When should neuroradiological imaging be undertaken in patients with normal tension glaucoma?

The Science behind the Tip

Clinicians must remain vigilant to detect intracranial pathology in patients with normal tension glaucoma. Most patients do not need to be investigated. However, neuroradiological imaging should be considered under the following circumstances:

· Monocular loss of visual acuity in the absence of advanced cupping or other ocular pathology

· Monocular loss of colour vision (using Ishihara colour plates)

· Visual field loss that is not consistent with glaucomatous nerve fibre layer loss (in rare cases chiasmal lesions can produce cupping with superior visual field loss)

· Rapidly progressing optic nerve disease in the presence of good IOP control (glaucoma is generally a slowly progressive disease)

· Optic disc pallor, especially of the neuroretinal rim

Contributor: J F Salmon MD FRCS, Oxford Eye Hospital

References

1. Mills RP. The cupped disc: who needs neuroimaging (editorial) Ophthalmology 1998; 105: 1873

2. Ahmed I I, Feldman F, Kucharczyk W, Trope G E. Neuroradiologic screening in normal-pressure glaucoma: study results and review of the literature. Glaucoma 2002; 11:279-286.

Tip Reviewer: Roger Hitchings
Tip Editors: Ann Hoste, John Salmon and John Thygesen