JAPAN GLAUCOMA SOCIETY: CLINICAL PRACTICE GUIDELINES FOR GLAUCOMA

 

The Japan Glaucoma Society published the Clinical Practice Guidelines for Glaucoma in 2003, as well as the subsequent revised editions in 2006, 2012, and 2017. The fifth edition has been released in February 2023. 

The guidelines are presented in the following chapters, a short summary of which is being posted here.

https://link.springer.com/article/10.1007/s10384-022-00970-9

Chapter 1: Definition of Glaucoma

Glaucoma is a disease characterized by functional and structural abnormalities of the eye, with characteristic changes in the optic nerve and visual field, wherein optic neuropathy can be alleviated or suppressed by sufficiently lowering intraocular pressure (IOP).

Chapter 2: Classification of Glaucoma

The definition of glaucomatous optic neuropathy (GON) is given as, damage to the optic nerve associated with glaucoma. 

The chapter deals with the classification of glaucomas according to various mechanisms.

Primary open-angle glaucoma (broad) is a disease concept that encompasses both “primary open-angle”, where IOP is higher than the normal range, and “normal-tension glaucoma”. In clinical practice, primary open-angle glaucoma (broad) is divided into high IOP (primary open-angle glaucoma) and normal IOP (normal-tension glaucoma) groups.

Ocular hypertension

Patients with IOP above the statistically defined upper limits of normal; however, without abnormalities in the optic nerve or visual field

Preperimetric glaucoma (PPG)

The term PPG refers to a condition in which there are abnormalities suggestive of glaucoma, such as glaucomatous optic nerve head and retinal nerve fiber defects on ophthalmoscopy and optical coherence tomography (OCT), but no visual field defects are seen on conventional automated static perimetry test.

1. Primary angle-closure glaucoma (PACG):

PACG is a disease in which elevated IOP results from (primary) angle closure induced by genetic background or age-related changes in anterior segment morphology, without other factors, and in which glaucomatous optic neuropathy has already occurred.

2. Primary angle-closure (PAC):

PAC is a condition in which primary angle-closure causes elevated IOP or peripheral anterior synechia (PAS) but does not cause glaucomatous optic neuropathy. The name and etiology of this condition according to the speed of onset are the same as those of PACG.

3. Primary angle-closure suspect (PACS):

PACS is a condition in which there is primary angle-closure but without elevated IOP, organic PAS, or GON. Conversely, only appositional angle closure is present.

Some forms of PACG and PAC develop acutely and are collectively referred to as acute glaucoma attacks. In acute PACG and acute PAC, elevated IOP is often markedly high (40–80 mmHg), and symptoms such as decreased visual acuity, blurring of vision, glaucomatous halo, ocular pain, headache, nausea, vomiting, and diminished or absent light reflexes are common.

Secondary glaucoma is a condition in which elevated IOP is caused by other ocular diseases, systemic diseases, or drug use. Secondary glaucoma is classified according to the mechanism of elevated IOP.

The term childhood glaucoma refers to glaucoma resulting from a condition that develops in childhood. Although the term developmental glaucoma was used in the previous guidelines, the definition and classification have been substantially changed based on the recommendations of the World Glaucoma Association Consensus Conference. However, the upper age limit for childhood glaucoma has not been clearly defined by international standards.

Secondary childhood glaucoma is classified into glaucoma associated with non-acquired ocular anomalies and glaucoma associated with non-acquired systemic disease or syndrome. Those caused by acquired factors such as trauma, steroids, uveitis, and retinopathy of prematurity are classified as glaucoma associated with acquired conditions. Additionally, glaucoma that develops after cataract surgery, which is more frequent among acquired factors, is classified separately as glaucoma following cataract surgery.

Chapter 3: deals with the examination for glaucoma. It consists of the following parts:

i.                    Initial medical interview.

ii.                  Slit-lamp examination.

iii.                Assessment of IOP

iv.                 Gonioscopy

v.                   Fundus examination

vi.                 Visual field analysis

 

Chapter 4: is regarding treatment. It consists of the following parts:

i.                    Principles of glaucoma treatment

ii.                  Treatment practice

 

Chapter 5 is regarding glaucoma drugs.

Chapter 6 informs about laser procedures and their parameters.

Chapter 7 is regarding incisional surgery.

Chapter 8 deals with glaucoma treatment by disease type.