Objective: In previous decades, glaucoma has been primarily attributed to elevated intraocular pressure (IOP), but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries. However, there still remain strong controversies in the definition of glaucoma in China. In this current review, we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries. Furthermore, we will briefly describe the "ocular-cranial pressure gradient" theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS) in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma. Data Sources: We performed a comprehensive search in both PubMed and SinoMed using the following keywords: (a) "primary glaucoma" and "guideline," (b) "ocular-cranial pressure gradient," and (c) "glaucoma," "Alzheimer's disease," and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date. Study Selection: The primary references were Chinese and English articles including (a) original guidelines and expert consensuses of primary glaucoma, (b) reviews focusing on the differences between various versions of these guidelines and consensuses, and (c) papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases. Results: The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines. Chinese definitions and classifications put more emphasis on the IOP, while international guidelines put more emphasis on the presence of optic neuropathy. The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma. Conclusions As regards the definition and classification of primary glaucoma, we find that there are still some discrepancies between Chinese expert consensuses and international guidelines. Glaucoma is a disease with complex etiologies, while its common characteristic is a specific optic neuropathy. The current definition and understanding of glaucoma is an ongoing and evolving process, reflecting our latest available evidence on its pathogenesis. Chinese ophthalmology community may need to update our guidelines, accommodating these latest developments.
China ; Glaucoma ; diagnosis ; physiopathology ; Glaucoma, Angle-Closure ; diagnosis ; physiopathology ; Glaucoma, Open-Angle ; diagnosis ; physiopathology ; Humans ; Intraocular Pressure ; physiology ; Ophthalmology ; methods

Glaucoma, Open-Angle ; etiology ; physiopathology ; Humans ; Intracranial Hypotension ; complications ; physiopathology ; Intraocular Pressure ; Male ; Middle Aged

BACKGROUNDAs intraocular pressure (IOP) and IOP fluctuation are known risk factors for glaucoma, it is important to understand the effects of high myopia on these ocular parameters. The aim of this study was to investigate if primary open-angle glaucoma (POAG) patients with high myopia exhibit higher IOP and greater IOP fluctuations at resting conditions over 24 hours.

METHODSWe designed a prospective control clinical study. Eighty-two eyes of 82 high-tension Chinese POAG patients only on prostaglandin analogue locally were divided into 3 groups according to various myopic grades (< -6.0 D, n = 27 and between -0.76 and -5.99 D, n = 33) or without myopia (-0.75 to 0.75 D, n = 22). Single time IOP at 10 am, mean corrected 24-hour IOP, mean corrected night IOP, 24-hour IOP fluctuation and IOPs of 10 am, 2 pm, 6 pm, 10 pm, 2 am, 6 am and 8 am were measured.

RESULTSThe IOP was higher in POAG patients with high myopia over those POAG alone in three ways: the elevated IOP value was 0.65 mmHg measured in single time IOP at 10 am, 0.84 mmHg in mean corrected 24-hour IOP, 0.97 mmHg in mean corrected night IOP. The 24-hour IOP fluctuation was lower in the two myopia groups than in non-myopia group. Further, using repeated measurement analysis of variance, there was no statistical significance among groups regarding the IOPs at the seven time points (P = 0.77) and there was no interaction between groups and time points (P = 0.71), but the difference of IOPs at the seven time points in same group was statistically significant (P = 0.01).

CONCLUSIONHigh-tension POAG patients with high myopia, even on pharmacological glaucoma therapy, still have higher IOP, but 24-hour IOP fluctuation at resting conditions was lower in these patients.

Adolescent ; Adult ; Aged ; Female ; Glaucoma, Open-Angle ; physiopathology ; Humans ; Intraocular Pressure ; physiology ; Male ; Middle Aged ; Myopia ; physiopathology ; Young Adult

OBJECTIVETo observe the effect of pricking blood at Neiyingxiang (EX-HN 9) on the intraocular pressure of patients of primary open angle glaucoma (POAG).

METHODSNinty-six cases (166 eyes) were randomly divided into an observation group (44 cases) and a control group (52 cases). The observation group was treated with pricking blood at Neiyingxiang (EX-HN 9), and the control group was treated with 0.5% Timolol Maleate drops in eyes. The changes of patients' intraocular pressure in both groups were observed before and after treatment.

RESULTSThe intraocular pressure were (29.81 +/- 3.49) mmHg and (23.18 +/- 3.61) mmHg before and after treatment in the observation group, and (29.94 +/- 3.64) mmHg and (23.88 +/- 3.96) mmHg in the control group respectively, there were significant differences after treatment in the two groups (both P<0.01), while there was no significant difference in decreasing the intraocular pressure between the two groups (P>0.05).

CONCLUSIONPricking blood at Neiyingxiang (EX-HN 9) can effectively decrease the intraocular pressure and the effect is equivalent to Timolol Maleate drops.

Acupuncture Points ; Adult ; Aged ; Bloodletting ; Female ; Glaucoma, Open-Angle ; physiopathology ; therapy ; Humans ; Intraocular Pressure ; Male ; Middle Aged

To estimate the rate of visual field progression in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), we reviewed the medical records of POAG and PACG patients who had a minimum of 5-year longitudinal Goldmann visual field data. I4e and I2e isopters were quantified using grid systems. The rate of change was calculated from the slope of a linear fit to a series of average visual field scores. Twenty-three eyes of POAG patients and 25 of PACG patients were studied. The rate of visual field score change was -2.00 +/- 2.0% per year in the PACG group, and -0.81 +/- 1.0% per year inthe POAG group. In these two patient groups, who were on conventional treatment at two referral hospitals, better visual field on initial presentation yielded faster progression in the POAG group, while the higher average of highest intraocular pressure in each year during follow-up was related to faster progression in the PACG group.
Adult ; Aged ; Comparative Study ; Disease Progression ; Female ; Glaucoma, Angle-Closure/*physiopathology ; Glaucoma, Open-Angle/*physiopathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Perimetry/methods ; Retrospective Studies ; Vision Disorders/etiology/*physiopathology ; *Visual Fields

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma (POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential (icVEP) testing, 24-2 standard automated perimetry (SAP), and Cirrus optical coherence tomography (OCT) examinations. Signal-to-noise ratio (SNR) measures obtained from icVEP responses to isolated checks presented at four depths of modulation (DOMs; 8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity (mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness (GCL+IPLT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls (P<0.001). A significant positive association was found between SNR at 14% DOM and GCL+IPLT at the inferior sector in early glaucoma (r=0.465, P=0.004). In moderate to advanced glaucoma, significant correlations were found between SNR at 32% DOM and mean GCL+IPLT (r=0.364, P=0.023), superior GCL+IPLT (r=0.358, P=0.025), and mean pRNFLT (r=0.396, P=0.025). In addition, in moderate to advanced glaucoma, there were significant correlations between mMS and all relevant measures of retinal thickness (r=0.330-0.663, P< 0.010). In early glaucoma, significant correlations were found between mean mMS and minimum GCL+IPLT (r=0.373, P=0.023), and between inferior mMS and superior GCL+IPLT (r=0.470, P=0.003). Linear models provided a good explanation for the relationship between SNR and inner retinal thickness (IRT), whereas nonlinear models better explained the relationship between mMS and IRT. In early glaucoma, both SNR and mMS were related moderately and significantly to IRT, whereas in moderate to advanced glaucoma, mMS was more strongly correlated with IRT than SNR.
Adult ; Aged ; Evoked Potentials, Visual/physiology* ; Female ; Glaucoma, Open-Angle/physiopathology* ; Humans ; Macula Lutea/physiopathology* ; Male ; Middle Aged ; Retina/physiopathology* ; Signal-To-Noise Ratio ; Tomography, Optical Coherence

OBJECTIVE: To investigate the difference in color pattern reversal visual evoked potential (CPR-VEP)between primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) patients. METHODS: Vision Monitor visual electrophysiograph made by Metro Vision Inc. in France was used to record CPR-VEP in 17 eyes of 12 POAG patients, 56 eyes of 41 PACG patients, and 26 eyes of 13 age-equivalent normal persons at an ascending series of temporal frequency (1, 2, 4, 8, 16, and 32 Hz) and color stimulation (black/white, red/green, and blue/yellow). P(100) wave amplitudes and latencies of these patients were compared respectively with those of the normal group. RESULTS: With black/white stimulation, the P(100) wave amplitudes were reduced with the increase of temporal frequency in the 3 groups. The P(100) wave latencies were extended with the increase of temporal frequency with different color stimulations. The P(100) amplitudes were PACG group > NC group > POAG group and black/white > blue/yellow > red/green. The P(100) wave latencies in the POAG group and the PACG group were extended compared with the NC group, but there was no significant difference between PACG group and POAG group. CONCLUSION CPR-VEP P(100) amplitudes in the PACG group and POAG group have their own characteristics. The P(100) amplitude of PACG is higher, and POAG is lower than normal. The P(100) wave latencies of PACG and POAG are extended.
Adult ; Aged ; Aged, 80 and over ; Color Vision ; Evoked Potentials, Visual ; physiology ; Female ; Glaucoma, Angle-Closure ; physiopathology ; Glaucoma, Open-Angle ; physiopathology ; Humans ; Male ; Middle Aged ; Photic Stimulation ; methods ; Young Adult

A 32-year-old man with blurred vision in the right eye and headache presented with anterior uveitis, an intraocular pressure (IOP) of 60 mmHg, an open angle, no visual field defects, and normal optic nerve. He had a history of five previous similar attacks. In each of the previous instances, his anterior uveitis and high IOP were controlled with antiglaucoma medications and topical steroids. However, at the fifth attack, his optic disc was pale and a superior paracentral visual field defect was shown. Brain magnetic resonance image studies were normal. This case represents that a recurrent Posner-Schlossman syndrome (PSS)-induced optic disc atrophy likely due to ocular ischemia caused by a recurrent, high IOP. Although PSS is a self-limiting syndrome, we should manage high IOP and prevent ischemia of the optic nerve head by treating with ocular antihypertensive medications.
Atrophy/diagnosis/etiology ; Diagnosis, Differential ; Glaucoma, Open-Angle/*complications/diagnosis/physiopathology ; Humans ; *Intraocular Pressure ; Male ; Optic Disk/*pathology ; Optic Nerve Diseases/diagnosis/*etiology/physiopathology ; Syndrome ; Young Adult

PURPOSE: To examine the prevalence of visual field deterioration in contralateral eyes of patients with worsening open-angle glaucoma and to evaluate the spatial concordance of visual field deterioration between both eyes. METHODS: One hundred sixteen open-angle glaucoma patients who underwent 8 or more visual field examinations over > or =6 years of follow-up were included. The rates of the fast and slow components of visual field decay for each of 52 visual field test locations were calculated with point-wise exponential regression analysis. The spatial concordance of visual field deterioration in contralateral eyes was evaluated with a concordance ratio (calculated as the number of overlapping locations divided by the total number of deteriorating locations) and by comparing the rate of decay in corresponding modified glaucoma hemifield test clusters. RESULTS: The average visual field mean deviation (+/-standard deviation [SD]) was -8.5 (+/-6.4) dB and the mean (+/-SD) follow-up time was 9.0 (+/-1.6) years. Sixty-three patients had mild damage, 23 had moderate damage, and 30 had severe damage. The mean concordance ratio (+/-SD) was 0.46 (+/-0.32) for the mild group, 0.33 (+/-0.27) for the moderate group, and 0.35 (+/-0.21) for the severe group. Thirty-one patients (27%) had deterioration in concordant locations (p < 0.05). Visual field deterioration was greater in the superior hemifield than the inferior hemifield (p < 0.05) when evaluated with both the concordance ratio and modified glaucoma hemifield test cluster analysis methods. CONCLUSIONS: There is only fair spatial concordance with regard to visual field deterioration between the both eyes of an individual. We conclude that testing algorithms taking advantage of inter-eye spatial concordance would not be particularly advantageous in the early detection of glaucomatous deterioration.
Aged ; Female ; Glaucoma, Open-Angle/diagnosis/*epidemiology/physiopathology ; Humans ; Male ; Middle Aged ; Prevalence ; Space Perception/*physiology ; Vision Disorders/diagnosis/*epidemiology/physiopathology ; Visual Field Tests ; Visual Fields/*physiology

PURPOSE: To evaluate the relationship between the structural damage as assessed by time-domain optical coherence tomography (OCT) and functional changes in glaucoma. METHODS: In total, 190 patients with normal tension glaucoma or primary open angle glaucoma were included in this study. The thickness of retinal nerve fiber layer (RNFL) around the optic disc and the area of RNFL defect were determined using OCT scans. The relationships between the RNFL thickness or area of the defect and visual field (VF) indices were assessed using the Lowess function, regression analysis and partial Spearman correlation. The differences between these associations depending on the stage of VF damage were further analyzed. Age, optic disc size, refraction, central corneal thickness and the presence of systemic disease were corrected for in order to exclude confounding factors. RESULTS: A logarithmic scale of RNFL thickness showed a negative linear relationship with VF indices. The area of the RNFL defect showed a weak correlation with the pattern of standard deviation, whereas the remnant RNFL thickness was moderately correlated with the pattern of standard deviation (partial Spearman correlation coefficient, 0.39, -0.47, respectively; p < 0.0001). Many outliers were detected in the Lowess-plotted graphs. Multiplication of the area and the inverted RNFL thickness showed a moderately correlated logarithmic relationship with the VF indices (partial Spearman correlation coefficient, 0.46; 95% confidence interval, 0.34 to 0.57; p < 0.0001). In the severe stage of VF damage, correlation between the area of the RNFL defect and mean deviation was significantly greater than in other stages (partial Spearman correlation coefficient, -0.66; p = 0.02). CONCLUSIONS: The thickness of the RNFL had a negative logarithmic correlation with the VF indices and was more relevant to the VF indices than the area of the RNFL defect, as measured by OCT.
Aged ; Female ; Glaucoma, Open-Angle/*physiopathology ; Humans ; Low Tension Glaucoma/*physiopathology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Optic Nerve Diseases/*physiopathology ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields/*physiology