Josef Flammer

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Professor Dr. Josef Flammer Josef flammer oktober 2014.jpg
Professor Dr. Josef Flammer

Josef Flammer (born April 21, 1948) is a Swiss ophthalmologist and long-time director of the Eye Clinic at Basel University Hospital. Flammer is a glaucoma specialist who developed a new pathogenetic concept of glaucomatous damage according to which unstable blood supply leads to oxidative stress, which in turn plays a major role in apoptosis (cell death) of cells in optic nerve and retina in glaucoma patients. [1]

Glaucoma eye disease that is characterized by an unstable or a sustained increase in the intraocular pressure which the eye cannot withstand without damage to its structure or impairment of its function

Glaucoma is a group of eye diseases which result in damage to the optic nerve and vision loss. The most common type is open-angle glaucoma with less common types including closed-angle glaucoma and normal-tension glaucoma. Open-angle glaucoma develops slowly over time and there is no pain. Peripheral vision may begin to decrease followed by central vision resulting in blindness if not treated. Closed-angle glaucoma can present gradually or suddenly. The sudden presentation may involve severe eye pain, blurred vision, mid-dilated pupil, redness of the eye, and nausea. Vision loss from glaucoma, once it has occurred, is permanent.


Life and medical training

Josef Flammer was born on a farm near the village of Bronschhofen in the Canton of St. Gallen. He attended secondary school in Wil and boarding school in Gossau. In 1968 he began to study medicine, first in Fribourg, then in Berne. Flammer spent his junior doctor years in the fields of internal medicine, neurology and ophthalmology - he finally decided to become an ophthalmologist and completed his education at the Department of Ophthalmology of the University of British Columbia in Vancouver before returning to the University of Berne. In 1984 he was appointed chief physician of the University Eye Clinic Berne, in 1987 he accepted an appointment as chair of ophthalmology and director of the University Eye Clinic Basel, over which he presided until his retirement in December 2013.[ citation needed ]

Bronschhofen Former municipality of Switzerland in St. Gallen

Bronschhofen is a former municipality in the Wahlkreis (constituency) of Wil in the canton of St. Gallen in Switzerland. It merged into Wil on 1 January 2013.

St. Gallen Place in Switzerland

St. Gallen or traditionally St Gall, in German sometimes Sankt Gallen is a Swiss town and the capital of the canton of St. Gallen. It evolved from the hermitage of Saint Gall, founded in the 7th century. Today, it is a large urban agglomeration and represents the center of eastern Switzerland. Its economy consists mainly of the service sector. Internationally, the town is known as the home of the University of St. Gallen, one of world's leading business schools.

University of British Columbia public research university in British Columbia, Canada

The University of British Columbia (UBC) is a public research university with campuses in Vancouver and Kelowna, British Columbia. Established in 1908, UBC is British Columbia's oldest university. The university is ranked among the top 20 public universities worldwide and among the top three in Canada. With an annual research budget of $600 million, UBC funds over 8,000 projects a year.

Scientific works

Flammer's scientific and medical endeavors were generally interdisciplinary. His first research focus was automatic perimetry for which he established normal values; [2] he studied short term and long term fluctuations of the human visual field and described influencing factors. [3] Together with Hans Bebie he developed the so-called Bebie curve, which plays a major role in the diagnosis of visual field loss due to glaucoma, he introduced the visual field indices. Flammer was one of the first researchers to demonstrate systemic side effects of locally administered beta blockers (i.e. eye drops) in ophthalmology. Flammer and his collaborators found that intraocular pressure variation is as important for the development of glaucoma, one of the main causes of blindness worldwide, as a constantly elevated intraocular pressure, [4] long considered the main, if not the only, cause of glaucoma. In numerous research projects he demonstrated that glaucoma could be caused by a dysregulation of ocular blood flow, even at normal levels of intraocular pressure. Flammer discovered that vasospasms in the eye are a manifestation of a general vasospastic syndrome. Later, he noted that such spasms are only the tip of the iceberg and an indication of a much more generalized vascular dysregulation in the human body. [5] This increases the risk of eye disease, in particular of normal tension glaucoma. Flammer noted that people with a primary vascular dysregulation have other symptoms and signs; this led to the establishment of the term Flammer syndrome. Flammer also demonstrated the relationship between eye disease and heart disease. [6] [7] In numerous laboratory studies, he contributed to the understanding of the role of endothelin - which according to his studies regulates retinal venous pressure - and nitric oxide in ocular perfusion. [8] . He also described the pathogenic role of ocular blood flow in retinitis pigmentosa. [9]

Flammer syndrome is a recently described clinical entity comprising a complex of clinical features caused mainly by dysregulation of the blood supply which has previously been called vascular dysregulation. It can manifest itself in many symptoms such as cold hands and feet and is often associated with low blood pressure. In certain cases it is associated with or predisposes for the development of diseases such as a normal tension glaucoma. Flammer syndrome is named after the Swiss ophthalmologist Josef Flammer.

Retinitis pigmentosa retinal degeneration characterized by the gradual deterioration of the photoreceptors or the retinal pigment epithelium of the retina leading to progressive sight loss

Retinitis pigmentosa (RP) is a genetic disorder of the eyes that causes loss of vision. Symptoms include trouble seeing at night and decreased peripheral vision. Onset of symptoms is generally gradual. As peripheral vision worsens, people may experience "tunnel vision". Complete blindness is uncommon.

Publishing and education

In addition to hundreds of original papers, Flammer is the author of several books. His book "Glaucoma", intended for the general public, has so far been published in 22 languages and went through 30 different editions; "Glaucoma" is thus considered the world's most widely used non-fiction book on this ocular disease. [10] His "Basic Sciences in Ophthalmology" has received praise for demonstrating the role of chemistry and physics in modern ophthalmological diagnostics and therapies. [11] The Basel Eye Clinic organizes each year - as initiated by Flammer - one of the most renowned conferences for ophthalmologists in Europe, the Basel Ophthalmo Meeting. [12]

Writings (selection)

International Standard Book Number Unique numeric book identifier

The International Standard Book Number (ISBN) is a numeric commercial book identifier which is intended to be unique. Publishers purchase ISBNs from an affiliate of the International ISBN Agency.

Related Research Articles

Heterochromia iridum disease resulting from genetics or injury causing someone to have different colored eyes

Heterochromia is a difference in coloration, usually of the iris but also of hair or skin. Heterochromia is determined by the production, delivery, and concentration of melanin. It may be inherited, or caused by genetic mosaicism, chimerism, disease, or injury. It occurs in humans and certain breeds of dogs and cats.

Amaurosis fugax a painless temporary loss of vision in one or both eyes

Amaurosis fugax is a painless temporary loss of vision in one or both eyes.

Intraocular pressure Fluid pressure inside the eye

Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg).

Pediatric ophthalmology is a sub-speciality of ophthalmology concerned with eye diseases, visual development, and vision care in children.

Red eye (medicine) type of eye disease

A red eye is an eye that appears red due to illness or injury. It is usually injection and prominence of the superficial blood vessels of the conjunctiva, which may be caused by disorders of these or adjacent structures. Conjunctivitis and subconjunctival hemorrhage are two of the less serious but more common causes.

Ocular tonometry procedure to determine intra ocular pressure

Tonometry is the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients at risk from glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg).

Ocular hypertension is the presence of elevated fluid pressure inside the eye, usually with no optic nerve damage or visual field loss.

Coats disease Human disease

Coats' disease,, is a rare congenital, nonhereditary eye disorder, causing full or partial blindness, characterized by abnormal development of blood vessels behind the retina. Coats' disease can also fall under glaucoma.

Iridocorneal Endothelial (ICE) syndromes are a spectrum of diseases characteriezed by slowly progressive abnormalities of the corneal endothelium and features including corneal edema, iris distortion, and secondary angle-closure glaucoma. [1,2,4] ICE syndromes are predominantly unilateral and nonhereditary [1,2,4]. The condition occurs in predominantly middle-aged women [1,3,4].

Iridodialysis Human disease

Iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.

The red reflex refers to the reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope. The reflex relies on the transparency of optical media and reflects off the fundus back through media into the aperture of the opthalmoscope. The red reflex is considered abnormal if there is any asymmetry between the eyes, dark spots, or white reflex (Leukocoria).

Optic disc drusen Human disease

Optic disc drusen (ODD) or optic nerve head drusen (ONHD) are globules of mucoproteins and mucopolysaccharides that progressively calcify in the optic disc. They are thought to be the remnants of the axonal transport system of degenerated retinal ganglion cells. ODD have also been referred to as congenitally elevated or anomalous discs, pseudopapilledema, pseudoneuritis, buried disc drusen, and disc hyaline bodies.

Weill–Marchesani syndrome autosomal genetic disease characterized by short stature, bachycephaly and other facial abnormalities, brachydactyly, joint stiffness and distinctive ocular abnormalities

Weill–Marchesani syndrome is a rare genetic disorder characterized by short stature; an unusually short, broad head (brachycephaly) and other facial abnormalities; hand defects, including unusually short fingers (brachydactyly); and distinctive eye (ocular) abnormalities. It was named after ophthalmologists Georges Weill (1866-1952) and Oswald Marchesani (1900-1952) who first described it in 1932 and 1939, respectively.

Brimonidine/timolol are combination eye drops indicated for the treatment of glaucoma. It is a combination of brimonidine and timolol, in concentrations of 0.2% and 0.5% respectively. Both substances work by decreasing the synthesis of aqueous humor.

Pseudoexfoliation syndrome, often abbreviated as PEX and sometimes as PES or PXS, is an aging-related systemic disease manifesting itself primarily in the eyes which is characterized by the accumulation of microscopic granular amyloid-like protein fibers. Its cause is unknown, although there is speculation that there may be a genetic basis. It is more prevalent in women than men, and in persons past the age of seventy. Its prevalence in different human populations varies; for example, it is prevalent in Scandinavia. The buildup of protein clumps can block normal drainage of the eye fluid called the aqueous humor and can cause, in turn, a buildup of pressure leading to glaucoma and loss of vision. As worldwide populations become older because of shifts in demography, PEX may become a matter of greater concern.


A trabectome is a surgical device that can be used for Ab interno trabeculotomy, a minimally invasive glaucoma surgery for the surgical management of adult, juvenile and infantile glaucoma. Trabecular meshwork is the main site of resistance for aqueous outflow. Hence most glaucoma surgeries work by either removing the trabecular meshwork or bypassing that. As angle surgeries such as Trabectome follow physiologic outflow pathway, the risk of complications are significantly lower than filtering surgeries. The Trabectome handpiece is inserted into the anterior chamber and positioned into the Schlemm's canal. Bent tip of its footplate fits into the canal and smoothly advanced parallel to the angle. The energy delivered by electrode cause plasma mediated trabeculat meshwork ablation without damaging nearby structures. Active irrigation of trabectome surgery system helps to keep anterior chamber formed during the procedure and precludes the need for ophthalmic viscoelastic device. Viscoelastics tend to trap produced debris or gas bubbles and diminish visualization.By ablating trabecular meshwork, aqueous get access to Schlemm's canal, therefore reducing intraocular pressure which is major risk factor for glaucomatous vision loss. The irrigation/aspiration device provides irrigation during surgery and collection of residual fluid and ablated tissue in a collection bag. This procedure is performed through a small incision and can be done on an outpatient basis.

Primary juvenile glaucoma is glaucoma that develops due to ocular hypertension and is evident either at birth or within the first few years of life. It is caused due to abnormalities in the anterior chamber angle development that obstruct aqueous outflow in the absence of systemic anomalies or other ocular malformation.

Normal tension glaucoma (NTG) is an eye disease, a neuropathy of the optic nerve, that shows all the characteristics of "traditional" glaucoma except one: the elevated intraocular pressure (IOP) - the classic hallmark of glaucoma - is missing. Normal tension glaucoma is in many cases closely associated with general issues of blood circulation and of organ perfusion like arterial hypotension, metabolic syndrome, and Flammer syndrome.


  1. Flammer J, Mozaffarieh M.: What is the present pathogenetic concept of glaucomatous optic neuropathy? Surv Ophthalmol. 2007 Nov;52 Suppl 2:S162-173
  2. A. Haas, J. Flammer, U. Schneider: Influence of age on the visual fields of normal subjects. Am J Ophthalmol 101:199-203 (1986)
  3. J. Flammer, S.M. Drance, M. Zulauf: Differential light threshold. Short- and long-term fluctuation in patients with glaucoma, normal controls and patients with suspected glaucoma. Arch Ophthalmol 102:704-706 (1984)
  4. P. Niesel, J. Flammer: Correlations between intraocular pressure, visual field and acuity, based on 11 years observations of treated chronic glaucomas. Int Ophthalmol 3:31-35 (1980)
  5. Flammer J, Konieczka K, Flammer AJ. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA 7;4(1):14 (2013)
  6. M. Pache, J. Flammer. A Sick Eye in a Sick Body? Systemic Findings in Patients with Primary Open-angle Glaucoma. Surv Ophthalmol 51(3):179-212 (2006)
  7. Flammer J, Konieczka K, Bruno RM, Virdis A, Flammer AJ, Taddei S. The eye and the heart. Eur Heart J 34,1270-78 (2013)
  8. Haefliger IO, Flammer J, Bény JL, Lüscher TF: Endothelium-dependent vasoactive modulation in the ophthalmic circulation. Prog Retin Eye Res. 2001 ;20(2):209-25.
  9. Konieczka K, Flammer AJ, Todorova M, Meyer P, Flammer J: Retinitis pigmentosa and ocular blood flow. EPMA J. 2012 Dec 3;3(1):17. doi: 10.1186/1878-5085-3-17. (Open access article)
  10. Josef Flammer: Glaucoma: A Guide for Patients, An Introduction for Care Providers, A Quick Reference. Hogrefe and Huber Publishing, Berne, Switzerland 2006. 978-0889373426
  11. Josef Flammer, Maneli Mozaffarieh and Hans Bebie: Basic Sciences in Ophthalmology: Physics and Chemistry. Springer, Heidelberg/ New York 2013, ISBN   978-3-642-32260-0.
  12. Glaucoma Meeting