According to the Ministry of Health, Labour and Welfare group study, glaucoma was ranked first (28.6%) as the cause of visual disturbance in Japan at the 2015-16 survey. It is expected that visual impairment due to glaucoma will continue to increase as the population ages. The goal of glaucoma treatment is to maintain visual function throughout life, and a treatment strategy for glaucoma in an aging society is necessary.
I. Ophthalmology and pharmacology: Pharmacological action of mydriatics
The iris sphincter and dilator, which are derived from the ectoderm, have almost no action of voltage-dependent Ca channels. They are mechanically special, and have completely different properties from the smooth muscle of other organs. Ophthalmology and pharmacology differ in how they regard the pharmacological effects of the mydriatics most commonly used in ophthalmology.
II. Search for glaucoma treatments other than intraocular pressure reduction
Regarding glaucoma treatments other than intraocular pressure, there is research that ties into treatment after first elucidating the mechanism. Since deformation of the lamina cribrosa is related to axonal damage, we used optical coherence tomography (OCT) to investigate what kinds of deformations were involved in the onset and visual field progression of glaucoma. In addition, we confirmed that high pressure causes swelling of ganglion cell axons in ex vivo glaucoma animal model experiments, and we investigated the potential of regulating this in neuroprotective therapies. In the pharmacological study, we examined the effects of various existing glaucoma therapeutic agents on ciliary artery vascular smooth muscle. We found that the various drugs being used to lower intraocular pressure had a completely different effect on vascular smooth muscle. This indicates the possibility that various glaucoma drugs are also involved in ocular circulation. In pharmacology, an unexpected drug may act on an unexpected organ, allowing the elucidation of a new mechanism and leading to the development of a new drug.
III. Epidemiological studies and big data
The development of glaucoma treatments other than intraocular pressure requires a large-scale analysis of the factors involved in the progression of glaucoma. To that end, large-scale epidemiological research over time and Big Data construction that collects a lot of data from daily clinical practice are necessary.
IV. Conclusion
There is a lot to learn from patients in daily clinical practice, and there is no doubt that it will lead to advancements in medicine. On one hand, basic research and statistical data analysis may not be glamorous and the results may not be clear. However, continuing modest research such as this is also necessary for progress in the field of medicine.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 187-209, 2021.