Satoshi Hasebe

Effect of Progressive Addition Lenses on Myopia Progression in Japanese Children: A Prospective, Randomized, Double-Masked, Crossover Trial

PURPOSE This prospective, randomized, double-masked, crossover trial was conducted to evaluate the clinical effectiveness of progressive addition lenses (PALs) compared with single-vision lenses (SVLs) on myopia progression in Japanese children. METHODS Ninety-two children fulfilling the inclusion criteria (age: 6-12 years, spherical equivalent refractive errors: -1.25 to -6.00 D) were randomly allocated to either 18 months of wearing PALs (near addition: +1.50 D) followed by 18 months of SVLs (group 1), or 18 months of wearing SVLs followed by 18 months of wearing PALs (group 2), and were followed up for 3 years (two-stage crossover design). The primary outcome measure was myopia progression, as determined by cycloplegic autorefraction. RESULTS Eighty-six (93%) children completed both treatment periods. A mixed-model, two-way analysis of variance (ANOVA) performed using 3-year data identified a significant treatment effect of PALs compared with SVLs (P = 0.0007), with a mean 18-month difference of 0.17 D (95% CI: 0.07-0.26 D). This analysis also indicated a significant period effect (P = 0.0040) and a significant treatment-by-period interaction (P = 0.0223): Group 1 showed a slower myopia progression than did group 2. CONCLUSIONS The use of PALs slowed myopia progression, although the treatment effect was small, as previously reported in ethnically diverse children in the United States. The significant treatment-by-period interaction suggests that early application of PALs would probably be more beneficial for these age and refraction ranges (isrctn.org number, 28611140).

Accommodative lag under habitual seeing conditions: comparison between myopic and emmetropic children.

PurposeTo determine whether or not myopic children have a larger lag of accommodation than emmetropic children under natural seeing conditions.MethodsIn 61 myopic children (age, 9.5 ± 1.3 years; spherical equivalent refractive error, −6.50 to −1.00 D), accommodative response was objectively measured while they were binocularly viewing a target at 50.5, 32.5, 20.9, or 16.0 cm (1.98–6.25 D) through fully correcting glasses. In the 33 children who habitually wore spectacles, the accommodative responses were also measured while they wore their own spectacles. As controls, 18 emmetropic children were recruited. Accommodative response gradients and lags were compared between the groups after calibration for residual refractive errors and the vertex distance of the glasses.ResultsWith fully correcting glasses, the myopic children showed a larger mean lag of accommodation than the emmetropic children, as well as wide intersubject variation. However, when the children wore their habitual, usually undercorrecting, spectacles, accommodative lags markedly decreased, and a significant correlation was found between residual refractive errors after correcting for the spectacles and accommodative lags. Myopic children with near-point exophoria tended to show smaller lags of accommodation.ConclusionUnder binocular viewing conditions, myopic children when viewing the target through fully correcting glasses tend to show larger lags of accommodation than emmetropic children, but the lags of accommodation are usually reduced by their spectacle undercorrection. Jpn J Ophthalmol 2005;49:189–194

Accommodative Lag Under Habitual Seeing Conditions: Comparison Between Adult Myopes and Emmetropes

PURPOSE To clarify whether myopes show poor accommodative response and thus have a larger accommodative lag under natural seeing conditions. METHODS Forty-three adults without other ocular abnormalities were classified into the early-onset myopia (EOM, n=28) and the emmetropia (EMM, n=15) groups. The subjects wore glasses or contact lenses that they habitually used, and accommodative responses to four accommodative targets (16.0-50.5 cm from their eyes) were measured under a monocular or binocular condition using an open-field infrared autorefractometer. RESULTS Under a binocular condition, the accommodative lag for each target was significantly smaller in the EOM group (analysis of variance, P<.01), but the mean slope of the accommodative stimulus-response function did not significantly differ between the EOM and EMM groups (1.05+/-0.11 and 1.02+/-0.10 D/D, respectively). The mean slope under a binocular condition was significantly steeper than that under a monocular condition in both groups (paired t-test, P<.05). CONCLUSIONS In adults with EOM, the accommodative stimulus-response function was not impaired, and the habitual accommodative lag was rather small, probably due to the reduced accommodative demand by a vertex distance and/or the intentional undercorrection of spectacles.

Advancement of medial rectus muscle to the original insertion for consecutive exotropia

Twenty-four patients who underwent surgery to correct consecutive exotropia that developed iatrogenically after surgical overcorrection were studied retrospectively. All patients underwent single or bilateral advancement of the medial rectus muscle to the original muscle insertion. The mean preoperative exodeviation was 26.7 prism diopters at distance and 35.2 delta at near. Postoperatively, in cases receiving advancement of a single medial rectus, the mean amount of correction was 23.2 delta at distance and 29.6 delta at near. In cases receiving bilateral medial rectus advancement, the mean amount of postoperative correction was 26.3 delta at distance and 39.8 delta at near. Adduction deficiency was normalized in five patients (71%), while convergence insufficiency was improved in only nine patients (45%) after surgery. Twelve (50%) patients had binocular single vision at distance on a normal or abnormal basis as determined by the Bagolini lens test.

Prism adaptation response is useful for predicting surgical outcome in selected types of intermittent exotropia

PURPOSE To evaluate the prevalence of prism adaptation response in Japanese patients with intermittent exotropia (X [T]) using the prism adaptation test and to assess whether patients with selected types of X [T] benefit from surgical outcome to which prism adaptation response may contribute. METHODS In a prospective study, 128 consecutive patients with X [T] between 1990 and 1995 were enrolled. The prism adaptation test was conducted by neutralizing the angle of deviation for 2 to 3 hours. Patients who showed an increase in exodeviation by 10triangle up or more with the prism adaptation test were defined as having a prism adaptation response. For classification of the pattern of X [T], we chose a value of 15triangle up as the difference between the distance and near measurements. RESULTS The percentage of patients in whom the prism adaptation response was observed at near fixation was significantly larger than those at distance fixation [35 (27%) patients versus 10 (8%) patients, P <.05]. Of 35 patients shown to have a prism adaptation response at near fixation, 21 patients (83%) had the basic type of exotropia. Fourteen patients (17%) with the basic type were changed to convergence insufficiency type because of an increase in near deviation and were defined as pseudo basic type. Patients with pseudo basic type had a significantly better surgical outcome compared with that of true basic type, whereas in the convergence insufficiency type, no definite tendency was found between the two subtypes, true and pseudo types. CONCLUSION Patients with the pseudo basic type of X [T] in whom a prism adaptation response was demonstrated had a more favorable surgical outcome.

Chromosomes 4q28.3 and 7q31.2 as New Susceptibility Loci for Comitant Strabismus

PURPOSE This study was designed to localize chromosomal susceptibility loci for comitant strabismus among Japanese families by genome-wide linkage analyses. METHODS Fifty-five Japanese families, with at least two members with comitant strabismus (esotropia and/or exotropia), were subject to full ophthalmic examination, careful ocular history, and review of medical records. DNA was obtained and genotyping was performed with PCR amplification of 400 microsatellite markers. Parametric and nonparametric linkage (NPL) analyses scores were calculated. Linkage analysis was performed for the whole set of families (55 families), and then a second analysis was performed for two subgroups with the phenotypes, esotropia and exotropia. RESULTS A multipoint parametric heterogeneity logarithm of the odds (HLOD) score of 3.62 was obtained at marker D4S1575 under a dominant model, with a NPL score of 2.68 (P=0.001). Testing under different penetrances and disease allele frequencies revealed two other susceptibility loci at 7q31.2 under a recessive model (HLOD scores=3.93 and 4.40 at 125.2 cM and 107.28 cM, respectively). Analysis of the subgroups revealed new susceptibility loci for esotropia; one locus at 8q24.21 is worthy of further investigation. CONCLUSIONS This study suggests multiple susceptibility loci for comitant strabismus. The loci at chromosomes 4q28.3 and 7q31.2 show a significant evidence of linkage.

Cycloplegic Effect of 0.5%Tropicamide and 0.5%Phenylephrine Mixed Eye Drops: Objective Assessment in Japanese Schoolchildren with Myopia

PurposeTo evaluate the cycloplegic effect of mixed eye drops containing 0.5% tropicamide and 0.5% phenylephrine in myopic children, and to determine whether their efficacy was associated with their clinical characteristics.MethodsEighty-one myopic children (age, mean ± SD, 11.0 ± 1.5 years; mean spherical equivalent refractive error, −4.27 ± 1.41 D; range, −1.57 to −8.66 D) were recruited. One drop of Mydrin-P was administered to each eye twice, with an interval of 5 min between. Twenty-five minutes after the second drop, accommodative responses were measured with an open-view autorefractometer, while the subject was encouraged to accommodate by binocularly looking at a Maltese cross located at a distance of 33 cm. The difference between the refractive reading and that obtained with a Maltese cross at 500 cm was regarded as residual accommodation (RA). The repeatability of this measurement was also evaluated.ResultsThe mean RA was 0.21 ± 0.29 D (range, −0.31 to 0.99 D). There was no association in RA between the right and left eyes, between RA and age, or between RA and sex, but RA was weakly correlated with refractive error (r = 0.274, P = 0.019). The intersubject difference found in RA can be explained mostly by the extent of repeatability (±0.71 D).ConclusionThe insignificant magnitude of RA indicated that the mixed eye drop is an acceptable and useful cycloplegic agent in Japanese schoolchildren with a wide range of myopic refractive errors. Jpn J Ophthalmol 2007;51:111–115

Accuracy of accommodation in heterophoric patients: testing an interaction model in a large clinical sample

A model of the cross‐link interactions between accommodation and convergence predicted that heterophoria can induce large accommodation errors (Schor, Ophthalmic Physiol. Opt. 1999;19:134–150). In 99 consecutive patients with intermittent tropia or decompensated phoria, we tested these interactions by comparing their accommodative responses to a 2.50‐D target under binocular fused conditions (BFC) and monocular occluded conditions (MOC). The accommodative response in BFC frequently differed from that in MOC. The magnitude of the accommodative errors in BFC, ranging from an accommodative lag of 1.80 D (in an esophoric patient) to an accommodative lead of 1.56 D (in an exophoric patient), was correlated with distance heterophoria and uncorrected refractive errors. These results indicate that heterophoria affects the accuracy of accommodation to various degrees, as the model predicted, and that an accommodative error larger than the depth of focus of the eye occurs in exchange for binocular single vision in some heterophoric patients.

Preoperative prism correction in patients with acquired esotropia

We performed a prospective study of preoperative prism adaptation in 77 patients with acquired esotropia. Sixty-three of them increased their angle of squint when wearing Fresnel press-on prisms for 5–7 days. After the angle had stabilized to a point that did not exceed the press-on prisms by more than 10 prism D, they were randomly divided into two groups. Thirty-two patients underwent surgery based on the prism-adapted angle. The other 31 patients underwent surgery based on their initially measured angle. Fourteen patients who did not respond to prism correction underwent surgery based on the angle before prism correction. Success rates with deviations between 0 and 10 prism diopters measured 1 year after surgery were highest in those in whom surgery was based on the prism-determined angle and were lowest in the nonresponders, who had no fusion response to the prisms.

Downward deviation of progressive addition lenses in a myopia control trial

Purpose:  To clarify how the downward deviation of progressive addition lenses (PALs) reduces their near‐addition effect in schoolchildren participating in a myopia control trial.