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February 1995

Magnetic Resonance Imaging in Patients With Low-Tension Glaucoma

Author Affiliations

From the Glaucoma Service at the Department of Ophthalmology (Drs Stroman, Stewart, and Golnik), and the Department of Radiology (Dr Curé and Mr Olinger), the Medical University of South Carolina, Charleston.

Arch Ophthalmol. 1995;113(2):168-172. doi:10.1001/archopht.1995.01100020050027

Objective:  To study diagnoses and anatomic findings found on magnetic resonance imaging in patients with low-tension glaucoma.

Patients:  We included in this study magnetic resonance images of 20 consecutive patients with low-tension glaucoma. We individually matched each patient with low-tension glaucoma to a control with normal ocular findings who had magnetic resonance imaging for reasons unrelated to the visual pathway.

Design:  We studied axial and coronal images of the orbit and optic nerve with digitizing software (Image-Pro Plus, Media Cybernetics, Silver Spring, Md). Statistical evaluation was with a Wilcoxon Signed Rank Test for anatomic findings and a McNemar Test for diagnosis.

Results:  We found no difference between groups in the optic nerve diameter or length, the carotid artery area, or the distance from the optic nerve to the carotid artery (P>.05). Left optic nerve area was greater in the control patients than patients with low-tension glaucoma (P=.026). The prevalence of intracranial abnormalities, including meningioma, aneurysm, and arteriovenous abnormality, was similar between groups (P>.05). However, diffuse cerebral small-vessel ischemic changes were found more in patients with low-tension glaucoma (n=8) than control patients (n=1) (P=.0196).

Conclusions:  This study proposes a hypothesis that cerebral small-vessel ischemia is more common in patients with low-tension glaucoma and potentially reflects indirectly a vascular cause of the optic nerve head damage at least in a subgroup of patients. Importantly, further research still is required to provide direct evidence for a vascular cause involved in low-tension glaucoma.

Stewart WC. Clinical Practice of Glaucoma . Thorofare, NJ: Slack Inc; 1990:129-148.
Levene RZ.  Low tension glaucoma: a critical review and new material . Surv Ophthalmol . 1980;24:621-664.Article
Swinscow TDV. Statistics at Square One . London, England: British Medical Association; 1976:58-61.
Siegel S. Nonparametric Statistics for the Behavioral Sciences . New York, NY: McGraw-Hill International Book Co; 1956:63-67.
Van Swieten JC, Hijdra A, Koudstaal PJ, van Gijn J.  Grading white matter lesions on CT and MRI: a simple scale . J Neurol Neurosurg Psychiatry . 1990;53:1080-1083.Article
Haffmans JHA.  Beiträge zu kenntnis des Glaucoms . Albrect von Graefes Arch Ophthalmol . 1861;8:148.
Von Graefe A.  Über die glaucomatose Natur der Amaurose mit Sehnervenexcavation und über das Wesen und die Classification des Glaucoms . Albrecht von Graefes Arch Ophthalmol . 1862;8:271-297.
Hayreh SS. Anterior Ischemic Optic Neuropathy . New York, NY: Springer-Verlag NY Inc; 1975.
Drance SM, Sweeney VP, Morgan RW, Feldman F.  Studies of factors involved in the production of low tension glaucoma . Arch Ophthalmol . 1973;89:457-465.Article
Zeiter JH, Shin DH, Juzych MS, Jarvi TS, Spoor TC, Zwas F.  Visual field defects in patients with normal-tension glaucoma and patients with high-tension glaucoma . Am J Ophthalmol . 1992;114:758-763.
Phelps CD, Corbett JJ.  Migraine and low-tension glaucoma: a case-control study . Invest Ophthalmol Vis Sci . 1985;26:1105-1108.
Drance SM, Douglas GR, Wijsman K, Schulzer M, Britton RJ.  Response of blood flow to warm and cold in normal and low-tension glaucoma patients . Am J Ophthalmol . 1988;105:35-39.
Netland PA, Chaturvedi N, Dreyer EB.  Calcium channel blockers in the management of low-tension and open-angle glaucoma . Am J Ophthalmol . 1993;115:608-613.
Usui T, Iwata K, Shirakashi M, Abe H.  Prevalence of migraine in low-tension glaucoma and primary open-angle glaucoma in Japanese . Br J Ophthalmol . 1991;75:224-226.Article
Usui T, Iwata K.  Finger blood flow in patients with low tension glaucoma and primary open-angle glaucoma . Br J Ophthalmol . 1992;76:2-4.Article
Lumme P, Juulonen A, Airaksinen PJ, Alanko HI.  Neuroretinal rim area in low tension glaucoma: effect of nifedipine and acetazolamide compared to no treatment . Acta Ophthalmol . 1991;69:293-298.Article
Drance SM, Morgan RW, Sweeney VP.  Shock-induced optic neuropathy: a cause of nonprogressive glaucoma . N Engl J Med . 1973;288:392-394.Article
Sugar HS.  Low tension glaucoma: a practical approach . Ann Ophthalmol . 1979;11:1155-1171.
Parravano JG, Toledo A, Kucharczyk W.  Dimensions of the optic nerves, chiasm, and tracts: MR quantitative comparison between patients with optic atrophy and normals . J Comput Assist Tomogr . 1993;17:688-690.Article
Bradley WG.  Investigators solve mystery of unidentified bright spots . Diagn Imaging . (November) 1988:322-326.
Chimowitz MI, Estes ML, Furlan AJ, Awad IA.  Further observations on the pathology of subcortical lesions identified on magnetic resonance imaging . Arch Neurol . 1992;49:747-752.Article
Mirsen TR, Lee DH, Wong CJ, et al.  Clinical correlates of white-matter changes on magnetic resonance imaging scans of the brain . Arch Neurol . 1991;48:1015-1021.Article
Jay WM, Williamson MR.  Incidence of subcortical lesions not increased in nonarteritic ischemic optic neuropathy on magnetic resonance imaging . Am J Ophthalmol . 1986;104:398-400.
Herholz K, Heindel W, Rackl A, et al.  Regional cerebral blood flow in patients with leuko-araiosis and atherosclerotic carotid artery disease . Arch Neurol . 1990;47:392-396.Article
Boone KB, Miller BL, Lesser IM, et al.  Neuropsychological correlates of white-matter lesions in healthy elderly subjects: a threshold effect . Arch Neurol . 1992;49:549-554.Article