Fumiki Okamoto

Long-Term Effect of Overnight Orthokeratology on Axial Length Elongation in Childhood Myopia: A 5-Year Follow- Up Study

PURPOSE Our prospective study was conducted to compare axial length elongation in myopic children receiving long-term overnight orthokeratology (OK) treatment to those wearing spectacles as controls. METHODS There were 59 subjects enrolled in this study. The OK group comprised 29 subjects who matched the inclusion criteria for OK. The control group comprised 30 subjects who also matched the inclusion criteria for OK, but preferred spectacles for myopia correction. Axial length was measured periodically for 5 years using an IOLMaster device, and the time course of changes was evaluated and compared between the groups. RESULTS A total of 43 subjects (22 and 21 in the OK and control groups, respectively) completed the 5-year follow-up examinations. At baseline, the mean age ± SD was 10.04 ± 1.43 and 9.95 ± 1.59 years, the spherical equivalent refractive error was -1.89 ± 0.82 and -1.83 ± 1.06 diopters (D), and the axial length was 24.09 ± 0.77 and 24.22 ± 0.71 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 5-year study period was 0.99 ± 0.47 and 1.41 ± 0.68 mm for the OK and control groups, respectively, and the difference was statistically significant (P = 0.0236, unpaired t-test). The annual increases in axial length were significantly different between the groups for the first (P = 0.0002), second (P = 0.0476), and third years (P = 0.0385), but not for the fourth (P = 0.0938) and fifth (P = 0.8633) years. There were no severe complications throughout the study period. CONCLUSIONS The current 5-year follow-up study indicated that OK can suppress axial length elongation in childhood myopia.

Comparison of corneal thickness measurements using Orbscan II, non-contact specular microscopy, and ultrasonic pachymetry in eyes after laser in situ keratomileusis

Aims: To compare central corneal thickness measurements of three pachymetry devices in eyes after laser in situ keratomileusis (LASIK). Methods: Central corneal thickness was measured in 203 eyes after myopic LASIK. Orbscan II scanning slit topography (Bausch & Lomb), SP-2000P non-contact specular microscopy (Topcon), and ultrasonic pachymetry (Tomey) were used in this sequence. Results: Three devices gave significantly different corneal thickness readings (p<0.0001, repeated measure analysis of variance). The measurements of Orbscan II (445.6 (SD 60.0) μm) were significantly smaller than those of noncontact specular microscopy (467.9 (SD 40.2) μm; p<0.0001, Tukey multiple comparison) and ultrasonic pachymetry (478.8 (SD 41.9) μm; p<0.0001). The value obtained with SP-2000P non-contact specular microscopy was significantly smaller than that taken with ultrasonic pachymetry (p<0.001). There were significant linear correlations between scanning slit topography and non-contact specular microscopy (Pearson’s correlation coefficient r = 0.912, p<0.0001), non-contact specular microscopy and ultrasonic pachymetry (r = 0.968, p<0.0001), and ultrasonic pachymetry and scanning slit topography (r = 0.933, p<0.0001). Conclusion: In post-LASIK eyes, Orbscan II scanning slit topography significantly underestimated corneal thickness. Non-contact specular microscopy gave smaller thickness readings than ultrasonic pachymetry, but these two units showed an excellent linear correlation.

Visualization of sub-retinal pigment epithelium morphologies of exudative macular diseases by high-penetration optical coherence tomography.

PURPOSE To evaluate the clinical significance of the newly developed long-wavelength probe optical coherence tomography (LP-OCT) for the diagnosis of exudative macular diseases. METHODS Fourteen eyes of 13 participants were prospectively enrolled in the study. There were seven type I and five type II choroidal neovascularization (CNV) cases associated with age-related macular degeneration and idiopathic neovascularization and one case of polypoidal choroidal vasculopathy (PCV). A custom-built LP-OCT based on swept-source OCT (SS-OCT) technology was used. This new OCT uses a probe beam with a wavelength of 1060 nm that provides deeper penetration into the choroid and higher image contrast to the structures beneath the retinal pigment epithelium (RPE) and pathologic tissues than does conventional OCT. The depth resolution is 10.4 microm in tissue and the measurement speed is 28,000 depth scans/s. All the eyes were also examined by standard short wavelength probe OCT (SP-OCT). The image contrasts of the LP- and SP-OCT were qualitatively evaluated and analyzed by Wilcoxons paired signed rank test and Spearmans rank correlation test. RESULTS In 10 of 14 eyes, high-contrast visualization of the diseases beneath the RPE, CNV, or fibrin was attained. These diseases were almost invisible in the SP-OCT images. The LP-OCT of the remaining eyes also revealed significant improvement in the image contrasts beneath the RPE and CNV. Qualitative evaluation of the image contrasts and subsequent statistical test indicated statistically significant improvement in the image penetration to the choroid of LP-OCT to that of SP-OCT. CONCLUSIONS LP-OCT provided significant improvement in the image contrast of exudative macular diseases.

Refractive changes in diabetic patients during intensive glycaemic control.

AIMS To evaluate the clinical course and the characteristics of transient refractive error occurring during intensive glycaemic control of severe hyperglycaemia. METHODS 28 eyes of patients with persistent diabetes were included in this prospective study. During the observation period, patients underwent general ophthalmological examination and A-mode scan ultrasonography was performed at each examination—at days 1, 3, and 7, and then once every week or every other week until recovery of hyperopia. RESULTS A transient hyperopic change occurred in all patients receiving improved control after hyperglycaemia. Hyperopic change developed a mean of 3.4 (SD 2.0) days after the onset of treatment, and reached a peak at 10.3 (6.1) days, where the maximum hyperopic change in an eye was 1.47 (0.87) D (range 0.50–3.75 D). Recovery of the previous refraction occurred between 14 and 84 days after the initial assessment. There was a positive correlation between the magnitude of the maximum hyperopic change and (1) the plasma glucose concentration on admission (p<0.01), (2) the HbA1c level on admission (p<0.005), (3) the daily rate of plasma glucose reduction over the first 7 days of treatment (p<0.001), (4) the number of days required for hyperopia to reach its peak (p<0.001), and (5) the number of days required for the development and resolution of hyperopic changes (p<0.0001). There was a negative correlation between the maximum hyperopic change of an eye and baseline value of refraction (p<0.01). During transient hyperopia, no significant changes were observed in the radius of the anterior corneal curvature, axial length, lens thickness, or depth of anterior chamber. CONCLUSIONS The degree of transient hyperopia associated with rapid correction of hyperglycaemia is highly dependent on the rate of reduction of the plasma glucose level. A reduction of refractive index in intraocular tissues, especially in lens, appears to be responsible for this hyperopic change.

Effect of Vitrectomy for Epiretinal Membrane on Visual Function and Vision-Related Quality of Life

PURPOSE To evaluate the vision-related quality of life (VR-QOL) in patients undergoing vitrectomy for epiretinal membrane (ERM) removal and to investigate the relationship between VR-QOL and the severity of pre/postoperative metamorphopsia. DESIGN Prospective, interventional, consecutive, comparative case series. METHODS The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was self-administered by 28 patients (age, 66.7 +/- 8.5 years, mean +/- standard deviation) with ERM before and 3 months after vitrectomy. Preoperative and postoperative clinical data were collected, including logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA), letter contrast sensitivity, central macular thickness, and severity of metamorphopsia. The NEI VFQ-25 was also measured in 26 age-matched normal controls. RESULTS The preoperative NEI VFQ-25 composite score was significantly lower in ERM patients than in normal controls (P < .0001). Vitrectomy significantly improved NEI VFQ-25 composite score as well as scores of 10 out of 12 subscales (P < .0001), except for general health and peripheral vision. The postoperative NEI VFQ-25 composite score in ERM patients, however, remained significantly lower than that in normal controls (P < .0001). The preoperative NEI VFQ-25 composite score significantly correlated with the severity of preoperative metamorphopsia (P < .05) but not with preoperative logMAR BCVA, letter contrast sensitivity, and central macular thickness. The postoperative NEI VFQ-25 composite score significantly correlated with the degree of postoperative metamorphopsia and logMAR BCVA (P < .05). The changes in NEI VFQ-25 composite score significantly correlated with changes in the severity of metamorphopsia (P < .05), but not with other parameters. CONCLUSIONS VR-QOL is significantly impaired in patients with ERM, which is remarkably improved by vitrectomy. The severity of metamorphopsia strongly influences VR-QOL in patients with ERM.

Vision-Related Quality of Life and Visual Function after Vitrectomy for Various Vitreoretinal Disorders

PURPOSE To investigate vision-related quality of life (VR-QOL) in patients undergoing vitrectomy for various vitreoretinal disorders and to evaluate the relationship between VR-QOL and visual function. METHODS The study included 100 normal control subjects and 299 patients with various vitreoretinal disorders including proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), macular hole (MH), epiretinal membrane (ERM), and rhegmatogenous retinal detachment (RD). The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was answered by the patients with vitreoretinal disorders before and 3 months after pars plana vitrectomy, as well as by the normal control subjects. Clinical data were collected, including visual acuity, contrast sensitivity, and severity of metamorphopsia. RESULTS Vitrectomy significantly improved the VFQ-25 composite score in all vitreoretinal disorders. Preoperative VFQ-25 composite scores in MH and ERM were significantly higher than those in PDR, DME, and BRVO. Postoperative VFQ-25 composite scores were significantly higher in MH, ERM, and RD than in PDR, DME, BRVO, and CRVO. A greater improvement in the VFQ-25 composite score was observed in ERM than in DME. Multiple regression analysis revealed that changes in contrast sensitivity had a significant correlation with changes in the VFQ-25 composite score in PDR and DME. Changes in metamorphopsia were significantly associated with changes in the VFQ-25 composite score in MH and ERM. CONCLUSIONS Vitrectomy significantly improved VR-QOL in various vitreoretinal disorders. The largest improvement in VR-QOL was observed in ERM and smallest improvement in DME. The visual function parameters associated with VR-QOL are different depending on vitreoretinal disorders.

Vision-related Quality of Life and Visual Function after Retinal Detachment Surgery

PURPOSE To compare the vision-related quality of life (VR QOL) after rhegmatogenous retinal detachment (RD) surgery with that of normal controls and to investigate the relationship between the VR QOL and visual function after surgery for RD. DESIGN Prospective, consecutive, comparative case series. METHODS The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was self-administered by 51 RD patients at six months after surgery. Among the patients with RD, 33 underwent pars plana vitrectomy and 18 received scleral buckling. We examined the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), contrast sensitivity with the CSV-1000E (Vector Vision Co, Greenville, Ohio, USA), and low-contrast visual acuity (VA) with the CSV-1000LanC10% (Vector Vision Co). From the data obtained by CSV-1000E, the area under the log contrast sensitivity function (AULCSF) was calculated. The VFQ-25 also was administered to the 46 age-matched normal controls. RESULTS The VFQ-25 composite score and the subscales associated with near activities, mental health, dependency, and peripheral vision were significantly lower in the RD group than in the normal controls (P < .05). The VFQ-25 composite score significantly correlated with AULCSF (r = 0.354; P < .05) and low-contrast VA (r = -0.475; P < 0.001), whereas there was no correlation between the VFQ-25 composite score and logMAR BCVA (r = 0.172; P = .229). CONCLUSIONS The VR QOL is significantly impaired in patients after surgery for RD. The disturbance in VR QOL was significantly associated with deterioration of postoperative contrast sensitivity.

Investigation of multifocal choroiditis with panuveitis by three‐dimensional high‐penetration optical coherence tomography

A single case of multifocal choroiditis with panuveitis (MFCPU) was investigated by a three-dimensional (3-D) high-penetration optical coherence tomography. The HP-OCT is based on a swept-source OCT technology, uses a probe beam with a center wavelength of 1060 nm, and possesses a depth resolution of 10.4 micromin tissue. Two eyes of an MFCPU patient were involved in this study. The eyes were also examined by color fundus photograph, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Findings in these four modalities are comparatively discussed. The OCT scans revealed the following characteristic properties of the lesion sites. Thinning of the retina, destructuring of the retinal layers, and disappearance of the junction of the inner and outer segments of the photoreceptor (IS/OS). Due to the high penetration of this OCT system, the following characteristic properties of the lesions were also observed: localized thinning of the choroid, occlusion of the choroidal vessels, and localized hyper-reflectivity that may represent hyper-pigmentation of the choroid.

Time course of changes in ocular higher-order aberrations and contrast sensitivity after overnight orthokeratology.

PURPOSE To investigate prospectively the time course of changes in ocular higher-order aberration and contrast sensitivity after overnight orthokeratology. METHODS Data from 34 eyes of 17 patients who completed 1-year follow-up examinations were analyzed. The manifest refraction was -2.17 +/- 0.86 D at baseline. Ocular higher-order aberrations for a 4-mm pupil were measured, and the root-mean-square (RMS) of the third-, fourth-, and total higher-order aberrations were determined. Contrast sensitivity was assessed at four spatial frequencies, and the area under the log contrast sensitivity function (AULCSF) was calculated. These examinations were performed before and 1, 2, 3, 6, and 12 months after commencement of the procedure. RESULTS The treatment significantly increased third-, fourth-, and total higher-order RMS (all P < 0.0001, paired t-test). Log contrast sensitivity significantly decreased at all four spatial frequencies, and AULCSF was also significantly reduced after the treatment (P < 0.0001). To assess the time course of changes in these parameters, posttreatment data were analyzed by using repeated-measures analysis of variance. There were no significant fluctuations in manifest refraction; uncorrected visual acuity; third-, fourth-, and total higher-order RMS; and AULCSF (all P > 0.05). In addition, there was no significant variance in log contrast sensitivity at each spatial frequency during the 1-year follow-up period (all P > 0.05). CONCLUSIONS The initial reduction in optical quality of the eye and quality of vision after the procedure is stable during the treatment period of at least 1 year, and the reduction does not worsen further after 1 month. Orthokeratology candidates should be fully informed of these changes.

Vision-related quality of life and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole

Aim: To evaluate the relationship between vision-related quality of life (VR-QOL) and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole (MH). Methods: The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was self-administered by 32 patients with MH (age 66.2 (SD 5.4) years) preoperatively and at 3 months postoperatively. Clinical data were collected, including logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA), severity of metamorphopsia and letter contrast sensitivity. The severity of metamorphopsia was evaluated by the M-Charts. MH index was measured using optical coherence tomography. The presence and severity of cataract were graded using the Lens Opacities Classification System III reference standards. Multiple regression analysis was performed to investigate the relationship between various explanatory variables and VFQ-25 questionnaire scores. Explanatory variables tested were the severity of metamorphopsia, visual acuity, letter contrast sensitivity, MH index and grade of cataract. Results: Vitrectomy for MH significantly improved VFQ-25 composite score as well as subscale scores, including general vision, near activities, distance activities, social functioning, mental health and dependency (p<0.05, Wilcoxon signed-rank test). Multiple regression analysis revealed that, both preoperatively and postoperatively, the severity of metamorphopsia had a significant correlation with VFQ-25 composite score (p<0.05), whereas other explanatory variables did not. In addition, changes in the severity of metamorphopsia was the single variable that was significantly related to changes in VFQ-25 composite score (p<0.01). Conclusion: Vitrectomy for MH significantly improved VR-QOL. The severity of metamorphopsia was significantly associated with both preoperative and postoperative VR-QOL.