Top-ten Japan Glaucoma Society Meeting
Fukuoka, Fukuoka, Japan, September 24-26, 2009
Akihiko Tawara
A new staging system was devised based on Visual Field Index (VFI)
in 574 eyes of 378 patients by calculating VFI equivalent of Mean Deviation
(MD) -6dB and -12dB with Humphrey visual field analyzer, which is the
gold standard of existing staging system. The results indicate that
MD -6dB and -12dB were nearly equivalent to VFI 81.5% (AUC=0.978) and
59.5% (AUC=0.981) respectively, and suggest the new staging system based
on VFI; early glaucoma with VFI≥82%, moderate with 60%<VFI < 82% and
advanced with VFI≤60%. (Kazunori Hirasawa, Sagamihara)
A multi-center study was conducted to investigate a correlation
between disability of daily life and a reduction of the binocular visual
field in patients with glaucoma. One hundred twenty-nine patients with
advanced stages of glaucoma were enrolled for the study. A reduction
in the total deviation (TD) of the 10-2 mode of Humphrey field analyzer
of the patients was measured for each quadrant to assess the binocular
visual field. Although the reduction of TD in the lower quadrants was
smaller than that in the upper quadrants, it showed higher correlation
with disability of dairy life than that in upper ones. The data imply
the importance of the visual field in the lower quadrants for daily
life. (Kenji Mizuki, Kasukabe)
In 38 glaucomatous eyes with generalized enlargement optic disc
type (GEOD), the correlation of the optic disc microcirculation evaluated
by laser speckle flowgraphy (LSFG) to mean deviation (MD) of Humphrey
field analyzer, average retinal nerve fiber layer thickness (avgRNFLT)
by OCT, or vertical cup disc ratio (vC/D) by HRTII was investigated.
The mean blur rates (MBR) of the total, tissue and vessel blood flow
in the optic nerve head measured by LSFG were significantly correlated
to MD, avgRNFLT, and vC/D. Especially, MBR of the tissue blood flow
showed a strong correlation to the parameters for glaucoma patients
with GEOD. (Naki Chiba, Sendai)
The efficacy and safety of bimatoprost as replacement for latanoprost,
travoprost, or tafluprost were prospectively evaluated. Subjects were
133 eyes on monotherapy of latanoprost, travoprost, or tafluprost at
the baseline, with average IOP at Day 0 of 15.2±2.9mmHg. Treatments
were switched to bimatoprost monotherapy, resulting in statistically
significant IOP reduction after the switch, at four weeks and 12 weeks
(average IOP: 14.2±2.9mmHg, 14.3±3.1mmHg respectively); however, their
conjunctival hyperemia scores were significantly increased at 4 weeks
and 12 weeks. There was no change in the degree of superficial punctate
keratopathy. Photos of eye lid area were obtained in 60 cases, and 27
cases were positive for deepening of eyelid superior sulcus, out of
which, one case terminated the bimatoprost administration. There were
10 cases out of 133 that terminated the therapy. Switching to bimatoprost
is shown as an effective therapeutic option, but the explanations for
the reported conjunctival hyperemia and deepening of the eyelid superior
sulcus are necessary. (Jun Takayama, Tokyo)
Causes that preclude patient's compliance of glaucoma-medication
in 114 non-compliants were studied based on dosing time by means of
taxonomies (i.e. systemic classification). Structured interviews elicited
191 unique situational problems, which were grouped into four separate
and major categories: 114 patients-related factors (60.7%), 25 medication
regimen factors (13.1%), 6 provider-related factors (3.2%) and 44 environmental
factors (22.0%). Patient-related factors showed the highest incidence
in both dosing time. Sleeping and taking a bath caused 39 patients (20.4%)
to miss medication in patients with eyedrops in the evening. Therefore,
each dosing time may have its own situational problems, which may be
multidimensional and must be individualized for the patient. (Hiroshi
Kobayashi, Shimonoseki)
To assess whether the asymmetry of the ganglion cell layer (GCL)
thickness was associated with glaucomatous structural abnormalities
in the macula, a macular GCL symmetry index, which was defined as "Log10
(inferior GCL thickness/superior GCL thickness)", was examined using
OCT. The confidential intervals of the GCL thickness symmetry index
values along the vertical macular scan were computed, and then generated
colored maps with 1% and 5% confidential limit curves. The mean GCL
symmetry index at each 0.5-mm segment from the central fovea was calculated.
Macular GCL symmetry index was compared among preperimetric and early
glaucoma, and normal eyes. The GCL symmetry analysis sensitivity was
85.7% in eyes with preperimetric glaucoma and 75.0% in eyes with early
glaucoma. The specificity was 100%. GCL symmetry analysis may be useful
to detect preperimetric and early glaucomatous structural abnormalities
in the macula. (Noriko Nakano, Kyoto) Ganglion cell thickness symmetry
analysis using OCT, may be useful to detect preperimetric and early
glaucomatous structural abnormalities in the macula. (Noriko Nakano,
Kyoto)
The effects of oral Yokukansan (YKS, TJ-54), a kind of anti-dementia
drugs in traditional Chinese medicine, on the rabbit intraocular pressure
(IOP) and ocular circulation were examined using an ultrasonic pulsed
Doppler methods (SSA-260: Toshiba). The drug increased the blood flow
velocities significantly in both short posterior ciliary and ophthalmic
arteries. It also caused a significant decrease of IOP by 53.2% 6 hours
after one shot administration. These results suggest that Yokukansan
could be available as an anti-glaucoma agent. (Ritsuko Yamada, Yokohama)
The usefulness of a newly devised tonometer, the principle of which
is based on the measurement of the natural frequency of the cornea,
was assessed. The vibration of the cornea was generated by the air jet
that is used in a non-contact tonometry system. The natural frequency
of the cornea was calculated by the vibration analysis at the cycle
of optical signal strength of the reflected light from the irradiated
cornea. As a result, the natural frequency of the cornea of porcine
eyes was significantly correlated with the intraocular pressure regulated
by a hydrostatic pressure system. The results suggest that the device
could be a new tonometer that is based on the different principle from
previous ones. (Kotaro Ishii, Tsukuba) The measurements of a newly devised
tonometer of which the principle is based on the natural frequency of
the cornea, generated by an air jet as used in non-contact tonometry,
were significantly correlated with a pressure related hydrostatic pressure
system. . (Kotaro Ishii, Tsukuba)
To study the risk factors of iridocorneal angle closure, dark-light
change of cross-sectional iris area (IA) in patient with PACG or PAC
was examined using anterior OCT, and compared with that of normal control
(NC). The iris section was divided in two parts, pupil-side iris (PSI)
and peripheral iris (PI) by the line drawing at 500µm away from the
scleral spur. The IAs in PACG and PAC were significantly reduced compared
to that of in NC. In both groups, the IA of PI was significantly smaller
in the dark room than in the light. Although the IA of PSI was larger
in the dark room than in the light, the trend was not significantly
different. A significant negative correlation was found between the
Angle Opening Distance 500 and IA of PSI in the dark room in patients
with PACG or PAC. The difference in behavior between PI and PSI might
lead an angle closure in both PACG and PAC. (Takanori Mizoguchi, Sasebo)
To investigate the effect of glaucomatous optic neuropathy (GON)
on higher brain function, an ocular hypertension (OH) model was established
for the first time in ferret eyes because ferrets have a binocular vision
among the small animals. Cultured conjunctival cells were injected into
the anterior chamber to occlude aqueous outflow pathway. Intraocular
pressure of treated eyes was significantly elevated by 80% compared
to that of contralateral control eyes for 44 weeks after the injection,
and glaucomatous cupping of the optic disc was histologically detected.
Then, 5μl of cholera toxin B with red and green fluorescent dyes was
injected into the treated and control eyes, respectively. Four days
after injection, flurorescent signal of the colliculus superior and
lateral geniculate nucleus (LGN) was obviously deteriorated in the correspondent
area projected from the treated eye. Microscopically, the flurorescent
signal in LGN was deteriorated not only in the area correspondent with
the treated eye but also in that with the control eye. These data indicate
that secondary degeneration due to OH may affect LGN in both sides by
binocular projected neuronal fibers, and suggest that ferret has a great
potential to investigate GON and higher brain function by OH. (Takashi
Fujishiro, Saitama) Secondary degeneration due to ocular hypertension
may affect the lateral geniculate nucleus on both sides by binocular
projected neuronal fibers, and suggest that the ferret ocular hypertension
model has a great potential to investigate glaucomatous optic atrophy
and higher brain function. (Takashi Fujishiro, Saitama)