Glaucoma (Fridays at AM/PM)
Prof Nakamura, Dr Yamada, Dr Kanamori, graduate students, etc. are in charge of Glaucoma clinic and involved in medical practice for many outpatients and inpatients. In addition to patients with primary open angle glaucoma (POAG) or primary angle closure glaucoma (PACG), those with developmental glaucoma or secondary glaucoma are being referred from nearby medical institutions. In outpatients’ clinic, we make a diagnosis using state of the art imaging devices as well as a basic ocular examination by slit lamp microscopy and funduscopy. For instance, we use ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (OCT) (CASIA, Tomey) to evaluate the shape of the anterior segment of the eye and four different OCTs to analyze the structure of the optic nerve head and the macula. Regarding surgical treatment, we perform common glaucoma surgeries including trabeculectomy, trabeculotomy, goniosynechialysis. Additionally, we diligently conduct trabeculectomy with amniotic implantation for refractory glaucoma or leaking filtering bleb, and get good surgical results. We also do tube-shunt surgery for patients who have failed conventional trabeculectomy. In addition, we are a participant in several projects lead by Japan Glaucoma Society and are a part of the front line glaucoma team in Japan.
Neuro-ophthalmology, Strabismus and Amblyopia (Wednesdays at AM/PM)
To look at something, it’s essential that the visual information from the light that enters the eye is conducted along a neural pathway from the retina to the brain and is properly processed there. It’s also important that the eyes are properly aligned with each other and move concomitantly and smoothly. In Neuro-ophthalmology, Strabismus and Amblyopia clinic (at AM), we see such patients that have an impairment of visual pathway, eye position, or eye movement. For example, patients with normal eye balls may exhibit subjective symptoms including visual disturbance, visual defect, or double vision if they have a disorder of nerve pathway from the optic nerve to the brain or a problem of muscles or nerves that control eye movement. We investigate the diseases that cause these symptoms, make a diagnosis, and treat patients. In Strabismus and Amblyopia clinic (at PM), we examine and treat little children who suffer strabismus (a condition in which the eyes are not properly aligned with each other), amblyopia (decreased vision that results from abnormal visual development in infancy and early childhood), entropion (a condition in which the eyelid folds inward), congenital cataract, or other diseases that require special medical care by pediatric ophthalmologists.
Macula (Wednesdays at AM/PM)
We diagnose and treat macular diseases including age-related macular degeneration (AMD) at Macula clinic. Treatment of AMD has dramatically changed during the past several years. Nowadays, anti-vascular endothelial growth factor (VEGF) therapy is the mainstay for the treatment of exudative (wet) AMD. We routinely perform intravitreal injection of Lucentis (ranibizumab) or Eylea (aflibercept) to treat eyes with visual impairment secondary to wet AMD and obtain satisfactory results. We are involved in multicenter studies evaluating the effect and safety of anti-VEGF therapy for wet AMD. As we treat patients as a group of doctors, we have a meeting every week to decide a treatment policy for each patient.
Retina and Vitreous (Mondays at AM)
We diagnose and treat vitreoretinal diseases including diabetic retinopathy and rhegmatogenous retinal detachment at Retina and Vitreous clinic. We have performed a large number of laser surgeries and vitrectomies every year. We have 6 experienced full-time vitreoretinal surgeons and can promptly cope with patients who need emergency medical treatment. We also see infants having retinopathy of prematurity (ROP) on Fridays (at AM). We do laser treatment to such infants that have severe ROP. In more severe cases with retinal detachment, we perform plasmin-assisted vitrectomy as well as conventional vitrectomy to get the best visual outcome the patients could have.
Cornea and Dry Eye (Fridays at AM/PM)
In Cornea and Dry Eye clinic, we treat a variety of corneal diseases including corneal infection (caused bacterial, fugal, or viral infection), immune disorders, keratoconus, corneal dystrophies, trauma, and bullous karatopathy. As the corneal surface is connected to the conjunctiva and both are covered with tears, conjunctival diseases and tear film abnormalities can be responsible for corneal diseases. Therefore, we also treat patients with conjunctival diseases or dry eye as well. We use lacrimal opening plugs, punctual occlusion, autologous serum eye drops, and cyclosporine eye drops for the management of ocular surface diseases. We also perform corneal transplantation such as penetrating keratoplasty (PKP) and ocular surface surgeries including amniotic membrane transplantation. Besides, we pay attention to mental support the patients who have corneal surgery in collaboration with Eye Bank staff members.
Orbita (Mondays at AM)
In Orbita clinic, we treat Basedow disease, orbital tumors including orbital lymphoma, eyelid tumors, and lacrimal apparatus diseases. We especially perform lots of surgeries for the deformation of eye lids or eye misalignment secondary to Basedow diseases and surgeries for orbital malignant lymphoma and its genetic diagnosis.
Uveitis (Mondays at PM)
In Uveitis clinic, we first focus on making a correct diagnosis of intraocular inflammatory diseases and then choose the best therapeutic method for each patient. For example, we have successfully controlled ocular inflammation in intractable cases with Behçet’s disease using infliximab (Remicade), a chimeric monoclonal antibody against TNF-α. We also treat patients suffering ocular malignant lymphoma with intravitreal methotrexate injection.