Purpose We investigated the difference in clinical characteristics between cases with enlarged retinal nerve fiber layer defects (RNFLD) and stable RNFLDs in normal-tension glaucoma (NTG). Patients and Methods We retrospectively reviewed NTG patients that were diagnosed and followed up for at least 3 years at 1-month to 2-month intervals by the same examiner, and selected eyes with distinct RNFLD borders. Using fundus photographs, for which we extracted only a blue ingredient and processed it into black and white, we measured RNFLD angles and divided NTG cases into 2 groups, enlarged RNFLD and stable RNFLD, and compared the clinical characteristics between both groups. Results Ninety-three eyes from 93 patients (mean follow-up, 8.2 y) were selected and enlargement of RNFLD was detected in 55 eyes. Disc hemorrhage (DH) was found in 35 of 55 eyes (63.6%) in the enlarged group and in 6 of 38 eyes (15.8%) in the stable group (P<0.0001). Twenty-one eyes (38.2%) from the enlarged group exhibited recurrent DH. In 48 eyes (87.3%) from the enlarged group, the enlargement of RNFLD was toward the fovea. When DHs located apart from RNFLD were excluded, RNFLD enlarged in the direction of DH in 21 of 25 eyes (84.0%). The cumulative probability of non progression in the visual field was significantly lower in the enlarged group (10–year survival rate: 0.52±0.11) than in the stable group (10-year survival rate: 0.89±0.08) (P=0.0019). Conclusions The enlargement of RNFLD in NTG was closely associated with DH occurrence and the deterioration of visual field.

To investigate the influence of clinical factors (duration of diabetes mellitus, fasting blood sugar level, fructosamine concentration, and hemoglobin A1c) on blue-on-yellow (B-on-Y) perimetry compared with white-on-white (W-on-W) perimetry for diabetics without retinopathy. Both B-on-Y perimetry and W-on-W perimetry were performed for 33 diabetics without retinopathy. Thirty-three subjects with healthy eyes served as age-matched controls. For both diabetic patients and controls, mean deviation (MD) and corrected pattern SD of perimetry showed no difference irrespective of B-on-Y or W-on-W perimetry. For diabetics, MD of B-on-Y perimetry decreased in proportion to the morbid period with diabetes mellitus, with the same being true with deterioration of the clinical factors. Multiple regression analysis disclosed no differences in MD of clinical factors for W-on-W perimetry, despite the duration of diabetes mellitus exerting a significant influence on MD of B-on-Y perimetry. Even at the premorbid stage of diabetic retinopathy, longer duration of diabetes mellitus and longer persistence of poorly controlled diabetes mellitus are associated with an insidious progress of dysfunction in the retinal blue cone system.

Introduction: This study assesses two-year efficacy and safety following implantation of a single trabecular micro-bypass stent (iStent^®) with concomitant phacoemulsification cataract surgery in Japanese patients with open-angle glaucoma (OAG). Materials and Methods: This retrospective, consecutive case series included eyes that underwent iStent implantation with phacoemulsification and were followed for 24 months postoperative. Efficacy and safety measures included intraocular pressure (IOP), number of glaucoma medications, adverse events, secondary surgeries, visual fields, and endothelial cell counts. Results: Of 73 operated eyes, 53 eyes had 24 months of follow-up and are analyzed. Diagnoses included primary open-angle glaucoma (POAG, n=25), normal-tension glaucoma (NTG, n=16), and pseudoexfoliative glaucoma (PXG, n=12). At 24 months, mean IOP reduced by 18% to 13.6± 3.0 mmHg versus 16.5± 3.4 mmHg preoperatively (p< 0.0001), and mean medication number reduced by 81% to 0.37± 0.74 versus 1.96± 0.98 preoperatively (p< 0.0001). The percentage of medication-free eyes was 77% versus 0% preoperatively, and 81% of eyes had IOP ≤ 15 mmHg versus 42% preoperatively. Results were similarly favorable across glaucoma subtypes (POAG, NTG, PXG). Notably, mean IOP in NTG eyes decreased to 12.8± 1.4 mmHg from 14.4± 3.0 mmHg preoperatively (p=0.03), and medications decreased by 87% to 0.31± 0.70 versus 2.38± 0.72 preoperatively (p< 0.0001). At 24 months, 81% of NTG eyes were medication-free (versus 0% preoperatively); 2 NTG eyes (13%) were on ≥ 2 medications (versus 100% preoperatively). Throughout the follow-up, visual fields and endothelial cell counts remained stable; 1 eye (1.9%) underwent filtration surgery. Discussion: Favorable safety and significant IOP and mediation reductions were achieved through two years following iStent implantation with phacoemulsification in a Japanese population. These gains were achieved across all glaucoma subtypes (including POAG, NTG, PXG). Conclusion: This real-world study supports the viability of iStent implantation to treat Japanese patients with glaucoma and shows that the benefits extend to those with NTG or PXG in addition to POAG.

The short wavelength sensitive (S) cone electroretinograms (ERGs) were examined in two patients with the complete type of congenital stationary night blindness (CSNB). Ganzfeld spectral flashes in the presence of strong white adapting fields were used to elicit the S cone ERGs. The S cone ERG b-wave was not detectable to short wavelength stimuli, while the mixed long (L) and middle (M) wavelength sensitive cone responses appeared normal in waveforms with normal amplitude in both patients. Both patients had normal colour vision on the Farnsworth Panel D-15. These ERG results indicated that the S cone system as well as rod system is more impaired in complete CSNB than the L and M cone system and that normal colour vision may not depend on a normal S cone ERG to full field stimuli.

Purpose: The purpose of this study was to clarify differences between highly myopic and non-myopic primary open-angle glaucoma (POAG) patients, including normal-tension glaucoma patients. Patients and methods: A total of 269 POAG patients were divided into two groups: patients with ≥26.5 mm of axial length (highly myopic group) and patients with <24.0 mm of axial length (non-myopic group). Results: We analyzed 53 highly myopic and 93 non-myopic POAG patients. Age at first visit of the highly myopic group was significantly less than that of the non-myopic group (P<0.0001). Baseline intraocular pressures (IOPs) showed no significant differences. Follow-up IOPs of the non-myopic group were significantly lower than those of the highly myopic group (P=0.0009). According to the mean deviation definition of progression, the cumulative probability of non-progression of visual field (VF) loss was significantly greater in the highly myopic group (10-year survival rate, 73.7%±6.8%) than in the non-myopic group (10-year survival rate, 46.3%±5.8%; log-rank test, P=0.0142). The occurrence of disk hemorrhage (DH) in the non-myopic group (1.60±3.04) was significantly greater than that in the highly myopic group (0.93±2.13, P=0.0311). The cumulative probability of DH was significantly lower in the highly myopic group (10-year survival rate, 26.4%±5.4%) than in the non-myopic group (10-year survival rate, 47.2%±6.6%, P=0.0413). Conclusion: Highly myopic POAG is considered as a combination of myopic optic neuropathy and glaucomatous optic neuropathy (GON). If GON is predominant, it has frequent DH and more progressive VF loss. However, when the myopic optic neuropathy is predominant, it has less DH and less progressive VF loss.