Introduction A large-scale epidemiological survey of glaucoma, recently conducted in Japan, clearly showed that there is an extremely large number of patients with normal tension glaucoma (NTG). 1 However, in contrast to the chronic pro- gression of open-angle glaucoma, including NTG, many cases of angle-closure glaucoma (ACG) result in a sudden increase in intraocular pressure (IOP), thereby leading to loss of visual function within a short period of time. However, owing to the improvement in the percentage of patients being tested and examined, many cases of open-angle glaucoma are discovered before they reach the terminal stage, by the detection of elevated IOP, an enlarge- ment of optic disc cupping, and visual field loss. Neverthe- less, it is practically impossible for medical examiners other than ophthalmologists to diagnose ACG prior to an attack. Consequently, many ACG patients undergo ophthalmolog- ical examination only after an attack and receive medical treatment thereafter. Therefore, the prognosis is not always good. 2 In eyes with narrow angles that are at high risk for an ACG attack, it is well known that an attack can be avoided by appropriate procedures such as laser iridotomy (LI). 3,4 Because of this,ACG is considered to be a disease for which prophylactic procedures are effective. On the other hand, although there are reports of complications resulting from LI, including bullous keratopathy, a particularly serious Jpn J Ophthalmol 2004;48:133–140 DOI 10.1007/s10384-003-0023-1 © Japanese Ophthalmological Society 2004 CLINICAL INVESTIGATION Examination and Treatment of Patients with Angle-Closure Glaucoma in Japan: Results of a Nationwide Survey Kenji Kashiwagi and Shigeo Tsukahara Department of Ophthalmology, University of Yamanashi Faculty of Medicine,Tamaho, Japan Abstract Purpose: To assess the present state of examination procedures and treatments for angle-closure glau- coma (ACG) in Japan. Methods: A nationwide questionnaire survey was conducted, targeting 1237 registered facilities to Japanese Ophthalmological Society. Results: Valid replies were obtained from 754 of 1232 facilities (61.2%). Primary ACG comprised a small percentage of the glaucoma types diagnosed in outpatient examinations. More than 50% of the laser iri- dotomy (LI) procedures were prophylactic at 52.9% of the facilities. Gonioscopy was most frequently used for determining indications for prophylactic LI. Specular microscopy was always performed prior to LI in 7.8% of the facilities. Prophylactic LI resulted in complications at 20.5% of the surveyed facil- ities, although the incidence was low. The following residual complications were reported at 82.9% of the facilities when treating ACG attacks: cataract, persistent elevation of intraocular pressure, and bullous keratopathy. One-third of the facilities experienced inadequate treatment of an ACG attack by physi- cians other than ophthalmologists. Conclusions: The incidence of LI-induced complications was higher in ACG eyes than in narrow-angle eyes. However, prophylactic LI sometimes results in persistent ocular complications. Jpn J Ophthal- mol 2004;48:133–140 © Japanese Ophthalmological Society 2004 Key Words: angle-closure glaucoma, bullous keratopathy, laser iridotomy, questionnaire, survey Received: June 6, 2003 / Accepted: September 30, 2003 Correspondence and reprint requests to: Kenji Kashiwagi, Depart- ment of Ophthalmology,University of Yamanashi Faculty of Medicine, 1110 Shimokato,Tamaho 409-3898, Japan e-mail: kenjik@yamanashi.ac.jp