The pillar of the current understanding of normal tension glaucoma is a reduced IOP tolerance of the retinal ganglion cells and the cells in the optic nerve head - an IOP of, for example, 17 or 19 mm Hg that would not affect a healthy eye leads to damage in the eye of an NTG patient. Risk factors
In many patients, normal tension glaucoma is common in individuals with a generalized reduced perfusion of organs and certain body tissues. A low blood pressure - whether consistently low or with sudden pressure drops - is associated with NTG as are conditions like Flammer syndrome and obstructive sleep apnea. Flammer syndrome has been attributed to increase the likelihood of ganglion cell damage in normal tension glaucoma patients with disc hemorrhages as a characteristic clinical sign. Besides race (Japanese) and low blood pressure, the female gender is also a risk factor. Diagnosis
While tonometry, the measuring of IOP and thus a classical instrument in the diagnosis of glaucoma, is not helpful, ophthalmoscopy leads to the diagnosis by showing typical glaucomatous damage, primarily at the optic nerve head, in the absence of elevated IOP. While the excavation of the optic nerve head and the thinning of its rim appear in all kinds of glaucoma (with high tension and with normal tension, in Primary open angle glaucoma (POAG) and in secondary glaucoma), small hemorrhages close to the optic disc have been identified as a characteristic clinical sign of normal tension glaucoma. Visual field is very important to detect NTG.
The longest recorded survivor of variant Creutzfeldt–Jakob disease (vCJD) was Jonathan Simms, a Northern Irish man who lived 10 years after his diagnosis. Epidemiology
CDC monitors the occurrence of CJD in the United States through periodic reviews of national mortality data. According to the CDC:
CJD occurs worldwide at a rate of about 1 case per million population per year. On the basis of mortality surveillance from 1979 to 1994, the annual incidence of CJD remained stable at approximately 1 case per million people in the United States. In the United States, CJD deaths among people younger than 30 years of age are extremely rare (fewer than five deaths per billion per year). The disease is found most frequently in people 55–65 years of age, but cases can occur in people older than 90 years and younger than 55 years of age. In more than 85% of cases, the duration of CJD is less than one year (median: four months) after the onset of symptoms.Further information from the CDC:
Risk of developing CJD increases with age. CJD incidence was 3.5 cases per million among those over 50 years of age between 1979 and 2017. Approximately 85% of CJD cases are sporadic and 10-15% of CJD cases are due to inherited mutations of the prion protein gene. CJD deaths and age-adjusted death rate in the United States indicate an increasing trend in the number of deaths between 1979 and 2017.Although not fully understood, additional information suggests that CJD rates in African American and nonwhite groups are lower than in whites.