ABSTRACT.Purpose: To determine whether normal-tension glaucoma (NTG) is associated with metabolic syndrome and to evaluate which components of metabolic syndrome are related to NTG. Methods: This study included 18240 participants who underwent health check-ups including fundus photography and intraocular pressure measurements. For NTG diagnosis, all participants with findings suggestive of glaucoma completed a further glaucoma evaluation, including applanation tonometry, gonioscopy and standard automated perimetry. The National Cholesterol Education Program Adult Treatment Panel III guideline was used to characterize metabolic syndrome. Results: Of the 18240 participants, 3635 (19.9%) had metabolic syndrome and 300 (1.6%) were diagnosed with NTG. The prevalence of NTG was 1.5% in subjects without metabolic syndrome and 2.1% in subjects with metabolic syndrome. The presence of metabolic syndrome was not significantly associated with NTG (p = 0.067). There were significant associations of NTG with hypertension and impaired glucose tolerance (IGT) among the individual components of metabolic syndrome (OR, 1.53; 95% CI, 1.20-1.94; p = 0.001 and OR, 1.47; 95% CI, 1.12-1.94; p = 0.006). NTG was positively associated with the number of metabolic syndrome components (OR, 1.10; p = 0.040). Multivariable analysis showed the prevalence of NTG to be significantly higher in participants aged between 50 and 70 years relative to those aged 40 to 50 years, male gender, participants with higher baseline intraocular pressure, hypertension and IGT. Conclusions: Of the metabolic syndrome components, hypertension and IGT contributed to an increased risk of NTG. These findings suggest that metabolic syndrome components may play a role in the pathogenesis of NTG.

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PurposeTo investigate and compare the circadian pattern of blood pressure (BP), intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) while experiencing undisturbed sleep in normal-tension glaucoma (NTG) and non-glaucoma control patient groups.MethodsTwenty-four eyes from 24 patients diagnosed with NTG and 22 eyes from 22 control group patients were enrolled. Systolic BP, diastolic BP and IOP were measured every two hours except for the period of time from 1 AM to 7 AM in the NTG group and from 11 PM to 7 AM in the control group over a one-day period. IOP and hemodynamic parameters were then compared between the two groups. NTG patients were subdivided according to the degree of morning BP dip and IOP, and hemodynamic parameters and visual field indices (mean deviation and pattern standard deviation) were also compared among these subgroups.ResultsThere were no significant differences in mean systolic BP, mean diastolic BP and mean arterial pressure (MAP) between the NTG and the control groups. The NTG group showed a significantly large morning BP dip compared to the control group (7.1±4.2% vs. 3.8±3.4%, p=0.022). However, there were no significant differences in mean or fluctuation of MOPP between the two groups. Morning over-dippers showed significantly large MAP and MOPP fluctuations compared to non-dippers and dippers, while there were no significant differences in visual field indices among the three subgroups.ConclusionsNTG patients showed significant morning BP dips compared to the control group. The marked morning BP dip was associated with significantly large MAP or MOPP fluctuations but was not associated with visual field indices.

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