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C CLINICAL RESEARCH

A Unique Presentation of Rapid Onset Normal Tension Glaucoma and Possible Association
with Breast Cancer

Aysha Hassan OD; Lisa Prokopich MSc, OD; Sarah MacIver OD, FAAO
School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario
A 70-year-old Caucasian woman presented for a routine assessment with no complaints after not having had an eye exami-
nation in 6 years. Medical history was remarkable for hypertension, atrial fibrillation and breast cancer, the latter of which
was treated with localized radiation therapy (2008), recurred, and was subsequently treated with a right mastectomy (2015).
Record review between 1985 and 2010 revealed cupping between 0.1-0.2 in the right eye and 0.1-0.3 in the left and IOPs be-
tween 14-23mmHg. Best-corrected visual acuity was 20/25 OD and 20/20 OS. A trace relative afferent pupillary defect was
noted on the right. Dilated examination revealed late to end-stage cupping of the optic nerves at 0.95 OD and 0.85 OS. No
pallor was observed. Complete superior and inferior visual field loss with central sparing was documented in the
right eye, and partial superior arcuate loss in the left eye. Advanced, asymmetrical, rapid onset and fast progressing
normal tension glaucoma (NTG) was diagnosed, with non-glaucomatous optic neuropathy to be investigated along
with other systemic conditions such as breast cancer itself, ocular or orbital metastasis, autoimmune and vascular
causes, and the contribution of radiotherapy. MRI imaging of the brain and orbits with contrast was unremarkable
for compressive or metastatic lesions; results from other systemic tests are pending. NTG is often a slow progressing
condition; therefore, this case report will highlight some critical as well as uncommon systemic disease associations
with NTG that clinicians should consider investigating when rapid progression is noted. In addition, the case report
will also describe the possible associations of rapidly progressing normal tension glaucoma with history of breast
cancer and systemic adverse effects of treatment.

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32 CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 NO. 2