ophthalmol. 1988;106(7):898–900.CrossRefGoogle Scholar
  14. 14.
    Shields MB. Textbook of glaucoma. Lippincott, Williams & Wilkins, 1992.Google Scholar
  15. 15.
    Hollows FC, Graham PA. Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol. 1966;50(10):570–86.CrossRefGoogle Scholar
  16. 16.
    Jonas JB, Wang N, Yang D, Ritch R, Panda-Jonas S. Facts and myths of cerebrospinal fluid pressure for the physiology of the eye. Prog Retin Eye Res. 2015;46:67–83.CrossRefGoogle Scholar
  17. 17.
    Zhang Z, Liu D, Jonas JB, Wu S, Kwong JM, Zhang J, Liu Q, Li L, Lu Q, Yang D, Wang J, Wang N. Axonal transport in the rat optic nerve following short-term reduction in cerebrospinal fluid pressure or elevation in intraocular pressure. Invest Ophthalmol Vis Sci. 2015;56(8):4257–66.CrossRefGoogle Scholar
  18. 18.
    Ren R, Jonas JB, Tian G, Zhen Y, Ma K, Li S, Wang H, Li B, Zhang X, Wang N. Cerebrospinal fluid pressure in glaucoma: a prospective study. Ophthalmology. 2010;117(2):259–66.CrossRefGoogle Scholar
  19. 19.
    Wang N, Xie X, Yang D, Xian J, Li Y, Ren R, Peng X, Jonas JB, Weinreb RN. Orbital cerebrospinal fluid space in glaucoma: the Beijing intracranial and intraocular pressure (iCOP) study. Ophthalmology. 2012;119(10):2065–73.CrossRefGoogle Scholar
  20. 20.
    Liu H, Yang D, Ma T, Shi W, Zhu Q, Kang J, Wang N. Measurement and associations of the optic nerve subarachnoid space in Normal tension and primary open-angle Glaucoma. Am J Ophthalmol. 2018;186:128–37.CrossRefGoogle Scholar
  21. 21.
    Yang D, Fu J, Hou R, Liu K, Jonas JB, Wang H, Chen W, Li Z, Sang J, Zhang Z, Liu S, Cao Y, Xie X, Ren R, Lu Q, Weinreb RN, Wang N. Optic neuropathy induced by experimentally reduced cerebrospinal fluid pressure in monkeys. Invest Ophthalmol Vis Sci. 2014;55(5):3067–73.CrossRefGoogle Scholar
  22. 22.
    Stone EM, Fingert JH, Alward WL, Nguyen TD, Polansky JR, Sunden SL, Nishimura D, Clark AF, Nystuen A, Nichols BE, Mackey DA, Ritch R, Kalenak JW, Craven ER, Sheffield VC. Identification of a gene that causes primary open angle glaucoma. Science. 1997;275(5300):668–70.CrossRefGoogle Scholar
  23. 23.
    Wiggs JL, Allingham RR, Vollrath D, Jones KH, De La Paz M, Kern J, Patterson K, Babb VL, Del Bono EA, Broomer BW, Pericak-Vance MA, Haines JL. Prevalence of mutations in TIGR/Myocilin in patients with adult and juvenile primary open-angle glaucoma. Am J Hum Genet. 1998;63(5):1549–52.CrossRefGoogle Scholar
  24. 24.
    Fingert JH, Héon E, Liebmann JM, Yamamoto T, Craig JE, Rait J, Kawase K, Hoh ST, Buys YM, Dickinson J, Hockey RR, Williams-Lyn D, Trope G, Kitazawa Y, Ritch R, Mackey DA, Alward WL, Sheffield VC, Stone EM. Analysis of myocilin mutations in 1703 glaucoma patients from five different populations. Hum Mol Genet. 1999;8(5):899–905.CrossRefGoogle Scholar
  25. 25.
    Rezaie T, Child A, Hitchings R, Brice G, Miller L, Coca-Prados M, Héon E, Krupin T, Ritch R, Kreutzer D, Crick RP, Sarfarazi M. Adult-onset primary open-angle glaucoma caused by mutations in optineurin. Science. 2002;295(5557):1077–9.CrossRefGoogle Scholar
  26. 26.
    Thonginnetra O, Greenstein VC, Chu D, Liebmann JM, Ritch R, Hood DC. Normal versus high tension glaucoma: a comparison of functional and structural defects. J Glaucoma. 2010;19(3):151–7.CrossRefGoogle Scholar
  27. 27.
    Shields MB. Normal-tension glaucoma: is it different from primary open-angle glaucoma? Curr Opin Ophthalmol. 2008;19(2):85–8.CrossRefGoogle Scholar
  28. 28.
    Sommer A, Tielsch JM, Katz J, Quigley HA, Gottsch JD, Javitt J, Singh K. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991;109(8):1090–5.CrossRefGoogle Scholar
  29. 29.
    Liu JH, Zhang X, Kripke DF, Weinreb RN. Twenty-four-hour intraocular pressure pattern associated with early glaucomatous changes. Invest Ophthalmol Vis Sci. 2003;44(4):1586–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
  2. 2.Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
  3. 3.Hamilton Glaucoma Center and the Department of OphthalmologyUniversity of California, San DiegoLa JollaUSA

Personalised recommendations