Impact of patient access to Internet health records on glaucoma medication: randomized controlled trial.

BACKGROUND: Glaucoma is one of the leading causes of blindness. Reduction of intraocular pressure is the only proven way to prevent progression of glaucomatous optic neuropathy. The majority of glaucoma patients need to use antiglaucoma ophthalmic solutions over the course of their life. Thus, good adherence and persistency of glaucoma treatment are important factors for better glaucoma care. OBJECTIVE: The purpose of this study was to investigate the impact of an Internet-based glaucoma care support system on glaucoma medication use. METHODS: Patients were randomly divided into two groups. The non-Internet access (NIA) group consisted of patients who had access to the Internet-based glaucoma care support system during the 4-year period only when they were examined by ophthalmologists. The Internet access (IA) group consisted of patients who had the same Internet-based glaucoma care support system access as the NIA group for the first 2 years following enrollment but who were also given free access to the glaucoma care support system for the remaining 2 years. Changes in glaucoma medication use were investigated. RESULTS: In total, 81 patients in the IA group and 90 patients in the NIA group satisfied the study protocol. The number of antiglaucoma ophthalmic solutions used during the study period significantly increased in the NIA group (P<.03) but not in the IA group. The percentages of patients with unchanged, increased, and decreased antiglaucoma ophthalmic solution use during the study period were 61.1% (55/90), 17.8% (16/90), and 3.3% (3/90), respectively, in the NIA group, and 56.8% (46/81), 8.6% (7/81), and 13.6% (11/81), respectively, in the IA group (P<.001). Internet access significantly shifted from an increasing intraocular pressure trend to a decreasing trend in the IA group (P=.002) among the patients who did not have any medication changes. CONCLUSIONS: Allowing patients to browse their medical data may reduce the use and improve the effectiveness of glaucoma medication. TRIAL REGISTRATION: UMIN-CTR Clinical Trial Number: UMIN000006982; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000008238&language=E (Archived by WebCite at http://www.webcitation.org/6MRPQeEAv).

Five-year incidence of angle closure among glaucoma health examination participants.

BACKGROUND AND AIM: To investigate incidence of angle closure (AC) and its associated factors through a community-based longitudinal study over a 5-year period. METHODS: Japanese residents aged 40 years or over who underwent two glaucoma health examinations held in 2005 and 2010 were enrolled. Of the participants of the first glaucoma health examination (first examination), those who satisfied exclusion criteria such as having eyes with angle closure, glaucoma, incisional ocular surgery, or other conditions that could influence the results were eliminated from the second glaucoma health examination (second examination). In addition to routine ophthalmic examination, a scanning peripheral anterior chamber depth analyzer (SPAC) was employed to investigate the anterior chamber configuration. The incidence of angle closure over the 5-year period and its associated factors were investigated. RESULTS: Of the 754 participants of the first examination, 569 participants were invited for the second examination and 331 participants (87 males and 244 females, age: 62.6 ± 12.7 years), or 619 eyes, were analyzed after eliminating eyes matching exclusion criteria. In the 5-year period, the incidence of AC was 5.4 % (95 % CI: 3.5-8.4 %) of participants or 5.5 % (95 % CI: 4.0-7.6 %) of eyes, including eight eyes (1.3 %) with primary angle-closure glaucoma. Eyes that developed AC had a much smaller SPAC grade at the first examination and a greater decrease in SPAC grade than those that did not develop AC, whereas age and sex were not associated. CONCLUSIONS: AC was developed by 5.4 % of senior Japanese residents over the 5-year period. The shallow anterior chamber and the marked decrease in anterior chamber depth were associated with AC development.

Association between genetic variants associated with vertical cup-to-disc ratio and phenotypic features of primary open-angle glaucoma.

PURPOSE: To assess the association between the genetic variants associated with the optic nerve vertical cup-to-disc ratio (VCDR) and the phenotypic features in patients with primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG) and high-tension glaucoma (HTG). DESIGN: Case-control study. PARTICIPANTS AND CONTROLS: Japanese patients with NTG (n = 213) and HTG (n = 212) and 191 control subjects without glaucoma. METHODS: DNA samples were genotyped for 7 single nucleotide polymorphisms (SNPs) associated with VCDR: rs1063192 (near gene: CDKN2B), rs10483727 (SIX1), rs17146964 (SCYL1), rs1547014 (CHEK2), rs1900004 (ATOH7), rs1926320 (DCLK1), and rs12015126 (RERE). MAIN OUTCOME MEASURES: The VCDR was compared between genotypes, and allele frequency differences were compared between NTG or HTG subjects and control subjects. Demographic and clinical features were compared between alleles in patients with NTG or HTG. RESULTS: There were significant VCDR differences (P = 0.0077 and P = 0.019) between the genotypes for rs1063192 (CDKN2B) and rs1547014 (CHEK2), respectively. There were significant differences in the rs1063192 (CDKN2B) and rs1900004 (ATOH7) allele frequencies between the NTG subjects and control subjects (P = 0.0023 and P = 0.028, respectively) and a significant difference (P = 0.013) in the rs1547014 (CHEK2) allele frequencies between the HTG subjects and control subjects. Ages at diagnosis were significantly different in the NTG subjects with and without the rs10483727 (SIX1) C allele (P = 0.017) or the rs1926320 (DCLK1) T allele (P = 0.040). Likewise, the age at diagnosis was significantly different (P = 0.037) in the HTG subjects with and without the rs12025126 (RERE) T allele. There were no significant associations between the maximum intraocular pressure (IOP) and 7 genotyped SNP alleles in patients with NTG or HTG. CONCLUSIONS: The rs1063192 (CDKN2B) and rs1900004 (ATOH7) seem to be non-IOP-related genetic risk factors for NTG, and the rs1547014 (CHEK2) is a genetic risk factor for HTG. Although the rs10483727 (SIX1), rs1926320 (DCLK1), or rs12025126 (RERE) alone may not be sufficient for the development of POAG, the association of these SNPs with a phenotypic feature in patients with NTG or HTG suggests that these loci contribute to the pathogenesis of POAG.

Lack of association between p53 gene polymorphisms and primary open angle glaucoma in the Japanese population.

PURPOSE: To assess whether tumor protein p53 gene (p53) polymorphisms are associated with primary open angle glaucoma (POAG) in the Japanese population. METHODS: Four hundred and twenty-five Japanese patients with POAG, including normal tension glaucoma (NTG, n=213) and high tension glaucoma (HTG, n=212) and 189 control subjects without glaucoma were analyzed for two p53 polymorphisms (rs1042522; a G-->C substitution at codon 72 in exon 4 and rs59758982; a 16 base pair insertion in intron 3) using allele specific primer PCR and a pyrosequencing technique respectively. The genotypic and allelic frequencies were compared between NTG or HTG patients and control subjects. RESULTS: No significant difference (NTG versus control, p=0.99, and HTG versus control, p=0.69, chi(2) test) was observed regarding the p53 genotype frequencies at codon 72 between the NTG (GG: 43.2%, GC: 44.6%, CC: 12.2%) or HTG (GG: 40.1%, GC: 48.1%, CC: 11.8%) patients and the control subjects (GG: 43.9%, GC: 43.9%, CC: 12.2%). In addition, there was no significant difference (NTG versus control, p=0.94; and HTG versus control, p=0.66, Fisher's exact test) in the p53 allele frequencies at codon 72 between the NTG (G allele: 65.5%, C allele: 34.5%) or HTG (G allele: 64.2%, C allele: 35.8%) patients and the control subjects (G allele: 65.9%, C allele: 34.1%). No 16 base pair insertion in intron 3 was found in this study. CONCLUSION: p53 polymorphisms were not associated with POAG in the Japanese population. Further studies in the other ethnic populations should therefore be performed to elucidate whether the p53 intron 3 insertion polymorphism is a genetic risk factor for POAG, because the intron 3 insertion polymorphism occurs very rarely in the Japanese population.

Changes in anterior chamber depth due to contusion.

PURPOSE: We aimed to investigate changes in anterior chamber depth (ACD) prospectively in patients with recent unilateral contusion but no signs of angle recession, using a scanning peripheral anterior chamber depth analyzer (SPAC). METHODS: Among patients whose chief complaint was recent unilateral contusion and who showed no signs of angle recession by gonioscopy in 2006 and 2007, those who satisfied the following criteria were subjected to SPAC evaluation of ACD from the central to the peripheral region: no history of ocular diseases or ocular surgery including laser treatment, and similar refractory error in both eyes before trauma. RESULTS: Thirty-seven patients satisfied the criteria (29 males, 8 females; age: 28.6 +/- 23.5 years). Fourteen patients presented with commotio retinae. Fifteen showed no ocular manifestations related to the contusion. The mean SPAC-determined ACD grades of contused and noncontused eyes were 10.7 +/- 1.6 and 9.8 +/- 2.1, respectively, demonstrating that the contused eyes had significantly larger ACD values than the noncontused ones (p = 0.0005). The contused eyes had larger ACD values in both the central and the peripheral regions. The difference in ACD between the contused and noncontused eyes tended to increase with greater distance from the center. The equivalent refractive errors were -2.3 +/- 2.2 and -1.7 +/- 2.1 dpt, respectively (p = 0.004). There were no significant differences in best-corrected visual acuity and intraocular pressure between the contused and the noncontused eyes. CONCLUSION: Contusion may increase ACD particularly in the peripheral region even in patients who have no apparent manifestations in the anterior ocular segment.

Lysyl oxidase-like 1 gene polymorphisms in Japanese patients with primary open angle glaucoma and exfoliation syndrome.

PURPOSE: To assess whether lysyl oxidase-like 1 (LOXL1) polymorphisms are associated with primary open-angle glaucoma (POAG) and exfoliation syndrome (XFS). METHODS: Japanese patients with POAG (n=213) or XFS (n=89) and 191 control subjects were analyzed for LOXL1 polymorphisms (rs1048661: 758G/T, Arg141Leu and rs3825942: 794G/A, Gly153Asp). Demographic and clinical features of POAG patients and control subjects were compared in terms of the TT/GG compound genotype of rs1048661 and rs3825942. RESULTS: There was a significant difference in the genotype frequencies between XFS patients and control subjects (p<0.0001). Frequencies of the T allele of rs1048661 and the G allele of rs3825942 were significantly higher in XFS patients than in control subjects (rs1048661: 99.4% versus 55.0%; rs3825942: 99.4% versus 85.3%; p<0.0001). Except for one who had the TG/AG compound genotype, all XFS patients had the TT/GG compound genotype. An almost 250 fold increase in the risk of XFS (p<0.0001; odds ratio: 252.2; 95% confidence interval: 32.7 to more than 1000) was found in patients with the TT/GG compound genotype compared to those without the genotype. There were no significant differences in the genotype and allele frequencies between POAG patients and control subjects. Furthermore, no significant differences were noted in the demographic and clinical features of POAG patients as well as control subjects with and without the TT/GG high-risk compound genotype. CONCLUSIONS: LOXL1 polymorphisms were associated with XFS. However, the frequencies of the polymorphisms differed between Japanese and Caucasian XFS patients. These polymorphisms had no influence on the phenotypic features of POAG patients.

Effect of uncompensated corneal polarization on the detection of localized retinal nerve fiber layer defects.

PURPOSE: To investigate the effect of corneal polarization on the detection of retinal nerve fiber layer (RNFL) defects in an artificial eye using scanning laser polarimetry. METHODS: The model eye was composed of a film with a birefringence magnitude of 80 nm (single-pass retardance) in front of a plastic disc with a radial axis of birefringence, which was partially covered with a strip of black paper. The plastic disc, black paper and the film simulated the RNFL, the RNFL defect and the cornea, respectively. The model eye was located at 25 cm from the lens of the Nerve Fiber Analyzer II (NFA II) or GDx with variable corneal compensator (GDx-VCC). Using NFA II, the retardation of the laser beam was measured with/without the artificial cornea in differently simulated corneal birefringence axes that are 15 degrees nasally downward, and 15 degrees nasally upward. Using a GDx, the model eye with/without cornea was measured with a fixed corneal compensator (GDx-FCC) or GDx-VCC. RESULTS: Using NFA II or GDx-FCC, there were three areas in the RNFL thickness profile where an RNFL defect was detected, undetected and reversed. The mean thickness of the RNFL defects was not different from the mean thickness of RNFL in one model eye using NFA II (p = 0.3). Using GDx-VCC, all RNFL defects were detected in all model eye settings. CONCLUSIONS: The influence of incorrect compensation of the anterior segment birefringence is significant. With an FCC, there were particular locations in the retina where the RNFL defects were not detected. The GDx-VCC is a promising tool in glaucoma diagnosis because it detects RNFL defects in any corneal setting.

Efficacy and Safety of Switching Prostaglandin Analog Monotherapy to Tafluprost/Timolol Fixed-Combination Therapy.

PURPOSE: To assess the efficacy and safety of switching from prostaglandin analog (PGA) monotherapy to tafluprost/timolol fixed-combination (Taf/Tim) therapy. SUBJECTS AND METHODS: Patients with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension who had received PGA monotherapy for at least 3 months were enrolled. Patients were examined at 1, 2, and 3 months after changing therapies. Subsequently, the patients were returned to PGA monotherapy. The examined parameters included intraocular pressure (IOP) and adverse events. A questionnaire survey was conducted after the switch to Taf/Tim therapy. RESULTS: Forty patients with a mean age of 66.5 ± 10.3 years were enrolled; 39 of these patients completed the study protocol. Switching to Taf/Tim significantly reduced the IOP from 18.2 ± 2.6 mmHg at baseline to 14.8 ± 2.5 mmHg at 1 month, 15.2 ± 2.8 mmHg at 2 months, and 14.9 ± 2.5 mmHg at 3 months (P < 0.001). Switching back to the original PGA monotherapy returned the IOP values to baseline levels. Taf/Tim reduced the pulse rate insignificantly. No significant differences were observed in blood pressure, conjunctival hyperemia, or corneal adverse events. A questionnaire showed that the introduction of Taf/Tim did not significantly influence symptoms. CONCLUSIONS: Compared with PGA monotherapy, Taf/Tim fixed-combination therapy significantly reduced IOP without severe adverse events.

The OPA1 gene polymorphism is associated with normal tension and high tension glaucoma.

PURPOSE: To assess whether genetic polymorphisms of optic atrophy 1 (OPA1) are associated with primary open-angle glaucoma (POAG). DESIGN: Prospective case control association study. METHODS: Japanese patients with normal tension glaucoma (NTG, n = 194), and high tension glaucoma (HTG, n = 191), and 185 control subjects were analyzed for the OPA1 intervening sequence (IVS) 8+4 cystosine thymine (C/T) and IVS 8+32 thymine cystosine (T/C) polymorphisms using pyrosequencing technique. RESULTS: There was a significant difference in the OPA1 IVS 8 +32 T/C genotype frequencies between the NTG patients and control subjects (P = .0074), and the frequency of the cystosine (C) allele was significantly higher in the NTG patients compared with the control subjects (19.3% vs 11.6%, P = .0036). Adjusted for age, gender, refractive error, and intraocular pressure, an almost two-fold increased risk of NTG (P = .004, odds ratio 2.27, 95% confidence interval 1.30 to 3.97) was found with the OPA1 IVS 8 +32 C allele. Although there was no significant difference in the OPA1 IVS 8 +32 T/C genotype frequencies between the HTG patients and control subjects (P = .24), the age at the time of diagnosis (53 +/- 11.0 years, median value +/- median absolute deviation) in the HTG patients with the OPA1 IVS 8 +32 C allele was significantly younger than that (57 +/- 12.0 years) in the HTG patients without C allele (P = .048). CONCLUSIONS: The OPA1 IVS 8 +32 T/C polymorphism is associated with NTG, and may be used as a marker for this disease association. This polymorphism also influences the phenotypic feature in patients with HTG and should be considered to be a genetic risk factor not only for NTG, but also for HTG.

Case finding of angle closure glaucoma in public health examination with scanning peripheral anterior chamber depth analyzer.

PURPOSE: Despite the fact that the occurrence of angle closure glaucoma (ACG) or acute primary angle closure (PAC) can be prevented, in many cases, nonphysicians fail to detect them in regular health examinations before their onset. This study was aimed at examining the utility of a newly developed noncontact scanning peripheral anterior chamber depth analyzer (SPAC) in finding eyes at risk of ACG and acute PAC in a public health examination by nonphysicians. METHODS: A total of 535 local residents 40 years old or over were enrolled. In primary screening, nonphysicians use SPAC to determine up to 21 consecutive circumferential measurements of anterior chamber depth (ACD). The subjects were classified into 4 groups on basis of the previously established criteria: group 1: all ACD values above the minimum value of 72% confidence interval (CI); group 2: 1 or more ACD values below the minimum value of 72% or less than 4 ACD values below the minimum value of 95% CI; group 3: 4 or more ACD values below the minimum value of 95% CI; and group 4: no ACD data available. All the subjects from group 3 and those from group 2 or group 4 who were suspected to be at risk of ACG as diagnosed by a glaucoma specialist were subjected to a definitive examination. RESULTS: Fifty-seven (10.7%) subjects were recruited to the definitive examination. The final diagnoses were 1 subject with primary ACG (1.8%), 23 subjects with PAC (40.4%), 15 PAC suspect subjects (26.3%), and 18 subjects (31.6%) had eyes with open angle. All of them were from group 3. CONCLUSIONS: SPAC detected eyes at risk of ACG in a public health examination.

Methylenetetrahydrofolate reductase gene polymorphisms c.677C/T and c.1298A/C are not associated with open angle glaucoma.

PURPOSE: To assess whether or not the c.677C/T and c.1298A/C genetic polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene are associated with open angle glaucoma (OAG). METHODS: Genomic DNA was examined in a cohort of 131 Japanese patients with normal tension glaucoma (NTG), 133 patients with primary open angle glaucoma (POAG), and 106 control subjects. The mean age at the time of blood sampling was 62.8+/-13.3 years (mean+/-SD) in the patients with NTG, 61.8+/-15.4 years in the patients with POAG, and 65.0+/-10.5 years in the control subjects. MTHFR c.677C/T and c.1298A/C genotype and allele frequencies were determined using pyrosequencing analysis, and the findings were compared between the OAG patients and control subjects. The frequencies of compound MTHFR c.677C/T and c.1298A/C genotypes were also compared between OAG patients and control subjects. RESULTS: No significant differences were observed (p>0.05, chi2 test or Fisher's exact test) regarding the MTHFR c.677C/T genotype (TT: 14.5%, CT: 44.3%, CC: 41.2% for patients with NTG; TT: 20.3%, CT: 41.4%, CC: 38.3% for patients with POAG; TT: 17.9%, CT: 36.8%, CC: 45.3% for control subjects) and c.1298A/C (CC: 0%, AC: 38.9%, AA: 61.1% for patients with NTG; CC: 2.3%, AC: 32.3%, AA: 65.4% for patients with POAG; CC: 0.9%, AC: 41.5%, AA: 57.6% for control subjects). There were no allele frequencies between the NTG or POAG patients and the control subjects. In addition, no significant differences (p>0.05, chi2 test) were found in the frequencies of the compound MTHFR c.677C/T and c.1298A/C genotypes between the NTG or POAG patients and the control subjects. CONCLUSIONS: The MTHFR c.677C/T and c.1298A/C polymorphisms were not found to be associated with NTG and POAG. Further studies in the different ethnic populations should be performed to elucidate the relationship between MTHFR and OAG.

Comparison between newly developed scanning peripheral anterior chamber depth analyzer and conventional methods of evaluating anterior chamber configuration.

PURPOSE: To compare the newly developed scanning peripheral anterior chamber depth analyzer (SPAC) with the Van Herick technique, the Shaffer grading system, and ultrasound biomicroscopy (UBM), in terms of accuracy of measurement of peripheral anterior chamber depth (ACD). METHODS: The subjects were well-controlled glaucoma patients who were being treated at the University of Yamanashi Hospital. Ten eyes from each of the 4 groups classified as Shaffer grades 1 to 4 were evaluated by SPAC, the Van Herick technique, and UBM. All measurements were performed independently on the temporal side in a masked fashion. SPAC evaluated ACD consecutively from the pupil center to the limbus at 0.4 mm intervals. UBM measurements were carried out at a depth of 500 mum (angle-opening distance 500) from the scleral spur. A dummy eye was used for evaluating SPAC measurement accuracy. RESULTS: The results of SPAC measurement were well correlated with those of the Van Herick technique and the Shaffer grading system. The SPAC measurement results were also significantly correlated with angle-opening distance 500. The correlation coefficients at distances of 2, 4, 4.8, and 5.6 mm from the pupil center were r=0.68, 0.69, 0.69, and 0.61, respectively, and the P values of all the correlations were less than 0.0001. Study of the dummy eye revealed that SPAC has high accuracy for measuring ACD and that the coefficient variances were less than 1.0% at all measured points. CONCLUSIONS: The results of SPAC measurement correlate well with those of the conventional methods.

Development of a fully automated peripheral anterior chamber depth analyzer and evaluation of its accuracy.

PURPOSE: The aim of this study was to improve the scanning peripheral anterior chamber depth analyzer (SPAC) for measuring anterior chamber depth (ACD), differentiating eyes with shallow anterior chamber, and automatically categorizing eyes into subgroups based on the ACD values. We also investigated its accuracy for measuring anterior ocular biometry. MATERIALS AND METHODS: The improved SPAC system was equipped with an auto-focusing system for measuring ACD from the optical axis to the limbus without contacting the ocular surface, in addition to an auto-measuring system for determining central corneal thickness (CCT) and corneal radius of curvature (CRC). This system was also equipped with an auto-diagnosing program for differentiating eyes with narrow angle and an auto-classifying program for categorizing eyes into 12 subgroups according to the ACD values. A dummy eye was used for investigating the measurement accuracy and reproducibility of CCT, CRC, and ACD. Measurement duration and clinical availability were investigated using healthy subjects and glaucoma patients. RESULTS: The SPAC-measured CCT, CRC, and ACD values were very similar to the theoretical values obtained from the dummy eye and their coefficients of variation were less than 1%. This system completed ACD measurement in 15.6+/-1.0 seconds and the mean coefficient of variation of ACD was 8.8+/-2.3%. The improved SPAC system successfully differentiated eyes with narrow angle from those with wide open angle. CONCLUSIONS: The improved SPAC system can measure ACD easily with good accuracy and reproducibility, and is considered to be suitable for evaluating ACD in routine examinations and screening eyes with narrow angle.

Effects of small-incision phacoemulsification and intraocular lens implantation on anterior chamber depth and intraocular pressure.

PURPOSE: To examine prospectively the effects of small-incision phacoemulsification and intraocular lens implantation (PEA+IOL) on anterior chamber depth (ACD) and intraocular pressure (IOP) using a newly developed scanning peripheral ACD analyzer (SPAC). MATERIALS AND METHODS: Twenty-eight eyes of 21 patients who underwent PEA+IOL without any complications were examined and divided into 7 eyes each of grades 1 to 4 according to the Van Herick technique. The SPAC measured ACD consecutively from the vicinity of the pupil center to the periphery at 0.4-mm intervals. Changes in ACD and IOP as a result of PEA+IOL were investigated, and the factors contributing to the changes in ACD and IOP were examined. RESULTS: PEA+IOL increased ACD significantly at all groups. The average changing rates were 3.19 +/- 0.67 times (Van Herick grade 1), 2.00 +/- 0.80 times (Van Herick grade 2), 1.92 +/- 0.32 times (Van Herick grade 3), and 1.36 +/- 0.65 times (Van Herick grade 4), respectively. The closer to the pupil center the measurement point was, the larger was the increase in ACD. However, the rates of increase in ACD were similar among the measurement points. The increases in ACD were significantly large in patients having a shallow preoperative ACD and a small optic axis length. The IOP reduction became significantly large in eyes with a shallow preoperative ACD. CONCLUSIONS: The SPAC enabled quantitative measurement of changes in ACD from the vicinity of the pupil center to the periphery as a result of PEA+IOL. Changes in ACD resulting from PEA+IOL were thought to exert a greater effect on aqueous humor outflow facility as the postoperative ACD became shallower.

The apolipoprotein E gene polymorphism is associated with open angle glaucoma in the Japanese population.

PURPOSE: To assess whether genetic polymorphisms of the apolipoprotein E (APOE) gene are associated with open angle glaucoma (OAG) in the Japanese population. METHODS: Genomic DNA was examined in a cohort of 310 Japanese patients with OAG and 179 control subjects. The average age was 63.5+/-14.4 years (mean+/-SD) for the OAG patients and 65.5+/-11.6 years for the control subjects. The presence or absence of OAG in patients and controls was based on clinical examination and/or ophthalmic records. The APOE allele frequency (epsilon2, epsilon3, and epsilon4 alleles) was studied by restriction fragment length polymorphism, and compared between OAG patients and control subjects. The association between the intraocular pressure (IOP) and the APOE alleles was also evaluated. RESULTS: There was a significant difference in the APOE genotype frequencies between these groups (p=0.0006 chi2 test). The frequencies of the epsilon2 and epsilon4 alleles were significantly lower in the OAG patients (epsilon2: 2.6%; epsilon4: 6.0%) compared to the control subjects (epsilon2: 5.0%, p=0.048; epsilon4: 10.6%, p=0.012; Fisher's exact test). The frequency of the epsilon3 allele was significantly higher in the OAG patients (91.4%) compared to the control subjects (84.4%, p=0.0010; Fisher's exact test). Adjusted for age, gender, and IOP, an appropriate three fold reduction in OAG risk (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.10 to 0.80; p=0.018) was found with the epsilon2 allele and a two fold increased risk of OAG (OR 1.97, 95% CI 1.06 to 3.67; p=0.033) was found with the epsilon3 allele. The maximum IOP (18.3+/-6.0 mm Hg) in patients with the epsilon4 allele was significantly lower than that (21.3+/-9.1 mm Hg) in patients without the epsilon4 allele (p=0.006, Student's t-test). CONCLUSIONS: The APOE gene polymorphism is associated with OAG in the Japanese population. Further studies in the other ethnic populations should be performed to elucidate the relationship between APOE and OAG.

Different expression role among glutamate transporters in rat retinal glial cells under various culture conditions.

Using cultured rat retinal glial cells, the changes in the expression of glutamate transporters (GLTs) under such conditions as the degree of confluence of the cells, hypoxia, glutamate loading, and potassium loading, were assessed. After the retinal glial cells were isolated from 3-day-old Sprague-Dawley rats, GLAST, GLT-1, and EAAC1 mRNA expression was confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and their protein expression was confirmed by Western blot analysis and immunostaining. Changes in the expression of the GLTs at 6 h after passage and at confluence, during culture in 5% oxygen, during glutamate loading and during potassium loading were assessed using real-time PCR. Although the GLAST mRNA expression was increased during glutamate and potassium loading, no changes in the expression were observed during hypoxia and at confluence. By contrast, the GLT-1 mRNA expression was increased during hypoxia and at confluence, but not during glutamate and potassium loading, and the EAAC1 mRNA expression was not changed only during glutamate loading. The expression of EAAC1 in the cultured retinal glial cells was confirmed. The expression of the GLTs varied according to the environment and the type of load suggests that the involvement of the GLTs in retinal physiology and pathology varies depending on the subtype.

De novo age-related retinal disease and intraocular-pressure changes during a 10-year period in a Japanese adult population.

PURPOSE: To determine the proportion of age-related ophthalmologic diseases discovered in a healthy Japanese adult population, as well as to evaluate the age-related changes in intraocular pressure (IOP) in this population during a 10-year period. METHODS: Ophthalmologic surveys were conducted in 1988 and 1998 at Tamaho-cho in Yamanashi Prefecture. The target population of the first survey was 1389 subjects over 40 years of age, and of these, 1250 subjects (473 men and 777 women) participated in the survey. Their mean age was 57.8 +/- 11.9 years. Of these 1250 subjects, 245 subjects participated in the second ophthalmologic survey in 1998. The cases of glaucoma or age-related ophthalmologic diseases developing over the intervening 10-year period were determined among the subjects who had been diagnosed with no ophthalmologic abnormalities in the 1988 survey. We also compared the IOP values of the 219 subjects who were diagnosed with no ophthalmologic abnormalities in either the 1988 or the 1998 survey. RESULTS: The number of cases in the 1998 survey with newly discovered ocular diseases were as follows: two cases (0.82%) of normal-tension glaucoma, two cases (0.82%) of epiretinal membrane, one case (0.41%) of age-related macular degeneration, one case (0.41%) of angle-closure glaucoma, and one case (0.41%) of branch retinal vein occlusion. The mean IOP of the 219 subjects diagnosed with no ophthalmic abnormalities in either survey was 13.88 +/- 3.04 mmHg in 1988, which declined significantly to 13.16 +/- 2.75 mmHg in 1998 (P < 0.0001). CONCLUSIONS: The 10-year follow-up of the 245 subjects participating in both surveys showed one or two de novo cases of age-related macular degeneration, epiretinal membrane, branch retinal vein occlusion, normal-tension glaucoma, or angle-closure glaucoma. IOP was found to decline significantly with age.

Agreement between peripheral anterior chamber depth evaluation using the van Herick technique and angle width evaluation using the Shaffer system in Japanese.

PURPOSE: To examine the correlation between the van Herick system and the Shaffer system in a large-scale epidemiological survey conducted on healthy Japanese subjects. METHODS: The van Herick technique was performed on 14,779 subjects aged 40 years and over who participated in an ophthalmic epidemiological survey conducted in Tajimi City, Gifu Prefecture. Eyes classified as grade 1 or 2 according to the van Herick technique were diagnosed as narrow angle eyes, and those eyes were subjected to secondary examination using a gonioscope. In the secondary examination, glaucoma specialists evaluated angle width based on the Shaffer system. RESULTS: Nine hundred and twenty-three eyes of 505 subjects (108 men and 397 women) were determined to be narrow-angle eyes among the 14 779 subjects surveyed. There were 78 grade 1 eyes and 845 grade 2 eyes. Three hundred and eighty-three subjects (75.8%) underwent gonioscopic examination, and 426 eyes (65.9%) had an angle as narrow as or narrower than Shaffer grade 2. Among the 51 eyes evaluated as van Herick grade 1, 44 (86.3%) had an angle an narrow as or narrower than Shaffer grade 2, while among the 595 eyes evaluated as van Herick grade 2,382 (64.2%) had an angle as narrow as or narrower than Shaffer grade 2. CONCLUSIONS: The van Herick technique closely coincided with the Shaffer system and was found to have a potential for use as a simple method for evaluating narrow-angle eyes in Japanese.

Personality assessment based on the five-factor model of personality structure in patients with primary open-angle glaucoma.

PURPOSE: Several characteristic personality types have been reported for glaucoma patients in previous studies. However, none of the previous studies used a common structural theory of personality. In this study, we conducted a multicenter cross-sectional case-control study using the recently established five-factor model of personality structure. METHODS: Personality was evaluated using the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI), which is a questionnaire specifically designed to test the five-factor model of personality: neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C). Eligible questionnaires were obtained from 196 patients with primary open-angle glaucoma (POAG) (99 men, 97 women) and 223 reference subjects with no ocular disease except cataract (87 men, 136 women). The mean score of each NEO-FFI factor for POAG patients was compared to the scores for the reference subjects. RESULTS: Compared with the reference subjects, the mean N score was significantly higher (P = 0.013), the mean scores for A and C were significantly lower (P = 0.007 and P = 0.001, respectively), and the mean E score tended to be lower (P = 0.055) in male POAG patients. The mean E score was significantly lower (P = 0.023) in female POAG patients. CONCLUSIONS: Characteristic personality traits were noted in POAG patients, and a more significant relationship was found between personality and glaucoma in men than in women.