Yoshimune Hiratsuka

Prevalence of Visual Impairment in the Adult Japanese Population by Cause and Severity and Future Projections

Purpose: To present a comprehensive estimate of the total number of people with visual impairment in the adult Japanese population by age, gender, severity and cause, and to estimate future prevalence based on population projections and expected demographic changes. Methods: Definitions of visual impairment used in this study were based on the United States criteria. Total visual impairment was calculated as the sum of low vision and blindness. The prevalence estimates were based on input from a number of Japanese epidemiological surveys, census material and official population projections. Results: There were an estimated 1.64 million people with visual impairment in 2007 in Japan. Of these, 187,800 were estimated to be blind. The prevalence of visual impairment in Japan increased with age and half of the people with visual impairment were aged 70 years or older. The leading causes of visual impairment in Japan were glaucoma (24.3%), diabetic retinopathy (20.6%), degenerative myopia (12.2%), age-related macular degeneration (10.9%), and cataract (7.2%). These five major causes comprised three-quarters of all visual impairment. The prevalence of visual impairment was projected to increase from 1.3% of the population in 2007 to 2.0% by 2050. Conclusions: This comprehensive study presents the prevalence of total visual impairment in the adult Japanese population. The projected increases in the prevalence of visual impairment over time reflect the demographic changes of a declining and aging Japanese population. These projections highlight that the burden of disease due to visual impairment and imposed on society is likely to increase.

Global Inequality in Eye Health: Country-Level Analysis From the Global Burden of Disease Study

OBJECTIVES We assessed global inequality in eye health by using data on the global burden of disease measured in disability-adjusted life years (DALYs). METHODS We estimated the burden of eye disease by calculating the sum of DALYs (from the Global Burden of Disease study, 2004 update) due to trachoma, vitamin A deficiency, glaucoma, cataract, refractive errors, and macular degeneration. We assessed the geographic distribution of eye disease in relation to economic status and etiology by calculating the Gini coefficient, the Theil index, and the Atkinson index. RESULTS The global burden of eye disease was estimated at 61.4 million DALYs worldwide (4.0% of total DALYs). Vitamin A deficiency and trachoma were distributed more unevenly than were noncommunicable eye diseases, regardless of economic status. For noncommunicable eye diseases, the major contributor was refractive errors, regardless of economic status. The most uneven distribution was observed for cataract (high-income countries) and refractive errors (middle- and low-income countries). CONCLUSIONS Creating new eye health service for refractive errors and reducing the unacceptable eye health disparity in refractive errors should be the highest priorities for international public health services in eye care and eye health.

Prevalence of pterygium in a population in Northern Japan: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study

Purpose:  The aim of the study was to determine the prevalence and risk factors for pterygium in a population aged 40–74 years in Fukushima Prefecture, Japan.

Cost-effectiveness of cataract surgery in Japan.

PurposeTo evaluate the cost-effectiveness of cataract surgery through measurement of the cost per quality-adjusted life-year (QALY) in Japan.MethodsA total of 549 patients scheduled for cataract surgery at 12 clinical sites from November 2008 through February 2010 were included in the study. Prospective assessment of patient preference-based quality of life (utility) was performed before and after the surgery using the time tradeoff method, EuroQol, and Health Utilities Index Mark 3. Multiple regression analysis was used to determine the correlation between utility and visual acuity. The QALYs gained through cataract surgery were estimated, and cost-utility analysis was performed.ResultsThe utilities significantly correlated with the visual acuity in the better seeing eye. In all the subgroups (first eye surgery, second eye surgery, and bilateral surgery), mean utility improvement was statistically significant. Average QALYs for unilateral cataract surgery and bilateral cataract surgery were 2.40 and 3.40, respectively. The cost per QALY gained from surgery was estimated at ¥122,472 (US

Quality of life and cost-utility assessment after strabismus surgery in adults

1,307) for unilateral surgery and ¥145,562 (US

Identification of novel mutations of the CHST6 gene in Vietnamese families affected with macular corneal dystrophy in two generations.

1,553) for bilateral surgery.ConclusionsRoutine cataract surgery in Japan is highly cost-effective. Factors that contribute to this are the high clinical effectiveness of the surgery, the substantial improvement in patient-perceived quality of life, and the reasonable cost of the surgery.

Comparison of the influence of intracameral gentamicin, gatifloxacin, and moxifloxacin on the corneal endothelium in a rabbit model

PurposeTo understand the functional and psychosocial aspects of strabismus surgery, an evaluation based on the patient’s perspective is essential. In this study, we assessed quality of life and utility in adult patients who had undergone strabismus surgery, and we modeled the cost of providing this intervention in order to calculate the cost-utility of strabismus surgery in adults.MethodsThe study population comprised 226 patients with strabismus aged 18 years or older who were scheduled for ocular alignment surgery at 12 facilities of the Strabismus Surgery Study Group in Japan. Survey questionnaires consisting of the Japanese versions of the Visual Function Questionnaire-25 (VFQ-25) and 8-Item Short-Form Health Survey (SF-8) and utility assessment by a time trade-off method were administrated preoperatively and 3 months postoperatively. On the basis of the cost model and measured utility data, the gains in quality-adjusted life years (QALYs) and

Traumatic Wound Dehiscence After Penetrating Keratoplasty

/QALY were estimated.ResultsPostoperatively, the subscale scores of the VFQ-25 and the physical and mental component summary scores of the SF-8 showed a statistically significant improvement. A significant improvement of utility was also noted: 0.82 ± 0.28 postoperatively versus 0.76 ± 0.31 preoperatively. On the basis of the life expectancy of these patients and the cost model, the surgery resulted in a mean value gain of 0.99 QALYs and a cost-utility for strabismus surgery of 1,303

Geographical distribution of eye health professionals and cataract surgery in Lao People’s Democratic Republic

/QALY.ConclusionsBy using standard tools to assess vision-associated and general health status, we confirmed the psychosocial benefits of corrective surgery for adults with strabismus. Our study concurrently demonstrated that strabismus surgery in adults is very cost-effective.

Mutation Analysis of the TGFBI Gene in Vietnamese with Granular and Avellino Corneal Dystrophy

Purpose. To report the clinical and genetic findings of Vietnamese families affected with macular corneal dystrophy (MCD) in 2 generations. Methods. Two families, including 7 patients and 3 unaffected members, were examined clinically. Blood samples were collected. Fifty normal Vietnamese individuals were used as controls. Genomic DNA was extracted from leukocytes. Analysis of the carbohydrate sulfotransferase (CHST6) gene was performed using polymerase chain reaction and direct sequencing. Results. The typical form of MCD was recognized in family B, in which sequencing of CHST6 gene revealed an nt 1067-1068ins(GGCCGTG) mutation (frameshift after 125V) homozygously in MCD patients and heterozygously in the unaffected members. Family N also showed clinical features of MCD, moderate in the mother but severe in the affected son. Sequencing revealed a single heterozygous Arg211Gln in the mother, compound heterozygous Arg211Gln+ Gln82Stop in the affected son, and heterozygous Arg211Gln mutation in the unaffected members. The identified mutations in these pedigrees were excluded from normal controls. Conclusions. The novel frameshift and compound heterozygous mutations might be responsible for MCD in the families studied. The phenotypic variation between affected parents and offspring was unclear. In family N, severe MCD phenotype seen in the affected son may be due the fact that he had an early stop codon mutation (Gln82Stop).