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.

About the author

Toru Nakazawa received the Ph.D. degree in Ophthalmology in 2002. He spent the following three years at Massachusetts Eye and Ear Infirmary as the research fellow under the direction of Prof. Joan W Miller. He has been a Professor and Chairman of Department of Ophthalmology at Tohoku University since 2011.  He conducts the translational research aimed at the development of clinical therapy by using the results of basic research. Prof. Nakazawa’s research interests have been focused on the study of neuroprotection related.  He creates various animal models in eye disease and with extensive technology, he locates the important signal transduction to explore the target of neuroprotection treatment.  By contrast in clinical research, he focuses on the research of ocular blood flow which is one of major intraocular pressure independent factors for glaucoma.  Also, he discloses the relationship between OCT and a visual field in the innovative method to examine the way of progression measurement of glaucoma and focusing on fragmenting patients successfully.

Dr. Nakazawa has published more than 440 articles in board reviewed international journals.

About the author

Yurina Yamada graduated from St. Marianna Medical University in 2018. She did her initial clinical training at Tohoku University Hospital and joined Department of Ophthalmology, Tohoku University School of Medicine in 2020.
She entered Tohoku University Graduate School in 2022. At the graduate school, under the guidance of Dr. Nakazawa, she focused on the relationship between the autonomic nervous system and glaucoma and tested outpatients with the Kiritsu-Meijin and reported that the response of the autonomic nervous system is important based on multiple parameters. Currently, she conducts research on various self-care methods that work on the autonomic nervous system.


  1. Yamada Y, Kiyota N, Yoshida M, Omodaka K, Nakazawa T. The Relationship Between Kiritsu-Meijin-Derived Autonomic Function Parameters and Visual-Field Defects in Eyes with Open-Angle Glaucoma. Curr Eye Res. 2023 ;48(11):1006-1013. doi: 10.1080/02713683.2023.2234105.

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  1. Kiyota N, Shiga Y, Omodaka K, Pak K, Nakazawa T. Time-Course Changes in Optic Nerve Head Blood Flow and Retinal Nerve Fiber Layer Thickness in Eyes with Open-angle Glaucoma. Ophthalmology. 2021 May;128(5):663-671. doi: 10.1016/j.ophtha.2020.10.010.

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