Nobuyuki Shoji

Ocular dominance and patient satisfaction after monovision induced by intraocular lens implantation.

Purpose: To elucidate the relationship between ocular dominance and patient satisfaction with monovision induced by intraocular lens implantation. Setting: Eye Clinic, Kitasato University School of Medicine Hospital, Sagamihara, Kanagawa, Japan. Methods: The durations of exclusive visibility of dominant‐ and nondominant‐eye targets were measured in 16 patients with successful monovision and 4 patients with unsuccessful monovision to determine the characteristics of ocular dominance. The dominant eye was determined using the hole‐in‐card test (sighting dominance). The contrast of target in nondominant eye was fixed at 100%; the contrast of target in the dominant eye varied (ie, 100% to 80% to 60% to 40% to 20%) using rectangular gratings of 2 cycles per degree that were 4 degrees in size. Results: In the successful monovision group, the reversal thresholds (ie, exclusive visibility of the nondominant eye crosses over that of the dominant eye) were displayed only at low decreasing contrast (80% and 60%). However, in the unsuccessful monovision group, the reversal thresholds were at high decreasing contrast (20%) or not at all. The reversal thresholds in patients with unsuccessful monovision were at a significantly lower contrast than in patients with successful monovision (P<.05). Conclusions: Success and patient satisfaction in monovision patients were significantly influenced by the magnitude of ocular dominance. The balance technique seems to be a good method to evaluate the quantity of ocular dominance and prospectively evaluate the monovision technique.

Effects of dominant and nondominant eyes in binocular rivalry.

Purpose. To investigate the relation between sighting and sensory eye dominance and attempt to quantitatively examine eye dominance using a balance technique based on binocular rivalry. Methods. The durations of exclusive visibility of the dominant and nondominant eye target in binocular rivalry were measured in 14 subjects. The dominant eye was determined by using the hole-in-card test (sighting dominance). In study 1, contrast of the target in one eye was fixed at 100% and contrast of the target in the other eye was varied from 100% to 80% to 60% to 40% to 20%, when using rectangular gratings of 1, 2, and 4 cycles per degree (cpd) at 2°, 4°, and 8° in size. In study 2, contrast of the target in the nondominant eye was fixed at 100% and contrast of the target in the dominant eye was varied from 100% to 80% to 60% to 40% to 20%, when using a rectangular grating of 2 cpd at 4° in size. Results. In study 1, the total duration of exclusive visibilities of the dominant eye target; that is, the target seen by the eye that had sighting dominance was longer compared with that of the nondominant eye target. When using rectangular gratings of 4 cpd, mean total duration of exclusive visibility of the dominant eye target was statistically longer than that of the nondominant eye target (p < 0.05). In study 2, reversals (in which duration of exclusive visibility of the nondominant eye becomes longer than the dominant eye when the contrast of the dominant eye target is decreased) were observed for all contrasts except for 100%. Conclusions. The dominant sighting eye identified by the hole-in-card test coincided with the dominant eye as determined by binocular rivalry. The contrast at which reversal occurs indicates the balance point of dominance and seems to be a useful quantitative indicator of eye dominance to clinical applications.

Binocular function of the patient with the refractive multifocal intraocular lens

Purpose: To investigate binocular function in bilateral and unilateral implantation of the refractive multifocal intraocular lens (IOL). Setting: Department of Ophthalmology, Musashino Red Cross Hospital, Tokyo, Japan. Methods: Sixty‐six eyes of 40 patients were enrolled in this retrospective study. Twenty‐six were implanted bilaterally and 14 were implanted unilaterally with the 3‐zone refractive multifocal IOL. Distance visual acuity, near visual acuity, and contrast sensitivity were measured monocularly and binocularly. Stereopsis, aniseikonia, and the use of spectacles were also evaluated. Results: There were no significant between‐group differences in monocular and binocular visual acuity. In the bilateral group, 85% had 60 seconds or more of stereopsis; in the unilateral group, 43% had the same level of stereopsis (P = .009). Ninety‐two percent and 21%, respectively, had no aniseikonia (P = .001), and 89% and 50%, respectively, did not use spectacles (P = .012). In the unilateral group, in 4 of 5 cases in which surgery was performed in the dominant eye, spectacles were not required; in 9 cases in which surgery was performed in the nondominant eye, 78% used spectacles for reading (P = .063). Conclusions: Bilateral implantation of the multifocal IOL appeared to lead to better results than unilateral implantation. However, our results suggest that the patient may be satisfied with unilateral implantation when it is performed in the dominant eye.

Corneal biomechanical properties in normal-tension glaucoma

Purpose:  To investigate the intraocular pressure (IOP) and corneal biomechanical properties of normal and normal‐tension glaucoma (NTG) eyes.

Underestimation of Intraocular Pressure in Eyes After Laser In Situ Keratomileusis

PURPOSE Retrospectively, we reviewed the records of 65 patients (115 eyes) regarding the intraocular pressure (IOP) after laser in situ keratomileusis (LASIK). METHODS The mean patient age was 31.2 +/- 10.5 years. The average preoperative spherical equivalent was -6.85 +/- 2.54 diopters. A noncontact pneumatic tonometer and a Goldmann applanation tonometer were used in measuring the IOP. RESULTS The IOP after LASIK was significantly lower than that before surgery (Mann-Whitney U-test). The IOP correlated significantly with the corrected diopter value, corneal thickness, and corneal curvature (Spearman rank correlation). CONCLUSIONS The postoperative IOP can be underestimated due to decreased corneal thickness and curvature. When evaluating IOP after LASIK surgery, this possibility should be carefully investigated.

Intraocular pressure lowering effect of brinzolamide 1.0% as adjunctive therapy to latanoprost 0.005% in patients with open angle glaucoma or ocular hypertension: an uncontrolled, open-label study.

ABSTRACT Purpose: A prospective study was conducted to evaluate the intraocular pressure (IOP) lowering effect of brinzolamide 1.0% ophthalmic suspension as an adjunctive therapy with latanoprost 0.005% ophthalmic solution in patients with open angle glaucoma or ocular hypertension. Patients and methods: Fourteen patients with open angle glaucoma (OAG) or ocular hypertension (OH) who had been using latanoprost 0.005% for more than 6 months were initiated on adjunctive brinzolamide therapy. The IOP values at 1 month, 2 months, and 3 months were compared with those measured immediately before adding brinzolamide to the regimen (baseline). The incidence of adverse events such as conjunctival hyperemia and corneal epithelial defect were also examined. Results: The baseline IOP was 21.1 ± 4.8 mmHg (mean ± standard deviation). After 1 month, 2 months, and 3 months of therapy IOP was 16.9 ± 4.5 mmHg, 16.6 ± 4.0 mmHg, and 15.9 ± 3.1 mmHg, respectively, showing significant reductions in IOP at all the measuring time-points during the study compared with the baseline value ( p < 0.01). Conjunctival hyperemia developed in one patient after 1 month and in another after 2 months; however, both were mild, and therapy was continued. Corneal epithelium defect was observed in 3 patients. One of them had mild defect before brinzolamide was added to the regimen. Increase of eye discharge was seen in one patient. No serious side effects were otherwise observed. Conclusion: The addition of brinzolamide to a latanoprost 0.005% regimen may further lower intraocular pressure in patients with open angle glaucoma or ocular hypertension.

Quantitative measurement of ocular dominance using binocular rivalry induced by retinometers

PURPOSE: To develop a new method using binocular rivalry and retinometers to quantitatively examine ocular dominance and to investigate the magnitude of ocular dominance in cataract patients preoperatively and postoperatively. SETTING: Eye Clinic, Kitasato University School of Medicine Hospital, Sagamihara, Kanagawa, Japan. METHODS: The duration of exclusive visibility of the dominant and nondominant eye target in binocular rivalry were measured in 60 healthy volunteers (study 1) and preoperatively and postoperatively in 10 cataract patients (study 2). Rivalry targets were presented directly to the retina of each eye using 2 retinometers. Subjects reported the exclusive visibility of 1 eye target, and the total duration of exclusive visibility for each eye in dominant and nondominant eye trials was evaluated. RESULTS: In study 1, the magnitude of ocular dominance was quantitatively assessed with 4 grades based on differences in total duration of exclusive visibility between dominant and nondominant eyes. In study 2, magnitude of ocular dominance could be evaluated in all cataract patients regardless of refractive and cataract conditions. Magnitude of ocular dominance displayed significant correlations between preoperative and postoperative conditions (simple regression, P<.001). CONCLUSIONS: Ocular dominance can be quantitatively evaluated using this new method based on binocular rivalry and retinometers, particularly in cataract patients. Magnitude of ocular dominance may indicate preoperatively whether a patient with cataracts will have sufficient ocular dominance to adjust to monovision correction.

Clinical features of bleb-related infection: a 5-year survey in Japan.

Purpose:  To present clinical features and microbial data for bleb‐related infections obtained by the 5‐year‐long Japan Glaucoma Society Survey of Bleb‐related Infection (JGSSBI).

Evaluation of Glaucoma Progression in Large-Scale Clinical Data: The Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG).

PURPOSE To develop a large-scale real clinical database of glaucoma (Japanese Archive of Multicentral Databases in Glaucoma: JAMDIG) and to investigate the effect of treatment. METHODS The study included a total of 1348 eyes of 805 primary open-angle glaucoma patients with 10 visual fields (VFs) measured with 24-2 or 30-2 Humphrey Field Analyzer (HFA) and intraocular pressure (IOP) records in 10 institutes in Japan. Those with 10 reliable VFs were further identified (638 eyes of 417 patients). Mean total deviation (mTD) of the 52 test points in the 24-2 HFA VF was calculated, and the relationship between mTD progression rate and seven variables (age, mTD of baseline VF, average IOP, standard deviation (SD) of IOP, previous argon/selective laser trabeculoplasties (ALT/SLT), previous trabeculectomy, and previous trabeculotomy) was analyzed. RESULTS The mTD in the initial VF was -6.9 ± 6.2 dB and the mTD progression rate was -0.26 ± 0.46 dB/year. Mean IOP during the follow-up period was 13.5 ± 2.2 mm Hg. Age and SD of IOP were related to mTD progression rate. However, in eyes with average IOP below 15 and also 13 mm Hg, only age and baseline VF mTD were related to mTD progression rate. CONCLUSIONS Age and the degree of VF damage were related to future progression. Average IOP was not related to the progression rate; however, fluctuation of IOP was associated with faster progression, although this was not the case when average IOP was below 15 mm Hg.

Clinical evaluation of a 5.5 mm three-zone refractive multifocal intraocular lens

Purpose: To evaluate the results of implanting the P359‐TUV 5.5 mm three‐zone refractive multifocal intraocular lens (IOL). Setting: Musashino Red Cross Hospital, Tokyo, Japan. Methods: The lens was implanted in 29 eyes of 19 patients who were followed for a mean of 13.5 months. Distance visual acuity (DVA), near visual acuity (NVA), and contrast sensitivity were measured postoperatively. Results: Ninety‐three percent of eyes obtained 20/20 or better DVA with correction and J1 or better NVA with correction. Seventy‐nine percent obtained J1 or better NVA with distance correction and 93% obtained J3 or better. Postoperative astigmatism was easier to control than with the former large model multifocal IOL. In almost all cases, good DVA and NVA could be obtained without correction and the cases that did not need spectacle correction increased. In unilaterally implanted cases, contrast sensitivity was slightly less in eyes with multifocal IOLs than in eyes with monofocal IOLs. In bilaterally implanted cases, there was no significant difference in contrast sensitivity between the multifocal and monofocal eyes. Conclusion: The small model P359‐TUV lens is an effective multifocal lens, especially when implanted bilaterally.