{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:48:49Z","timestamp":1761767329087,"version":"3.44.0"},"reference-count":40,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2024,5,27]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:p>Glaucoma is a progressive optic neuropathy resulting from pathological changes at the optic disc due to elevated intraocular pressure. Its diagnosis, treatment and follow-up are almost entirely conducted in ophthalmology clinics, with screening conducted by community optometrists. Despite this, neurologists may encounter glaucoma in both its acute presentation (as angle closure, presenting as acute headache) and its chronic forms (often as optic neuropathy of unknown cause). An awareness of the underlying pathological process, and the key distinguishing signs and symptoms, will allow neurologists to identify the glaucomatous process rapidly. Timely referral is essential as glaucoma invariably results in progressive visual loss without treatment. This review therefore condenses the wide field of glaucoma into a practical summary, aimed at practitioners with limited clinical experience of this ophthalmic condition.<\/jats:p>","DOI":"10.1136\/pn-2023-003905","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T13:22:25Z","timestamp":1718976145000},"page":"493-502","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Glaucoma: what the neurologist needs to know"],"prefix":"10.1136","volume":"24","author":[{"given":"Gavin L","family":"Reynolds","sequence":"first","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordon","family":"Plant","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Epps","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rani","family":"Sebastian","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-3567","authenticated-orcid":false,"given":"Luke","family":"Bennetto","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK"},{"name":"Department of Neuroscience, North Bristol NHS Trust Southmead Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"2025090411341103000_24.6.493.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j3889","article-title":"Glaucoma and intraocular pressure in EPIC-Norfolk eye study: cross sectional study","volume":"358","author":"Chan","year":"2017","journal-title":"BMJ"},{"key":"2025090411341103000_24.6.493.2","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2015.288"},{"key":"2025090411341103000_24.6.493.3","unstructured":"Lee NSY , Woo TL , Agar A , et al . Acute angle closure glaucoma Misdiagnosed as sinusitis. 2023. Available: https:\/\/pn.bmj.com\/content\/early\/2023\/09\/07\/pn-2023-003864 [Accessed 19 Sep 2023]."},{"key":"2025090411341103000_24.6.493.4","doi-asserted-by":"publisher","DOI":"10.3109\/0142159X.2010.540594"},{"key":"2025090411341103000_24.6.493.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00200-9"},{"key":"2025090411341103000_24.6.493.6","doi-asserted-by":"crossref","DOI":"10.21037\/aes.2019.12.06","article-title":"Optical coherence tomography use in idiopathic intracranial hypertension","volume":"5","author":"Malhotra","year":"2020","journal-title":"Ann Eye Sci"},{"key":"2025090411341103000_24.6.493.7","doi-asserted-by":"crossref","first-page":"102688","DOI":"10.1016\/j.msard.2020.102688","article-title":"Late-onset Leber's hereditary optic neuropathy presenting with Longitudinally extensive Myelitis Harbouring the M.14484T>C Mutation: extending the genotype-phenotype spectrum","volume":"48","author":"Cleaver","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"2025090411341103000_24.6.493.8","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2012-000270"},{"key":"2025090411341103000_24.6.493.9","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(83)90389-6"},{"key":"2025090411341103000_24.6.493.10","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/98.1.13"},{"key":"2025090411341103000_24.6.493.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.04.012"},{"key":"2025090411341103000_24.6.493.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2016.12.002"},{"key":"2025090411341103000_24.6.493.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2004.04.054"},{"key":"2025090411341103000_24.6.493.14","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/WON.0000000000000080","article-title":"Optic nerve Cupping and the neuro-Ophthalmologist","volume":"33","author":"Fraser","year":"2013","journal-title":"J Neuroophthalmol"},{"key":"2025090411341103000_24.6.493.15","doi-asserted-by":"crossref","first-page":"3872","DOI":"10.1167\/iovs.15-17328","article-title":"Retinal ganglion cell and inner Plexiform layer loss correlate with visual acuity loss in LHON: A longitudinal, Segmentation OCT analysis","volume":"57","author":"Moster","year":"2016","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2025090411341103000_24.6.493.16","first-page":"5507","article-title":"Retinal nerve fibre layer analysis in toxic and nutritional optic neuropathy","volume":"59","author":"Patel","year":"2018","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2025090411341103000_24.6.493.17","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1016\/j.ophtha.2012.05.009","article-title":"Patterns of Peripapillary retinal nerve fiber layer thinning in vigabatrin-exposed individuals","volume":"119","author":"Clayton","year":"2012","journal-title":"Ophthalmology"},{"key":"2025090411341103000_24.6.493.18","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30278-8"},{"key":"2025090411341103000_24.6.493.19","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp001"},{"key":"2025090411341103000_24.6.493.20","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001155"},{"key":"2025090411341103000_24.6.493.21","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/01658107.2016.1195413","article-title":"Idiopathic acquired temporal wedge visual field defects","volume":"40","author":"Gilhooley","year":"2016","journal-title":"Neuro-Ophthalmology"},{"key":"2025090411341103000_24.6.493.22","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2011-301189"},{"key":"2025090411341103000_24.6.493.23","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.4103\/ijo.IJO_2134_21","article-title":"Topiramate-induced acute angle closure: A systematic review of case reports and case series","volume":"70","author":"Al Owaifeer","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"2025090411341103000_24.6.493.24","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1001\/archopht.120.6.701","article-title":"The ocular hypertension treatment study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma","volume":"120","author":"Kass","year":"2002","journal-title":"Arch Ophthalmol Chic Ill"},{"key":"2025090411341103000_24.6.493.25","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2010.20"},{"key":"2025090411341103000_24.6.493.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(01)00964-3"},{"key":"2025090411341103000_24.6.493.27","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1038\/s41433-019-0681-y","article-title":"The role of intracranial pressure in glaucoma and therapeutic implications","volume":"34","author":"Baneke","year":"2020","journal-title":"Eye (Lond)"},{"key":"2025090411341103000_24.6.493.28","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1080\/01658107.2016.1226344","article-title":"Asymmetrical intraocular pressures and asymmetrical papilloedema in pseudotumor cerebri syndrome","volume":"40","author":"Lawlor","year":"2016","journal-title":"Neuro-Ophthalmology"},{"key":"2025090411341103000_24.6.493.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.07.033"},{"key":"2025090411341103000_24.6.493.30","doi-asserted-by":"crossref","first-page":"e220","DOI":"10.1097\/WNO.0000000000001095","article-title":"Optic disc edema and posterior globe flattening secondary to ocular hypotony: case report and discussion regarding pathophysiology and clinical findings","volume":"41","author":"Albano de Guimar\u00e3es","year":"2021","journal-title":"J Neuroophthalmol"},{"key":"2025090411341103000_24.6.493.31","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1177\/1120672118804791","article-title":"Study of Lamina Cribrosa depth and optic nerve in patients with spontaneous intracranial hypotension","volume":"29","author":"Soares","year":"2019","journal-title":"Eur J Ophthalmol"},{"key":"2025090411341103000_24.6.493.32","doi-asserted-by":"crossref","first-page":"101193","DOI":"10.1016\/j.mam.2023.101193","article-title":"Neuroprotection in glaucoma: mechanisms beyond intraocular pressure lowering","volume":"92","author":"Tribble","year":"2023","journal-title":"Molecular Aspects of Medicine"},{"key":"2025090411341103000_24.6.493.33","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.121.1.48"},{"key":"2025090411341103000_24.6.493.34","doi-asserted-by":"publisher","DOI":"10.1097\/00055735-200304000-00006"},{"key":"2025090411341103000_24.6.493.35","doi-asserted-by":"publisher","DOI":"10.1089\/jop.1993.9.373"},{"key":"2025090411341103000_24.6.493.36","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1080\/17512433.2021.1931123","article-title":"Oral acetazolamide for intraocular pressure lowering: balancing efficacy and safety in ophthalmic practice","volume":"14","author":"Gulati","year":"2021","journal-title":"Expert Rev Clin Pharmacol"},{"key":"2025090411341103000_24.6.493.37","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/S0140-6736(18)32213-X","article-title":"Selective laser Trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (light): a Multicentre randomised controlled trial","volume":"393","author":"Gazzard","year":"2019","journal-title":"The Lancet"},{"key":"2025090411341103000_24.6.493.38","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3109\/09286589409071443","article-title":"An analysis of referral routes and diagnostic accuracy in cases of suspected glaucoma","volume":"1","author":"Sheldrick","year":"1994","journal-title":"Ophthalmic Epidemiol"},{"key":"2025090411341103000_24.6.493.39","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.survophthal.2017.09.010","article-title":"Glaucoma and the brain: Trans-synaptic degeneration, structural change, and implications for Neuroprotection","volume":"63","author":"Lawlor","year":"2018","journal-title":"Surv Ophthalmol"},{"key":"2025090411341103000_24.6.493.40","doi-asserted-by":"crossref","unstructured":"Jindahra P , Plant GT , Jindahra P , et al . Retinal nerve fibre layer thinning in Alzheimer disease. In: The Clinical Spectrum of Alzheimer\u2019s Disease -The Charge Toward Comprehensive Diagnostic and Therapeutic Strategies. IntechOpen.2011. Available: https:\/\/www.intechopen.com\/chapters\/19248 [accessed 2 Jan 2024].","DOI":"10.5772\/16891"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2023-003905","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T18:34:22Z","timestamp":1757010862000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2023-003905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,21]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,11,17]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/pn-2023-003905"],"URL":"https:\/\/doi.org\/10.1136\/pn-2023-003905","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"type":"print","value":"1474-7758"},{"type":"electronic","value":"1474-7766"}],"subject":[],"published":{"date-parts":[[2024,6,21]]}}}