{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:22:34Z","timestamp":1790716954368,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cheil Nam-Myung Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The aim of this study was to identify the most reliable ocular exam and establish a threshold for deciding whether to perform neuroimaging in order to screen for diverse diseases other than normal-tension glaucoma (NTG). A retrospective, observational, comparative study was used. Methods: In total, 106 individuals with atypical features of NTG who underwent glaucoma assessments and contrast-enhanced MRI of the brain or orbit were included. The criteria for atypical NTG included the following: (1) unilateral normal-tension glaucoma, (2) visual field (VF) damage inconsistent with optic disc appearance, (3) fast VF progression, (4) worsening of visual acuity, (5) optic disc pallor, (6) scotoma restricted by a vertical line, and (7) central scotoma. Glaucoma evaluations included measurements of visual acuity, intraocular pressure, central corneal thickness, axial length, cup\u2013disc ratio, retinal nerve fiber layer (RNFL) thickness, ganglion cell\u2013inner plexiform layer (GCIPL) thickness, mean deviation (MD), and visual field index (VFI). Statistical analyses involved independent t-tests, receiver operating characteristic (ROC) curves, and area under the curve (AUC) in order to differentiate neuro-ophthalmological conditions from NTG, compare the diagnostic power of each factor, and determine the cut-off value. Results: Relatively fewer diagnoses of non-glaucomatous diseases were associated with unilateral NTG, the worsening of VA, and central scotoma. Factors such as rapid visual field progression, optic disc pallor, and scotoma restricted by a vertical line had a relatively higher diagnostic rate of non-glaucomatous diseases. There were significant differences in average RNFL and GCIPL thicknesses at the nasal quadrant between NTG and NTG-mimicking conditions. Only the GCIPL thickness at the nasal quadrant had reliable power for discriminating between neuro-ophthalmological disease and NTG. For the GCIPL thickness at the nasal quadrant, the AUC was 0.659, and the cut-off value was 65.75. Conclusions: When deciding whether to proceed with imaging, such as carrying out an MRI test, for NTG patients with atypical NTG characteristics, it would be advisable to consider the nasal sector cut-off value of GCIPL thickness.<\/jats:p>","DOI":"10.3390\/jcm13216585","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T11:53:43Z","timestamp":1730462023000},"page":"6585","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Discriminating Diseases Mimicking Normal-Tension Glaucoma (NTG) from NTG"],"prefix":"10.3390","volume":"13","author":[{"given":"Hee-Kyung","family":"Ryu","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Ah","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee-Jong","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan-Kee","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4536-5332","authenticated-orcid":false,"given":"Hae-Young Lopilly","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1097\/00061198-199812000-00003","article-title":"The definition of normal-tension glaucoma","volume":"7","author":"Lee","year":"1998","journal-title":"J. Glaucoma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"250","DOI":"10.4103\/tjo.tjo_30_20","article-title":"Normal tension glaucoma in Asia: Epidemiology, pathogenesis, diagnosis, and management","volume":"10","author":"Chen","year":"2020","journal-title":"Taiwan J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kosior-Jarecka, E., Wr\u00f3bel-Dudzi\u0144ska, D., Pietura, R., Pankowska, A., Szczuka, B., \u017barnowska, I., \u0141ukasik, U., and \u017barnowski, T. (2020). Results of neuroimaging in patients with atypical normal-tension glaucoma. BioMed Res. Int., 2020.","DOI":"10.1155\/2020\/9093206"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.4103\/ijo.IJO_1577_19","article-title":"Importance of neuroimaging in normal tension glaucoma","volume":"68","author":"Sharma","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_5","first-page":"219","article-title":"Compressive optic neuropathy. Not everything that progresses is glaucoma","volume":"96","author":"Badosa","year":"2021","journal-title":"Arch. Soc. Espa\u00f1ola Oftalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/00061198-199204000-00007","article-title":"Incidence of Systemic and Ocular Disease That May Mimic Low-Tension Glaucoma","volume":"1","author":"Stewart","year":"1992","journal-title":"J. Glaucoma"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Greenfield, D.S. (1999). Glaucomatous versus nonglaucomatous optic disc cupping: Clinical differentiation. Seminars in Ophthalmology, Taylor & Francis.","DOI":"10.3109\/08820539909056069"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kim, J.M., Park, K.H., Kim, S.J., Jang, H.J., Noh, E., Kim, M.J., Kim, T.W., Kim, D.M., and Caprioli, J. (2013). Comparison of localized retinal nerve fiber layer defects in highly myopic, myopic, and non-myopic patients with normal-tension glaucoma: A retrospective cross-sectional study. BMC Ophthalmol., 13.","DOI":"10.1186\/1471-2415-13-67"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hangai, M. (2015). Glaucoma Diagnosis in Myopic Eyes. Myopia and Glaucoma, Springer.","DOI":"10.1007\/978-4-431-55672-5_3"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/ICU.0b013e32835cef31","article-title":"Myopia and glaucoma: Diagnostic and therapeutic challenges","volume":"24","author":"Chang","year":"2013","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Yum, H.R., Park, S.H., Park, H.-Y.L., and Shin, S.Y. (2016). Macular ganglion cell analysis determined by cirrus HD optical coherence tomography for early detecting chiasmal compression. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153064"},{"key":"ref_13","first-page":"7","article-title":"Ganglion cell complex loss in chiasmal compression by brain tumors","volume":"37","author":"Tieger","year":"2017","journal-title":"J. Neuro-Ophthalmol. Off. J. N. Am. Neuro-Ophthalmol. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"509","DOI":"10.18240\/ijo.2024.03.13","article-title":"Neuroimaging in atypical normal tension glaucoma: Debating routine implementation in the absence of classic neurological findings","volume":"17","author":"Guvenc","year":"2024","journal-title":"Int. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Senthil, S., Nakka, M., Sachdeva, V., Goyal, S., Sahoo, N., and Choudhari, N. (2021). Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations. Seminars in Ophthalmology, Taylor & Francis.","DOI":"10.1080\/08820538.2021.1897855"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/2008-322X.183914","article-title":"Update on Normal Tension Glaucoma","volume":"11","author":"Mallick","year":"2016","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1001\/jama.2013.5099","article-title":"Do findings on routine examination identify patients at risk for primary open-angle glaucoma? The rational clinical examination systematic review","volume":"309","author":"Hollands","year":"2013","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/01.opx.0000134911.36521.b4","article-title":"Retinal nerve fiber loss in high- and normal-tension glaucoma by optical coherence tomography","volume":"81","author":"Mok","year":"2004","journal-title":"Optom. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s10143-023-01990-w","article-title":"Optical coherence tomography detects early optic nerve damage before visual field defect in patients with pituitary tumors","volume":"46","author":"Sasagawa","year":"2023","journal-title":"Neurosurg. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"118064","DOI":"10.1016\/j.jns.2021.118064","article-title":"Visual fields and optical coherence tomography (OCT) in neuro-ophthalmology: Structure-function correlation","volume":"429","author":"Donaldson","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.ophtha.2012.11.021","article-title":"Transneuronal retrograde degeneration of the retinal ganglion cells in patients with cerebral infarction","volume":"120","author":"Park","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dias, D.T., Ushida, M., Battistella, R., Dorairaj, S., and Prata, T.S. (2017). Neurophthalmological conditions mimicking glaucomatous optic neuropathy: Analysis of the most common causes of misdiagnosis. BMC Ophthalmol., 17.","DOI":"10.1186\/s12886-016-0395-x"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1167\/tvst.12.3.11","article-title":"Discriminating Between Compressive Optic Neuropathy with Glaucoma-Like Cupping Glaucomatous Optic Neuropathy Using OCT and OCTA","volume":"12","author":"Lei","year":"2023","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1167\/iovs.63.5.26","article-title":"Ocular and hemodynamic factors contributing to the central visual function in glaucoma patients with myopia","volume":"63","author":"Hong","year":"2022","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lee, E.J., Han, J.C., and Kee, C. (2017). Intereye comparison of ocular factors in normal tension glaucoma with asymmetric visual field loss in Korean population. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186236"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1016\/S0161-6420(99)90497-9","article-title":"Early Manifest Glaucoma Trial: Design and baseline data","volume":"106","author":"Leske","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/WNO.0000000000000589","article-title":"Retinal ganglion cell topography in patients with visual pathway pathology","volume":"38","author":"Zehnder","year":"2018","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Keller, J., S\u00e1nchez-Dalmau, B.F., and Villoslada, P. (2014). Lesions in the posterior visual pathway promote trans-synaptic degeneration of retinal ganglion cells. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097444"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1136\/jnnp.26.5.402","article-title":"Trans-synaptic retrograde degeneration in the visual system of primates","volume":"26","year":"1963","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11910-017-0725-2","article-title":"Trans-synaptic retrograde degeneration in the human visual system: Slow, silent, and real","volume":"17","author":"Dinkin","year":"2017","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.survophthal.2021.06.001","article-title":"Trans-synaptic degeneration in the visual pathway: Neural connectivity, pathophysiology, and clinical implications in neurodegenerative disorders","volume":"67","author":"Sharma","year":"2022","journal-title":"Surv. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s10384-018-0593-6","article-title":"Comparison of changes of macular ganglion cell-inner plexiform layer defect between stable group and progression group in primary open-angle glaucoma","volume":"62","author":"Seol","year":"2018","journal-title":"Jpn. J. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6585\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:26:49Z","timestamp":1760113609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6585"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":32,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13216585"],"URL":"https:\/\/doi.org\/10.3390\/jcm13216585","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,1]]}}}