Takahiro Hiraoka

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.

Central corneal thickness measurements using orbscan II scanning slit topography, noncontact specular microscopy, and ultrasonic pachymetry in eyes with keratoconus

Purpose: To compare corneal thickness measurements using Orbscan II scanning slit topography, Topcon SP-2000P noncontact specular microscopy, and ultrasonic pachymetry in eyes with keratoconus. Methods: Central corneal thickness was measured in 22 eyes with keratoconus. Eyes with apparent corneal opacity were excluded. Scanning slit topography, noncontact specular microscopy, and ultrasonic pachymetry were used in this sequence. The acoustic equivalent correlation factor (0.92) was used for Orbscan readings. Results: Three devices gave significantly different corneal thickness readings (P < 0.001, repeated-measure analysis of variance). Measurements with Orbscan scanning slit topography (449.5 ± 43.2 [SD] μm) were significantly smaller than those of ultrasonic pachymetry (485.0 ± 29.3 μm; P < 0.001, Tukey multiple comparison) and SP-2000P noncontact specular microscopy (476.7 ± 28.3 μm; P = 0.002). There were significant linear correlations between ultrasonic pachymetry and scanning slit topography (Pearson correlation coefficient r = 0.741, P < 0.001), between scanning slit topography and noncontact specular microscopy (r = 0.880, P < 0.001), and between noncontact specular microscopy and ultrasonic pachymetry (r = 0.811, P < 0.001). Conclusion: In eyes with keratoconus, Orbscan II scanning slit topography system gave significantly smaller corneal thickness readings than the other 2 devices. Measurements taken by noncontact specular microscopy and ultrasonic pachymetry were comparable. Three devices showed significant linear correlations with one another.

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.

Age-Related Changes in Anterior, Posterior, and Total Corneal Astigmatism

PURPOSE To evaluate age-related changes in anterior, posterior, and total corneal astigmatism by comparing simulated keratometric astigmatism to total corneal astigmatism. METHODS Corneal topography of the anterior and posterior surfaces was evaluated using three-dimensional optical coherence tomography in 419 patients with normal eyes (218 men and 201 women) with ages ranging from 8 to 93 years (mean ± standard deviation: 49.5 ± 23.1 years). Keratometric astigmatism was calculated using the keratometric index (1.3375) and radius of the anterior corneal curvature; anterior and posterior corneal curvature measurements were used to calculate total corneal astigmatism. RESULTS The keratometric and total astigmatism were 1.08 ± 0.71 diopters (D) and 1.03 ± 0.69 D, respectively. Vector analysis revealed a mean difference between keratometric and total astigmatism of 0.24 ± 0.09 D, which showed a significant correlation to age (P < .0001). In eyes with with-the-rule astigmatism, keratometric astigmatism overestimated total astigmatism. In eyes with against-the-rule astigmatism, keratometric astigmatism underestimated total astigmatism. CONCLUSIONS The anterior corneal surface shifts from with-the-rule to against-the-rule astigmatism with aging, whereas the posterior corneal surface remains as against-the-rule astigmatism in most cases. The variation in the anterior astigmatism is the most important factor contributing to this change. Total corneal astigmatism is a better predictor than keratometric astigmatism for selecting toric intraocular lenses.

Structural analysis of the cornea using scanning-slit corneal topography in eyes undergoing excimer laser refractive surgery.

Purpose To review the time course of corneal anteroposterior shift and refractive stability after myopic excimer laser keratorefractive surgery. Methods We examined 65 eyes undergoing photorefractive keratectomy (PRK) and 45 eyes undergoing laser in situ keratomileusis (LASIK). Corneal elevation maps and pachymetry were obtained by scanning-slit corneal topography before; 1 week; and 1, 3, 6, and 12 months after surgery. Results Both PRK and LASIK induced significant forward shifts of the cornea. Corneal forward shift was progressive up to 6 months after PRK, but no progression was seen after LASIK. Progressive thinning and expansion of the cornea were not observed after either procedure. The amount of corneal forward shift showed a significant negative correlation with preoperative corneal thickness (r = −0.586; P < 0.01) and a significant positive correlation with the amount of myopic correction (r = 0.504; P < 0.01). A significant correlation was found between the amount of forward shift and the degree of myopic regression after surgery (r = −0.347; P < 0.05). Conclusion Myopic PRK and LASIK induce significant forward shifts of the cornea, which are not true corneal ectasia. Eyes with thinner corneas and higher myopia requiring greater ablation are more predisposed to anterior protrusion of the cornea. Corneal forward shift was progressive up to 6 months after PRK but not progressive after LASIK. Forward shift of the cornea can be one of the factors responsible for myopic regression after surgery.

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.

Vision-Related Quality of Life and Visual Function Following Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE To evaluate the vision-related quality of life (VR-QOL) and visual function following vitrectomy for proliferative diabetic retinopathy (PDR). DESIGN Prospective, interventional, consecutive, comparative case series. METHODS The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was answered by 51 patients with PDR before and three months after 20-gauge pars plana vitrectomy. Among the patients with PDR, 30 underwent combined cataract surgery and vitrectomy. Clinical data were collected, including logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA), letter contrast sensitivity, and metamorphopsia. The VFQ-25 was also administered to 46 age-matched normal controls. RESULTS The preoperative VFQ-25 composite score was significantly lower in the PDR patients (56.3 +/- 18.8, mean +/- standard deviation) than in the normal controls (85.2 +/- 10.3; P < .0001). Vitrectomy significantly improved VFQ-25 composite score (P < .005) and eight of 12 subscales (P < .05). The preoperative VFQ-25 composite score significantly correlated with preoperative logMAR BCVA in the better-seeing eye (P < .001). The postoperative VFQ-25 composite score exhibited significant correlation with postoperative logMAR BCVA in the worse-seeing eye (P < .0001) as well as the better-seeing eye (P < .0001). Similar significant correlations were also observed between the VFQ-25 composite score and letter contrast sensitivity. CONCLUSIONS Vitrectomy for PDR significantly improves VR-QOL. The current study quantitatively indicates that VR-QOL in PDR patients depends on visual acuity and contrast sensitivity in the better-seeing eye preoperatively and in both the better-seeing and worse-seeing eyes postoperatively.

Quantitative evaluation of regular and irregular corneal astigmatism in patients having overnight orthokeratology

Purpose: To quantitatively assess changes in regular and irregular corneal astigmatism in patients having overnight orthokeratology. Setting: Matsumoto Eye Clinic, Ibaraki, Japan. Methods: A prospective study was conducted of 64 eyes of 39 patients having overnight orthokeratology for myopia. Inclusion criteria were an uncorrected visual acuity (UCVA) of 20/20 or better after treatment and a minimum follow‐up of 3 months. Using Fourier series harmonic analysis, videokeratography data were decomposed into spherical component, regular astigmatism, asymmetry (tilt or decentration), and higher‐order irregularity. Results: Orthokeratology significantly reduced the manifest refraction from −2.60 diopters (D) ± 1.13 (SD) to −0.17 ± 0.31 D (P<.0001, paired t test) and improved the UCVA from 0.82 ± 0.30 to −0.11 ± 0.06 logMAR (P<.0001). Regular astigmatism increased significantly from 0.53 ± 0.23 D preoperatively to 0.63 ± 0.40 D postoperatively (P = .0206). The asymmetry component increased significantly from 0.35 ± 0.22 D to 0.64 ± 0.40 D (P<.0001). Higher‐order irregularity did not change significantly: 0.14 ± 0.11 D before treatment and 0.17 ± 0.20 D after treatment (P = .2166). The amount of myopic correction correlated significantly with the increase in the asymmetry component (Pearson correlation coefficient, R = 0.40, P = .0009) but not with the increase in regular astigmatism (R = 0.24, P = .055). Conclusions: Irregular corneal astigmatism significantly increased, even in clinically successful orthokeratology cases. The effect of the changes on visual function should be studied further.