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Background/Objectives Although lifestyle habits may represent modifiable risk factors of glaucoma, the association between lifestyle factors and glaucoma is not well understood. The aim of this study was to investigate the association between lifestyle habits and the development of glaucoma. Subjects/Methods Participants who underwent health check-ups from 2005 to 2020 using a large-scale administrative claims database in Japan were included in the study. Cox regression analyses were performed where glaucoma development was regressed on the lifestyle (body mass index, current smoking, frequency and amount of alcohol consumption, eating habits, exercise habits and quality of sleep), age, sex, hypertension, diabetes mellitus and dyslipidaemia. Results Among the 3,110,743 eligible individuals, 39,975 developed glaucoma during the mean follow-up of 2058 days. Factors associated with increased risk of glaucoma were overweight/obese (vs. moderate weight: hazard ratio, 1.04 [95% confidence interval, 1.02–1.07]), alcohol consumption of 2.5–4.9 units/day, 5–7.4 units/day, and ≥7.5 units/day (vs. Conclusions Moderate body mass index, having breakfast, avoiding late dinner, limiting alcohol intake to

Background/Objectives: This study aimed to compare the cost-effectiveness of prophylactic laser peripheral iridotomy (LPI) with that of observation for primary angle-closure suspect (PACS) in Japan. Subjects/Methods: A Markov model was developed to compare the costs and utilities of prophylactic LPI with those of observation of 40-year-old patients with PACS. In the model with a yearly cycle over a 20-year time horizon, the disease was postulated to irreversibly progress from PACS to primary angle closure, followed by primary angle-closure glaucoma, unilateral blindness, and bilateral blindness. The parameters were estimated based on a recent randomised controlled trial and analyses of Japanese claims data. The incremental cost-effectiveness ratio was estimated from the healthcare payer’s perspective and evaluated as the willingness-to-pay 5 million Japanese Yen per quality-adjusted life-year. The observation period was shortened, and the age at entry into the cohort was changed to 50 years in the sensitivity analyses. We conducted one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations with 10 000 iterations. Results The incremental cost-effectiveness ratio of LPI was 2 270 224 Japanese Yen (14 189 pounds sterling) per quality-adjusted life-year, which was below the willingness-to-pay threshold. The ratios were approximately 4 and 8 million in the 15-year and 10-year time horizons, respectively. Increasing the age at entry had little influence on the incremental cost-effectiveness ratio. The deterministic and probabilistic sensitivity analyses indicated that the results were robust. Conclusions Our results indicate that prophylactic LPI for middle-aged patients with PACS is cost-effective in Japan.

To clarify recent trends in glaucoma surgery in Japan, including minimally invasive glaucoma surgery.Retrospective cohort study.We used the Diagnostic Procedure Combination database, a nationwide administrative database in Japan. Patients who underwent glaucoma-related procedures were included. We calculated the number of surgeries stratified by procedures and age categories. We also investigated the number of glaucoma-related procedures in combination with cataract surgery.From fiscal years 2011 to 2019, we identified 134,331 glaucoma-related procedures at 720 hospitals. The total number of glaucoma-related procedures increased by 215% from 6516 in 2011 to 20,569 in 2019. The numbers of filtering surgeries, trabeculotomies, and glaucoma drainage devices with plates [GDD(p +)] procedures significantly increased (P = 0.002, 0.002, and 0.006, respectively), whereas the number of cyclocryotherapy procedures significantly decreased (P = 0.002). The number of iStent procedures increased by 49% from 371 in 2018 to 551 in 2019. The ≥ 65 year age group accounted for 80% of the iStent procedures. In the 0 to 14 year age group, trabeculotomy accounted for about 70% of the procedures, and the GDD(p +) procedure became the second most common procedure after trabeculotomy because of the decrease in filtering surgeries. Among combination surgeries, trabeculotomy was most frequently performed. The proportion of combination surgery increased, especially in trabeculotomy.The total number of glaucoma-related procedures increased throughout the observation period. Before 2017 filtering surgery was the most common procedure, whereas trabeculotomy was most common after 2018. The proportion of trabeculotomies performed in combination with cataract surgery continuously increased.

To describe recent trends in the treatment for primary angle-closure glaucoma (PACG) and its associated costs in a clinical setting.A retrospective cohort study.We included patients with PACG from 2011 to 2020 using a large-scale administrative claims database in Japan.We calculated the frequencies and costs of antiglaucoma drugs, ophthalmic examinations, and glaucoma-related surgeries, stratified by fiscal years and age groups.Frequencies and costs of antiglaucoma drugs, ophthalmic examinations, and glaucoma-related surgeries.We identified 5654 patients with PACG (15 338 patient-years). Prostanoid FP receptor agonist, nonselective β-blocker, and topical carbonic anhydrase inhibitor use decreased, whereas prostanoid EP2 receptor agonist, α-2 adrenergic agonist, Rho-associated protein kinase inhibitor, and fixed-combination eyedrops use increased. The total amount of drug per patient-year significantly decreased. In recent years, the frequency of cataract surgery increased, whereas that of laser peripheral iridotomy decreased. Visual field testing, slit-lamp examination, intraocular pressure measurement, and funduscopy were performed 0.83, 6.65, 5.15, and 4.61 times/patient-year, respectively. The total cost of drugs, examinations, and surgeries was 60 338 yen per patient-year. Patients with PACG spent more than twice the money on surgeries and examinations than they did on antiglaucoma drugs.The amount of antiglaucoma drugs dispensed decreased, and the proportion of fixed-combination and newly introduced eyedrops increased. Frequency of cataract surgery increased whereas that of laser peripheral iridotomy decreased in recent years. Surgeries and examinations were the major cost drivers for PACG treatment. The current results would be valuable information for future economic analyses and policy making.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Background:The effect of mydriasis on intraocular pressure (IOP) in normal tension glaucoma (NTG) eyes has not been investigated. In addition, although filtration surgery is a technique that can lower IOP under normal conditions and reduce IOP fluctuation, its effect on IOP after mydriasis is unknown. Against this background, we investigated the effect of mydriasis on IOP and of trabeculectomy on mydriasis-induced IOP fluctuations in the same patients with NTG.Methods:We identified data for NTG patients regularly monitored for more than 5 years before and after surgical periods. All patients were conservatively followed up as medical treatment and then underwent initial trabeculectomy with mitomycin C as the surgical treatment. The mean IOPs during episodes of mydriasis and non-mydriasis were calculated for each period. IOP fluctuation was defined as the IOP difference between the mydriatic and non-mydriatic states. For both periods, the mean IOP differences between the mydriatic and non-mydriatic eye were separately evaluated using the paired t-test or the Wilcoxon signed-rank test.Results:We included 23 eyes of 23 patients with NTG (mean age, 62.4 years). The follow-up periods were 5.7 years for medical treatment and 6.1 years after surgical treatment. The mean IOP of 14.3 mmHg decreased to 9.0 mmHg after surgery (P < 0.01). During medical treatment, the mean (± standard deviation) non-mydriatic and mydriatic IOPs were 14.2 ± 1.8 and 14.5 ± 1.8 mmHg, respectively. The IOP increased significantly after mydriasis (by 0.30 ± 0.11 mmHg, P = 0.009). After surgery, the mean non-mydriatic and mydriatic IOPs were 9.0 ± 2.5 and 9.1 ± 2.4 mmHg; the difference was 0.18 ± 0.16 mmHg (P = 0.28). Conclusions:We demonstrated for the first time that pharmacological mydriasis significantly increased IOP, but trabeculectomy could suppress not only IOP but also mydriasis-induced IOP fluctuations in patients with NTG.