Glaucoma is the leading cause of blindness in Japan, but the Tajimi Study conducted from 2000 to 2001 showed that the prevalence of glaucoma in Japan is 5% of those over 40 years of age, and many people are unaware that they have glaucoma and do not receive appropriate medical care. There is still no way to regain lost visual function and visual field impairment. Therefore, early detection and early treatment are important,p but patients are often unaware of abnormalities until they reach late-stage or end-stage visual field impairment, and even when treatment is introduced, it often fails to produce satisfactory results. Why is there a delay in detection? Why is it so difficult to obtain a satisfactory therapeutic effect? Why is it still the leading cause of blindness?
・Why is detection of glaucoma delayed?
Although glaucoma is known to be a disease that causes progressive visual field damage, the visual field does not necessarily narrow from the early stages of the disease. Over a period of years, areas of abnormal vision arise within the visible visual field and gradually enlarge, but if the disease does not progress to the center, vision is often preserved and is difficult to recognize. We are conducting various educational activities such as public lectures and Light Up in Green activities to raise awareness of the characteristic symptoms of glaucoma and to encourage people to receive appropriate medical treatment and to continue treatment.
・Why is it so difficult to obtain therapeutic effects for glaucoma?
Based on scientific evidence, it is known that IOP lowering therapy is effective in controlling the progression of glaucoma. However, it is not clear what is improved by lowering IOP, or how IOP lowering works against factors that cause deterioration and stops deterioration. In normal tension glaucoma, which accounts for 70% of glaucoma cases in Japan, it is not known why glaucoma develops and worsens when the intraocular pressure is almost the same as that of normal subjects, nor is it known why further lowering the normal intraocular pressure stops the deterioration. How does intraocular pressure within the normal range affect the optic nerve? We need to examine the effects of various cells, tissues, or environments that have networks in the axon or ganglion cell body. Some believe that fluctuations in intraocular pressure are the problem, but the mechanism that regulates intraocular pressure in the first place is also unknown.
The same symptoms may not stop even if the intraocular pressure is lowered. There may be a blood flow disorder or an environment in which some harmful substances accumulate, such as oxidative stress. Complications of sleep apnea and many other factors are also thought to be involved, but have not been linked to effective treatment. We believe that basic and clinical research on these mechanisms of glaucoma onset, progression, and suppression is necessary for future delineation of the disease of glaucoma and determination of appropriate treatment strategies.
・Why does glaucoma remain the leading disease causing blindness?
The most common factor is late detection and missed treatment timing. In addition, patients are less aware of the effects of treatment and are less likely to feel the effects of treatment, leading them to discontinue treatment. For this reason, educational activities are still important. On the other hand, we must also consider the fact that there is no way to recover deteriorated nerves or regain lost visual function. Promotion of regenerative medicine is also important. Furthermore, considering that IOP develops and progresses even when the intraocular pressure is in the normal range, it is naturally necessary to focus on a person's susceptibility to the disease. The search for susceptibility genes and personalized medicine based on this search are essential for the future of glaucoma treatment, and we consider this to be our most important project.
It is only natural that we should do everything we know how to do now to protect the visual function of the patient in front of us, and at this point, it is also necessary to consider how we can compensate for lost visual function impairment from the perspective of low vision care. On the other hand, new findings demonstrated by basic and clinical research must be properly evaluated, and sufficient discussion and verification must be conducted to see if they can be applied to medical practice. It is a major role of this society to provide such a forum. And the ultimate goal is to literally cure glaucoma. To regain lost visual function and prevent the onset of the disease. Solving these challenges will not be easy and will take time, and it may be the story of our next generation. Therefore, we must help nurture research that is just now beginning to sprout, and it is important to train young people to continue such research. At the same time, we need to ask patients to cooperate in clinical research, and we need to obtain funding to conduct such research. We ask for your support and hope that all members of the Glaucoma Society will work together to achieve our goals.
May 2024
The president of Japan Glaucoma Society
Nobuyuki Shoji, MD., PhD.
