Cluster Formation for Analyses of Glaucomatous Visual Field Defects in Central 10-2 Visual Field in Normal Tension Glaucoma Eyes.

Purpose: To develop a cluster system to analyze the retinal sensitivity loss of 68 test points in the central 10 degrees of standard automated perimetry (SAP) in eyes with normal tension glaucoma (NTG). Patients and Methods: Patients with NTG who met the following criteria were included: visual acuity ≥0.7, SAP-derived mean deviation ≥-15 dB, and pattern deviation probability plots with at least one point with a probability of <0.5% and/or two or more contiguous points with a probability of <1% that did not cross the horizontal meridian in the central 12 points of the 24-2 test points. SAP with the Swedish Interactive Threshold Algorithm Standard (SITA-S) 10-2 program (10-2) was performed within 6 months of the SITA-S 24-2. The averaged total deviation (TD) for each of the 68 test points in the 10-2 was calculated. Hierarchical cluster analyses were performed based on the deviation of the TDs of the test points, and a dendrogram was created. The number of clusters was determined following the Sturges' rule. Results: One hundred and twenty-six eyes of 126 patients (61.9±11.4 years) were studied. Hierarchical cluster analysis of the TD values statistically obtained a dendrogram that divided the 68 test points into 7 clusters. Of these 7 clusters, 21 points belonging to the clusters in the papillomacular region included cluster 5. Cluster 5 was distributed above and below the horizontal meridian, which does not agree with the course of the retinal nerve fiber layer (RNFL). Conclusion: The hierarchical cluster analysis of the TD values stratified the 68 test points of the 10-2 into seven clusters. Considering the course of the RNFL, cluster 5 was divided into clusters of 5a and 5b, and consequently eight clusters were considered to be appropriate for detecting glaucomatous visual field defects in the central 10 degrees in NTG eyes.

Comparison of head-mounted perimeter (imo®) and Humphrey Field Analyzer.

PURPOSE: The head-mounted automated perimeter imo® is a new portable perimeter that does not require a dark room and can be used to examine patients in any setting. In this study, imo 24plus (1-2) AIZE examinations were compared with previous Humphrey Field Analyzer (HFA) 30-2 (SITA standard) examinations within the same patient. PATIENTS AND METHODS: imo examinations (either head-mounted [i-H] or fixed [i-F] type) were performed in patients with glaucoma or suspected glaucoma who had already experienced HFA five or more times. Measurement time and correlations of mean deviation (MD) and visual field index (VFI) values were compared between groups for HFA, i-H, i-F, and imo total (i-T). Fixation loss (FL), false-positive (FP), and false-negative (FN) detection rates were compared. The percentage of binocular random single-eye tests under possible non-occlusion conditions using imo was determined. Mann-Whitney U test was performed, and Spearman's rank-order correlation coefficient was calculated. RESULTS: The inclusion period was July to December 2016. Among 273 subjects (543 eyes), 147 (292 eyes) were tested with i-H type and 126 (251 eyes) with i-F type. Mean MD values for HFA and i-T were -6.1±7.8 and -6.2±7.1 dB, respectively. Mean measurement times for HFA, i-H, i-F, and i-T were 15.23±2.07, 10.47±2.11, 11.04±2.31, and 10.54±2.19 minutes, respectively (P<0.01 for HFA vs i-H/i-F). Total mean measurement time was shorter by 30.8% for i-T vs HFA. Correlation coefficients of MD and VFI were R 2>0.81 for HFA vs i-H and i-F. FP and FN detection rates were significantly higher with i-T than HFA; there was no significant difference in FL. Binocular random single-eye tests were possible in 85% of cases. CONCLUSION: imo reduced measurement time by 30.8%. imo VFI and MD values were highly correlated with HFA. As i-F and i-H types produced similar results, imo can be used in accordance with the patient's situation.

Multicenter, Randomized, Investigator-Masked Study Comparing Brimonidine Tartrate 0.1% and Timolol Maleate 0.5% as Adjunctive Therapies to Prostaglandin Analogues in Normal-Tension Glaucoma.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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 < 0.001). However, the difference in the change from baseline IOP at week 12 between the brimonidine (-1.05 ± 1.81 mmHg) and timolol (-1.41 ± 1.40 mmHg) groups was 0.36 mmHg (95% confidence interval [CI] [-0.21, 0.92]), which exceeded the value of the non-inferiority margin (0.75 mmHg). Baseline systolic/diastolic blood pressure decreased significantly in both groups at certain visits (P < 0.05), while baseline pulse rates decreased significantly in the timolol group (P < 0.001), with no significant differences in the brimonidine group. AE-related treatment discontinuation occurred in 2/71 (2.8%) and 2/75 (2.7%) patients in the brimonidine and timolol groups, respectively. CONCLUSION: This study demonstrated an add-on effect of brimonidine to PGAs, although non-inferiority of brimonidine to timolol as adjunctive therapy in PGA-treated NTG in terms of IOP reduction was not observed. Brimonidine was associated with no adverse effects on pulse rate. FUNDING: Senju Pharmaceutical Co., Ltd. TRIAL REGISTRATION: UMIN Clinical Trials Registry identifier, UMIN000014810.

Relationship between visual field progression and baseline refraction in primary open-angle glaucoma.

PURPOSE: To analyze the relationship between visual field (VF) progression and baseline refraction in Japanese patients with primary open-angle glaucoma (POAG) including normal-tension glaucoma. PATIENTS AND METHODS: In this retrospective study, the subjects were patients with POAG who had undergone VF tests at least ten times with a Humphrey Field Analyzer (Swedish interactive thresholding algorithm standard, Central 30-2 program). VF progression was defined as a significantly negative value of mean deviation (MD) slope at the final VF test. Multivariate logistic regression models were applied to detect an association between MD slope deterioration and baseline refraction. RESULTS: A total of 156 eyes of 156 patients were included in this analysis. Significant deterioration of MD slope was observed in 70 eyes of 70 patients (44.9%), whereas no significant deterioration was evident in 86 eyes of 86 patients (55.1%). The eyes with VF progression had significantly higher baseline refraction compared to those without apparent VF progression (-1.9±3.8 diopter [D] vs -3.5±3.4 D, P=0.0048) (mean ± standard deviation). When subject eyes were classified into four groups by the level of baseline refraction applying spherical equivalent (SE): no myopia (SE > -1D), mild myopia (-1D ≥ SE > -3D), moderate myopia (-3D ≥ SE > -6D), and severe myopia (-6D ≥ SE), the Cochran-Armitage trend analysis showed a decreasing trend in the proportion of MD slope deterioration with increasing severity of myopia (P=0.0002). The multivariate analysis revealed that baseline refraction (P=0.0108, odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.25) and intraocular pressure reduction rate (P=0.0150, OR: 0.97, 95% CI: 0.94-0.99) had a significant association with MD slope deterioration. CONCLUSION: In the current analysis of Japanese patients with POAG, baseline refraction was a factor significantly associated with MD slope deterioration as well as intraocular pressure reduction rate. When baseline refraction was classified into four groups, MD slope in myopia groups was less deteriorated as compared to those in the emmetropic/hyperopic group.

Effects of Brinzolamide, a Topical Carbonic Anhydrase Inhibitor, on Corneal Endothelial Cells.

INTRODUCTION: This clinical study aimed to investigate the effect of brinzolamide, a topical carbonic anhydrase inhibitor, on corneal endothelial cells (CECs) in patients with glaucoma using a follow-up clinical study design. METHODS: Patients with primary open-angle glaucoma or ocular hypertension were administrated an ophthalmic solution of either latanoprost alone (LT) as a control (n = 18) or latanoprost plus brinzolamide (LT + BR; n = 16). CECs were examined at baseline and at 4, 12, 24, and 48 weeks in 18 and 16 eyes of the LT and LT + BR groups, respectively, using a non-contact specular microscope. CECs were evaluated by parameters, including cell density (CD), coefficient of variation (CV) in cell size, and percentage hexagonality (Hex). RESULTS: Compared with the baseline intraocular pressure (IOP), the mean IOP in the LT group was significantly reduced at 12 and 24 weeks, whereas that in the LT + BR group was significantly reduced at all time points (P < 0.01). The mean CD, CV, and Hex at baseline were not significantly different between the two groups. No significant time-course changes in CD, CV, or Hex were observed in either group. At 48 weeks, there was no significant difference in the mean CD, CV, or Hex between the two groups. CONCLUSION: Patients treated with LT + BR showed significant IOP reduction. However, the use of brinzolamide in addition to latanoprost had no influence on CECs during the one-year follow-up period.

Relationship between consecutive deterioration of mean deviation value and progression of visual field defect in open-angle glaucoma.

PURPOSE: To analyze the relationship between consecutive deterioration of mean deviation (MD) value and glaucomatous visual field (VF) progression in open-angle glaucoma (OAG), including primary OAG and normal tension glaucoma. PATIENTS AND METHODS: The subjects of the study were patients undergoing treatment for OAG who had performed VF tests at least 10 times with a Humphrey field analyzer (SITA standard, C30-2 program). The VF progression was defined by a significantly negative MD slope (MD slope worsening) at the final VF test during the follow-up period. The relationship between the MD slope worsening and the consecutive deterioration of MD value were retrospectively analyzed. RESULTS: A total of 165 eyes of 165 patients were included in the analysis. Significant progression of VF defects was observed in 72 eyes of 72 patients (43.6%), while no significant progression was evident in 93 eyes of 93 patients (56.4%). There was significant relationship between the frequency of consecutive deterioration of MD value and MD slope worsening (P<0.0001, Cochran-Armitage trend test). A significant association was observed for MD slope worsening in the eyes with three (odds ratio: 2.1, P=0.0224) and four (odds ratio: 3.6, P=0.0008) consecutive deterioration of MD value in multiple logistic regression analysis, but no significant association in the eyes with two consecutive deterioration (odds ratio: 1.1, P=0.8282). The eyes with VF progression had significantly lower intraocular pressure reduction rate (P<0.01). CONCLUSION: This retrospective study has shown that three or more consecutive deterioration of MD value might be a predictor to future significant MD slope worsening in OAG.

Relationship between progression of visual field defect and intraocular pressure in primary open-angle glaucoma.

PURPOSE: To analyze the relationship between intraocular pressure (IOP) and the progression of visual field defects in Japanese primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) patients. PATIENTS AND METHODS: The subjects of the study were patients undergoing treatment for POAG or NTG who had performed visual field tests at least ten times with a Humphrey field analyzer (Swedish interactive thresholding algorithm standard, C30-2 program). The progression of visual field defects was defined by a significantly negative value of the mean deviation slope at the final visual field test during the follow-up period. The relationships between the progression of visual field defects and IOP, as well as other clinical factors, were retrospectively analyzed. RESULTS: A total of 156 eyes of 156 patients were included in the analysis. Significant progression of visual field defects was observed in 70 eyes of 70 patients (44.9%), while no significant progression was evident in 86 eyes of 86 patients (55.1%). The eyes with visual field defect progression had significantly lower baseline IOP (P<0.05), as well as significantly lower IOP reduction rate (P<0.01). The standard deviation of IOP values during follow-up was significantly greater in the eyes with visual field defect progression than in eyes without (P<0.05). CONCLUSION: Reducing IOP is thought to be useful for Japanese POAG or NTG patients to suppress the progression of visual field defects. In NTG, IOP management should take into account not only achieving the target IOP, but also minimizing the fluctuation of IOP during follow-up period.

The efficacy and safety of add-on 0.1% brimonidine tartrate preserved with sodium chlorite in on-treatment Japanese normal-tension glaucoma patients.

BACKGROUND: To evaluate the efficacy and safety of newly formulated brimonidine (0.1% brimonidine tartrate preserved with sodium chlorite: brimonidine) as add-on therapy in on-treatment Japanese normal-tension glaucoma (NTG) patients. METHODS: Brimonidine was added to on-treatment NTG patients with intraocular pressures (IOP) of between 13 mmHg and 16 mmHg after three consecutive IOP measurements. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 4, 8, and 12 weeks after brimonidine instillation. RESULTS: Though 75 of 83 patients (31 males and 52 females; mean age: 63.4±11.6 years) completed the study, six patients discontinued because of side effects and two patients withdrew. The mean IOP after brimonidine addition at week 4 (12.6±1.8 mmHg, P<0.001), week 8 (12.4±1.7 mmHg, P<0.001), and week 12 (12.6±1.8 mmHg, P<0.001) was significantly decreased compared with that before the addition of brimonidine (13.9±1.2 mmHg). No significant changes in superficial punctate keratitis or conjunctival hyperemia scores were observed throughout the study. Dizziness, sleepiness, eye pain, and itching (mild to moderate) were noted in five, four, three, and three patients, respectively. CONCLUSIONS: The addition of newly formulated brimonidine to on-treatment Japanese NTG patients with IOP of 13-16 mmHg further reduced the levels of IOP with minimal side effects and adverse events.

Multicentre clinical study of the herpes simplex virus immunochromatographic assay kit for the diagnosis of herpetic epithelial keratitis.

BACKGROUND/AIMS: The novel immunochromatographic assay (ICGA) kit was recently developed to diagnose herpes simplex virus (HSV) infection. This multicentre study aimed to evaluate the value of the ICGA kit for the diagnosis of herpetic epithelial keratitis by comparing it with immunofluorescence assay (IFA) and real-time PCR. METHODS: Corneal scrapings were collected from 117 patients, including 77 with herpetic keratitis as their final clinical diagnosis as well as 40 others at 21 facilities. These samples were tested by the ICGA kit, IFA and real-time PCR. RESULTS: The positive concordance between final clinical diagnosis and ICGA was 46.7% (35/75 cases) and the negative concordance was 100% (39/39). The positive and negative concordance between real-time PCR and ICGA were 57.4% (35/61 cases) and 100% (53/53), respectively. The positive and negative concordance between IFA and ICGA were 61.1% (22/36 cases) and 83.3% (55/66), respectively. In 92 cases where anti-HSV drugs were not prescribed prior to corneal scraping, the positive and negative concordance between final clinical diagnosis and ICGA were 55.0% (33/60 cases) and 100% (32/32), respectively. CONCLUSIONS: The ICGA kit has moderate sensitivity and high specificity, indicating clinical utility in the diagnosis of herpetic epithelial keratitis.

Assessment of retinal sensitivity using a time-saving strategy in normal individuals.

BACKGROUND: The purpose of this study was to compare retinal sensitivities in normal individuals obtained using the Swedish Interactive Threshold Algorithm Standard (SITA-S) on the Humphrey field analyzer with those obtained using the Dynamic strategy on the Octopus. METHODS: Prior to visual field examinations, the background luminance, stimulus size, and exposure time with the Octopus 101 were conformed to the Humphrey field analyzer II settings. Volunteers over 20 years of age without apparent ophthalmic abnormalities were examined with the SITA-S central 30-2 program followed by the Dynamic 32 program. Eye with corrected visual acuity ≥ 0.8, refraction ≥ -6.0 diopters, and fields with satisfactory levels of reliability in SITA-S and Dynamic were selected. RESULTS: Sixty-seven eyes from 67 normal individuals of mean age 51.3 ± 16.3 (range 22-76) years satisfied the selection criteria and were analyzed. Mean retinal sensitivity was significantly (P < 0.0001) higher with SITA-S (29.0 ± 2.4 dB) than with Dynamic (26.8 ± 2.1 dB). Changes in retinal sensitivity with increasing age were significantly (P = 0.0003) greater with Dynamic (-0.09 ± 0.04 dB/year; 95% confidence interval [CI] -0.10 to -0.08 dB/year) than with SITA-S (-0.07 ± 0.04 dB/year, 95% CI -0.08 to -0.06 dB/year). When classifying the visual field into three areas (central, mid-peripheral, and peripheral), retinal sensitivities with SITA-S were significantly higher in all areas than with Dynamic (P < 0.0001 for all three areas). CONCLUSION: Differences in Dynamic and SITA-S strategies may contribute to the differences in retinal sensitivities observed in normal individuals.

Bimatoprost ophthalmic solution 0.03% lowered intraocular pressure of normal-tension glaucoma with minimal adverse events.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of bimatoprost ophthalmic solution 0.03% (bimatoprost) in Japanese normal-tension glaucoma (NTG) patients with an intraocular pressure (IOP) of 18 mmHg or less. METHODS: Bimatoprost was instilled into the unilateral conjunctival sac of Japanese NTG patients with a baseline IOP of 18 mmHg or less. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 2, 4, 8, and 12 weeks post bimatoprost instillation. RESULTS: Thirty-two of the 38 enrolled NTG patients (mean age, 64.1 ± 12.6 years; 19 males and 19 females) completed the study, with six patients unable to complete the study (two patients discontinued because of side effects and four patients withdrew). The levels of IOP in the treated eyes were significantly reduced (P < 0.0001) from the baseline IOP levels. No significant change in IOP was observed in the fellow eyes. There were significant increases in conjunctival hyperemia. No significant superficial punctate keratitis scores were noted between the baseline and each point examined. Eyelash disorder, eyelid pigmentation, and deepening of the upper eyelid sulcus were observed in 28, six, and three eyes, respectively. CONCLUSION: Bimatoprost effectively lowered the IOP. It was well tolerated in Japanese NTG patients, with few patients having to discontinue because of adverse events.

Effect of long-term treatment with eyedrops for glaucoma on conjunctival bacterial flora.

OBJECTIVE: The effect of eyedrops for glaucoma on conjunctival bacterial flora was investigated by comparing a group of patients treated with such eyedrops for at least 1 year to a control group that did not use eyedrops. METHODS: In both groups, bacterial culture came from scrapings of the conjunctival sac, and the bacterial infection rate and pattern of drug resistance were determined. Findings were analyzed in various subgroups stratified by age, frequency of instillation, and concentration of antiseptic benzalkonium chloride in the eyedrops. RESULTS: The culture-positive rate was significantly lower in the glaucoma eyedrop group (43/119 eyes, 40.3%) than in the control group (19/28 eyes, 67.8%) (P < 0.05). No differences in infection rate were found among the different age groups. The most frequent bacteria in both groups was coagulase-negative staphylococci. Gram-negative bacteria were only detected in the glaucoma eyedrop group. Retrospective evaluation was possible for 86 eyes of patients from the glaucoma eyedrop group, among which 45 eyes (52.3%) showed some corneal epithelium damage. There was no difference in the culture-positive rate of bacteria between patients who used eyedrops containing 0.01% or higher dose of benzalkonium chloride and those containing less than 0.01%. Strains that showed resistance to levofloxacin were significantly less frequent in the glaucoma eyedrop group (six strains, 15.0%) than in the control group (11 strains, 39.3%) (P < 0.05). CONCLUSION: Patients using eyedrops for glaucoma had a lower culture-positive rate of bacteria in the conjunctival sac, probably due to being washed out by the eyedrops. However, Gram-negative bacteria were detected in the eyedrop group. Bacteria isolated from the eyedrop group had lower resistance to levofloxacin, a finding that may have clinical relevance.

[Correlation between visual field index values and mean deviation values of Humphrey field analyzer].

PURPOSE: We examined the correlation between the visual field index (VFI) and mean deviation (MD), as well as the correlation on VFI slope and MD slope. METHODS: This retrospective study was performed on 105 eyes of 60 patients. All eyes underwent examination by the Humphrey visual field analyzer. The correlation of the (i) VFI and MD, (ii) VFI slope and MD slope were analyzed in all eyes and the eyes were classified by visual field patterns (paracentral, peripheral, mixed and normal defect type). (iii) The agreement degree between the VFI slope and MD slope was examined. A generalized-estimating-equation(GEE) model and kappa statistic were used for analysis. RESULT: A significant correlation between MD and VFI was shown in all eyes, including eyes classified of visual field defect. The correlation between the VFI slope and MD slope was significant in all eyes. However, these correlations were not evident in paracentral type of defect but in the other types. K statistic evaluated a moderate agreement between the VFI slope and MD slope. CONCLUSION: A significant correlation was shown between the VFI and MD, VFI slope and MD slope in all eyes. However, no correlation between the VFI slope and MD slope existed in the paracentral area. It seems that the evaluation of progression of visual field defect in the central area needs to be considered carefully.

Efficacy and safety of tafluprost in normal-tension glaucoma with intraocular pressure of 16 mmHg or less.

PURPOSE: To evaluate the intraocular pressure (IOP)-reducing effects and safety of 0.0015% tafluprost ophthalmic solution (tafluprost) in normal-tension glaucoma (NTG) patients with an IOP of 16 mmHg or less. METHODS: NTG patients with a baseline IOP of 16 mmHg or less were enrolled for a one-eye study in which tafluprost was applied once daily for 12 weeks. The presence of adverse drug reactions and the cumulative incidence of adverse events were also investigated. RESULTS: Among the 44 enrolled patients, 41/44 (93.2%) eyes completed the study. The baseline IOP was 13.2 ± 1.3 mmHg in the study eyes and 13.0 ± 1.3 mmHg in the fellow eyes, which was not statistically significant (P = 0.9173, Student's t test). The values obtained for IOP in the study eyes versus fellow eyes were 10.2 ± 1.6 versus 12.1 ± 1.5 mmHg at week 12. The IOP difference between the study eyes and the fellow eyes was statistically significant (P < 0.0001, Student's t test). The cumulative incidence of adverse events was 58.5% by week 12. Ocular itching was the most frequently observed adverse event (29.3%). All adverse events were clinically tolerable. CONCLUSIONS: Tafluprost induced significant IOP reductions in NTG patients with a baseline IOP of 16 mmHg or less without raising any safety concerns.

[Anderson criteria in early glaucomatous visual field defects with the SITA Standard].

PURPOSE: We evaluated the positive rate of the Anderson criteria of suspected early glaucomatous visual field defects (GVFDs). SUBJECTS AND METHODS: Ninety-six eyes of 96 patients, who had suspected primary open-angle glaucoma with apparent glaucomatous optic disc changes and who had more than -6.0 dB of mean deviation (MD) with Swedish Interactive Thresholding Algorithm Standard (SITA-S) Central 30-2 program in the Humphrey Field Analyzer, were selected. We applied the Anderson criteria and calculated the positive rates for these criteria and for three elements pattern deviation probability plots (PD plots), glaucoma hemifield test (GHT), pattern standard deviation (PSD). RESULTS: The positive rate of the Anderson criteria was 78.1% and the PD plots (77.1%) were significantly higher rate than the GHT (62.5%) or the PSD (63.5%). The positive rate of the Anderson criteria was 100% in the MD of less than -3.0 dB and was 65.6% even in the MD of more than -3 dB (p < 0.0001). On the other hand, 57.9% of the eyes with an MD between -2 dB and -1 dB showed positive in all elements. At more than -1.0 dB of MD, the PD plots (50.0%) were significantly higher than the PSD (18.8%) or the GHT (21.9%) (PSD: p = 0.0085, GHT : p = 0.0190). CONCLUSION: Using the SITA-S, the Anderson criteria showed a high positive rate in eyes with suspected early GVFDs.

Effects of switching to SofZia-preserved travoprost in patients who presented with superficial punctate keratopathy while under treatment with latanoprost.

PURPOSE: To investigate the effects of switching to SofZia-preserved travoprost (TRV) on superficial punctate keratopathy (SPK) observed in patients using benzalkonium chloride (BAC)-preserved latanoprost (LAT). METHODS: Patients with either primary open-angle glaucoma or ocular hypertension treated with LAT for at least 1 month who presented with SPK participated in this prospective, multicenter, open-label uncontrolled study. After the switch from LAT to TRV, patients were monitored at 2 weeks and at 1, 2, and 3 months. The use of concomitantly employed ophthalmic solutions was continued during the observation period. The intensity of SPK in each of five areas defined on the cornea was scored on a standard scale. Repeated measurements were tested with a linear mixed model. RESULTS: Of the 48 patients enrolled, 45 patients completed the study. After the switch to TRV, the mean SPK score in the whole cornea decreased significantly at every observation point (P < 0.0001 at each point) while intraocular pressure did not change significantly. Throughout the observation period, the SPK score tended to be higher in patients using a larger number of concomitant medications that contained BAC. CONCLUSION: Switching to TRV improved SPK observed in a population using LAT, likely because of a decrease in exposure to BAC.

[Quality of life evaluation in elderly normal tension glaucoma patients using the Japanese version of VFQ-25].

PURPOSE: To evaluate the quality of life (QOL) related to the visual functioning of elderly normal-tension glaucoma(NTG) patients quantitatively. SUBJECTS & METHODS: 231 NTG patients 65 years or older with visual field loss in Humphrey visual field analysis were studied. The correlation of the subjects' VFQ-25 scores were studied with their patient background information, as well as with their eye test values for intraocular pressure, corrected visual acuity, refraction, mean deviation (MD), and pattern standard deviation (PSD) in the worst seeing eye. RESULTS: No correlation with the VFQ-25 scores (VFQ-S) was found in any of the 12 sub-scales for gender, age, or duration of the disease. However, the number of glaucoma eye-drop solutions showed a negative correlation with 2 sub-scales. Driving was the only sub-scale in which a correlation was found between the VFQ-S and the subjects' intraocular pressure. Corrected visual acuity demonstrated correlations in many of the sub-scales. MD measurements showed a high correlation with the VFQ-S in all items except general health and ocular pain. On the other hand, no correlation with the VFQ-S was observed in any of the sub-scales for the PSD measurements. CONCLUSION: The VFQ-S of elderly NTG patients showed a high degree of reliability. The VFQ-25 scores were useful and suitable tools for evaluating the QOL of glaucoma patients with visual field and acuity impairment.

[Ocular pulse amplitude in patients with open-angle glaucoma, normal-tension glaucoma, and ocular hypertensionby dynamic observing tonometry].

PURPOSE: The aim of this study was to compare the ocular pulse amplitude (OPA) in patients with different types of glaucoma, and also to evaluate the usefulness of OPA for the elucidation of normal-tension glaucoma (NTG). OPA is thought to reflect choroidal circulation. SUBJECTS: Sixty-six patients with normal-tension glaucoma (NTG), 52 patients with primary open angle glaucoma (POAG), 42 with ocular hypertension (OH) and 68 normal controls (NC) were enrolled in this study. METHODS: OPA was measured in all participants by dynamic observing tonometry(DOT). The correlation between OPA and the following parameters [IOP, refraction error (Ref), blood pressure, pulse pressure (PP), MD of Humphrey field analyzer 30-2, type of groups] was analyzed by linear and multiple regression analysis (MRA). Multiple logistic regression analysis (MLR) was used to estimate the adjusted odds ratio (OR) for evaluation of the association between OPA (including other factors) and the proportion of NTG. RESULTS: In MRA, IOP, Ref (< -3 D), PP and type of groups were significantly associated with OPA. The OPA in NTG was significantly lower than NC (p < 0.05). MLR demonstrated that OPA [OR 0.26 (95% CI, 0.12-0.57), p = 0.001] was associated with increased risk of having NTG. CONCLUSIONS: Lower OPA in patients with NTG suggests that there is insufficiency of ocular circulation in NTG. Evaluation of OPA may be useful for the elucidation of the pathogenesis of glaucoma.

Addition of or switch to topical bunazosin hydrochloride in elderly patients with normal-tension glaucoma: A one-year follow-up study.

PURPOSE: To evaluate the efficacy and safety of 0.01% bunazosin hydrochloride ophthalmic solution (bunazosin) for elderly patients with normal-tension glaucoma (NTG) as an addition to or instead of their previous therapy. METHODS: Bunazosin was administered to NTG patients aged 65 years or over who had been undergoing topical glaucoma therapy. In accordance with the study protocol, intraocular pressure (IOP) and visual field measurement were performed and the safety of the treatment was evaluated periodically between week 0 and week 52 at the five facilities where the study was carried out. RESULTS: Of the 98 enrolled patients, 84 (85.7%) were followed up for 52 weeks. During the follow-up period, IOP significantly and persistently decreased (week 0, 15.0 +/- 2.5 mmHg; week 52, 13.4 +/- 2.4 mmHg, P < 0.0001), but the decrease in mean deviation (MD) was not significant. Although no systemic adverse reactions were observed, local adverse events were noted in 7 of the 98 patients. CONCLUSIONS: The addition of or the switch to bunazosin in elderly NTG patients resulted in a significant reduction of IOP without apparent exacerbation of visual field defects or systemic or local adverse reactions other than conjunctival hyperemia.