The results demonstrate that patients with normal-tension glaucoma show evident psychosomatic involvement. However, the sequence of the pathogenetic development remains unclear. Therefore, it is not known whether these psychological disturbances are factors contributing to the development of normal-tension glaucoma or whether they are a result of normal-tension glaucoma. Nevertheless, some patients with normal-tension glaucoma had these disturbances. Besides reduction of intraocular pressure and improvement of vascular condition, those who display psychological disturbances should receive psychological support, such as autogenic training.

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A low magnification (5 degrees x 20 degrees) and a 50 x 50 frame allows a global assessment of HRF parameters at the papilla with high reliability. In healthy eyes, the HRF values are influenced by the level where measurements are made at the papilla. This might be of importance in glaucoma patients with excavated papilla.

The aim of the study was to evaluate whether the Heidelberg retina flowmeter (HRF), a new device for retinal and anterior optic nerve blood flow assessment, can gauge, at least semiquantitatively, a known effect such as an increase in optic nerve blood flow by hypercapnia or a decrease in optic nerve blood flow by hyperoxia or high intraocular pressure (IOP). Measurements with the HRF were obtained at the papilla of three groups of 5 young healthy subjects (1) at baseline and after breathing 5% carbogen, (2) at baseline and after breathing 100% oxygen and (3) at baseline and after increasing IOP to 20 and 50 mm Hg. The changes in the value of the HRF parameter ‘flow’ were analyzed by means of a paired Student’s t test. Breathing 100% oxygen for 7 min resulted in a statistically significant decrease of 34.7±2.5% (mean ± SEM) in HR parameter ‘flow’ (p < 0.01) at the papilla. Breathing 5% carbogen for 7 min resulted in a statistically significant increase of 18.3±2.6% in HRF parameter ‘flow’ (p = 0.024). Increasing IOP to 20 mm Hg did not result in a statistically significant change in HRF parameter ‘flow’ (–9.6±7.4%; p = 0.13). Increasing IOP from 20 to 50 mm Hg, however, resulted in a statistically significant decrease of 40.1±6.6% in HRF parameter ‘flow’ (p = 0.003). With the applied stimuli, the HRF parameter ‘flow’ changed in the expected direction, i.e. an increase with hypercapnia and a decrease with hyperoxia or high IOP. The simplicity of use of the HRF instrument suggests that it might be well suited for a non-invasive, at least semiquantitative, assessment of changes in blood flow at the papilla.

The intra-ocular pressure rises when body position is changed from sitting to supine. This phenomenon occurs to the same extent in healthy people and glaucoma patients. The purpose of this preliminary study was to determine the effect of posture on the visual field. Visual fields of 15 eyes of 12 normal-tension glaucoma (NTG) patients, 16 eyes of 11 high-tension glaucoma (HTG) patients and 30 eyes of 26 healthy controls were measured in the upright and supine positions with program GIX on an Octopus swivel-arm perimeter. The delta mean defect (ΔMD), that is MDupright–MDsupine, was calculated for each patient and compared among study groups. Whereas visual fields improved in healthy controls (ΔMD = +0.45 dB), glaucoma patients showed a slight deterioration of the visual field after changing position from supine to upright (HTG: ΔMD = ––0.25 dB, NTG: ΔMD = ––0.24 dB). The difference between HTG and controls, as well as between NTG and controls, was statistically significant (p < 0.002, Student’s t test). These findings indicate that in some glaucoma patients the regulatory mechanisms for blood supply in the optic nerve head are insufficient.