Features of medical and surgical treatment of normal-tension glaucoma

Normal-tension glaucoma is a progressive optic neuropathy characterized by thinning of the peripapillary retinal nerve fiber layer and the development of typical visual field defects, open anterior chamber angle, and intraocular pressure levels that do not exceed the statistically normal range. The course of this disease differs from that of hypertensive glaucoma by the presence of more localized and deeper defects of light sensitivity, as well as by a higher rate of progression. The management of normal-tension glaucoma (medical, laser, or surgical) is aimed at reducing intraocular pressure and achieving target levels at which further loss of visual function can be halted. A distinctive feature of the therapeutic approach to this form of glaucoma is the need for lower target intraocular pressure values, which, in combination with the high rate of disease progression, necessitates a more rapid transition to surgical treatment. The challenge of normal-tension glaucoma lies in its diagnostic features, clinical manifestations, and treatment strategies, all of which require a differentiated and personalized approach. This literature review analyzes current data on the morphological and functional differences between normaltension glaucoma and typical primary open-angle glaucoma, evaluates the effectiveness of various pharmacological classes of hypotensive medications, and examines modern trends in the surgical management of this disease.