Tomo Nishi

Choroidal thickness in children with hyperopic anisometropic amblyopia

Purpose To determine the choroidal thickness (CT) in the macular area of eyes of children with hyperopic anisometropic amblyopia and to compare the thickness with that of fellow eyes and age-matched controls. Materials and methods Twenty-five patients (6.6±2.2 years, mean±SD) with hyperopic anisometropic amblyopia and twenty age-matched controls (6.7±1.9 years) were studied. The CT was measured with the enhanced depth imaging programme of a spectral domain optical coherence tomographic instrument in all patients and controls. The CT of the subfoveal area and at 1 mm and 3 mm diameter around the fovea was determined. In addition, the correlation between the CT and axial length was calculated. Results The mean subfoveal CT was 351.3±54.7 µm in the amblyopic eyes, 283.5±55.2 µm in the fellow eyes and 282.7±73.3 µm in the control eyes. The subfoveal choroid in amblyopic eyes was significantly thicker than that of the fellow eyes and control eyes (p=0.001). There was a significant negative correlation between the subfoveal CT and the axial length in the amblyopic eyes (amblyopic eyes: r=−0.51, p=0.01) and the control eyes (r=−0.46, p=0.01). Conclusions The subfoveal choroid of eyes with hyperopic anisometropic amblyopia is significantly thicker than that of the fellow eye and the age-matched controls. The profile of the CT in the amblyopic eyes was different from that of the fellow eyes and control eyes.

Effect of total higher-order aberrations on accommodation in pseudophakic eyes.

PURPOSE: To analyze the effect of total higher‐order aberrations (HOAs) on the range of accommodation in pseudophakic eyes and the size of near‐vision optotypes. SETTING: Department of Ophthalmology, Nara Medical University, Nara, Japan. METHODS: The study comprised 30 patients (44 eyes) who were diagnosed with cataract at Nara University of Medical Science Hospital and Municipal Oyodo Hospital. Inclusion criteria included no other eye disorder and a best corrected distance acuity of 20/20 or better 1 month after cataract surgery. All patients had small‐incision phacoemulsification followed by in‐the‐bag implantation of a monofocal intraocular lens (SA60AT, Alcon). All incisions were self‐sealing. Accommodation in pseudophakic eyes was measured by the lens‐loading method in an examination room under constant illumination. Ocular HOAs were measured using the KR‐9000PW Hartmann‐Shack wavefront analyzer (Topcon). RESULTS: The mean patient age was 75.8 years ± 5.4 (SD) (range 64 to 83 years). The Pearson correlation coefficient (r) showed a significant positive correlation between the range of accommodation and Z7 (vertical coma) for a 4.0 mm pupil using the 1.0 near‐vision optotype. There was a significant negative correlation between the range of accommodation and Z12 (spherical aberration) for a 4.0 mm pupil using the 1.0 near‐vision optotype (r = .311, P = .040 for Z7; r = −.365, P = .015 for Z12). No other parameter was significantly correlated with the range of accommodation. CONCLUSIONS: Measurement of accommodation in pseudophakic eyes by the lens‐loading method using the 1.0 near‐vision optotype showed that eyes with larger vertical coma aberrations achieved a larger range of accommodation. In contrast, eyes with larger spherical aberrations had smaller amounts of accommodation. The size of the near‐vision optotype may affect accommodation analysis in pseudophakic eyes.

Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab

Purpose To report the effects of aflibercept on eyes with large retinal pigment epithelial detachment (PED) associted with polypoidal choroidal vasculopathy (PCV). Methods We reviewed the medical records of patients with PEDs associated with PCV that were treated with aflibercept after intravitreal ranibizumab had failed. Results Three eyes of patients aged 72, 79, and 80 years were studied. Reflective material was seen in the PED along the outer surface of the retinal pigment epithelium (RPE) by spectral-domain optical coherence tomography (SD-OCT). A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED. In addition, one eye developed a retinal hemorrhage and a recurrent PED just after the third injection of aflibercept. The visual acuity in this eye decreased from 10/20 to 2/20. Conclusion The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization. Intravitreal aflibercept could be considered for large PEDs in eyes with PCV but should be carefully applied.

Higher Cognitive Function in Elderly Individuals with Previous Cataract Surgery: Cross-Sectional Association Independent of Visual Acuity in the HEIJO-KYO Cohort

Cataract surgery improves visual acuity and drastically increases the capacity for light reception to the retina. Although previous studies suggested that both light exposure and visual acuity were associated with cognitive function, the relationships between cataract surgery, visual acuity, and cognitive function have not been evaluated in large populations. In this cross-sectional study, we measured cognitive function using the Mini-Mental State Examination and best-corrected visual acuity in pseudophakic (previous cataract surgery) and phakic (no previous cataract surgery) elderly individuals. Of 945 participants (mean age 71.7 years), 166 (17.6%) had pseudophakia and 317 (33.5%) had impaired cognitive function (score ≤26). The pseudophakic group showed significantly better visual acuity than the phakic group (p = 0.003) and lower age-adjusted odds ratio (ORs) for cognitive impairment (OR 0.66; p = 0.038). Consistently, in multivariate logistic regression models, after adjusting for confounding factors, including visual acuity and socioeconomic status, ORs for cognitive impairment were significantly lower in the pseudophakic group than in the phakic group (OR 0.64; 95% confidence interval 0.43-0.96; p = 0.031). This association remained significant in sensitivity analysis, excluding participants with low cognitive score ≤23 (n = 36). In conclusion, in a general elderly population, prevalence of cognitive impairment was significantly lower in pseudophakic individuals independently of visual acuity. The association was also independent of several major causes of cognitive impairment such as aging, gender, obesity, socioeconomic status, hypertension, diabetes, sleep disturbances, depressive symptoms, and physical inactivity.

Retinal thickness in children with anisohypermetropic amblyopia

Purpose To determine the thickness of the fovea in eyes of children with anisohypermetropic amblyopia, their fellow eyes and eyes of age-matched controls. Additionally, to assess the effects of optical treatment on the foveal thickness in eyes with anisohypermetropic amblyopia. Materials and methods Twenty-one patients (6.0±2.3 years, mean±SD) with anisohypermetropic amblyopia and 25 age-matched controls (5.6±1.9 years) were studied. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain OCT images. The foveal thickness and the thickness of the outer nuclear layer (ONL), photoreceptor inner segment (IS) layer and outer segment (OS) layer were measured by the embedded OCT software. Results The length of the OS was significantly greater in the fellow eyes (48.0±6.6 µm) than in the amblyopic eyes (42.4±4.6 µm, p=0.03). One year after the optical treatment of the anisohypermetropia, the best-corrected visual acuity (BCVA) improved and the length of the OS was significantly increased (p=0.0001). After optical treatment, there was no more significant difference in the OS length between the amblyopic eyes and the fellow eyes (p=0.95). The change of BCVA was significantly correlated with the change of the length of the OS 1 year after the treatment (r=0.52; p=0.0004). Conclusions Anisohypermetropic amblyopic eyes have qualitative and quantitative differences in the retinal microstructures of the fovea from normal eyes. An increase in the OS length was detected in the amblyopic eyes after the optical treatment. A significant correlation was found between the increased OS length and better BCVA. Trial registration number The trial registration number of the internal review board of Nara Medical University was 774.

Choroidal Structure in Children with Anisohypermetropic Amblyopia Determined by Binarization of Optical Coherence Tomographic Images

Purpose To compare the choroidal structure of the subfoveal area in the eyes of children with anisohypermetropic amblyopia to that of the fellow eyes and to age-matched controls using a binarization method of the images obtained by enhanced depth imaging optical coherence tomography (EDI-OCT). Methods This study was performed at Nara Medical University Hospital, Tokushima University Hospital, and Kagoshima University Hospital, Japan. Forty amblyopic eyes with anisohypermetropic amblyopia and their fellow eyes (5.9 ± 2.1 years, mean ± standard deviation), and 103 age-matched controls (6.7 ± 2.4 years) were studied. The control eyes were divided into myopic, emmetropic, and hyperopic eyes. The total choroidal area, luminal area and stromal area of the subfoveal choroid were measured by the binarization method. The luminal/stromal ratio and the axial length of the amblyopic eyes were compared to that of the control eyes. Results The total choroidal area in the amblyopic eyes was significantly larger than that of the fellow eyes (P = 0.005). The luminal/stromal ratio was significantly larger in the amblyopic eyes than that of the fellow eyes (P<0.001) and the control hyperopic eyes (P<0.001). There was a significant negative correlation between the luminal/stromal ratio and the axial length in the control eyes (r = -0.30, P = 0.001), but no significant correlation was found in the amblyopic eyes. Conclusions The choroidal structure of the amblyopic eyes was different from that of the fellow and the control hyperopic eyes. The choroidal changes are related to amblyopia.

The effect of blue-blocking intraocular lenses on circadian biological rhythm: protocol for a randomised controlled trial (CLOCK-IOL colour study)

Introduction Blue light information plays an important role in synchronising internal biological rhythm within the external environment. Circadian misalignment is associated with the increased risk of sleep disturbance, obesity, diabetes mellitus, depression, ischaemic heart disease, stroke and cancer. Meanwhile, blue light causes photochemical damage to the retina, and may be associated with age-related macular degeneration (AMD). At present, clear intraocular lenses (IOLs) and blue-blocking IOLs are both widely used for cataract surgery; there is currently a lack of randomised controlled trials to determine whether clear or blue-blocking IOLs should be used. Methods and analysis This randomised controlled trial will recruit 1000 cataract patients and randomly allocate them to receive clear IOLs or blue-blocking IOLs in a ratio of 1:1. The primary outcomes are mortality and the incidence of cardiovascular disease, cancer and AMD. Secondary outcomes are fasting plasma glucose, triglycerides, cholesterol, glycated haemoglobin, sleep quality, daytime sleepiness depressive symptoms, light sensitivity, the circadian rhythm of physical activity, wrist skin temperature and urinary melatonin metabolite. Primary outcomes will be followed until 20 years after surgery, and secondary outcomes will be assessed at baseline and 1 year after surgery. Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board of Nara Medical University (No. 13-032). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) home page. Trial registration number UMIN000014680.

Comparisons of Objective Sleep Quality Between Elderly Individuals With and Without Cataract Surgery: A Cross-Sectional Study of the HEIJO-KYO Cohort

BACKGROUND Cataract surgery (CS) drastically increases the capacity for light reception to the retina. Several previous studies have suggested the beneficial effect of CS on subjectively measured sleep quality; however, the association between CS and objectively measured sleep quality remains uncertain. METHODS To evaluate the association between CS and objectively measured sleep quality in home settings, we conducted a cross-sectional study in 1037 elderly individuals (mean age, 71.9 years). We evaluated actigraphically measured sleep quality, urinary 6-sulfatoxymelatonin excretion, and ambulatory light levels, in addition to CS status. RESULTS The CS group (n = 174) showed significantly higher sleep efficiency and shorter wake after sleep onset than the no CS group (n = 863), even after adjustment for age, gender, body mass index, current smoking status, alcohol consumption, hypertension, diabetes, sleep medication, bedtime, rising time, daytime physical activity, daytime and nighttime light exposure, and urinary 6-sulfatoxymelatonin excretion (sleep efficiency: 85.8% in the CS group vs 84.4% in the no CS group, P = 0.042; wake after sleep onset: 45.7 min vs 50.6 min, respectively, P = 0.033). In contrast, urinary 6-sulfatoxymelatonin excretion, sleep onset latency, total sleep time, and sleep-mid time did not differ significantly between the CS and no CS groups. CONCLUSIONS Among a community-dwelling elderly population, CS is significantly associated with objectively measured sleep quality, but urinary levels of melatonin metabolite do not differ between individuals with and without CS. These associations are independent of daily light exposure profiles.

Comparisons of amplitude of pseudoaccommodation with aspheric yellow, spheric yellow, and spheric clear monofocal intraocular lenses

Purpose To determine the amplitude of pseudoaccommodation and higher-order aberrations with three types of implanted monofocal intraocular lenses (IOLs): aspheric yellow (IQ); spheric yellow (NT); and spheric clear (AT). Setting Department of Ophthalmology, Nara Medical University, Nara, Japan. Methods We studied 60 patients who underwent small incision phacoemulsification with the implantation of a monofocal IQ, NT, or AT IOL. The pseudoaccommodation was measured by the lens-loading method, and the postoperative ocular higher-order aberrations were measured with a Hartmann–Shack wavefront analyzer through natural and 4 mm pupils. Results Sixty eyes of 60 patients were studied. The average amplitude of the pseudoaccommodation was 0.45±0.24 D with the IQ IOL, which was significantly lower than that with the AT IOL at 0.81±0.37 D (Tukey’s test; P<0.01). The differences in the amplitude of the pseudoaccommodation between the IQ and the NT IOLs, and between the NT and the AT IOLs were not significant (Tukey’s test; P>0.05). The degree of spherical aberration was significantly different for the IQ, NT, and AT lenses (analysis of variance, P=0.016). The spherical aberration through the IQ IOL was significantly lower than that through the NT and the AT IOLs (Tukey’s test; P<0.01). The fourth-order RMS (root mean square) aberration of the IQ lens was also significantly lower than that of the NT and AT IOLs (Tukey’s test; P<0.01). Conclusion Our results suggest that the spherical aberration and selective spectral transmission of IOLs may work together to increase the amplitude of the pseudoaccommodation.

A Case of Juvenile Limbal Xanthogranuloma

Juvenile xanthogranuloma (JXG) is a benign cutaneous granulomatous disease mainly affecting infants less than 1 year old and, less commonly, older children and adults. Approximately 10% of cases exhibit ocular manifestations leading to serious complications. Ocular lesions mainly affect the iris, ciliary body, optic nerve, eyelids, or orbit. Solitary JXG affecting the corneoscleral limbus is a rare form of ocular involvement. Only 18 cases of JXG involving the corneoscleral limbus have been previously reported. Of these, only six cases were in patients less than 5 years of age. Here, we report a case in a 3-year-old child, who was diagnosed as having JXG affecting the corneoscleral limbus. The tumor gradually became enlarged.