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Purpose To report the occurrence probability of disc haemorrhage (DH) and risk factors for it in otherwise healthy Japanese normal-tension glaucoma (NTG) patients who had lower normal intraocular pressure (IOP) and were followed without treatment for 5 years. Methods A prospective observational study. Normal-tension glaucoma (NTG) patients with IOP consistently ≤15 mmHg without treatment were enrolled. The presence or absence of DH was checked semi-annually on the fundus photographs by three independent observers, while patients were followed without treatment. Cox proportional hazards model taking inter-eye correlation into consideration was adopted to identify risk factors for DH occurrence. The main outcomes were DH occurrence probability during 5-year period and its risk factors. Results One hundred seventeen eyes of 90 patients with mean age of 54.1 years, mean deviation value of -3.6 decibels and mean IOP during follow-up of 12.4 mmHg were included. Disc haemorrhage (DH) was observed at least once in 34 eyes and more than twice in 15 eyes during the follow-up. The DH occurrence probability at 5 years was 31% (95% confidence interval: 21-40%), and lower myopic refraction (HR = 1.18; p = 0.018), higher IOP during follow-up (HR = 1.35; p = 0.047) and presence of DH at baseline (HR = 4.19; p = 0.002) were its risk factors. Conclusion Disc haemorrhage (DH) occurrence probability of Japanese healthy NTG patients with mean IOP of 12.4 mmHg and no systemic and/or topical treatment was 31% at 5 years. Lower myopic refraction, higher IOP and its existence at baseline were its risk factors.

Kiyoshi Yaoeda,1,2 Atsushi Fukushima,1 Motohiro Shirakashi,3 Atsushi Miki,4 Takeo Fukuchi2 1Department of Ophthalmology, Yaoeda Eye Clinic, Nagaoka, Niigata, Japan; 2Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan; 3Department of Ophthalmology, Kido Eye Clinic, Niigata, Niigata, Japan; 4Department of Ophthalmology, Kawasaki Medical School, Kurashiki, Okayama, Japan Purpose: The aim of this study was to determine whether fluctuations in intraocular pressure (IOP) occur as a result of the order of IOP measurements or successive IOP measurements in patients with glaucoma and, if so, identify the factors causing these fluctuations.Patients and methods: Four hundred twenty-eight eyes of 214 Japanese patients with primary open-angle glaucoma (POAG) were enrolled. Patients treated with beta-blockers or prostaglandin analogs alone were included. Additionally, in the IOP measurements by noncontact tonometer, the same cases of IOP of the right and left eyes prior to this study were included in this study. Four successive IOP measurements were carried out using a Goldmann applanation tonometer as follows: IOP was measured in the first eye (right or left) and then in the fellow eye and IOP was again measured in the first eye and then in the fellow eye. Repeated-measures analysis of variance was used to test the differences in IOP between successive measurements. Generalized linear mixed models were used to test differences in IOP measurements between the right and the left eyes on repeated applanation tonometry and according to the order of measurement. Conditional binomial logistic regression analysis was used to identify factors associated with fluctuating repeated applanation tonometry measurements. A P-value of

Kiyoshi Yaoeda,1,2 Atsushi Fukushima,1 Motohiro Shirakashi,3 Takeo Fukuchi2 1Yaoeda Eye Clinic, Nagaoka, 2Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, 3Kido Eye Clinic, Niigata, Japan Purpose: To investigate the correlation coefficients between intraocular pressure (IOP) before and after adjusting for central corneal thickness (CCT) and corneal biomechanical properties. Patients and methods: A total of 218 eyes of 218 patients with primary open-angle glaucoma (mean age =71.5years; mean spherical equivalent =-0.51D; mean deviation determined by Humphrey visual field analyzer =-3.22dB) were included in this study. The tIOP and tIOPCCT, which were adjusted by the CCT (with tIOP meaning IOP not adjusted by CCT, as determined using the CT-1P; and tIOPCCT meaning IOP adjusted by CCT, as determined using the CT-1P), were determined using a noncontact tonometer. The IOPg and IOPCCT, which were adjusted by CCT, and IOPcc adjusted by corneal biomechanical properties were determined using a Reichert 7CR (with IOPg meaning IOP not adjusted by CCT or corneal biomechanical properties, asdetermined using the Reichert 7CR; IOPCCT meaning IOP adjusted by CCT, as determined using the Reichert 7CR; and IOPcc meaning IOP adjusted by corneal biomechanical properties, as determined using the Reichert 7CR). The GT and GTCCT adjusted by CCT were determined using a Goldmann applanation tonometer (with GT meaning IOP not adjusted by CCT, as determined using the Goldmann applanation tonometer; and with GTCCT meaning IOP adjusted by CCT, as determined using the GAT). Pearson’s correlation coefficients among the IOPs were calculated and compared. P-values

To characterize the natural history and define the risk factors associated with the progression of normal-tension glaucoma (NTG) in Japanese patients who were followed up closely without treatment.Prospective 5-year study.Patients with NTG with intraocular pressure (IOP) consistently ≤15 mmHg without treatment at baseline.Visual field (VF) examinations were performed every 3 months, and disc/peripapillary retina photographs were taken every 6 months. Patients were followed up without treatment.Deterioration in VF was defined by reference to Guided Progression Analysis Software of the Humphrey VF Swedish Interactive Thresholding Algorithm 24-2 (Carl Zeiss Meditec, Jena, Germany) and disc/peripapillary retina deterioration as adjudged by 3 independent observers. Life table analysis was used for evaluating the time to disease progression, as defined by VF or deterioration of the optic nerve head structure. The Cox proportional hazards model was used to identify risk factors for glaucoma progression.We enrolled 90 patients (mean age, 53.9 years; baseline IOP, 12.3 mmHg; mean deviation [MD], -2.8 decibels [dB]). The MD slope averaged -0.33 dB/year (median, -0.23; 95% confidence interval [CI], -0.44 to -0.22). Glaucoma progression probability at 5 years was 66% (95% CI, 55-78), as defined by VF deterioration or disc/peripapillary retina deterioration (criterion 1): 52% (95% CI, 37-60), as defined by VF deterioration (criterion 2), and 50% (95% CI, 38-71), as defined by disc/peripapillary retina deterioration (criterion 3). Presence or history of disc hemorrhage (DH) (P0.001), long-term IOP fluctuation (P = 0.020), and a greater vertical cup-to-disc ratio (v-C/D) (P = 0.018) were significant predictors for progression defined by criterion 1. Long-term IOP fluctuation (P = 0.011) and a greater v-C/D (P = 0.036) were significant predictors for progression by criterion 2. Presence or history of DH (P = 0.0018) and long-term IOP fluctuation (P = 0.022) were significant predictors for progression by criterion 3.In Japanese patients with NTG with mean baseline IOP of 12.3 mmHg without treatment, estimated mean MD slope for 5 years was -0.33 dB/year; probability of glaucoma progression based on VF or disc/peripapillary end points at 5 years was 66%. Presence or history of DH, long-term IOP fluctuation, and greater v-C/D significantly contributed to progression.

This study compared the efficacy and safety of adjunctive brimonidine tartrate 0.1% ophthalmic solution (brimonidine) and timolol maleate 0.5% ophthalmic solution (timolol) in prostaglandin analogue (PGA)-treated normal-tension glaucoma (NTG), assessing the non-inferiority of brimonidine in terms of intraocular pressure (IOP) reduction. In this multicenter, randomized, investigator-masked, parallel-group, clinical study, adjunctive brimonidine or timolol was administered twice daily for 12 weeks in eyes with NTG that had been treated with PGA for at least 90 days and required additional treatment despite an IOP of 16 mmHg or less. IOP was measured on at least three visits before add-on therapy (mean baseline IOP), and at weeks 4, 8, and 12 after adjunctive administration. Systolic/diastolic blood pressure, pulse rate, and adverse events (AEs) were recorded at each visit. A total of 152 individuals were enrolled and 128 (84.2%) were eligible for efficacy analyses. IOP in both groups at each visit decreased significantly from baseline (P

Atsushi Miki1,2, Motohiro Shirakashi1, Kiyoshi Yaoeda1, Yu Kabasawa1, Satoshi Ueki1, Mineo Takagi1, Haruki Abe11Department of Ophthalmology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 2Department of Ophthalmology, Kawasaki Medical School, Okayama, JapanPurpose: To investigate, using optical coherence tomography (OCT), whether retinal nerve fiber layer thickness (RNFLT) is affected in amblyopic eyes.Methods: Using OCT (Stratus OCT™ [Carl Zeiss, Dublin, CA]), the RNFLT was measured in 26 patients with persistent unilateral amblyopia and in 25 patients with recovered unilateral amblyopia. The RNFLT was compared between the affected and fellow eyes in patients with persistent amblyopia and in those with recovered amblyopia, and between the amblyopic eyes of patients with persistent amblyopia and the previously amblyopic eyes of patients with recovered amblyopia.Results: In patients with persistent amblyopia and in those with recovered amblyopia, the affected eyes were significantly more hyperopic than the fellow eyes. The average (±standard deviation) RNFLT measured 105.5 ± 14.0 µm for the persistently amblyopic eyes; this value did not significantly differ from that of the fellow eyes (105.2 ± 13.0 µm) or the previously amblyopic eyes of recovered amblyopia (107.1 ± 11.7 µm). Also, logistic regression analysis adjusting for refraction showed no significant difference in the RNFLT between the persistently amblyopic eyes and the previously amblyopic eyes.Conclusions: Our results indicate that there is no significant change in the RNFLT in amblyopic eyes.Keywords: optical coherence tomography, retinal nerve fiber layer thickness, amblyopia

Blockage of axonal transport by intraocular pressure (IOP) elevation was studied quantitatively in monkey eyes, using liquid scintillation counting. After 5 h of IOP elevation (perfusion pressure of 30 mmHg), axonally transported protein was measured in the distal third of each optic nerve, which was divided into superotemporal, inferotemporal, superonasal, and inferonasal portions. The ratio of the amount of radioactive protein in each portion of the optic nerve to that in the whole optic nerve was calculated. In eyes with IOP elevation, the mean ratio for the temporal optic nerve was significantly lower than that for the nasal optic nerve. It appeared that axonal transport was not affected homogenously throughout the optic nerve but was more impaired in the temporal half of the optic nerve following IOP elevation.

Purpose: To evaluate the correlation between neural capacity, determined by high-pass resolution perimetry, and thickness of the retinal nerve fiber layer, evaluated by scanning laser polarimetry, in patients with primary open-angle glaucoma or normal-tension glaucoma. Methods: Thickness of the peripapillary retinal nerve fiber layer was measured by scanning laser polarimetry in 19 eyes of 19 patients with primary open-angle glaucoma and in 23 eyes of 23 patients with normal-tension glaucoma. There were no significant differences between the two groups in mean age, sex ratio, or mean neural capacity. Results: Neural capacity was significantly correlated with thickness of the retinal nerve fiber layer in all 42 eyes (r = 0.31, P = 0.0429). Neural capacity was significantly correlated with thickness of the retinal nerve fiber layer in the eyes of patients with primary open-angle glaucoma (r = 0.60, P = 0.0061), but not in the eyes of patients with normal-tension glaucoma (r = 0.04; P = 0.8522). Conclusion: The degree of correlation between neural capacity determined by high-pass resolution perimetry and thickness of the retinal nerve fiber layer measured by scanning laser polarimetry appeared to differ in patients with primary open-angle glaucoma vs those with normal-tension glaucoma.

PURPOSE NT-4000 (Nidek Co. Ltd., Gamagori, Japan) is a new non-contact tonometer (NCT) equipped with pulse synchronous measurement function that can measure intraocular pressure (IOP) synchronized with the ocular pulse. The purpose of this study was to evaluate the usefulness of NT-4000 in normal subjects and in patients with glaucoma and ocular hypertension. METHODS This study included 175 eyes of 175 subjects. Firstly, the IOP was measured using NT-4000 without the pulse synchronous measurement function (NTn). Secondly, the IOP at peak, middle, and trough phases of the pulse signal were measured using NT-4000 with the pulse synchronous measurement function (NTp, NTm, NTt, respectively). Additionally, the IOP was measured with Goldmann applanation tonometer (GT). The coefficient of variation (CV) of three readings in the NCT measurements was used to evaluate the intra-session reproducibility. Statistical comparisons were performed using Wilcoxon signed rank test and one-way analysis of variance with Scheffe's test. Linear regression analysis was used to calculate correlation coefficients. P values less than 0.05 were accepted as statistically significant. RESULTS The CV of NTn, NTp, NTm, and NTt were 6.4%, 5.5%, 4.9%, and 5.2%, respectively. The CV of NTp, NTm, and NTt were significantly smaller than that of NTn (P = 0.007, P < 0.001, P < 0.001, respectively). NTp was significantly higher than NTt (P = 0.038). GT was significantly correlated with NTn, NTp, NTm, and NTt (r = 0.898, P < 0.001; r = 0.912, P < 0.001; r = 0.908, P < 0.001; r = 0.900, P < 0.001, respectively). CONCLUSION NT-4000 can detect the fluctuation of IOP associated with the ocular pulse.

PURPOSE: To determine whether differences in the optic disc topography and those in the relation between the optic disc topography and visual field indices exist between Japanese patients with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: The study included consecutive Japanese patients with POAG (n = 60) or NTG (n = 60). Using the Heidelberg Retina Tomograph (HRT), we measured disc area, cup area, cup-to-disc area ratio, rim area, cup volume, rim volume, cup shape measure, and height variation contour. Each HRT parameter was measured in the total optic disc and in its four 90 degree quadrants (superior, temporal, inferior, and nasal). The mean deviation for the entire field and the sum of the total deviation values corresponding to each optic disc quadrant were calculated using the Humphrey full-threshold 30-2 program. RESULTS: No significant differences were found between the POAG and NTG groups for any HRT parameter either globally or regionally. There were no significant differences between the two groups in the correlation coefficients between any HRT parameter and the corresponding visual field indices either globally or regionally. CONCLUSION: No significant differences were apparent between Japanese patients with POAG and NTG both in the optic disc parameters as measured by HRT and in the degree of correlation between HRT parameter and the corresponding visual field indices.

PURPOSE To study whether the correlation between indices of Humphrey perimetry and Frequency Doubling Technology (FDT) perimetry differs in the early and later stages of glaucoma. METHODS This study included 200 eyes of 200 patients with primary open-angle glaucoma or normal-tension glaucoma. The eyes were classified into the early and later stages by the median value (-4.51 dB) (Classification 1; n = 100 and 100, respectively) or the average value of the maximum and minimum values (-11.90 dB) (Classification 2; n = 165 and 35, respectively) of mean deviation (MD) obtained from a set of measurements with the Humphrey Full-Threshold 30-2 program in all eyes. The correlation between MD (H-MD) or pattern standard deviation (PSD) (H-PSD), as obtained from another set of measurements with the Humphrey Full-Threshold 30-2 program, and MD (F-MD) or PSD (F-PSD), as calculated by the Full-Threshold N-30 program of FDT perimetry, were evaluated using linear regression analysis. RESULTS Overall, H-MD and H-PSD significantly correlated with F-MD (r = 0.713; P < 0.001) and F-PSD (r = 0.731; P < 0.001), respectively. In each of Classifications 1 and 2, H-MD and H-PSD significantly correlated with F-MD and F-PSD, respectively, both in the early and later stages. However, in each classification, the correlation between H-MD and F-MD differed significantly between the two stages (Classification 1; P < 0.001; Classification 2, P = 0.003), while the correlation between H-PSD and F-PSD did not differ significantly between the two stages. CONCLUSION The degree of correlation between H-MD and F-MD differed between the early and later stages of glaucoma.

Purpose: To study the relationship between optic nerve head blood flow velocity and visual field loss in patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). Methods: This study included 44 eyes of 44 patients with POAG and 44 eyes of 44 patients with NTG. To evaluate optic nerve head blood flow velocity, the square blur rate (SBR) was measured by means of laser speckle flowgraphy. The correlation between SBR and Humphrey visual field indices was evaluated with linear regression analysis. Results: In the NTG group, the average SBR at the superior and inferior temporal neuroretinal rim was positively correlated with mean deviation (MD) (r = 0.349, p = 0.020). The SBR at the superior or inferior temporal neuroretinal rim was positively correlated with the sum of the total deviations in the corresponding hemifields (r = 0.299, p = 0.049; r = 0.354, p = 0.019, respectively). The correlations between SBR and MD did not differ statistically between the NTG and POAG groups; however, no significant correlation between SBR and visual field indices was observed in the POAG group. Conclusion: These results suggested that the change in the circulation of the optic nerve head may be related to visual field damage in the NTG group but may be less involved in visual field damage in the POAG group.

To report blood flow in the optic nerve head between the right and left eyes or the superior and inferior neuroretinal rims in normal volunteers using laser speckle flowgraphy.This prospective study included 120 eyes of 60 normal volunteers (mean age, 50.0 +/- 16.9 years; range, 21 to 77 years). The square blur rate was measured by laser speckle flowgraphy (Kyushu Institute of Technology, Iizuka, Japan). The sequence of eye measurements was randomized. In each eye, measurements were taken at the neuroretinal rim away from visible vessels. Linear regression analysis, paired two-tailed t test, and two-way analysis of variance were used for statistical analysis. P values less than.05 were accepted as statistically significant.There was a significant correlation in square blur rate between the right and left eyes (r = 0.587, P.001). Square blur rate in the superior temporal neuroretinal rim significantly correlated with that in the inferior temporal neuroretinal rim in each of the right (r = 0.546, P.001) and left (r = 0.465, P.001) eyes. Square blur rate in the right eye was higher than that in the left eye (P =.049). Square blur rate in the superior neuroretinal rim was higher than that in the inferior neuroretinal rim in both the right (P =.035) and left (P =. 005) eyes.There were statistically significant differences of optic nerve head blood flow in normal volunteers using laser speckle flowgraphy between the right and left eyes and between the superior and inferior temporal neuroretinal rims. These normal data can be used for understanding physiological ocular hemodynamics.

PURPOSE: To evaluate and compare blood flow measurements by laser speckle flowgraphy and scanning laser Doppler flowmetry in the optic nerve head of normal volunteers. METHODS: This prospective study included 60 eyes of 60 normal volunteers (50.0 years; range, 21 to 77 years). Measurements were taken at the temporal neuroretinal rim away from visible vessels. The square blur rate, a quantitative index of relative blood velocity, was measured by laser speckle flowgraphy. Using scanning laser Doppler flowmetry, volume, flow, and velocity were measured at the same neuroretinal rim locations. RESULTS: The average square blur rate, volume, flow, and velocity were 7.11 ± 1.65, 7.74 ± 3.19, 151.85 ± 70.63, and 0.53 ± 0.23 arbitrary units, respectively (n = 60). Square blur rate correlated significantly with flow and velocity (r = .361, P = .005; r = .359, P = .005, respectively). However, there was no significant correlation between square blur rate and volume (r = .101, P = .441). Although square blur rate decreased significantly with increasing age (r = −.375, P = .003), volume, flow, or velocity showed no significant correlation with age (r = −.249, P = .054; r = −.166, P = .205; r = −.143, P = .275, respectively). Square blur rate also decreased significantly with mean blood pressure (r = −.315, P = .014), but volume, flow, or velocity showed no significant correlation with mean blood pressure (r = −.159, P = .225; r = −.059, P = .654; r = −.043, P = .742, respectively). CONCLUSION: We found only a weak correlation between the blood flow indexes, as measured by laser speckle flowgraphy and scanning laser Doppler flowmetry because of basic differences in the principles of measurement.

Purpose: To determine if there are any age-dependent changes in the thickness of the retinal nerve fiber layer (RNFL) in the peripapillary area. Methods: Sixty normal volunteers (31 men, 29 women) (120 eyes) whose ages ranged from 23–75 years (mean 48.4 years) participated in this study. The thickness of the RNFL was determined using a scanning laser polarimeter along the peripapillary area with a 1.75 disc diameter and along another ring 0.8 mm away from the disc margin. Results: The thickness of the RNFL was not significantly correlated with age in either of the two ring areas. However, the RNFL thickness ratio of total/nasal area decreased significantly with increase in age in both rings. There was an increase in the difference of RNFL thickness between the right and left eyes of the same individual with aging, in both rings. Conclusions: It was suggested that the RNFL thickness determined along both rings demonstrated almost identically the relationship between age and RNFL thickness in normal subjects.

AIMS—To evaluate the relation between the optic disc size and the thickness of the peripapillary retinal nerve fibre layer (RNFL) in normal Japanese subjects by means of scanning laser polarimetry. METHODS—Scanning laser polarimetry was performed in 60 normal subjects. One eye of each subject was randomly selected for study. Using a scanning laser polarimeter, the integral of RNFL thickness was measured totally and regionally within a circular band located 1.75 disc diameters from the centre of the optic disc. The correlation between the optic disc size and the integral of RNFL thickness was examined. RESULTS—The optic disc size showed a significant correlation with the integral of RNFL thickness (R = 0.497, p

· Purpose: To investigate the correlation between the deterioration in optic disc cupping during the chronic elevation of intraocular pressure (IOP) and the reversal of cupping during a subsequent reduction in IOP in experimental glaucoma. · Methods: We examined changes in the vertical and horizontal cup to disc ratios, the rim area to disc area ratio, and the cup volume to disc area ratio in 11 monkey eyes with laser-induced glaucoma using computerized stereo-image analysis. Correlations between changes in disc parameters during a spontaneous IOP reduction and changes in disc parameters during a period of chronic IOP elevation from baseline before laser exposure (baseline) to before the IOP reduction (pre-IOP reduction) and during the period from baseline to after the reduction in IOP (post-IOP reduction) were determined by linear regression analysis. · Results: All disc parameters improved significantly during IOP reduction and deteriorated significantly during the periods from baseline to the pre-IOP reduction and from baseline to the post-IOP reduction. The degree of reversal in disc parameters was correlated with the deterioration from baseline to the pre-IOP reduction and from baseline to the post-IOP reduction in the vertical cup to disc ratio (r=0.68, P=0.0218 and r=0.97, P

To measure the retardation distribution of the optic retinal nerve fiber layer (RNFL) from a single image, we have developed a new polarization analysis system that is able to detect the Stokes vector using a fundus camera. The polarization analysis system is constructed with a CCD area image sensor, a linear polarizing plate, a microphase plate array, and a circularly polarized light illumination unit. In this system, the Stokes vector expressing the whole state of polarization is detected, and the influence of the background scattering in the retina and of the retardation caused by the cornea are numerically eliminated. The measurement method is based on the hypothesis that the retardation process of the eye optics can be quantified by a numerical equation that consists of a retardation matrix of all the polarization components. We show the method and the measurement results for normal eyes. Our results indicate that the present method may provide a useful means for the evaluation of retardation distribution of the RNFL.

We studied the relationship between intraocular pressure (IOP) and progression of visual filed loss in 83 eyes of 83 patients with advanced primary open-angle glaucoma (loss of at least one quarter of the visual field on Goldmann perimetry). During the 15-year follow-up study, 71 eyes (86%) showed progression of visual field loss. The mean IOP was significantly lower in eyes that remained stable (13.4 +/- 1.3 mm Hg) than in those that showed progression of visual field loss (19.4 +/- 2.6 mm Hg). These results suggest that it is necessary to reduce IOP to below 15 mm Hg to prevent further progression of visual filed loss in advanced glaucoma.

Atsushi Miki1,2, Motohiro Shirakashi1, Kiyoshi Yaoeda1, Atsushi Fukushima1, Mineo Takagi1, Haruki Abe11Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 2Department of Ophthalmology, Kawasaki Medical School, Okayama, JapanPurpose: To evaluate the optic disc characteristics of eyes with superior segmental optic hypoplasia (SSOH) using the Heidelberg retina tomograph (HRT).Patients and methods: Thirteen eyes of 13 Japanese patients with SSOH were studied with the HRT (software version: 3.0). The group included six males and seven females, with a mean age of 34.7 years. Six optic disc parameters in the six sectors derived from the patients with SSOH were compared with those of 13 eyes of 13 normal controls. In addition, the diagnostic classification performance of the Frederick S Mikelberg (FSM) discriminant function, glaucoma probability score (GPS), and Moorfields regression analysis (MRA) were assessed.Results: When compared with normal subjects, many of the optic disc parameters were significantly altered in SSOH in the superior sectors. The area under the curve (AUC) for the receiver operating characteristic was 0.932 for the rim area, 0.926 for the cup-to-disc area ratio, and 0.882 for the cup shape measure. Among the HRT parameters, the largest AUC (0.988) was found for the cup shape measure in the nasal superior segment. The proportion classified as outside normal limits by the FSM discriminant function was 92.3% (12 eyes). For GPS, six eyes (46.2%) were classified as outside normal limits. For MRA, when borderline cases were considered test-negative or test-positive, 10 eyes (76.9%) or 11 eyes (84.6%) were classified as outside normal limits, respectively. The AUCs were 0.976 for the FSM discriminant function, 0.914 for the MRA overall classification, and 0.710 for the GPS overall classification.Conclusions: In eyes with SSOH, there is a significant thinning of the rim, especially in the nasal superior sector. Approximately half of the eyes with SSOH were classified as abnormal using indices developed for detecting glaucoma, but the sectorial analysis revealed that the affected sectors were different from those of glaucoma. Optic nerve head measurements using the HRT may be useful in evaluating the optic disc characteristics in eyes with SSOH.Keywords: superior segmental optic hypoplasia, Heidelberg retina tomography

Background: The authors prospectively and longitudinally studied changes in optic disc topography during spontaneous reduction of intraocular pressure (IOP) in five monkeys with experimental glaucoma, using a computerized image analyzing system (Topcon IMAGEnet). Methods: Glaucomatous optic neuropathy was produced in one eye of each animal by repeated argon laser photocoagulation of the trabecular meshwork. The duration of follow-up was 12 months. After laser treatment, IOP fluctuated and tended to increase. Spontaneous reduction in IOP was frequently observed during follow-up. Changes in optic disc parameters (vertical and horizontal cup-to-disc ratios, rim area/disc area, cup volume/disc area) that accompanied a given magnitude of spontaneous reduction in IOP at the early stage of glaucoma (first 4 months of follow-up) were compared with those at the later stage of glaucoma (last 4 months of follow-up). Results: All optic disc parameters improved significantly during IOP reduction at each stage of glaucoma. Although there was no significant difference between the two stages in the magnitude of IOP reduction, the extent of improvement in each disc parameter was significantly less in the later stage than in the early stage. In both stages, reversal of cupping occurred symmetrically in the vertical and horizontal dimensions. Expansion of the cup occurred symmetrically in the early stage, but this was predominantly vertical in the later stage. Conclusion: These results suggest that the extent of cupping reversal after IOP reduction may decrease with progressive glaucomatous damage in primate glaucoma.

To evaluate the optic disc characteristics using the Heidelberg retina tomograph (HRT) II in a large sample of normal Japanese subjects.Cross-sectional study.A total of 3576 eyes of 2036 normal subjects, with good-quality HRT II images, of 6042 eyes of 3021 subjects aged 40 years or more who participated in the Tajimi Study, a population-based eye study in Japan.Optic disc parameters were obtained using HRT II, and the association of gender, age, height, weight, blood pressure, ocular perfusion pressure, refraction, intraocular pressure (IOP), central corneal thickness (CCT), and disc size on HRT parameters was assessed using simple and multiple regression analyses.HRT parameters, including disc area, cup area, rim area, cup-to-disc area ratio, cup volume, rim volume, mean cup depth, maximum cup depth, height variation contour, cup shape measure, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area, and the crude and partial correlations of the potential confounders with the HRT parameters.Disc area, cup-to-disc area ratio, and rim area averaged 2.06+/-0.41 mm(2) (mean+/-standard deviation), 0.23+/-0.13, and 1.55+/-0.29 mm(2), respectively. All HRT parameters were strongly or moderately correlated between right and left eyes (Pearson's correlation coefficients = 0.45-0.83, P0.001). Absolute inter-eye differences in several HRT parameters were positively correlated with disc area (P0.05). Multiple regression analyses adjusting for the confounders showed weak but significant correlations of height, refractive error, IOP, and CCT with several HRT parameters (partial correlation coefficient (absolute value) = 0.04-0.16, P0.05), and moderate or weak but significant correlations of disc area with all HRT parameters (partial correlation coefficient [absolute value] = 0.05-0.73, P0.05). Gender, weight, blood pressure, and ocular perfusion pressure did not significantly correlate with HRT parameters.This report presents reference data of normality for the HRT parameters based on a large sample of normal Japanese subjects. There were small but significant influences of height, refractive error, IOP, and CCT on several HRT parameters. Many HRT parameters were moderately or weakly affected by disc size.Proprietary or commercial disclosure may be found after the references.

Visual disturbance in 11 patients with melanocytoma of the optic disk was analyzed. Goldmann visual field examination showed enlargement of Mariotte's blind spot in 7 of 10 patients (70%) and visual field defect or depression in 7 patients (70%). In 6 of the 7 patients with visual field defect of depression (86%), the portion of visual field damage corresponded with the location of the tumor and retinal nerve fiber bundle defect. In 1 patient, sudden loss of visual acuity occurred, presumably due to anterior ischemic optic neuropathy induced by melanocytoma.

Few studies have been performed regarding the topographic information obtained with the Heidelberg retina tomograph (HRT) in normal Japanese. In this study, we examined the factors influencing optic disc parameters and hemisphere symmetry obtained with the HRT in normal Japanese subjects. Mean values and the standard deviation range for the main HRT parameters were evaluated in 223 eyes of 223 normal Japanese subjects. The influence of age, sex, and disc size on HRT topographic data was analyzed. The superior and inferior hemisphere topographic parameters were compared. Disc area showed a significant difference by sex (P = 0.0493). Rim volume (r = −0.208, P = 0.019), height variation contour (r = −0.275, P = 0.001), and mean retinal nerve fiber layer (RNFL) thickness (r = −0.366, P = 0.001) declined with age. All parameters except height variation contour and mean RNFL thickness showed a clinically significant correlation with disc size (−0.159 < r < 0.719, P < 0.01). Cup parameters in the superior hemisphere were significantly greater than those in the inferior hemisphere. In contrast, rim parameters in the superior hemisphere were significantly smaller than those in the inferior hemisphere. Some factors, namely, sex, age, and disc size, affected the optic disc parameters in the HRT measurements. Possible parameter asymmetry between the two hemispheres should be considered in normal eyes. Jpn J Ophthalmol 2005;49:469–476 © Japanese Ophthalmological Society 2005

Background: We report a patient who was diagnosed as having steroid-induced glaucoma after radial keratotomy (RK) and who suffered from severe visual field defect. Case: A 29-year-old man underwent RK for both eyes. After the operation, he was treated for six months with topical medication including 0.1% and 0.01% betamethasone without an intraocular pressure (IOP) measurement. When he consulted an ophthalmologist, his IOP was 43 mmHg in the right eye and 51 mmHg in the left eye. At our initial examination, his IOP was 8 mmHg in the right eye and 10 mmHg in the left eye. He was taking 750 mg acetazolamide peroral, 0.5% timolol maleate, and latanoprost eyedrops. There were 16 RK incisions on the cornea and we found severe glaucomatous visual field loss. Finally we performed trabeculotomy in both eyes for IOP control with conservative therapy. Conclusion: As keratorefractive surgery becomes popular, we must be alert for problems, such as steroid-induced glaucoma, and the change in refraction following the change in IOP. Nippon Ganka Gakkai Zasshi

To investigate the effect of myopic refraction on the central visual field in patients with advanced open-angle glaucoma (OAG).Multicenter cross-sectional study.Three hundred thirteen OAG eyes (176 eyes of 176 primary open-angle glaucoma [POAG] patients and 137 eyes of 137 normal-tension glaucoma [NTG] patients) with clear ocular media and a mean deviation (MD)-15 dB. Patients with a recorded maximum intraocular pressure (IOP) of 22 mmHg or greater were classified as POAG, and those with an IOP of 21 mmHg or less were classified as NTG.Multiple regression analysis was used to study the influence of refraction on 12 central test points of the C30-2 Humphrey program, and the differences in visual field defects between POAG and NTG eyes were examined using logistic discriminant analysis. In the multiple regression analysis, total deviation (TD) of the 12 test points was graded and used as the dependent variable, and MD and the spherical equivalent refraction were the explanatory variables. In the logistic discrimination analysis, TD, MD, and refraction were covariants that determined the OAG subtypes.TD values of the 12 central test points (C30-2 program).Higher myopic refraction was significantly associated with more damage at a point just temporal and inferior to the fixation point in POAG eyes, whereas it was significantly associated with less damage at test points just temporal and superior to the fixation point in NTG eyes. After correcting for the influence of refraction, POAG eyes had significantly more damage at a test point just temporal and inferior to the fixation point, whereas NTG eyes had significantly more damage at those test points nasal and inferior to the fixation point.High myopia constitutes a threat to the remaining lower cecocentral visual field and is one of the factors that interfere with the quality of vision in advanced OAG with high IOP but not low IOP.

Aims: To investigate the usefulness of the scanning laser polarimeter (GDx; GDx Nerve Fiber Analyzer) for glaucoma detection in the Japanese population, and to investigate the difference in the thickness of retinal nerve fibre layer (RNFL) between normal tension glaucoma (NTG) and primary open angle glaucoma (POAG). Methods: 69 eyes of 69 normal subjects and 115 eyes of 115 chronic open angle glaucoma patients (60 NTG and 55 POAG patients) were studied. The thickness of RNFL was measured with GDx. An eye was diagnosed as glaucomatous, if at least one original GDx variable showed p

Background We report a patient with persistent hyperplastic primary vitreous(PHPV) who presented with acute angle-closure glaucoma in his adult life. Case A 30-year-old man had an attack of acute angle-closure glaucoma associated with retrolenticular fibrous tissue, atrophic retina, and elongated cilliary process in his right eye. Result Ultrasound biomicroscopy(UBM) study showed iris bowing, shallow anterior chamber, and elongated cilliary body which were being pulled by the retrolenticular mass. The posterior chamber was normal. Conclusion Although the mechanisms of secondary angle-closure glaucoma in PHPV are complicated, we suspected pupillary block resulting from constriction by the retrolenticular mass in this case.

To determine a mathematically optimal sector pattern of the central 30 degree visual field for the follow-up of glaucomatous visual field change based on a large number of actual visual field test data of patients with glaucoma.Visual field test data obtained from 1,039 eyes of 1,039 patients with open-angle glaucoma (OAG) using the 30-2 program of the Humphrey Field Analyzer were used for sectorization of the central 30 degree visual field. Of the 1,039 visual field data, 698 (modeling data) were used for determining the sector pattern and 341 (testing data) for checking the sector pattern. The modeling data were further divided into three groups according to the mean deviation (MD) (MDor = -10 dB, -20or = MD-10 dB, and MD-20 dB), and the sector pattern was constructed from visual field data of each group using a clustering procedure called VARCLUS. The testing data were used for determining the optimal sector pattern. In a separate set of repeated visual field data of 303 patients with OAG, the fluctuation of MD, sector values of each sector determined, and total deviation of each test point were calculated and compared.The sector pattern constructed from visual field data of MDor = -10 dB summarized the visual field performance most effectively. The fluctuation of the sector value of each sector was roughly 1.5 times smaller than the total deviation of each test point.The sector pattern determined may be useful in analyses of the visual field data of patients with glaucoma.

AIMS—To determine whether any differences may exist in the relation between the neural capacity as determined by high pass resolution perimetry and the thickness of the retinal nerve fibre layer (RNFL) in patients having normal tension glaucoma (NTG) with a relatively high intraocular pressure (IOP) between 16 and 21 mm Hg (HNTG) v those with a lower IOP below 15 mm Hg (LNTG). METHODS—Scanning laser polarimetry and high pass resolution perimetry were performed in 20 eyes of 20 patients with HNTG and 21 eyes of 21 patients with LNTG. The correlation between total and regional thickness of the peripapillary RNFL and the corresponding total and regional neural capacity with linear regression analysis were evaluated. RESULTS—Overall, although the total RNFL thickness was not significantly correlated with the total neural capacity, the RNFL thickness in each of the superior and inferior quadrants was significantly correlated with the corresponding regional neural capacity (r=0.44, p=0.0045; r=0.39, p=0.0126 for each). The RNFL thickness in each of the superior and inferior quadrants in the HNTG group was significantly correlated with the corresponding regional neural capacity (r=0.52, p=0.0196; r=0.49, p=0.0286 for each). No significant correlation between neural capacity and the RNFL thickness was observed either globally or regionally in the LNTG group. CONCLUSION—The degree of the correlation between neural capacity as determined by high pass resolution perimetry and thickness of the RNFL as measured by scanning laser polarimetry appeared to differ in NTG patients with an IOP higher than 15 mm Hg v those with a lower IOP. Keywords: scanning laser polarimetry; high pass resolution perimetry; normal tension glaucoma

Purpose To evaluate functional magnetic resonance imaging as an objective method for detecting visual dysfunction in various ophthalmologic disorders involving the optic nerve and the chiasm. Methods We performed functional magnetic resonance imaging during monocular visual stimulation on seven patients with visual field loss caused by lesions of the optic nerve and the chiasm and on three normal control subjects with no visual field loss. We correlated static threshold perimetry in the seven patients with the results of functional magnetic resonance imaging. Results In the three normal control subjects, we found good intrasubject similarity in areas of bilateral occipital lobe activation between monocular stimulation of the right and left eyes. In the patients with unilateral optic neuropathy, including glaucoma, stimulation of the affected eye induced no activation of the primary visual cortex in the portion corresponding to the central visual field defects and reduced activity of the associated visual cortex. In the patients with chiasmal compression, monocular stimulation resulted in a marked asymmetry of activation in the primary visual cortex, which corresponded to the visual field abnormality. Conclusions Functional magnetic resonance imaging appears to be useful in confirming the clinical diagnosis of optic atrophy because it can objectively disclose visual field loss, even a small defect such as central scotoma.

PURPOSES We studied the control of intraocular pressure(IOP) by various types of blebs after non-penetrating trabeculectomy(NPT) and the difference between bleb formation after penetrating trabeculectomy(PT) and that after NPT. METHODS The filtering blebs of 45 yeys from 40 patients after NPT were studied using ultrasound biomicroscopy. They were grouped into four types, and the space under the scleral flap was classified into three types. The filtering blebs and the space under the scleral flap were correlated with IOP level. RESULTS Overall, 40% of the blebs were L(low-reflective) type, 16% H(high-reflective) type, 16% E (encapsulated) type, and 29% F(flattened) type, but in good IOP control cases 59% of the blebs were L type, 14% H type, 14% E type, and 14% F type. L type blebs were found in 94% of eyes with good IOP control. CONCLUSION Though filtering blebs of the L type could produce sufficient IOP reduction, blebs after NPT showed a greater tendency to become flattened than after PT. Additional systematic therapy must be designed to maintain the L type of filtering blebs after NPT.

Tsutomu Yamashita1, Atsushi Miki1,2,3, Yoshiaki Ieki2, Junichi Kiryu2, Kiyoshi Yaoeda3,4, Motohiro Shirakashi3,51Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 2Department of Ophthalmology, Kawasaki Medical School, Kurashiki, Okayama, Japan; 3Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 4Yaoeda Eye Clinic, Nagaoka, Japan; 5Kido Eye Clinic, Niigata, JapanPurpose: We investigated at which corneal region the intraocular pressure as measured by the Icare® rebound tonometer (Finland Oy, Espoo, Finland) (hereinafter referred to as IC) was closest to the intraocular pressure as measured by the Goldmann applanation tonometer (hereinafter referred to as GT). We also investigated which parameters would be best for preparing the most suitable model for predicting GT.Methods: A total of 102 normal eyes in 102 subjects were enrolled. IC measurements were carried out at the central, superior, inferior, temporal, and nasal regions of the cornea (ICC, ICS, ICI, ICT, and ICN, respectively), followed by GT calculations. Differences between GT and IC were analyzed using the Bland–Altman method. Stepwise multiple regression analysis was performed using GT as the objective variable, and age, laterality of eye, spherical equivalent refractive error, corneal radius, axial length, central corneal thickness, GT, ICC, ICS, ICI, ICT, and ICN as the explanatory variables.Results: IC was higher than GT at all of the corneal regions, but the region with the least bias was ICC, followed by ICT. In the multiple regression analysis, the following prediction formula was calculated: GT = (0.445 × ICC) + (0.198 × ICN) + 3.022. When ICC was excluded from the explanatory variables, ICT had the highest partial correlation coefficient with GT.Conclusion: ICC was closest to GT, but GT could be explained better by adding ICN to the prediction model. Moreover, in instances where ICC cannot be calculated or where reliability is clearly poor due to abnormal ocular rigidity, ICT was the closest to GT measured in the central corneal region.Keywords: IOP, Icare, Goldmann applanation tonometer, ocular rigidity

Atsushi Miki1,2, Motohiro Shirakashi1, Kiyoshi Yaoeda1, Yu Kabasawa1, Satoshi Ueki1, Mineo Takagi1, Haruki Abe11Department of Ophthalmology, Niigata University Graduate School of Medical and Dental Sciences, Niigata; 2Department of Ophthalmology, Kawasaki Medical School, Okayama, JapanPurpose: To investigate the characteristics of optic disc parameters in amblyopic eyes in which retinal involvement is uncertain.Methods: A total of 44 patients with a history of unilateral amblyopia (27 patients with persistent amblyopia and 17 patients with resolved amblyopia) were examined using the Heidelberg Retina Tomograph (HRT) II. Parameters examined included disc area, cup area, cup volume, rim area, rim volume, cup-to-disc area ratio, and mean retinal nerve fiber layer thickness.Results: In patients with persistent amblyopia, the amblyopic eyes were significantly more hyperopic than the fellow eyes. In the HRT parameters, there were no significant differences between the amblyopic and fellow eyes. In addition, after adjusting for refraction, the presence of strabismus, and the disc area, there was no significant difference in any HRT parameter between the amblyopic eyes of patients with persistent amblyopia and the previously amblyopic eyes of patients with resolved amblyopia.Conclusions: We did not find any strong evidence for the deformity of the optic disc of amblyopic eyes.Keywords: Heidelberg Retina Tomograph, amblyopia, optic disc, retinal nerve fiber layer thickness

PURPOSE To demonstrate the three-dimensional macular thickness distribution in normal subjects by spectral domain optical coherence tomography (SD-OCT) and evaluate its association with sex, age, and axial length. METHODS Mean regional retinal thickness measurements on the Early Treatment Diabetic Retinopathy Study (ETDRS) layout were obtained by three-dimensional raster scanning (6 x 6 mm) using SD-OCT in 248 normal eyes of 248 Japanese subjects. RESULTS Mean foveal thickness was 222 +/- 19 microm; it was significantly greater in men (226 +/- 19 microm) than in women (218 +/- 18 microm; P = 0.002) and did not correlate with age in either sex. Mean sectoral retinal thickness was also significantly greater in the men than in the women in all the quadrants of the inner ring (1-3 mm; P < 0.001 and P = 0.001-0.007) and in the temporal quadrant of the outer ring (3-6 mm; P < 0.001). The retinal thicknesses of each of the ETDRS sectors did not correlate significantly with axial length after adjustment for age in either sex. Retinal thickness in six of the eight sectors in the inner and outer rings showed a negative correlation with age after adjustment for axial length in the men (P < 0.001 and P = 0.001-0.018), whereas no correlation with age was observed in the women. CONCLUSIONS SD-OCT demonstrated the three-dimensional macular thickness distribution in normal eyes. Macular thickness varied significantly with sex and age. These variables should be considered while evaluating macular thickness.

We studied the prevalence of migraine in low-tension glaucoma (LTG) and primary open-angle glaucoma (POAG). Seventy seven Japanese patients with LTG, 73 with POAG, and 75 normal subjects were randomly selected and tested with a headache questionnaire. The prevalence of headache with or without typical migrainous features (unilateral headache or ocular pain, nausea, vomiting, and visual disturbance before headache) was 51% in LTG, 42% in POAG, and 44% in normal patients. The prevalence of headache with two migrainous features or more (probable migraine) was 17% in LTG, 11% in POAG, and 12% in normal subjects. The prevalence of headache with three migrainous features (classical migraine) was 5% in LTG, 3% in POAG, and 3% in normal subjects. There was no statistically significant difference in the prevalence of any types of migraine between the three groups of patients (p greater than 0.05). These results suggest there is no significant relationship between migraine and LTG or POAG in Japanese patients.

We studied the change in the optic disk topography during spontaneous pressure reduction in laser-induced primate glaucoma (7 eyes, follow-up of 20 weeks) using computerized image analysis (vertical and horizontal cup-to-disk ratios CDR(V), CDR(H); neuroretinal rim area/disk area; cup volume/disk area). A significant correlation was found between the percent pressure reduction and the percent reversal in each disk parameter. There was no significant difference in the percent reversal between CDR(V) and CDR(H). These results suggest that reversal of cupping may depend on the percent pressure reduction, and may occur symmetrically in primate glaucoma.

As generally known, the mechanism of optic nerve (ON) damage in primary open-angle glaucoma and in low tension glaucoma is not yet fully understood. Vascular, mechanical, and combined mechanisms have been suggested; however, in spite of a long history of discussion and investigation, an approach to understanding ON damage is not yet clear. Recently, my clinical and experimental investigations have revealed opposing facts to the vascular theory. We will present them in detail.

We studied the long-term efficacy of argon laser trabeculoplasty, applying low-power (a mean of 450 mW), a duration of 0.1 second, and a small number of burns (a mean total energy of 1.85 J) over 90 to 120 degrees of the trabecular meshwork. Fifty-four eyes with poorly controlled open-angle glaucoma were treated. The mean follow-up was 46 months. The mean intraocular pressure decrease was 5.3 mmHg in 35 eyes at one year, 6.1 mmHg in 23 eyes at 3 years, 5.1 mmHg in 13 eyes at 5 years, and 5.4 mmHg in 5 eyes at 6 years. Life-table analysis showed that the probability of success was 58% at one year, 49% at 3 years, and 46% at 5 years. Both the incidence and magnitude of the intraocular pressure rise in the early post-laser period were minimal and no serious complications were observed.

PURPOSE: Ultrasound biomicroscopy(UBM) was performed on filtering blebs with laser treatment including laser gonioplasty(GP), laser iridotomy(LI), and YAG laser trabeculopuncture(YLT) after non-penetrating trabeculectomy(NPT). The filtering blebs were grouped into four types, L, H, E and F, and the spaces under the scleral flap were classified into three. La, S, and N. CASES: In case 1, an F type, an S bleb was not changed despite laser treatment 9 months after NPT. In case 2, YLT was performed twice to release the incarcerated iris. The filtering bleb was changed to the L type, an La bleb. In case 3, an F type, an S bleb was turned into an H type after GP, LI, and YLT. In case 4, GP effectively released peripheral anterior synechia formation and the filtering bleb was kept as an L type, La. CONCLUSION: Appropriate laser treatment may be effective in turning a flattened and localized bleb into a good filtering bleb.

Nineteen eyes of 19 Japanese patients with medically uncontrollable chronic angle-closure glaucoma following laser iridotomy or surgical iridectomy underwent argon laser trabeculoplasty (ALT), applying low-power and a small number of laser burns over a small extent of the trabecular meshwork. All the eyes had glaucomatous optic disc damage, visual field loss, and intraocular pressure elevation before ALT. In each case, the extent of peripheral anterior synechiae was equal or less than 50% of the angle. The mean follow-up was 35 months. Life-table analysis (Kaplan-Meier method) showed that the probability of success was 66% at the end of three years after ALT. It is concluded that in the cases of uncontrollable chronic angle-closure glaucoma following laser iridotomy or surgical iridectomy, ALT should be tried before filtration surgery.