14 eyes of 14 normal tension glaucoma (NTG) patients with the maximum intraocular pressure (IOP) > or = 19 mmHg and 16 eyes of 16 NTG patients with the maximum IOP < 19 mmHg were examined. All patients had a scotoma confined to the upper or lower hemifield. Eyes with the maximum IOP > or = 19 mmHg showed significantly diffuse retinal nerve fiber layer (RNFL) loss in the RNFL area corresponded to the spared visual hemifield as compared to those with the maximum IOP < 19 mmHg. The results suggests that, even in NTG, IOP may be an important factor causing optic nerve damage.