Glaucoma Research

- General information -

Epidemiology:
Glaucoma is a disease which afflicts people worldwide. There are several types of glaucoma. The Japanese, for e.g., tend to suffer more often from normal tension glaucoma (NTG), whereas North-Americans are more likely to suffer from high tension glaucoma (HTG).

Mechanisms leading to intraocular pressure (IOP) increase:
The cause of the IOP increase has been determined for some types of glaucomas (e.g. angle-closure glaucoma). The reasons for a pressure increase in primary open angle glaucoma (POAG) have not yet been clarified.

Genetics:
Certain types of glaucoma are genetically predisposed. In most cases, however, it is not certain whether genetic factors play a role.

Development of glaucomatous damage:
Both mechanical as well as ocular perfusionn play a central role in the development of glaucomatous damage.

Diagnosis of glaucomatous damage:
A lot of new instruments have emerged to diagnose and quantify glaucomatous damage. Biomarkers are of particular interest (see 'Glaucoma Research in Basel').

Psychophysics:
Glaucoma leads to visual field defects, disturbances of color vision, contrast sensitivity and dark adaptation. For more details on quantiication of visual field (perimetry) see 'Glaucoma Research in Basel'.

Treatment of glaucoma:
Today, there are alternative possibilities to treat glaucoma in addition to lowering IOP (see 'Glaucoma Research in Basel').
IOP can be decreased by laser, operations, and in particular by medications.

- Research in Basel -

Glaucoma research at the Department of Ophthalmology, University of Basel:
The Basel research team focuses mainly on the role of ocular blood flow in glaucoma. This takes place at various stages.

Clinical studies:
Ocular blood flow is measured using various methods in the eye (and in other organs) of glaucoma patients and the results are compared to healthy controls. Our studies show that ocular blood flow is reduced at baseline levels and that it’s also reduced in other organs.
More important, however, ist he observation that regulation of blood flow is reduced. In other words, when blood pressure is reduced or the IOP increased there is no adequate regulation to keep blood flow constant. The blood vessels don’t react as anticipated when stimulated e.g. by flickering light, cold, emotional stress etc. This deficient regulation of blood vessels is known as a vascular dysregulation.

In vitro studies:
In isolated blood vessels it was shown that endothelial cells take part in the regulation of blood flow. The effect of different medications and their mechanisms of action were tested for.

Methods to measure ocular blood flow:
The Basler research group has various instruments to measure ocular blood flow and blood flow in other parts of the body. They group developed as well new measuring methods by themselves.

Diagnosis of glaucoma:
Glaucoma can be diagnosed phenomenologically, in other words we see changes both in the optic nerve head as well as in the retina. We can identify risk factors such as an increased IOP, low blood pressure or a vascular dysregulation.

Our research group has also focused on the development of biomarkers. Changes in the lymphocytes of the circulating blood are not only indicative of glaucoma but can also give us information of the mechanisms involved in the glaucomatous damage.

Glaucoma surgery:
The Basler group does fistulating operations and has also introduced new operating techniques such as for e.g. stich less trabekulektomie with a long tunnel or viskocanaloplastik.

Documentation:
Our research is documented in form of books or articles published in different scientific journals (see 'Literatur').