To elucidate the visual field (VF) characteristics of normal-tension glaucoma (NTG) patients with either autonomic dysfunction or abnormal peripheral microcirculation.

Prospective, observational study.

participants: Sixty NTG patients. procedures: All subjects underwent a complete ophthalmic examination and were then referred to a rheumatology department, where they were subjected to heart rate variability (HRV) assessment and nailfold capillaroscopy. Subjects with VF defect clusters confined to the central 10 degrees or outside the central 10 degrees (defined as peripheral) in 1 hemifield were selected (n = 60). The central and peripheral regions were divided further into superior and inferior sectors. Patients were classified into low, middle, and high HRV groups using HRV assessment or normal and abnormal capillaroscopy groups using nailfold capillaroscopy findings. The VF characteristics of the groups were compared. main outcome measures: Location of the VF defect, depth of the VF defect, mean deviation, and the pattern standard deviation of the VF.

The VF defect was more frequent and deepest in the superior central sector in both the low HRV and abnormal capillaroscopy groups. The mean deviation was similar between groups, but the pattern standard deviation was significantly higher in eyes with central defects than in eyes with peripheral defects among those in the low HRV group or abnormal capillaroscopy group. Logistic regression analysis revealed that the group classified by the HRV assessment and the presence of abnormalities in the capillaroscopy were related to the location of the VF defect.

NTG patients with low heart rate variability or abnormal nail capillaroscopy may present as central VF defects. Therefore, vascular risk factors need to be considered when NTG patients have central VF defects.