Hitoshi Tabuchi

Macular Choroidal Thickness and Volume in Healthy Pediatric Individuals Measured by Swept-Source Optical Coherence Tomography

PURPOSE We evaluated the choroidal thickness and volume in healthy pediatric individuals by swept-source optical coherence tomography (SS-OCT) and compared the findings to those of adults. METHODS We examined 100 eyes of 100 healthy pediatric volunteers (3-15 years) and 83 eyes of 83 healthy adult volunteers (24-87 years) by SS-OCT with a tunable long wavelength laser source. The three-dimensional raster scan protocol was used to construct a choroidal thickness map. When the built-in software delineated an erroneous chorioscleral border in the B-scan images, manual segmentation was used. RESULTS The central choroidal thickness and volume within a 1.0-mm circle were significantly larger in the children (260.4 ± 57.2 μm, 0.205 ± 0.045 mm(3)) than in the adults (206.1 ± 72.5 μm, 0.160 ± 0.056 mm(3), both P < 0.0001). In the children, the mean choroidal thickness of the nasal area was significantly thinner than that of all other areas (P < 0.005). Pediatric choroidal thinning with increasing age in the central area was faster than that in the outer areas. Stepwise regression analysis showed that the axial length and body mass index had the highest correlation with the choroidal thickness (R(2) = 0.313, P < 0.0001). CONCLUSIONS The macular choroidal thickness and volume in the pediatric individuals were significantly larger than those in the adults. The pediatric choroidal thinning with increasing age is more rapid in the central area. Pediatric choroidal thickness is associated with several systemic or ocular parameters, especially the axial length and body mass index. These differences should be remembered when the choroidal thickness is evaluated in pediatric patients with retinochoroidal diseases.

Morphologic Characteristics of Macular Complications of a Dome-Shaped Macula Determined by Swept-Source Optical Coherence Tomography

PURPOSE To investigate the morphologic characteristics of macular complications of dome-shaped maculas using swept-source optical coherence tomography (OCT). DESIGN Retrospective observational case series. METHODS Axial length measurements and swept-source OCT were performed in 49 highly myopic eyes (in 5 male and 30 female subjects) with dome-shaped maculas. We classified the dome patterns and measured the central retinal thickness, central choroidal thickness, central scleral thickness, and the macular bulge height, and assessed the associations of these parameters with macular complications. RESULTS The central scleral thickness was significantly negatively correlated with age and the axial length. We classified the eyes into 3 groups: 6 with choroidal neovascularization (CNV group), 8 with retinal pigment epithelial detachment (PED group; 5 with serous retinal detachment), and 35 with no complications (no complications group). Nine eyes had a round dome and 40 had horizontally oriented oval-shaped domes. There were no significant differences in the frequency of macular complications between these patterns. The CNV group was significantly older and had a longer axial length than the other groups. The PED group had significantly larger values for both the central scleral thickness and bulge height than the other groups. The central choroidal thickness was significantly thinner in the CNV group than in the no complications group. CONCLUSION A dome-shaped macula results from relative thickening of the macular sclera, and this may lead to PED. Thinning of the sclera owing to long-term changes and elongation of the axis may develop CNV and cause visual impairment.

Latanoprost therapy after sunken eyes caused by travoprost or bimatoprost.

Purpose. To report clinical results of switching to latanoprost therapy in patients with deepening of the upper eyelid sulcus caused by travoprost and bimatoprost. Methods. Prospective, clinical, observational case reports. Four patients presented with eyelid changes giving the eye a sunken eye appearance; two were being treated with travoprost and two with bimatoprost. Both patients on bimatoprost and one of the patients on travoprost therapy were switched to latanoprost while the eyelid sign was evident. The other patient discontinued the travoprost therapy for 4 months and switched to latanoprost therapy 1 month later, i.e., 5 months after discontinuing travaprost therapy. The physical changes in the eyelids were documented by photography and the intraocular pressure by Goldmann applanation tonometry. Results. Three patients had a resolution of the sunken eye appearance 2 to 3 months after switching to latanoprost. The one patient who switched to latanoprost after recovery of the sunken eye had no recurrence during a 6 months follow-up period. There were no significant changes in the intraocular pressure in any of the subjects. Conclusions. A deepening of the upper eyelid sulcus is a complication of prostaglandin F2&agr; analogs. However, this side effect may be less common with latanoprost and eyes with this side effect caused by travoprost or bimatoprost may tolerate latanoprost therapy.

The Relationship between Corvis ST Tonometry Measured Corneal Parameters and Intraocular Pressure, Corneal Thickness and Corneal Curvature

The purpose of the study was to investigate the correlation between Corneal Visualization Scheimpflug Technology (Corvis ST tonometry: CST) parameters and various other ocular parameters, including intraocular pressure (IOP) with Goldmann applanation tonometry. IOP with Goldmann applanation tonometry (IOP-G), central corneal thickness (CCT), axial length (AL), corneal curvature, and CST parameters were measured in 94 eyes of 94 normal subjects. The relationship between ten CST parameters against age, gender, IOP-G, AL, CST-determined CCT and average corneal curvature was investigated using linear modeling. In addition, the relationship between IOP-G versus CST-determined CCT, AL, and other CST parameters was also investigated using linear modeling. Linear modeling showed that the CST measurement ‘A time-1’ is dependent on IOP-G, age, AL, and average corneal curvature; ‘A length-1’ depends on age and average corneal curvature; ‘A velocity-1’ depends on IOP-G and AL; ‘A time-2’ depends on IOP-G, age, and AL; ‘A length-2’ depends on CCT; ‘A velocity-2’ depends on IOP-G, age, AL, CCT, and average corneal curvature; ‘peak distance’ depends on gender; ‘maximum deformation amplitude’ depends on IOP-G, age, and AL. In the optimal model for IOP-G, A time-1, A velocity-1, and highest concavity curvature, but not CCT, were selected as the most important explanatory variables. In conclusion, many CST parameters were not significantly related to CCT, but IOP usually was a significant predictor, suggesting that an adjustment should be made to improve their usefulness for clinical investigations. It was also suggested CST parameters were more influential for IOP-G than CCT and average corneal curvature.

3-D choroidal thickness maps from EDI-OCT in highly myopic eyes.

Purpose Myopic chorioretinal atrophy is a debilitating condition that causes severe loss of primary vision. However, its mechanisms and pathologic course are not well understood. We performed volumetric measurements of the posterior choroid via three-dimensional analysis of the choroid in patients with high myopia to understand its structure, and we compared the measurements with those of normal subjects. Methods Twenty-five highly myopic but otherwise normal eyes and 25 nonmyopic eyes were evaluated. Enhanced depth imaging optical coherence tomography (EDI-OCT) was performed using 20 × 20–degree raster scans consisting of 25 high-speed line scans. Three-dimensional retinal and choroidal thickness maps were produced from the EDI-OCT data. For the quantitative analyses, the macula was divided into nine regions, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) layout, and the mean retinal and choroidal thicknesses of each region were obtained. Results The choroidal thicknesses at all regions in the high-myopia group were significantly smaller than those in the normal refractive group (p < 0.0001). The foveal choroidal thickness was the greatest in the normal group but not in the high-myopia group. In the high-myopia group, the choroidal thickness at the fovea was significantly greater than that at the outer nasal quadrants (p < 0.0001) but significantly smaller than that at the outer superior (p < 0.0001) quadrants. Conclusions Three-dimensional choroidal thickness maps obtained via EDI-OCT are useful for quantifying choroid thickness in subjects with high myopia more accurately.

Comparison of Visual Performance of Multifocal Intraocular Lenses with Same Material Monofocal Intraocular Lenses

Purpose To compare the visual performance of multifocal intraocular lenses (IOLs) and monofocal IOLs made of the same material. Methods The subjects included patients implanted with either Tecnis® monofocal IOLs (ZA9003 or ZCB00) or Tecnis® multifocal IOLs (ZMA00 or ZMB00) bilaterally. We conducted a retrospective study comparing the two types of IOLs. The multifocal group included 46 patients who were implanted with Tecnis® multifocal IOLs bilaterally. The monofocal group was an age- and sex-matched control group, and included 85 patients who were implanted with Tecnis® monofocal IOLs bilaterally. Lens opacity grading, the radius of corneal curvature, corneal astigmatism, axial length and the refractive status were measured preoperatively. Pupil size, ocular aberrometry, distance, intermediate and near visual acuity, contrast sensitivity with and without glare and the responses to a quality-of-vision questionnaire were evaluated pre- and postoperatively. Results The uncorrected near visual acuity was significantly better in the multifocal group, whereas both the corrected intermediate and near visual acuity were better in the monofocal group. Contrast sensitivity (with and without glare) was significantly better in the monofocal group. The rate of spectacle dependency was significantly lower in the multifocal group. There were no significant differences between the two groups regarding most items of the postoperative quality-of-vision questionnaire (VFQ-25), with the exception that the patients in the monofocal group reported fewer problems with nighttime driving. Conclusions The multifocal IOLs used in this study reduced spectacle dependency more so than monofocal IOLs and did not compromise the subjective visual function, with the exception of nighttime driving.

Prostaglandin-associated periorbitopathy in latanoprost users

Purpose We investigated the incidence of prostaglandin-associated periorbitopathy (PAP) in subjects with glaucoma treated with latanoprost ophthalmic solution. Subjects and methods One eye and the forehead in 22 subjects were evaluated. All patients had used latanoprost for more than 1 year (range, 12 to 45 months; mean, 26.0 months) and were prostaglandin F2α analogue treatment-naïve. Digital photographs of the subjects obtained before latanoprost therapy and at the last examination were compared retrospectively. Four signs of PAP (deepening of the upper eyelid sulcus (DUES), upper eyelid ptosis, flattening of the lower eyelid bags, and inferior scleral show) and supplemental side effects around the eyelids (eyelash growth, poliosis, and eyelid pigmentation) were judged to be negative or positive by three independent observers. If the observers unanimously rated a sign as positive, the result was defined as positive. Results Twelve subjects (54.5%) had no apparent signs. Three subjects were judged to have DUES (13.6%), and two subjects each were judged to have flattening of the lower eyelid bags and eyelid pigmentation (9.0%). The other signs were judged as positive in only one subject each, respectively (4.5%). A univariate logistic regression analysis showed no significant associations between any of the signs and age, sex, or the duration of therapy. Conclusion Latanoprost induced DUES, upper eyelid ptosis, flattening of the lower eyelid bags, inferior scleral show, and supplemental side effects around the eyelids; however, the rates of such occurrence might be relatively low.

Intraocular pressure of supine patients using four portable tonometers.

Purpose To evaluate the congruity of intraocular pressure (IOP) measurements from supine patients, which were obtained using four portable tonometers. Methods Intraocular pressure measurements were obtained from the right eye of 72 supine patients. We used the iCare (Tiolat Oy, Helsinki, Finland) rebound tonometer, the Diaton (BICOM Inc., Long Beach, NY) transpalpebral tonometer, the Tonopen XL (Reichert inc., Depew, NY), and a Kowa hand-held applanation tonometer (HAT; Kowa Company, Ltd., Nagoya, Japan). Relationships between mean IOPs were evaluated using Pearson correlation coefficients, and the mean differences between tonometers, using one-way analysis of variance followed by Tukey-Kramer post-hoc analysis. Levels of agreement were evaluated using Bland-Altman analysis. Results The mean IOPs (mean ± SD) were 18.2 ± 3.5 mm Hg for iCare, 14.8 ± 3.4 mm Hg for Diaton, 16.7 ± 3.7 mm Hg for Tonopen XL, and 16.8 ± 2.8 mm Hg for Kowa HAT. Pearson correlation coefficients between iCare, Tonopen XL, and Kowa HAT ranged from 0.382 to 0.577, whereas those between Diaton and other tonometers ranged from 0.041 to 0.286. Post-hoc analysis indicated significant differences between all pairs except Tonopen XL and Kowa HAT. The mean difference between measurements from iCare and Diaton was 3.39 ± 3.39 mm Hg; iCare and Tonopen XL, 1.47 ± 3.52 mm Hg; iCare and Kowa HAT, 1.49 ± 2.90 mm Hg; Diaton and Tonopen XL, −1.93 ± 4.90 mm Hg; Diaton and Kowa HAT, −1.90 ± 4.15 mm Hg; and Tonopen XL and Kowa HAT, 0.02 ± 3.61 mm Hg. Computation of the width of the 95% limits of agreement resulted in a wide bias range when comparing Diaton with all tonometers. Relatively good agreements were observed between iCare, Tonopen XL, and HAT. Conclusions Intraocular pressure measurements obtained in a supine position by four portable tonometers were not interchangeable. Although iCare and Tonopen XL significantly overestimated IOP values in eyes with a higher IOP when compared with Kowa HAT, the agreements between iCare, Tonopen XL, and Kowa HAT were at clinically acceptable levels.

Comparison of anterior chamber depth measurements by 3-dimensional optical coherence tomography, partial coherence interferometry biometry, Scheimpflug rotating camera imaging, and ultrasound biomicroscopy

PURPOSE: To evaluate the congruity of anterior chamber depth (ACD) measurements using 4 devices. SETTING: Saneikai Tsukazaki Hospital, Himeji City, Japan. DESIGN: Comparative case series. METHODS: In 1 eye of 42 healthy participants, the ACD was measured by 3‐dimensional corneal and anterior segment optical coherence tomography (CAS‐OCT), partial coherence interferometry (PCI), Scheimpflug imaging, and ultrasound biomicroscopy (UBM). The differences between the measurements were evaluated by 2‐way analysis of variance and post hoc analysis. Agreement between the measurements was evaluated using Bland‐Altman analysis. To evaluate the true ACD using PCI, the automatically calculated ACD minus the central corneal thickness measured by CAS‐OCT was defined as PCI true. Two ACD measurements were also taken with CAS‐OCT. RESULTS: The mean ACD was 3.72 mm ± 0.23 (SD) (PCI), 3.18 ± 0.23 mm (PCI true), 3.24 ± 0.25 mm (Scheimpflug), 3.03 ± 0.25 mm (UBM), 3.14 ± 0.24 mm (CAS‐OCT auto), and 3.12 ± 0.24 mm (CAS‐OCT manual). A significant difference was observed between PCI biometry, Scheimpflug imaging, and UBM measurements and the other methods. Post hoc analysis showed no significant differences between PCI true and CAS‐OCT auto or between CAS‐OCT auto and CAS‐OCT manual. Strong correlations were observed between all measurements; however, Bland‐Altman analysis showed good agreement only between PCI true and Scheimpflug imaging and between CAS‐OCT auto and CAS OCT manual. CONCLUSION: The ACD measurements obtained from PCI biometry, Scheimpflug imaging, CAS‐OCT, and UBM were significantly different and not interchangeable except for PCI true and CAS‐OCT auto and CAS‐OCT auto and CAS‐OCT manual. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intradevice and Interdevice Agreement Between a Rebound Tonometer, Icare PRO, and the Tonopen XL and Kowa Hand-held Applanation Tonometer When Used in the Sitting and Supine Position.

Purpose:The aim of the study was to investigate the agreement between a new portable tonometer, Icare PRO, and the Tonopen XL and Kowa hand-held applanation tonometers (HAT). Methods:The right eyes of 127 healthy subjects were enrolled. Intraocular pressure (IOP) was measured in both sitting and supine positions using the Icare PRO, Tonopen XL, and Kowa HAT tonometers. The repeatability of the IOP measurements was evaluated by calculating intraclass correlation coefficients. Between-method agreements of tonometer measurements were evaluated using Bland-Altman analysis. Results:Intradevice agreement: The intraclass correlation coefficients (sitting, supine) of Icare PRO, Tonopen XL, and Kowa HAT were (0.863, 0.656), (0.845, 0.819), and (0.957, 0.956), respectively.Interdevice agreement: The Bland-Altman analysis revealed that, in the sitting position, the mean differences between Icare PRO and Tonopen XL, and between Icare PRO and Kowa HAT were −0.43 and 0.43 mm Hg, respectively (95% limits of agreement: −6.24 to 5.34 mm Hg, −4.04 to 4.90 mm Hg). In the supine position, the corresponding mean differences were −0.88 and 0.14 mm Hg (95% limits of agreement: −5.66 to 3.91 mm Hg, −4.06 to 4.33 mm Hg). IOP differences between Icare PRO and the other tonometers were unaffected by central corneal thickness. Conclusions:The repeatability of Icare PRO was slightly lower in the supine position than in the sitting position. Although Icare PRO underestimated IOP values in eyes with higher IOP when compared with Tonopen XL and Kowa HAT in both positions, we observed good interdevice agreement between Icare PRO and both Tonopen XL and Kowa HAT.