Correlation Between Autonomic Dysfunction and Visual Field Severity in Open-Angle Glaucoma: Insights from Kiritsu-Meijin Device Analysis

The autonomic nervous system (ANS) plays a major role in maintaining the physiological integrity and health of the eyes.  The ANS regulates the dilation and constriction of pupils, and influences the fluid dynamics within the eye that are vital in managing intraocular pressure and optic nerve health. Glaucoma is a disease that damages the eye’s optic nerve and usually happens when fluid builds up and increases pressure inside the eye. The Kiritsu-Meijin device measures autonomic function by assessing the body’s response to posture changes, and can provide important information on the sympathetic and parasympathetic activities during these transitions. To this end, new study published in the Journal of Current Eye Research and Led by Professor Toru Nakazawa from the Tohoku University and conducted by Yurina Yamada, Naoki Kiyota, Mitsuhide Yoshida, and Kazuko Omodaka, the researchers investigated the relationship between autonomic dysfunction, as measured by the Kiritsu-Meijin device, and visual field defects in patients with open-angle glaucoma (OAG).¹ In their study, the team enrolled patients diagnosed with open-angle glaucoma at Tohoku University Hospital who were previously diagnosed based on characteristic optic nerve damage and corresponding visual field defects without elevated intraocular pressure (IOP). The researchers used the Kiritsu-Meijin Device, which measures autonomic function and records heart rate variability during specific posture changes. The test they performed included sitting for two minutes to record baseline autonomic activity, standing for two minutes to assess the sympathetic nervous response, and sitting again for one minute to measure parasympathetic recovery. They measured basal activity, balance between autonomic systems, reaction to standing, switchover to sympathetic response, and recovery. Additionally, they performed visual field testing with the Humphrey Field Analyzer to obtain detailed analysis of mean and total deviations across various sectors of the visual field.

The authors found significant positive correlations between the parameters of activity, balance, and recovery, and the mean deviation values from visual field testing. This implies that lower scores in these autonomic parameters are associated with more severe visual field defects. Moreover, they showed that the severity of visual field defects varied across different sectors of the visual field. Notably, autonomic dysfunction (particularly lower activity and recovery scores) was more strongly associated with defects in the central and inferior visual field sectors compared to the superior sector. According to the authors, assessment of autonomic function with the Kiritsu-Meijin device, could serve as a useful clinical tool in the management of glaucoma. Additionally, the correlation between autonomic dysfunction and visual field severity may help in stratifying patients according to the risk of progression and tailoring treatment strategies accordingly. Indeed, the same research team previously shown that older patients with low blood flow had inferior visual field damage in glaucoma.²

Overall, Professor Toru Nakazawa’s and his research team study contribute to better understanding of the pathophysiology and management of OAG by examining autonomic function. It also highlighted that glaucoma’s risk factors extend beyond IOP to include ANS dysfunction, which suggests that vascular and neurogenic factors also play critical roles in the disease’s progression. The study’s proposal to measure autonomic parameters with the Kiritsu-Meijin device supported the potential for early detection and intervention, possibly before traditional indicators such as IOP changes become clear. This could lead to personalized treatment approaches targeting autonomic balance through pharmacological or lifestyle interventions. Additionally, the study offers insights into the uneven impact of autonomic dysfunction on different visual field sectors, which could refine diagnostic and monitoring practices and change the current glaucoma treatment paradigm  and enhance patient outcomes.