Megumi Saiki

The features of dry eye disease in a Japanese elderly population.

Purpose. The purpose of this study is to assess the features of dry eye disease in a Japanese elderly population. Methods. One hundred thirteen left eyes of 113 pensioners (50 males, 63 females; mean age, 67.5 ± 5.7 years) aged over 60 years were recruited in this study. The subjects underwent careful slit-lamp examinations of the conjunctiva, ocular surface, and the eye lids. Tear film breakup time (BUT) examinations, Schirmer test-I, and fluorescein staining of the ocular surface and transillumination of the eyelids were also performed. Dry eye symptomatology was assessed with a symptom questionnaire. Japanese Dry Eye Diagnostic Criteria were used in this study. Results. Ocular tiredness, irritation, dryness, and foreign body sensation were the most frequently reported symptoms by the patients. A total of 73.5% of the eyes had definite dry eyes. A total of 39.8% of the eyes had a Schirmer test reading <5 mm. Mean Schirmer test value was 9.4 ± 7.8 mm. The mean BUT score was 4.0 ± 2.8 seconds. A total of 76.9% of the eyes had positive fluorescein staining of the cornea. Meibomian gland dysfunction and conjunctivochalasis were found as frequent factors in relation to dry eye disease with meibomian grand dropout showing positive correlation with tear instability. Conclusion. Qualitative and quantitative disorders of the tear film were far more common than recognized in this population of elderly subjects, meibomian gland dysfunction being the most common associate of the tear film disorder and dry eye status. Conjunctivochalasis (conjunctival laxity), although commonly associated with dry eye disease in the elderly, was observed not to be related to age or gender in this study.

The evaluation of the treatment response in obstructive meibomian gland disease by in vivo laser confocal microscopy

PurposeTo evaluate the status of periglandular inflammation, ocular surface and tear function alterations in patients with obstructive meibomian gland disease (OMGD) by in vivo confocal microscopy before and after anti-inflammatory treatment, and to compare the results with patients receiving only topical non-preserved artificial tears and sodium hyaluronate eye drops without anti-inflammatory agents.MethodsThirty-two eyes of 16 OMGD patients receiving anti-inflammatory treatment (treatment group) and 22 eyes of 11 OMGD patients receiving only topical non-preserved artificial tears and sodium hyaluronate eye drops (control group) were recruited in this prospective study. All subjects underwent slit-lamp examinations, tear film break-up time (BUT) measurements, fluorescein and Rose-Bengal stainings, Schirmer test І without anesthesia, transillumination of the lids (meibography), and in vivo laser confocal microscopy of the lids (HRTII-RCM).ResultsThe mean BUT, fluorescein staining scores, and inflammatory cell densities observed by in vivo confocal microscopy improved significantly in the group receiving anti-inflammatory treatment (p < 0.05), whereas no significant alterations of these parameters were observed in the group not receiving anti-inflammatory agents (p > 0.05).ConclusionsIn vivo confocal microscopy was able to effectively demonstrate the treatment responses in patients with OMGD. Inflammatory cell density calculation seems to be a promising new parameter of in vivo confocal microscopy in the evaluation of treatment responses.

Effect of spherical aberration on visual function under photopic and mesopic conditions after cataract surgery.

PURPOSE: To evaluate the effect of spherical aberration on visual function under natural pupil conditions after cataract surgery. SETTING: Keio University Hospital, Tokyo, Japan. METHODS: This study comprised cataract patients who had cataract extraction with implantation of an acrylic intraocular lens. Preoperative and postoperative visual acuity, higher‐order aberration in the whole eye, contrast sensitivity function, and pupil diameter under photopic and mesopic conditions 1 month after surgery were measured. The area under log contrast sensitivity function (AULCSF) and spherical aberration corresponding to the individual pupil diameter under photopic and mesopic conditions were evaluated. RESULTS: One hundred seven eyes of 79 patients (30 men, 49 women; mean age 68.0 years ± 9.6 [SD]) were evaluated. The mean pupil diameter was 2.9 ± 0.50 mm under photopic conditions and 3.6 ± 0.57 mm under mesopic conditions. The mean spherical aberration was 0.03 ± 0.04 μm (range −0.12 to 0.34 μm) under photopic conditions and 0.05 ± 0.10 μm (range −0.14 to 0.55 μm) under mesopic conditions. The postoperative AULCSF without glare under photopic conditions was significantly negatively correlated with spherical aberration (P = .014). The postoperative AULCSF with and without glare under mesopic conditions was significantly negatively correlated with spherical aberration (P<.001 and P = .01, respectively). CONCLUSIONS: Postoperative spherical aberration had a significant effect on visual function under photopic and mesopic conditions. This result indicates that reduced postoperative spherical aberration improves postoperative visual function under photopic and mesopic conditions.

Improvement of Functional Visual Acuity After Cataract Surgery in Patients With Good Pre- and Postoperative Spectacle-corrected Visual Acuity

PURPOSE To report the changes in functional visual acuity in cataract surgery patients with good pre- and postoperative visual acuity. METHODS Functional visual acuity was evaluated in 13 eyes of 10 patients before and 1 month after phacoemulsification with implantation of acrylic intraocular lenses. Pre- and postoperative best spectacle-corrected visual acuities (BSCVA) were better than 20/25 in all patients. Low contrast visual acuity and Schirmer tests were also performed before and after surgery. RESULTS Mean pre- and postoperative logMAR BSCVA were -0.02 +/- 0.06 and -0.05 +/- 0.04, respectively (P > .05). Mean preoperative logMAR functional visual acuity improved from 0.29 +/- 0.17 to 0.092 +/- 0.13 postoperatively (P < .05). The visual maintenance ratio in functional visual acuity and low contrast visual acuity also improved significantly after cataract surgery (P < .05). CONCLUSIONS Measurement of functional visual acuity seems to be useful in the evaluation of timing of surgery, visual quality, and changes in kinetic vision after phacoemulsification surgery.

Alterations in the anterior chamber angle after implantation of iris-fixated phakic intraocular lenses

PURPOSE: To evaluate anterior chamber angle alterations after phakic intraocular lens (pIOL) implantation using the Pentacam rotating Scheimpflug camera (Oculus) and the effect on intraocular pressure (IOP) and anterior chamber inflammation. SETTING: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. METHODS: Twenty eyes of 11 patients with high myopia who had implantation of pIOLs (Artisan/Verisyse, model 204, Ophtec BV) were included. All pIOLs were fixated on the iris near the 3 o’clock and 9 o’clock positions. Angles at the 2, 3, 4, 8, 9, and 10 o’clock positions, IOP, and postoperative flare were evaluated retrospectively. RESULTS: The mean angle degree at 2, 3, 4, 8, 9, and 10 o’clock was 40.3 degrees ± 3.3 (SD) preoperatively and 36.5 ± 5.8 degrees postoperatively; the postoperative angles were significantly narrower than the preoperative angles (P<.001). The mean angles at 3 o’clock and 9 o’clock were 39.8 ± 3.7 degrees and 40.6 ± 3.5 degrees, respectively, preoperatively and 32.7 ± 6.0 degrees and 31.3 ± 5.4 degrees, respectively, postoperatively. The postoperative angles at 3 o’clock and 9 o’clock were narrower than the preoperative angles (P<.001). There was no significant difference between preoperative IOP and postoperative IOP (P = .22). The flare at 1 month (r = 0.573, P = .0071) and 1 year (r = 0.700, P = .004) was significantly correlated with the angle change. CONCLUSION: Partial localized narrowing of anterior chamber angles that occurred after pIOL implantation induced acute and chronic anterior chamber inflammation in patients with large angle alterations.

Tear function and lipid layer alterations in dry eye patients with chronic graft- vs -host disease

PurposeTo investigate the changes in the tear film lipid layer in haematopoietic stem cell transplantation (HSCT) patients with dry eye (DE) associated with chronic graft-vs-host disease (cGVHD) and compare with HSCT recipients without DE.MethodsWe performed a prospective study in 10 HSCT patients with DE associated with cGVHD and 11 HSCT recipients without DE. We performed Schirmers test, tear film break up time examinations, ocular surface dye staining and meibum expressibility test and DR-1 tear film lipid layer interferometry. DR-1 interferometry images of the tear film surface were assigned a ‘DR-1 grade’ according to the Yokoi severity grading system. The DR-1 grades were analysed according to the presence or absence of DE, conjunctival fibrosis and systemic cGVHD.ResultsThe mean DR-1 severity grade in patients with DE related to cGVHD (DE/cGVHD group; 3.9±0.9) was significantly higher than in patients without DE after HSCT (non-DE/non-cGVHD group; 1.3±0.6; P<0.05). The DR-1 grade for HSCT recipients with conjunctival fibrosis was significantly higher than in patients without conjunctival fibrosis (P<0.05). When DE severity was graded according to the recommendation of the 2007 Dry Eye Workshop Report, our results showed a correlation between the severity of DE and DR-1 grades (r=0.8812, P<0.0001).ConclusionDR-1 interferometry may be applicable to diagnosing DE and evaluating its progression subsequent to HSCT.

A new central–peripheral corneal curvature method for intraocular lens power calculation after excimer laser refractive surgery

Purpose:  To propose the central–peripheral (C‐P) method, which requires no data history to calculate intraocular lens (IOL) powers for eyes that underwent laser in situ keratomileusis (LASIK), and compare the accuracy of the C‐P method with other IOL formulas for eyes after LASIK.

Deep stromal opacity after corneal cross-linking.

Purpose: To describe 3 cases with deep corneal stromal opacity that occurred several months after corneal cross-linking. Methods: A 36-year-old man, a 19-year-old man, and a 14-year-old girl underwent corneal cross-linking for their progressive keratoconus. Corneal cross-linking was performed according to the Dresden protocol. The corneal epithelium was ablated using an excimer laser in 2 cases and manually in 1 case. After 30 minutes of riboflavin presoaking, hypotonic riboflavin solution was applied until the corneal stroma swelled, after which the eyes were exposed to ultraviolet irradiation. Slit-lamp microscopy findings, uncorrected visual acuity, best-corrected visual acuity, manifest refraction, intraocular pressure, and corneal endothelial cell counts were evaluated, and corneal topography with Scheimpflug imaging was performed. Results: In all cases, the epithelium healed without delay. All eyes showed mild stromal infiltration a few days after the procedure; however, the inflammation was resolved within 1 week. The corneal stroma revealed no opacity up to 1 month after the procedure. A deep stromal opacity that extended to the inferior paracentral area developed after a few months and remained for 6 months to 1 year. Because the opacity was not on the visual axis, the visual acuity was not involved. Conclusions: Deep stromal opacity developed several months after uneventful corneal cross-linking. Postoperative inflammation may play a crucial role in its pathogenesis.

Effect of neodymium:YAG laser capsulotomy on visual function in patients with posterior capsule opacification and good visual acuity

Purpose To evaluate the effect of neodymium:YAG (Nd:YAG) laser capsulotomy on the visual function in patients with posterior capsule opacification (PCO) and good visual acuity. Setting Keio University Hospital, Tokyo, Japan. Design Observational case series. Methods Eyes were evaluated that had previous cataract surgery with a clinical diagnosis of PCO requiring Nd:YAG laser capsulotomy regardless of a good corrected distance visual acuity (CDVA) (at least 20/20). The CDVA, 10% low contrast visual acuity (LCVA), wavefront aberrations from the 3rd to 6th order, and retinal straylight were measured before and after Nd:YAG laser capsulotomy. Results The study included 16 eyes of 16 patients (10 men, 6 women; mean age 69.5 years ± 9.3 [SD]). The mean CDVA, LCVA, and straylight after Nd:YAG laser capsulotomy improved significantly (P < .05). The root mean square (RMS) of the 3rd Zernike coefficients (S3) and the RMS of the total higher‐order aberrations (HOAs) from the 3rd to 6th order decreased significantly after capsulotomy (P < .05). The straylight correlated significantly with the total HOAs (r = 0.727, P = .002) and S3 (r = 0.748, P = .001) before capsulotomy. Subjective symptoms resolved after capsulotomy in all cases. Conclusions Neodymium:YAG laser capsulotomy enabled a significant improvement in visual function even in patients with PCO with good visual acuity. Straylight measurements might be useful to determine the indications for Nd:YAG laser capsulotomy when patients report visual disturbances without decreased visual acuity. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Functional visual acuity of early presbyopia

Purpose To evaluate visual function in patients with early presbyopia using the functional visual acuity (FVA) test. Methods This study included 27 eyes of 27 healthy older volunteers (mean age, 44.1 ± 2.6 years) and 14 eyes of 14 healthy young volunteers (mean age, 28.4±4.8 years). The distance-corrected visual acuity (DCVA), distance-corrected near VA (DCNVA), subjective amplitude of accommodation (AA), and distance and near pupillary diameters were measured. The distance FVA and distance-corrected near FVA (DCNFVA) were measured using the FVA Measurement System. The standard Schirmer test and standard tear break-up time measurement also were performed. Results The logarithm of the minimum angle of resolution (logMAR) DCVA was better than 0 in all subjects. The percentages of subjects with logMAR DCNVA below 0 was significantly lower in the presbyopia group than in the young group. The DCNFVA in the presbyopia group was significantly (P < 0.001) poorer than the DCNVA in that group. Significant linear negative correlations were seen between the DCNVA and AA (r = -0.507, P < 0.001) and the DCNFVA and AA (r = -0.681, P < 0.001) in the older subjects. Stepwise regression analysis showed that only the AA was a significant factor predictive of the DCNFVA in the presbyopia group. Tear function parameters were not adopted in the regression model. Conclusions Measurement of the DCNFVA can detect decreased AA in early presbyopia better than measurement of the conventional near VA. The DCNFVA is a good index for early presbyopia.