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C-reactive protein levels significantly higher in normal tension glaucoma patientsInflammation marker linked to one type of glaucoma

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Key Takeaway
Consider CRP as a potential adjunctive marker in normal tension glaucoma, but not definitive.

This meta-analysis evaluated C-reactive protein (CRP) levels in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) compared to controls, including 766 patients. The primary outcome was CRP levels in NTG patients versus controls, with a secondary outcome comparing POAG patients to controls.

Results showed significantly higher CRP levels in the NTG group compared to controls (SMD: 0.731; 95% CI: 0.147-1.316; z = 2.454; p = 0.014). In contrast, no significant difference in CRP levels was observed between POAG patients and controls (SMD: 0.093; 95% CI: -0.160-0.345; z = 0.719; p = 0.472).

The authors note that the clinical value of CRP as a marker for NTG remains provisional and requires confirmation in future prospective studies. The association between elevated CRP and NTG is noted, but systemic inflammatory contribution is suggested rather than proven. CRP may serve as an adjunctive marker for identifying high-risk individuals with NTG, but it should not be considered a definitive diagnostic tool, and causality of inflammation in glaucoma pathogenesis is not established.

A new analysis of 766 people suggests that inflammation may play a role in a specific type of glaucoma called normal tension glaucoma (NTG). In NTG, the optic nerve is damaged even though eye pressure is normal. Researchers found that people with NTG had significantly higher levels of C-reactive protein (CRP), a marker of inflammation in the blood, compared to people without glaucoma. The difference was large enough to be considered meaningful.

But the story is different for the more common form of glaucoma, primary open-angle glaucoma (POAG). In that group, CRP levels were not significantly different from controls. That suggests the inflammation link may be specific to NTG, not all glaucomas.

The study combined results from several smaller studies, which gives more statistical power. However, the researchers caution that CRP is not ready to be used as a diagnostic test for NTG. More research is needed to confirm whether CRP can help identify people at risk or guide treatment. The findings are an early step, not a final answer.

For now, if you have NTG, this doesn't change your care. But it opens a new avenue for understanding why some people develop this form of glaucoma and how inflammation might be involved.

What this means for you:
Higher CRP levels are linked to normal tension glaucoma, but more research is needed before using it as a test.

Common questions

What is normal tension glaucoma?

Normal tension glaucoma (NTG) is a type of glaucoma where the optic nerve is damaged even though eye pressure is within the normal range. It can lead to vision loss if not treated.

What is C-reactive protein (CRP)?

CRP is a substance made by the liver in response to inflammation. High levels in the blood can indicate inflammation somewhere in the body. It is often measured with a simple blood test.

Does this mean CRP can diagnose normal tension glaucoma?

Not yet. The study found an association between higher CRP and NTG, but the researchers say it is too early to use CRP as a diagnostic test. More studies are needed to confirm the link and determine if it helps in clinical practice.

How is this different from primary open-angle glaucoma?

In primary open-angle glaucoma (POAG), eye pressure is usually elevated. The study found no significant difference in CRP levels between POAG patients and controls, suggesting inflammation may play a different role in POAG compared to NTG.

Study Details

Study typeMeta analysis
Sample sizen = 766
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundNormal tension glaucoma (NTG) is a common subtype of glaucoma that progresses silently and can lead to irreversible vision loss if left untreated. Emerging evidence suggests that inflammation and vascular dysfunction may play a role in its pathogenesis. C-reactive protein (CRP), a marker of systemic inflammation and atherosclerosis, has been widely studied as a prognostic indicator in various diseases. However, its potential association with NTG remains unclear. This meta-analysis aims to clarify the relationship between CRP levels in individuals with NTG compared to those without the condition.MethodsWe systematically searched PubMed, Embase, and Scopus for observational studies published up to 31 October 2023 investigating CRP levels in NTG patients and controls. Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale. Eligible studies reporting CRP levels were analyzed using standardized mean differences (SMDs) and 95% confidence intervals (CIs).ResultsA meta-analysis of ten case-control studies involving 766 patients revealed that CRP levels were significantly higher in the NTG group compared to controls (SMD: 0.731, 95% CI: 0.147-1.316 ; z = 2.454;  = 0.014). However, no significant difference in CRP levels was observed between the POAG group and controls (SMD = 0.093; 95% CI: -0.160-0.345; z = 0.719;  = 0.472).ConclusionElevated circulating CRP levels were significantly associated with NTG, suggesting a potential systemic inflammatory contribution to its pathogenesis. Although CRP may serve as an adjunctive marker for identifying high-risk individuals, its clinical value remains provisional and requires confirmation in future prospective studies.
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