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Shi GL, Pan AP, Hu RL, Zhang YQ, Ma YJ, Yu AY. Preliminary Application of a Continuous Functional Contrast Visual Acuity System in the Assessment of Visual Function in Dry Eye Patients. Transl Vis Sci Technol 2023; 12:6. [PMID: 38054930 PMCID: PMC10702783 DOI: 10.1167/tvst.12.12.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose To investigate the feasibility and efficacy of a continuous functional contrast visual acuity (CFCVA) system in the assessment of visual function in dry eye disease (DED). Methods Twenty patients with DED and 15 normal controls were recruited. Subjective symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, and tear film stability was assessed by a noninvasive corneal topographer. Under natural blinking conditions, the custom-built CFCVA system was used to take serial visual acuity measurements at 100%, 25%, 10%, and 5% contrast for 60 seconds. A 5-minute measurement at a 100% contrast level was defined as the stress test (ST). Mean CFCVA was defined, and visual maintenance ratio (VMR) was the ratio of mean CFCVA divided by baseline visual acuity. Results In both groups, VMR decreased and mean CFCVA (logarithm of the minimum angle of resolution) increased with decreasing optotype contrast (from 100% to 5%). In ST, the ST VMR at the fourth and fifth minutes (VMR54 and VMR55) showed the strongest correlations with OSDI total, ocular symptoms, and vision-related function (-0.646 and -0.598, -0.688 and -0.693, and -0.599 and -0.555, respectively, P < 0.05). VMR54 and VMR55 also demonstrated the best discriminating ability for detecting DED, with areas under the curve of 0.903 and 0.867, respectively. Conclusions Extending the continuous measuring time was more effective for detecting vision-related functional abnormalities in patients with DED than simply decreasing the optotype contrast level. Translational Relevance The proposed CFCVA system and associated parameters offer a potential method for quantifying and interpreting the visual symptoms of DED in clinical care.
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Affiliation(s)
- Gui-Lian Shi
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - An-Peng Pan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Rui-Lin Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | | | - Yun-Jing Ma
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - A-Yong Yu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
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Pan AP, Ma Y, Hu R, Cao X, Wu Y, Zhou K, Tu R, Shao X, Chen S, Yu AY. Simultaneous real-time analysis of tear film optical quality dynamics and functional visual acuity in dry eye disease. EYE AND VISION (LONDON, ENGLAND) 2023; 10:16. [PMID: 37005660 PMCID: PMC10068140 DOI: 10.1186/s40662-023-00333-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/15/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND To assess the effect of tear film instability in dry eye disease (DED) by measuring visual performance and tear film optical quality in a simultaneous real-time analysis system. METHODS Thirty-seven DED participants and 20 normal controls were recruited. A simultaneous real-time analysis system was developed by adding a functional visual acuity (FVA) channel to a double-pass system. Repeated measurements of FVA and objective scatter index (OSI) were performed simultaneously with this system under blink suppression condition for 20 s. Patient-reported symptoms was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Mean FVA, mean OSI, and visual acuity break-up time were defined. The OSI maintenance ratio was calculated as an evaluation index to assess the difference between dynamic OSI changes and baseline OSI. The visual maintenance ratio was also calculated in the same way. RESULTS Moderate correlations were noted between mean OSI and FVA-related parameters (mean FVA, visual maintenance ratio, visual acuity break-up time: 0.53, - 0.56, - 0.53, respectively, P < 0.01 for all). Moderate to high correlations were noted between OSI maintenance ratio and FVA-related parameters (mean FVA, visual maintenance ratio, visual acuity break-up time: - 0.62, 0.71, 0.64, respectively, all P < 0.01). The metrics derived from the simultaneous real-time analysis system were moderately correlated with the patient-reported symptoms and the visual acuity break-up time possessed the highest correlation coefficients with OSDI total, ocular symptoms, and vision-related function (- 0.64, - 0.63, - 0.62, respectively, P < 0.01). The OSI-maintenance ratio alone appeared to exhibit the best performance of the metrics for the detection of DED with sensitivity of 95.0% and specificity of 83.8% and the combinations of FVA parameters and OSI parameters were valid and can further improve the discriminating abilities. CONCLUSIONS OSI-related metrics were found to be potential indicators for assessing and diagnosing DED which correlated with both subjective visual performance and patient-reported symptoms; the FVA-related metrics were quantifiable indicators for evaluating visual acuity decline in DED. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry, ChiCTR2100051650. Registered 29 September 2021, https://www.chictr.org.cn/showproj.aspx?proj=134612.
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Affiliation(s)
- An-Peng Pan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Yunjing Ma
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Ruilin Hu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Xuejiao Cao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Yifen Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Kaijing Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Ruixue Tu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Xu Shao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Shihao Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - A-Yong Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
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Ren X, Wang Y, Wu T, Jing D, Li X. Binocular dynamic visual acuity in dry eye disease patients. Front Neurosci 2023; 17:1108549. [PMID: 36968505 PMCID: PMC10030492 DOI: 10.3389/fnins.2023.1108549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
PurposeTo investigate binocular dynamic visual acuity (DVA) for patients with dry eye disease (DED).MethodsThe prospective study included DED patients. The binocular DVA at 40 and 80 degrees per second (dps), Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time first (TBUTF), corneal fluorescein staining (CFS), eyelid margin abnormalities and meibomian gland (MG) abnormalities morphology and function were evaluated. A deep learning model was applied to quantify the MG area proportion. The correlation between DVA and DED parameters was analyzed.ResultsA total of 73 DED patients were enrolled. The age, OSDI, CFS, MG expressibility, secretion quality, and eyelid margin abnormalities were significantly positively correlated with the DVA for 40 and 80 dps (all P < 0.05). The MG area proportion in the upper eyelid was negatively correlated with DVA at 40 dps (R = −0.293, P < 0.001) and at 80 dps (R = −0.304, P < 0.001). Subgroup analysis by MG grade demonstrated that the DVA of patients with severe MG dropout (<25% of the total area) was significantly worse than other mild and moderate groups, both in 40 and 80 dps (all P < 0.05). The patients with CFS showed worse 40 (P < 0.001) and 80 dps (P < 0.001) DVA than the patients without CFS.ConclusionBinocular DVA is significantly associated with DED symptoms and signs. The DED patients with CFS and severe MG dropout and dysfunction have worse DVA.
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Shanbhag SS, Tahboub MA, Chodosh J, Saeed HN. Visual function and quality of life in patients with Stevens-Johnson syndrome who received acute protocol-based ocular care. FRONTIERS IN TOXICOLOGY 2022; 4:992696. [PMID: 36408350 PMCID: PMC9666488 DOI: 10.3389/ftox.2022.992696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/14/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose: To report visual function and quality of life (VF/QOL) using the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the ocular surface disease index (OSDI) in patients in the chronic phase of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Methods: The NEI-VFQ-25 questionnaire was administered to 15 patients who received protocol-based care in the form of topical medications with or without amniotic membrane transplantation (AMT) for acute SJS/TEN. The scores obtained were compared with scores from a healthy population. The associations between the NEI-VFQ-25 and dry eye symptoms as measured by OSDI questionnaire were also studied. Results: Patients were surveyed at a mean of 4.47 ± 2.22 years after acute SJS/TEN. Eleven patients received AMT in the acute phase. The median best corrected visual acuity at the time of administration of the questionnaire was 20/20. The mean composite NEI-VFQ-25 score was 86.48 ± 12. Patients who received protocol-based treatment in the acute phase of SJS/TEN had comparable NEI-VFQ-25 scores with healthy subjects on all subscales except ocular pain (p = 0.027) and mental health (p = 0.014), which were significantly reduced. The NEI-VFQ-25 composite scores significantly correlated with OSDI (R = -0.75, p = 0.001). Conclusion: A protocol-based management strategy composed of early ophthalmic evaluation, grading based on severity, the use of topical corticosteroids and AMT in the acute phase of SJS/TEN in patients with ocular complications helped preserve the VF/QOL. This study highlights the impact of appropriate management of the ocular complications in the acute phase of SJS/TEN.
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Affiliation(s)
- Swapna S. Shanbhag
- The Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India,Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Mohammad A. Tahboub
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Hajirah N. Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States,Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States,Department of Ophthalmology, Loyola University Medical Center, Chicago, IL, United States,*Correspondence: Hajirah N. Saeed,
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Zheng X, Yamada H, Mitani A, Shiraishi A, Kamao T, Goto T. Improvement of visual function and ocular and systemic symptoms following blepharoptosis surgery. Orbit 2021; 40:199-205. [PMID: 32295447 DOI: 10.1080/01676830.2020.1752743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Purpose: To study the changes of the visual function and ocular and systemic symptoms following blepharoptosis surgery.Methods: Seventy-eight involutional blepharoptosis patients (72.1 ± 6.4 years) underwent levator advancement procedure. Before and at 2 months after the surgery, OPD-Scan III (Nidek) was used to measure corneal astigmatism, total higher order aberrations (HOAs), and area ratio (AR), an index of the objective contrast sensitivity. FVA-100 (Nidek) was used to determine the functional visual acuity (FVA) and visual maintenance ratio (VMR). The ocular and systemic symptoms were also determined by a questionnaire using visual analogue scale (VAS) scores.Results: Before surgery, the corneal astigmatism, HOAs, AR, FVA, and VMR were 1.56 ± 0.52 diopters (D), 0.23 ± 0.24 µm, 14.8 ± 4.2%, 0.68 ± 0.32 logMAR units and 0.76 ± 0.06, respectively. After surgery, these values were 1.29 ± 0.41 D, 0.19 ± 0.21 µm, 18.6 ± 3.4%, 0.31 ± 0.18 logMAR units and 0.88 ± 0.03, respectively. Corneal astigmatism and HOAs were significantly reduced after surgery (P=0.007 and P=0.023, paired t test, respectively), and AR, FVA and VMR were significantly improved after surgery (P=0.033, P=0.012 and P=0.016, respectively). The VAS scores significantly improved after surgery, and this improvement was positively and significantly correlated with the increase of the AR (r=0.421, P=0.003) and the VMR (r=0.497, P =0.005).Conclusions: Blepharoptosis surgery is visual functionally beneficial and can help to reduce the ocular and systemic symptoms.
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Affiliation(s)
- Xiaodong Zheng
- Department of Ophthalmology, Ehime University School of Medicine, Toon City, Japan
- Hanamizuki Eye Clinic, Matsuyama, Japan
| | - Hiroko Yamada
- Department of Ophthalmology, Ehime University School of Medicine, Toon City, Japan
| | - Arisa Mitani
- Department of Ophthalmology, Ehime University School of Medicine, Toon City, Japan
| | - Atsushi Shiraishi
- Department of Ophthalmology, Ehime University School of Medicine, Toon City, Japan
| | - Tomoyuki Kamao
- Department of Ophthalmology, Ehime University School of Medicine, Toon City, Japan
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Simsek C, Kojima T, Dogru M, Tanaka M, Takano Y, Wakamatsu T, Ibrahim O, Toda I, Negishi K, Tsubota K. The Early Effects of Alcohol Consumption on Functional Visual Acuity, Tear Functions, and the Ocular Surface. Eye Contact Lens 2021; 47:20-26. [PMID: 32701768 DOI: 10.1097/icl.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE We investigated the early effects of alcohol intake on tear functions and ocular surface health in this prospective controlled study. METHODS Forty-four eyes of 22 subjects (17 males, 5 females; mean age: 35.3 years) who drank 200 mL of 25% Japanese vodka and 44 eyes of age- and sex-matched 22 control subjects who drank water were investigated. Subjects were requested to refrain from alcohol consumption from the previous day and food ingestion 6 hr before the study. Each subject consumed exactly the same order prepared dinner and same quantity of alcohol over the same time frame. Subjects underwent breath alcohol level, tear evaporation and blink rate, tear lipid layer interferometry, tear film break-up time (BUT), fluorescein and Rose Bengal stainings, Schirmer test, and visual analog scale (VAS) evaluation of dry eye symptoms before, as well as 2 and 12 hr after alcohol intake. RESULTS The mean breath alcohol level was significantly higher in the alcohol group compared to the water group at 2 and 12 hr (P<0.001). The mean tear evaporation increased significantly from 2.5×10-7 to 8.8×10-7 gr/cm2/sec 12 hr after alcohol intake (P<0.001). The mean BUT shortened significantly from 15.0±5.0 to 5.0±2.5 sec 12 hr after alcohol intake. Lipid layer interferometry showed signs of tear film thinning 12 hr after alcohol intake in all subjects of the alcohol intake group, which was not observed in the water group. The mean blink rates increased significantly from 10.6±1.5 blinks/min to 13.5±0.9 blinks/min and 15.1±1.2 blinks/min at 2 and 12 hr, respectively, in the alcohol group (P<0.001). The Schirmer test values decreased significantly 12 hr after alcohol intake (P<0.001). The mean VAS score for dryness increased from baseline significantly in the alcohol group at 12 hr (P<0.001). No significant time-wise changes in tear functions were observed in the water group. CONCLUSION The tear film and ocular surface epithelia showed early and distinctive quantitative and qualitative changes associated with visual disturbances after alcohol intake.
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Affiliation(s)
- Cem Simsek
- Department of Ophthalmology (C.S., T.K., M.D., T.W., K.N., K.T.), Keio University School of Medicine, Tokyo, Japan ; Ajisai Eye Clinic (M.T.), Musashinoshi, Chiba, Japan ; Eye Clinic (Y.T.), Kawasaki Municipal Ida Hospital, Kawasaki, Japan ; Department of Ophthalmology (O.I.), Tokyo Dental College, Chiba, Japan ; Minamiaoyama Eye Clinic (I.T.), Tokyo, Japan ; and Department of Ophthalmology (C.S.), Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
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Corneal higher-order aberrations in phlyctenular keratitis. Jpn J Ophthalmol 2020; 64:478-484. [PMID: 32683555 DOI: 10.1007/s10384-020-00759-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To characterize tomographic patterns and quantify corneal higher-order aberrations (HOAs) in eyes with corneal scar due to phlyctenular keratitis. STUDY DESIGN Retrospective consecutive case series. METHODS This study included 51 eyes of 38 patients (24 women; 14 men) with corneal scar due to phlyctenular keratitis. HOAs of the total cornea, and of the anterior and posterior surfaces were measured using anterior segment optical coherence tomography (AS-OCT). Corneal tomographic patterns were classified into five types: increased regular astigmatism, ectasia, asymmetric, flattening and minimal change patterns. The correlation between corneal HOAs and visual acuity was evaluated. RESULTS Mean months from onset was 50.7 ± 74.7 and mean number of recurrences 2.1 ± 1.1 (1-5). Mean logarithm of the minimal angle of resolution (logMAR) was 0.19 ± 0.31. AS-OCT showed ectasia pattern in 16 eyes (31.4%), asymmetric pattern in 12 eyes (23.5%), increased regular astigmatism pattern in 9 eyes (17.6%), flattening pattern in 3 eyes (5.9%) and minimal change pattern in 11 eyes (21.6%). HOAs of the total cornea were 0.57 ± 0.44 μm and 1.16 ± 0.77 μm within a 4-mm and 6-mm diameter, significantly larger than in normal controls (P < 0.0001). LogMAR visual acuity was significantly correlated with corneal HOAs (4-mm: r = 0.558, P < 0.0001, 6-mm: r = 0.566, P < 0.0001), central corneal thickness (r = - 0.349, P = 0.016), and corneal astigmatism (r = 0.414, P = 0.004), but not with average keratometric value (r = - 0.092, P = 0.537). CONCLUSIONS The most common tomographic pattern was ectasia, followed by a asymmetric pattern in eyes with phlyctenular keratitis. Corneal HOAs were associated with decreased visual acuity in phlyctenular keratitis patients.
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Itoi M, Ueta M, Ogino K, Sumi E, Imai K, Teramukai S, Kinoshita S, Sotozono C. Clinical trial to evaluate the therapeutic benefits of limbal-supported contact lens wear for ocular sequelae due to Stevens-Johnson syndrome/toxic epidermal necrolysis. Cont Lens Anterior Eye 2020; 43:535-542. [PMID: 32513522 DOI: 10.1016/j.clae.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To analyze the therapeutic benefits of limbal-supported contact lens (CL) wear in patients with ocular sequelae due to Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). METHODS This interventional study enrolled 10 chronic SJS/TEN eyes with a spectacle best-corrected visual acuity (BCVA) of between 0.01 and 0.7 that were fitted with a limbal-supported CL. At baseline and at after 3-months CL use, CL-wear BCVA and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) scores were measured, and then compared. Incidence rates and severities of adverse events were also analyzed. RESULTS At after 3-months CL use, BCVA with the fitted CL significantly improved compared to that with spectacle correction at baseline (LogMAR: 0.76-0.15) (P = 0.0039), all NEI VFQ-25 scores improved, however, only in ocular pain and mental health showed statistically significant improvement (P = 0.0078 and 0.0039). No serious adverse events were observed during the follow-up. CONCLUSION Wearing of the limbal-supported CL improved vision compared to spectacles and reduced ocular pain in patients with ocular sequelae due to SJS/TEN.
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Affiliation(s)
- Motohiro Itoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramach-dori, Kamigyo-ku, Kyoto 602-0841, Japan.
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramach-dori, Kamigyo-ku, Kyoto 602-0841, Japan.
| | - Ken Ogino
- Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
| | - Eriko Sumi
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
| | - Kojiro Imai
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramach-dori, Kamigyo-ku, Kyoto 602-0841, Japan.
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Minami S, Nagai N, Suzuki M, Uchida A, Shinoda H, Tsubota K, Ozawa Y. Ocular and Systemic Effects of Antioxidative Supplement Use in Young and Healthy Adults: Real-World Cross-Sectional Data. Antioxidants (Basel) 2020; 9:antiox9060487. [PMID: 32503322 PMCID: PMC7346213 DOI: 10.3390/antiox9060487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/01/2022] Open
Abstract
Randomized controlled studies have shown that antioxidative supplements are effective in suppressing the progression of age-related macular degeneration and visual display terminal syndrome. However, effects of their general use in the real-world and by young and healthy individuals have not been well documented. We analyzed 27 participants who were under 35 years of age and had no diagnosed diseases. Mean functional visual acuity (FVA) score and visual maintenance ratio, which represent quick recognition of a target, both measured using FVA system, were better (both p < 0.01) in subjects who had had regular antioxidative supplement intake for more than 2 months (11 participants) compared with those who had not. Systemic data, i.e., total cholesterol, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) levels, which correspond to chronic low-grade inflammation, were lower (all p < 0.05) in the former. Overall, hs-CRP levels had a correlation with total cholesterol (p < 0.05) and a trend of correlation with HbA1c (p = 0.054) levels. Thus, current real-world data showed that young, healthy participants who had a regular intake of antioxidative supplements had better visual acuity and systemic levels of metabolic and low-grade inflammation markers. This study will help promote future research into the effects of general antioxidative supplement use.
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Affiliation(s)
- Sakiko Minami
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
| | - Norihiro Nagai
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Misa Suzuki
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
| | - Hajime Shinoda
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (S.M.); (N.N.); (M.S.); (A.U.); (H.S.); (K.T.)
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
- St. Luke’s International University, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
- Correspondence: or ; Tel.: +81-3-5363-3869
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Kaido M, Fukui M, Kawashima M, Negishi K, Tsubota K. Relationship between visual function and cognitive function in the elderly: A cross-sectional observational study. PLoS One 2020; 15:e0233381. [PMID: 32428010 PMCID: PMC7236991 DOI: 10.1371/journal.pone.0233381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/03/2020] [Indexed: 11/18/2022] Open
Abstract
It has been suggested that functional visual acuity (VA) testing may be able to measure both the visual performance and cognitive ability needed for driving and help to reduce the number of road traffic accidents. The aim of this study was to investigate the relationship between visual ability and cognitive function in healthy elderly subjects. The study included 34 eyes with a decimal best-corrected visual acuity (VA) ≥1.0 in 34 subjects (16 men, 18 women; mean age 72.7 ± 6.1 [range, 61-83] years) with the same type of monofocal intraocular lens implant. Using the score on the Japanese version of the Mini-Mental State Examination (MMSE) questionnaire, the subjects were divided into a mild cognitive impairment (MCI) group (score <28) and a normal cognition (NC) group (score ≥28). Visual ability was evaluated by functional VA testing. Functional VA was significantly lower in the MCI group (n = 10) than in the NC group (n = 24; P<0.02). There was no significant difference in best-corrected VA between the two groups. High correlations were found between the MMSE score and the logMAR functional VA (r = -0.36, P = 0.04), standard deviation of functional VA (r = -0.39, P = 0.02), and the visual maintenance ratio (r = 0.34, P = 0.048). In summary, despite a good best-corrected VA, deterioration in visual ability was detected in elderly individuals with MCI when measured by the functional VA test. Functional VA could be used to evaluate the integrated visual ability associated with age-related cognitive decline and have applications that help to reduce the disproportionately high rate of road traffic accidents in the elderly.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Wada Eye Clinic, Chiba, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Tokyo Medical Center, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Tsubota Laboratory, Inc., Tokyo, Japan
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11
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Kamao T, Takahashi N, Zheng X, Shiraishi A. Changes of Visual Symptoms and Functions in Patients with and without Dry Eye after Lacrimal Passage Obstruction Treatment. Curr Eye Res 2020; 45:1590-1597. [PMID: 32321316 DOI: 10.1080/02713683.2020.1760305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To determine the quality of life (QOL) and quality of vision (QOV) of patients who developed and did not develop dry eye disease (DED) after nasolacrimal duct obstruction (NLDO) treatment. Methods: This was a retrospective nonrandomized observational study of 91 patients diagnosed with unilateral NLDO. The subjects underwent lacrimal stent insertion, and the stent was removed after 10-12 weeks. The QOL and QOV of the patients were examined preoperatively and at 6 months after the stent was removed. The postoperative outcomes were assessed subjectively with the Glasgow Benefit Inventory (GBI) questionnaire and an ocular specific questionnaire of 6 symptoms. The best-corrected visual acuity, functional visual acuity, and dry eye scores were also determined. Results: Of the 91 eyes, 19 eyes (20.9%) were diagnosed with DED (D group) and 72 were not (N group). Five of the 6 symptoms improved in the N group, while only 3 symptoms improved in the D group without blurred vision. For the GBI questionnaire, the social support and physical health scores were significantly higher in the N group than in the D group. The functional visual acuity improved significantly in the N group but not significantly in the D group. Conclusions: Patients who develop DED after treatments for NLDO may not have an improvement of their QOL or QOV. Therefore, careful dry eye assessments are important before treatments for NLDO.
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Affiliation(s)
- Tomoyuki Kamao
- Department of Ophthalmology, Ehime University Graduate School of Medicine , Shitsukawa, Toon, Ehime, Japan
| | - Naomi Takahashi
- Department of Ophthalmology, Saiseikai Matsuyama Hospital , Matsuyama, Ehime, Japan
| | - Xiaodong Zheng
- Department of Ophthalmology, Ehime University Graduate School of Medicine , Shitsukawa, Toon, Ehime, Japan
| | - Atsushi Shiraishi
- Department of Ophthalmology, Ehime University Graduate School of Medicine , Shitsukawa, Toon, Ehime, Japan
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12
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Ibrahim OM, Yagi-Yaguchi Y, Noma H, Tsubota K, Shimazaki J, Yamaguchi T. Corneal higher-order aberrations in Stevens-Johnson syndrome and toxic epidermal necrolysis. Ocul Surf 2019; 17:722-728. [DOI: 10.1016/j.jtos.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/15/2019] [Accepted: 07/16/2019] [Indexed: 11/15/2022]
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Abstract
Dry eye (DE) causes irregularity of the ocular surface and reduces the quality of vision. An intact, regular tear film is essential for high-quality retinal images; however, visual tasks requiring sustained gazing can disrupt the tear film, eventually degrading visual function. A functional visual acuity (FVA) measurement system has been uniquely developed in Japan to evaluate visual function related to tear stability in patients with DE. FVA has been shown to correlate with optical quality. The system measures the change in visual acuity (VA) over time automatically in aqueous-deficient DE and short tear breakup tear film DE characterized by decreased tear stability and minimal epithelial damage. It is also useful to detect minimal visual deterioration correlated with minimal ocular surface abnormality and vision-related quality of life otherwise undetectable by conventional VA testing, to assess and quantify vision-related symptomatology, and to determine the efficacy of treatments for DE disease. Recently, its use has been expanded, such as for the analysis of visual function accompanying refractive surgery, contact lens, cataract and cataract-related disease, retinal disease, glaucoma, amblyopia, presbyopia, and vehicle driving. Its use has revealed that FVA reflects not only visual function related to tear dynamics, but also visual function related to quick recognition of the target. This simple, noninvasive, and sensitive FVA measurement system may be expected to be used worldwide.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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14
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Abstract
Purpose Dry eye is a major ocular pathology worldwide. Although dry eye is a multifactorial disease, recent studies have shown that chronic immunologic processes have a pivotal role in its pathogenesis, characterized by the infiltration of immune cells in the lacrimal glands, elevated levels of tear inflammatory cytokines, and increased density of immune cells in the cornea and conjunctiva. This review describes the recent advances in understanding the relationship between dry eye and inflammation. Methods This narrative review is based on searches of recent international literature using terms related to the immune response in dry eye, and includes clinical trials, animal experiments, and expert reviews. Results Although dry eye presents clinically as tear film instability associated with corneal/conjunctival epithelial disorders, Meibomian gland dysfunction, and decreased visual function, recent laboratory and clinical studies have indicated inflammation in the lacrimal glands, Meibomian glands, conjunctiva, cornea, and aqueous tears. Furthermore, inflammation at these locations leads to conjunctival goblet cell apoptosis, corneal epithelial barrier disruption, and corneal nerve damage. These inflammatory outcomes can be exacerbated by intrinsic and extrinsic factors, such as aging, sex steroid hormone, autoimmune diseases, contact lens use, visual display terminals, and dry environment. Conclusions Recent advances in dry eye research have revealed the inflammatory process and its pathogenesis, which has been proposed as an "inflammatory vicious cycle" of dry eye. Comprehensive assessment of dry eye based on inflammation will improve the selection of treatments and help break the inflammatory cycle in clinical settings.
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Affiliation(s)
- Takefumi Yamaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
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15
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Sotozono C, Ueta M, Yokoi N. Severe Dry Eye With Combined Mechanisms is Involved in the Ocular Sequelae of SJS/TEN at the Chronic Stage. ACTA ACUST UNITED AC 2018; 59:DES80-DES86. [DOI: 10.1167/iovs.18-24019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Uchino M, Kawashima M, Uchino Y, Tsubota K, Yokoi N. Association between tear film break up time and blink interval in visual display terminal users. Int J Ophthalmol 2018; 11:1691-1697. [PMID: 30364241 DOI: 10.18240/ijo.2018.10.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/11/2018] [Indexed: 01/03/2023] Open
Abstract
AIM To investigate the association between tear film break up time (TBUT) and blinking interval in visual display terminal (VDT) users. METHODS Nine hundred and thirty VDT users underwent dry eye testing, and functional visual acuity (FVA) test. The blinking interval during FVA was compared with TBUT. Subjects with longer blinking interval than TBUT were considered as unstable tear film. Logistic regression analysis revealed the risk factors for unstable tear group. RESULTS Among 930 workers, 858 subjects (92.3%) participated in this study. Almost 80% of the subjects were categorized into the unstable tear group. Unstable tear group has significantly lower Schirmer values and TBUT (17.5±11.6 vs 21.1±11.5 mm, 3.7±2.6 vs 5.7±2.7s, both P<0.001). There were no significant differences in epithelial staining or severity of symptoms. Logistic regression showed that over 40y was a risk for being unstable tear group [odds ratio (OR)=1.53; 95% confidence interval (CI)=1.06-2.20]. Contact lens use was protective factor for being in the unstable tear group (OR=0.37; 95%CI= 0.26-0.53). CONCLUSION Subjects with shorter TBUT than blinking interval are prevalent among VDT users. Subjects over the age of 40 shows an increased risk for unstable tear film.
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Affiliation(s)
- Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University School of Medicine, Kyoto 602-8566, Japan
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17
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Uchino M, Kawashima M, Uchino Y, Suzuki N, Mitamura H, Mizuno M, Hori Y, Yokoi N, Tsubota K. The evaluation of dry eye mobile apps for screening of dry eye disease and educational tear event in Japan. Ocul Surf 2018; 16:430-435. [PMID: 29883737 DOI: 10.1016/j.jtos.2018.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the usefulness of a dry eye mobile application (app) for screening dry eye disease (DED) at educational tear events in Japan. METHODS In this cross-sectional study, Japanese subjects visiting a "Tears Day" event were selected randomly. They completed questionnaires and underwent ophthalmic evaluations for DED (using Japanese revised diagnostic criteria) including a functional visual acuity (FVA) test. The app calculated FVA using the average of the continuous VA over 30 s. RESULTS Sixty-three general-population subjects were included: 25 men and 38 women (average age, 50.8 ± 15.9 years). The prevalence of DED was 66.7% (42 subjects); age was significantly higher among subjects with DED (55.2 ± 3.4 vs. 48.1 ± 2.7 years, p = 0.04; men, 54.0 ± 7.3 vs. 47.0 ± 3.0 years, p = 0.36; women, 55.5 ± 3.9 vs. 50.6 ± 3.8 years, p = 0.4). The prevalence of DED was significantly higher in women (p = 0.04). Tear film breakup time was significantly shorter (3.8 ± 2.4 vs. 8.7 ± 2.0, p = 0.04) and the meibum score was significantly higher (p = 0.02) among subjects with DED. Regarding the tear film breakup pattern, line and random breaks were most prevalent among DED. FVA showed a significant negative correlation with DED (r = -0.25, p = 0.047). CONCLUSIONS The app might motivate people to perform quick tests with the expectation of getting easy DED screening. The number of subjects diagnosed with DED was relatively high.
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Affiliation(s)
- Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Natume Suzuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroto Mitamura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Miki Mizuno
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University School of Medicine, Tokyo, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto, Prefectural University of Medicine, Kyoto, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Benefits of aflibercept treatment for age-related macular degeneration patients with good best-corrected visual acuity at baseline. Sci Rep 2018; 8:58. [PMID: 29311612 PMCID: PMC5758719 DOI: 10.1038/s41598-017-18255-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/08/2017] [Indexed: 11/23/2022] Open
Abstract
Currently, age-related macular degeneration (AMD) is treated while patients exhibit good best-corrected visual acuity (BCVA). However, previous clinical trials only include patients with poor BCVA. We prospectively analyzed the benefits of intravitreal aflibercept (IVA) treatment for AMD patients exhibiting good BCVA at baseline. Twenty-nine treatment-naive AMD patients (29 eyes) with BCVA better than 0.6 (74 letters in ETDRS chart) were treated with IVA once a month for 3 months and every 2 months thereafter with no additional treatments. Improvement in mean BCVA, measured using the conventional Landolt C chart, contrast VA chart, and functional VA (FVA) system, and reductions in mean central retinal thickness (CRT), central choroidal thickness, macular volume (MV), and choroidal area on optical coherence tomography images were observed at 6 and 12 months. Improvements in contrast VA and FVA scores, in contrast to conventional BCVA, correlated with MV reduction; no VA scores correlated with a reduced CRT. The MV correlated with choroidal area after IVA. No severe adverse events occurred. IVA improved visual function, retinal condition, and quality of life evaluated by Visual Function Questionnaire, and was beneficial in these patients. The contrast VA and FVA scores and MVs, which detect subtle changes, helped demonstrate the benefits.
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19
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Kaido M, Kawashima M, Shigeno Y, Yamada Y, Tsubota K. Relation of accommodative microfluctuation with dry eye symptoms in short tear break-up time dry eye. PLoS One 2017; 12:e0184296. [PMID: 28886090 PMCID: PMC5590915 DOI: 10.1371/journal.pone.0184296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate accommodative microfluctuations (AMFs) and visual function in short tear break-up time (BUT)-type dry eye (DE) and non-DE subjects. Methods This prospective comparative study included 48 volunteers with DE symptoms (mean age 34.8 ± 5.5 years, age range 25–42 years) and 73 without DE symptoms (mean age 30.6 ± 4.7 years, age range 25–42 years). The eyes were divided into two groups: (1) DE group with DE symptoms and BUT ≤ 5 s and (2) non-DE group without DE symptoms and BUT > 5 s. We excluded eyes with Schirmer score ≤ 5 mm and positive keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were performed. AMF parameters included total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), and HFC with high accommodation for deskwork (HFC2). Functional VA parameters included starting VA, functional VA, visual maintenance ratio, and blink frequency. Results A total of 33 and 34 eyes were categorized in the DE and non-DE groups, respectively. Mean blink frequency and HFC1 values were significantly higher in the DE group than they were in the non-DE group. Conclusions DEs with symptoms showed abnormal AMF and visual function, which may be associated with DE symptoms.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Shinanozaka Clinic, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Shigeno
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | | | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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20
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Koh S, Inoue Y, Ochi S, Takai Y, Maeda N, Nishida K. Quality of Vision in Eyes With Epiphora Undergoing Lacrimal Passage Intubation. Am J Ophthalmol 2017; 181:71-78. [PMID: 28673750 DOI: 10.1016/j.ajo.2017.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate visual function and optical quality in eyes with epiphora undergoing lacrimal passage intubation. DESIGN Prospective case series. METHODS Thirty-four eyes of 30 patients with lacrimal passage obstruction were enrolled. Before and 1 month after lacrimal passage intubation, functional visual acuity (FVA), higher-order aberrations (HOAs), lower tear meniscus, and tear clearance were assessed. An FVA measurement system was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio, and blink frequency were obtained. Sequential ocular HOAs were measured for 10 seconds after the blink using a wavefront sensor. Aberration data were analyzed in the central 4 mm for coma-like, spherical-like, and total HOAs. Fluctuation and stability indices of the total HOAs over time were calculated. Lower tear meniscus was assessed by anterior segment optical coherence tomography. RESULTS After lacrimal passage intubation, visual function significantly improved, as indicated by improved FVA (P = .003) and visual maintenance ratio (P < .001). Blink frequency decreased significantly after treatment (P = .01). Optical quality significantly improved, as indicated by a decrease in coma-like aberrations (P = .003), spherical-like aberrations (P = .018), and total HOAs (P = .001). Stability index increased (P < .001) and fluctuation index decreased (P = .019), and tear meniscus dimension decreased (P < .001). CONCLUSIONS Lacrimal passage intubation for eyes with epiphora significantly improved visual function and optical quality via patency of the lacrimal passage.
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Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yasushi Inoue
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan; Inoue Eye Clinic, Okayama, Japan
| | | | | | - Naoyuki Maeda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf 2017; 15:438-510. [PMID: 28736340 DOI: 10.1016/j.jtos.2017.05.011] [Citation(s) in RCA: 965] [Impact Index Per Article: 137.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022]
Abstract
The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjögren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.
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Affiliation(s)
- Anthony J Bron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
| | - Cintia S de Paiva
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Sunil K Chauhan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stefano Bonini
- Department of Ophthalmology, University Campus Biomedico, Rome, Italy
| | - Eric E Gabison
- Department of Ophthalmology, Fondation Ophtalmologique Rothschild & Hôpital Bichat Claude Bernard, Paris, France
| | - Sandeep Jain
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Erich Knop
- Departments of Cell and Neurobiology and Ocular Surface Center Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Victor Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Driss Zoukhri
- Tufts University School of Dental Medicine, Boston, MA, USA
| | - David A Sullivan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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TFOS DEWS II Diagnostic Methodology report. Ocul Surf 2017; 15:539-574. [DOI: 10.1016/j.jtos.2017.05.001] [Citation(s) in RCA: 836] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 01/09/2023]
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Uchino M, Kawashima M, Kaido M, Suwaki K, Uchino Y, Kawachi I, Negishi K, Tsubota K. Evaluation of a paper-based visual acuity questionnaire. Clin Ophthalmol 2017; 11:1213-1217. [PMID: 28721005 PMCID: PMC5499935 DOI: 10.2147/opth.s138399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To validate a paper-based visual acuity (PBVA) questionnaire. METHODS In 2015, a cross-sectional survey was conducted among 301 young and middle-aged, mostly male, Japanese subjects. The participants were asked to self-rate their visual acuity (VA) on a scale from 1 to 5. Self-ratings of VA were categorized into three groups: good (1 and 2), normal (3), and poor (4 and 5). For objective validation, we performed a functional VA (FVA) assessment in the same subjects. RESULTS A total of 301 subjects answered the PBVA and completed the FVA test including initial VA. We found out that the result of PBVA was significantly correlated with FVA test and initial VA (r=0.33, P<0.0001, r=0.273, P<0.0001). The trend test analysis between PBVA and FVA also showed statistically significant (P<0.0001). CONCLUSION There was a significant statistical correlation between the PBVA and the FVA, as well as the initial VA. This short questionnaire on VA might be a sensitive tool that is easy to implement and utilized in large epidemiological and clinical researches.
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Affiliation(s)
- Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo
| | - Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo
| | | | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo
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Functional visual acuity in patients with successfully treated amblyopia: a pilot study. Graefes Arch Clin Exp Ophthalmol 2017; 255:1245-1250. [PMID: 28236002 DOI: 10.1007/s00417-017-3623-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aim of this study was to use conventional visual acuity measurements to quantify the functional visual acuity (FVA) in eyes with successfully treated amblyopia, and to compare the findings with those for contralateral normal eyes. METHODS Nineteen patients (7 boys, 12 girls; age 7.5 ± 2.2 years) with successfully treated unilateral amblyopia and the same conventional decimal visual acuity in both eyes (better than 1.0) were enrolled. FVA, the visual maintenance ratio (VMR), maximum and minimum visual acuity, and the average response time were recorded for both eyes of all patients using an FVA measurement system. The differences in FVA values between eyes were analyzed. RESULTS The mean LogMAR FVA scores, VMR (p < 0.001 for both), and the LogMAR maximum (p < 0.005) and minimum visual acuity (p < 0.001) were significantly poorer for the eyes with treated amblyopia than for the contralateral normal eyes. There was no significant difference in the average response time. CONCLUSIONS Our results indicate that FVA and VMR were poorer for eyes with treated amblyopia than for normal eyes, even though the treatment for amblyopia was considered successful on the basis of conventional visual acuity measurements. These results suggest that visual function is impaired in eyes with amblyopia, regardless of treatment success, and that FVA measurements can provide highly valuable diagnosis and treatment information that is not readily provided by conventional visual acuity measurements.
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Hiraoka T, Miyata K, Hayashidera T, Iida M, Takada K, Minami K, Oshika T. Influence of intraocular lens subsurface nanoglistenings on functional visual acuity. PLoS One 2017; 12:e0173574. [PMID: 28328997 PMCID: PMC5362055 DOI: 10.1371/journal.pone.0173574] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/23/2017] [Indexed: 11/22/2022] Open
Abstract
To investigate the influence of intraocular lens subsurface nanoglistenings (SSNGs) on functional visual acuity (FVA), thirty-nine eyes of 29 patients were examined in this study. The SSNG group comprised 19 eyes of 14 patients (75.7± 5.4 years, mean ± standard deviation), and the control group comprised 20 eyes of 15 patients (73.6 ± 6.5 years). The SSNGs were diagnosed on the basis of the typical whitish IOL appearance upon slit-lamp examination and results of densitometry regarding surface light scattering using Scheimpflug images. The FVA measurement system (AS-28; Kowa, Aichi, Japan) was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio (VMR), maximum VA, minimum VA, standard deviation of VA, and number of blinks were assessed. The results were compared between the SSNG and control groups, and correlations of FVA parameters with the intensity of surface light scattering, time after surgery, and age were also evaluated. There were significant differences in VMR (P = 0.035) and standard deviation of VAs (P = 0.031) between the two groups, although no significant differences were found in baseline VA, FVA, maximum VA, minimum VA, and number of blinks. None of the FVA parameters showed any significant correlations with the intensity of surface light scattering, time after surgery, or age. There is a possibility that VA is unstable during a continuous gazing task in patients with SSNGs.
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Affiliation(s)
- Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Kazunori Miyata
- Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan
| | - Takeshi Hayashidera
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masaharu Iida
- Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan
| | - Keita Takada
- Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan
| | - Keiichiro Minami
- Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Kaido M, Toda I, Oobayashi T, Kawashima M, Katada Y, Tsubota K. Reducing Short-Wavelength Blue Light in Dry Eye Patients with Unstable Tear Film Improves Performance on Tests of Visual Acuity. PLoS One 2016; 11:e0152936. [PMID: 27045760 PMCID: PMC4821556 DOI: 10.1371/journal.pone.0152936] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/20/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate whether suppression of blue light can improve visual function in patients with short tear break up time (BUT) dry eye (DE). Methods Twenty-two patients with short BUT DE (10 men, 12 women; mean age, 32.4 ± 6.4 years; age range, 23–43 years) and 18 healthy controls (10 men, 8 women; mean age, 30.1 ± 7.4 years; age range, 20–49 years) underwent functional visual acuity (VA) examinations with and without wearing eyeglasses with 50% blue light blocked lenses. The functional VA parameters were starting VA, functional VA, and visual maintenance ratio. Results The baseline mean values (logarithm of the minimum angle of resolution, logMAR) of functional VA and the visual maintenance ratio were significantly worse in the DE patients than in the controls (P < 0.05), while no significant difference was observed in the baseline starting VA (P > 0.05). The DE patients had significant improvement in mean functional VA and visual maintenance ratio while wearing the glasses (P < 0.05), while there were no significant changes with and without the glasses in the control group (P > 0.05), Conclusions Protecting the eyes from short-wavelength blue light may help to ameliorate visual impairment associated with tear instability in patients with DE. This finding represents a new concept, which is that the blue light exposure might be harmful to visual function in patients with short BUT DE.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
- Wada Eye Clinic, Houjyou, Tateyama-shi, Chiba, Japan
- * E-mail:
| | - Ikuko Toda
- Minamiaoyama Eye Clinic, Kitaaoyama, Minato-ku, Tokyo, Japan
| | - Tomoo Oobayashi
- Minamiaoyama Eye Clinic, Kitaaoyama, Minato-ku, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yusaku Katada
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Katada Y, Negishi K, Watanabe K, Shigeno Y, Saiki M, Torii H, Kaido M, Tsubota K. Functional Visual Acuity of Early Presbyopia. PLoS One 2016; 11:e0151094. [PMID: 26959362 PMCID: PMC4784926 DOI: 10.1371/journal.pone.0151094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/22/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate visual function in patients with early presbyopia using the functional visual acuity (FVA) test. Methods This study included 27 eyes of 27 healthy older volunteers (mean age, 44.1 ± 2.6 years) and 14 eyes of 14 healthy young volunteers (mean age, 28.4±4.8 years). The distance-corrected visual acuity (DCVA), distance-corrected near VA (DCNVA), subjective amplitude of accommodation (AA), and distance and near pupillary diameters were measured. The distance FVA and distance-corrected near FVA (DCNFVA) were measured using the FVA Measurement System. The standard Schirmer test and standard tear break-up time measurement also were performed. Results The logarithm of the minimum angle of resolution (logMAR) DCVA was better than 0 in all subjects. The percentages of subjects with logMAR DCNVA below 0 was significantly lower in the presbyopia group than in the young group. The DCNFVA in the presbyopia group was significantly (P < 0.001) poorer than the DCNVA in that group. Significant linear negative correlations were seen between the DCNVA and AA (r = -0.507, P < 0.001) and the DCNFVA and AA (r = -0.681, P < 0.001) in the older subjects. Stepwise regression analysis showed that only the AA was a significant factor predictive of the DCNFVA in the presbyopia group. Tear function parameters were not adopted in the regression model. Conclusions Measurement of the DCNFVA can detect decreased AA in early presbyopia better than measurement of the conventional near VA. The DCNFVA is a good index for early presbyopia.
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Affiliation(s)
- Yusaku Katada
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
- * E-mail:
| | - Kazuhiro Watanabe
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
| | - Yuta Shigeno
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
| | - Megumi Saiki
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
| | - Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Japan
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Sotozono C, Ueta M, Nakatani E, Kitami A, Watanabe H, Sueki H, Iijima M, Aihara M, Ikezawa Z, Aihara Y, Kano Y, Shiohara T, Tohyama M, Shirakata Y, Kaneda H, Fukushima M, Kinoshita S, Hashimoto K. Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Am J Ophthalmol 2015; 160:228-237.e2. [PMID: 25979679 DOI: 10.1016/j.ajo.2015.05.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE To suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation. DESIGN Retrospective cohort study. METHODS The medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined. RESULTS The number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31 (35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11 (22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively). CONCLUSIONS At the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies.
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Affiliation(s)
- Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eiji Nakatani
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Amane Kitami
- Department of Dermatology, Showa University School of Medicine, Tokyo, Japan
| | - Hideaki Watanabe
- Department of Dermatology, Showa University School of Medicine, Tokyo, Japan
| | - Hirohiko Sueki
- Department of Dermatology, Showa University School of Medicine, Tokyo, Japan
| | - Masafumi Iijima
- Department of Dermatology, Showa University School of Medicine, Tokyo, Japan
| | - Michiko Aihara
- Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan
| | - Zenro Ikezawa
- Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yukoh Aihara
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoko Kano
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tetsuo Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mikiko Tohyama
- Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Yuji Shirakata
- Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Hideaki Kaneda
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Masanori Fukushima
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Hashimoto
- Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan
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Abstract
To evaluate mesopic functional visual acuity (FVA) with a newly developed system in normal subjects and to compare the results with photopic FVA, sixty-eight healthy volunteers (24.03 ± 4.42 [mean ± standard deviation] years) were enrolled in this study. A commercially available FVA measurement system (AS-28; Kowa, Aichi, Japan) was modified to measure FVA under mesopic conditions as well as photopic conditions. Measurements were performed monocularly in photopic conditions during 60 seconds. After dark adaptation for 15 minutes, the same measurements were repeated in mesopic conditions. Outcomes included starting visual acuity (VA), FVA (the average of VAs), visual maintenance ratio (VMR), maximum VA, minimum VA, and numbers of blinks during the 60-second measurement session, and were compared between mesopic and photopic conditions. Starting VA was –0.11 ± 0.08 and 0.39 ± 0.12 logarithm of the minimum angle of resolution (logMAR) in photopic and mesopic conditions, respectively. FVA was –0.06 ± 0.09 and 0.52 ± 0.14 logMAR, VMR was 0.98 ± 0.02 and 0.94 ± 0.04, maximum VA was –0.15 ± 0.06 and 0.33 ± 0.12 logMAR, the minimum VA was 0.05 ± 0.12 and 0.78 ± 0.20 logMAR, and the number of blinks was 8.23 ± 7.54 and 7.23 ± 6.20, respectively. All these parameters except the number of blinks were significantly different between the two conditions (P < 0.001). Besides, the difference between maximum and minimum VAs and standard deviation of VA were significantly larger in mesopic than in photopic conditions (P < 0.001). This study revealed that not only overall visual function decline but also instability of vision under mesopic conditions even in healthy subjects.
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Affiliation(s)
- Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Sujin Hoshi
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshifumi Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Ibrahim OMA, Dogru M, Kaido M, Kojima T, Fujishima H, Tsubota K. Functional visual acuity assessment of severe atopic keratoconjunctivitis. Cornea 2015; 33 Suppl 11:S13-8. [PMID: 25289719 DOI: 10.1097/ico.0000000000000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate changes in functional visual acuity (FVA) measurements before and after treatment with 0.1% cyclosporine ophthalmic solution for 3 months in patients with severe atopic keratoconjunctivitis (AKC). METHODS Pairs of eyes were analyzed from 3 boys (mean age 9 ± 3.6 years) who complained of having severe AKC and were recruited for the study. Conventional Landolt visual acuity, FVA, and visual maintenance ratio (VMR) measurements were conducted before and after 3 months of 0.1% cyclosporine eye drop treatment. Tear film lipid layer interferometry, tear film break-up time, fluorescein and rose bengal vital stainings, and the Schirmer test were also performed before and after treatment. RESULTS Eye drop treatment was associated not only with improvement of tear function and ocular surface status but also with better quality of visual function. The mean logarithm of the minimum angle of resolution FVA and Landolt visual acuity values improved from 0.45 ± 0.26 and 0.13 ± 0.17 before treatment to 0.16 ± 0.03 and -0.06 ± 0.05 after treatment, respectively. Similarly, the mean VMR values were markedly improved from 0.88 ± 0.06 to 0.95 ± 0.03 after treatment. CONCLUSIONS FVA and VMR are promising parameters in the assessment of dynamic visual acuity changes in AKC-affected patients and evaluation of treatment outcome.
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Affiliation(s)
- Osama M A Ibrahim
- *Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; †Department of Ophthalmology, Tokyo Dental College, Ichikawa, Japan; and ‡Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Japan
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Kaido M, Kawashima M, Yokoi N, Fukui M, Ichihashi Y, Kato H, Yamatsuji M, Nishida M, Fukagawa K, Kinoshita S, Tsubota K. Advanced dry eye screening for visual display terminal workers using functional visual acuity measurement: the Moriguchi study. Br J Ophthalmol 2015; 99:1488-92. [PMID: 25883086 DOI: 10.1136/bjophthalmol-2015-306640] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/31/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the validity of a dry eye (DE) screening method in visual display terminal (VDT) workers using functional visual acuity (VA) measurement combined with a symptoms questionnaire, and to make recommendations regarding practical use of the screening. METHODS This prospective cross-sectional study included 369 young and middle-age office workers, who use VDTs. Subjects completed two types of DE questionnaires and underwent DE testing and functional VA measurement. Subjects were assigned to DE and non-DE groups. Sensitivity and specificity of the DE prediction value were assessed. According to the probability distribution of DE and non-DE calculated by the discriminant analysis formula, we classified subjects into three categories based on the most appropriate cut-off levels. Positive predictive value (PPV) and negative predictive value (NPV) of the DE prediction value were also assessed. RESULTS Of 369 subjects, 218 and 151 subjects were assigned to the DE and non-DE groups, respectively. Sensitivity and specificity were 93.1% and 43.7%, respectively. Based on the probability prediction, the cut-off levels were defined as probability prediction ≥ 85%, 45% ≤ probability prediction < 85% and probability prediction < 45%. Subjects with a probability prediction ≥ 85% were defined positive (N = 130), while those with values < 45% were defined as negative (N = 73). The PPV and NPV were 83.8% and 80.8%, respectively. CONCLUSIONS Acceptable PPV and NPV were obtained by setting three discriminate categories. This improved version of the DE screening method may be acceptable for practical use in VDT workers.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Ichihashi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Kato
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Mitsuko Nishida
- Health Care Section, IT Products Business Division, AVC Networks Company, Panasonic Corporation, Osaka, Japan
| | | | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Sotozono C, Yamauchi N, Maeda S, Kinoshita S. Tear exchangeable limbal rigid contact lens for ocular sequelae resulting from Stevens-Johnson syndrome or toxic epidermal necrolysis. Am J Ophthalmol 2014; 158:983-93. [PMID: 25036881 DOI: 10.1016/j.ajo.2014.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/11/2014] [Accepted: 07/11/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the therapeutic benefits of tear-exchangeable, limbal, rigid contact lenses (limbal CLs) in patients with Stevens-Johnson syndrome- or toxic epidermal necrolysis-associated ocular sequelae. DESIGN Noncomparative, retrospective, interventional case series. METHODS We enrolled 53 eyes of 42 patients (mean age, 51.8 ± 13.9 years; mean follow-up, 25.7 ± 15.7 months) with Stevens-Johnson syndrome- or toxic epidermal necrolysis-associated ocular sequelae and divided them into 3 groups according to the best-corrected visual acuity (BCVA) before limbal CL fitting: (1) BCVA worse than 20/2000 (11 eyes), (2) BCVA ranging from 20/200 to 20/2000 (31 eyes), and (3) BCVA of 20/200 or better (11 eyes). The BCVA and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite score before fitting and after 3 months of limbal CL use were evaluated. The change in BCVA (in logarithm of the minimal angle of resolution [logMAR] units) and 25-item National Eye Institute Visual Function Questionnaire composite score change were compared among the 3 groups. RESULTS Best-corrected visual acuity improved from 1.61 to 0.86 logMAR at 3 months after fitting CL use. Improvement in BCVA in groups 1, 2, and 3 was 0.95 logMAR, 0.82 logMAR, and 0.37 logMAR, respectively. The mean 25-item National Eye Institute Visual Function Questionnaire composite score for the 11 subscales improved from 37.6 ± 16.0 to 58.4 ± 17.4 (P = .000001). All 11 subscores, except that for driving ability, improved significantly. The general vision subscore improved most in group 3, yet the general health subscore improved most in group 1. No serious adverse events attributable to limbal CL use occurred. CONCLUSIONS The tear-exchangeable limbal CL is safe and effective for the improvement of vision and quality of life in Stevens-Johnson syndrome or toxic epidermal necrolysis patients with severe ocular sequelae.
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Kaido M, Ishida R, Dogru M, Tsubota K. Short-Term Effects of Instillation of a Rebamipide Suspension on Visual Function. J Ocul Pharmacol Ther 2014; 30:313-8. [DOI: 10.1089/jop.2013.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Wada Eye Clinic, Chiba, Japan
| | - Reiko Ishida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Ishida Eye Clinic, Shizuoka, Japan
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Watanabe K, Kaido M, Ishida R, Dogru M, Negishi K, Tsubota K. The effect of tinted soft contact lens wear on functional visual acuity and higher-order aberrations. Cont Lens Anterior Eye 2014; 37:203-8. [PMID: 24721637 DOI: 10.1016/j.clae.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/30/2013] [Accepted: 11/20/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the differences of functional visual acuity (FVA) and high order aberrations (HOAs) in relation to tinted and clear hydrogel soft contact lens (SCL) wear. METHODS A prospective comparative study was performed in 16 eyes of 16 healthy volunteers. Dynamic visual acuity (using a FVA measurement system) and higher-order aberrations (using a wavefront sensor) were compared in subjects wearing two types of soft contact lenses: 1-day Acuvue(®) (Vistakon, Jacksonville, FL) clear and the 1-day Acuvue(®) Define(TM) (Vistakon, Jacksonville, FL) tinted lens. The blink rates were recorded during FVA testing. The correlation between the difference of HOAs and differences in FVA values was analyzed. RESULTS The mean LogMAR FVA scores with clear and tinted SCLs were 0.07 ± 0.13 and 0.14 ± 0.17 (P<0.05). The mean blink frequencies with clear and tinted SCL wear were 18.4 ± 8.3 and 25.3 ± 4.7 blinks/min (P<0.05). Both 3rd-order aberrations and total HOAs showed statistically significant differences between the two types of soft contact lenses for 6mm pupil measurements (P<0.05). A significant positive linear correlation was observed between ΔHOAs and ΔLogMAR FVA for 6mm pupil measurements (R=0.53, P=0.04). CONCLUSIONS Tinted contact lens wear appears to induce a reduction in optical quality. Functional visual acuity measurement is a useful procedure to study the changes of visual performance and quality in tinted contact lens wear.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Reiko Ishida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Department of Ophthalmology, Tokyo Dental College, Ichikawa Hospital, Chiba, Japan.
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Nishi Y, Shinoda H, Uchida A, Koto T, Mochimaru H, Nagai N, Tsubota K, Ozawa Y. Detection of early visual impairment in patients with epiretinal membrane. Acta Ophthalmol 2013; 91:e353-7. [PMID: 23387556 DOI: 10.1111/aos.12060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients with epiretinal membrane sometimes complain of impaired central visual function, despite good best corrected visual acuity (BCVA), as measured by visual acuity (VA) charts. Here, we evaluate early epiretinal membrane-induced changes in central VA. METHODS Subjects were 72 eyes of 36 patients with epiretinal membrane in only one eye and a BCVA in each eye better than 1.0, as measured by conventional Landolt C chart, at the Retina Division Clinic of the Department of Ophthalmology, Keio University Hospital, between December 2010 and November 2011. The conventional Landolt VA, functional VA (FVA) and contrast VA measurements were taken after a general eye examination. For the FVA, Landolt optotypes were sequentially displayed every 2 seconds, which size was changed according to the correctness of the answer. To exclude the influence of other diseases, a standard Schirmer test was performed to diagnose dry eye, and corneal and lens densities were evaluated. RESULTS Average BCVA measured by Landolt C chart was not changed between affected and unaffected fellow eyes. However, the affected eyes showed a poorer FVA score (0.21 ± 0.12, affected; 0.09 ± 0.12, fellow) and visual maintenance ratio (VMR) (0.90 ± 0.04, affected; 0.94 ± 0.04, fellow), measured by the FVA system, and contrast VA score (0.35 ± 0.11, affected; 0.25 ± 0.14, fellow) than fellow eyes. The FVA and contrast VA values were correlated with the presence of epiretinal membrane, but not with the presence of dry eye, cataract and corneal densities. CONCLUSION FVA and contrast VA results reflected early changes in central visual function caused by epiretinal membrane, which were not detected by conventional Landolt BCVA.
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Affiliation(s)
- Yasuyo Nishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Hiraoka T, Yamamoto T, Okamoto F, Oshika T. Changes in functional visual acuity and ocular wavefront aberration after administration of eye ointment. J Ocul Pharmacol Ther 2013; 29:770-5. [PMID: 23808568 DOI: 10.1089/jop.2013.0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the influence of an eye ointment on functional visual acuity (FVA) and ocular wavefront aberration. METHODS In 11 healthy volunteers (6 men and 5 women), visual function parameters, such as FVA, visual maintenance ratios (VMR), and minimal visual acuity (minVA), were assessed by the FVA measurement system before and 2, 5, 10, 20, 30, 40, 50, 60, 90, 120, 180, and 240 min after administration of ofloxacin eye ointment. Ocular aberration was also measured, and the root mean square (RMS) of second-, third-, fourth-, and total higher-order aberrations was determined. The time course of changes in each parameter was statistically analyzed by using repeated-measures analysis of variance and the Dunnett post hoc test, and relationships between visual function and ocular aberration parameters were also analyzed by the Pearson correlation test. RESULTS FVA, VMR, and minVA showed significant deteriorations at 2-, 5-, 10-, and 20 min after administration of eye ointment compared with the baseline values (P<0.05). All components of ocular wavefront aberration such as second-, third-, fourth-, and total higher-order RMS significantly increased at 2- and 5 min after the administration of eye ointment compared with the baseline values (P<0.05). In addition, deteriorations of these visual function parameters were significantly correlated with reduced blink numbers (Pearson's correlation coefficient; r=- 0.76, P=0.017 for FVA, r=0.79, P=0.013 for VMR, and r=-0.62, P=0.040 for minVA), and VMR was significantly related with changes in second-order RMS (r=-0.60, P=0.049). CONCLUSIONS Eye ointment significantly reduced visual function for at least 20 min. Especially, minVA was worse than 0.155 logMAR, which is legally required for driving, for 3 h after the administration. In addition, increases in lower-order aberration and low blink rates were associated with the degradation of visual function.
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Affiliation(s)
- Takahiro Hiraoka
- 1 Department of Ophthalmology, Faculty of Medicine, University of Tsukuba , Ibaraki, Japan
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Kaido M, Uchino M, Kojima T, Dogru M, Tsubota K. Effects of diquafosol tetrasodium administration on visual function in short break-up time dry eye. J Ocul Pharmacol Ther 2013; 29:595-603. [PMID: 23537148 DOI: 10.1089/jop.2012.0246] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the effect of diquafosol tetrasodium on tear and visual function in short break-up time (sBUT) dry eye (DE). METHODS This interventional nonrandomized comparative study involved 11 eyes in 11 patients with sBUT DE (symptom-positive sBUT group) and 13 eyes in 13 volunteers with BUT values ≤5 s without DE symptoms (symptom-negative sBUT group). Tear function was assessed by measuring BUT and Schirmer values. Serial measurements were made of visual acuities (using a functional visual acuity measurement system) and higher-order aberrations (using a wavefront sensor). The parameters were compared before and 1 month after diquafosol tetrasodium instillation. Any changes in symptomatology after administration were also recorded. RESULTS After diquafosol tetrasodium administration, BUT values tended to increase in the symptom-positive sBUT group (P=0.07) and significantly increased in the symptom-negative sBUT group (P<0.05). LogMAR functional, minimal, and maximal visual acuities and higher-order aberrations significantly decreased after diquafosol tetrasodium administration in the symptom-positive sBUT group (P<0.05), while there were no significant changes in these values in the symptom-negative sBUT group (P>0.05). Diquafosol tetrasodium administration provided relief of DE symptoms in 75% of patients in the symptom-positive sBUT group. CONCLUSIONS Diquafosol tetrasodium appeared to improve tear film stability and visual function in sBUT DE.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
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Watanabe K, Negishi K, Kawai M, Torii H, Kaido M, Tsubota K. Effect of experimentally induced astigmatism on functional, conventional, and low-contrast visual acuity. J Refract Surg 2013; 29:19-24. [PMID: 23311738 DOI: 10.3928/1081597x-20121211-01] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 10/23/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the changes in functional visual acuity (FVA) in eyes with experimentally induced astigmatism. METHODS This study included 26 right eyes from 26 healthy participants (mean age: 27.0±4.4 years). After confirming best correction under cycloplegia, the cylinder power ×90° and ×180° (against-the-rule [ATR] and with-the-rule [WTR] astigmatism, respectively) were added with 0.50-diopter (D) steps, from 0.50 to 2.50 D. Conventional visual acuity (VA), FVA as measured by the FVA Measurement System (NIDEK Co Ltd), and 10% low-contrast visual acuity (LCVA) were measured with 3-mm artificial pupil under each condition. RESULTS The mean corrected logMAR VA, FVA, LCVA were -0.18±0.00 (20/13), -0.10±0.08 (20/16), and 0.06±0.06 (20/23), respectively. The VA, FVA, and LCVA had a significant linear negative correlation with the addition of cylinder irrespective of the axes. A significant decrease in FVA was noted on addition of ⩾0.50 D WTR astigmatism and ⩾1.00 D ATR astigmatism. With the addition of 1.00 D of cylindrical lens, 96% of eyes with WTR and ATR astigmatism could maintain 20/20 in VA testing, whereas only 50% and 62% of eyes with WTR and ATR astigmatism, respectively, could maintain 20/20 in FVA testing. CONCLUSIONS Astigmatism may be associated with deterioration of visual function even when conventional VA of 20/20 is attained. Functional VA testing seems to be useful in evaluating the masked astigmatic visual impairment that cannot be detected by conventional VA testing.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of Opthalmology, Keio University School of Medicine, Tokyo, Japan
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Abstract
Dry eye disease (DED) is a growing public health concern causing ocular discomfort, fatigue and visual disturbance that interferes with quality of life (QoL), including aspects of physical, social, psychological functioning, daily activities and workplace productivity. This paper assesses the current understanding of the impact of DED on QoL and vision. The full impact of DED on a patient's QoL is not easily quantifiable, but several methods and techniques have been evaluated to measure the decreased quality of vision from DED, and a number of questionnaires have been developed to quantify the impact of DED on various aspects of patient QoL. We summarize available evidence on the impact of DED based on a review of published literature.
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Affiliation(s)
- Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine
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The relation between visual performance and clinical ocular manifestations in Stevens-Johnson syndrome. Am J Ophthalmol 2012; 154:499-511.e1. [PMID: 22818907 DOI: 10.1016/j.ajo.2012.03.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/27/2012] [Accepted: 03/28/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the relation between visual function, clinical findings, and visual symptoms in Stevens-Johnson syndrome (SJS) and to compare the results with Sjögren syndrome (SS) patients and normal subjects. DESIGN Cross-sectional comparative study. METHODS One hundred fifteen eyes of 59 consecutive patients with SJS and toxic epidermal necrolysis (TEN), 208 eyes of 104 healthy normal subjects, and 132 eyes of 66 SS patients were investigated in this multicenter study. All study subjects underwent tear function and ocular surface examinations, Landolt and functional visual acuity examinations, and the Japanese version of the NEI VFQ-25 (National Eye Institute Visual Function Questionnaire). RESULTS The mean ocular surface grading scores were significantly higher and the mean score of all 12 NEI VFQ subscales was significantly lower in the SJS patients compared to the SS patients and the normal subjects (P < .05). The conventional and functional logarithm of minimal angle of resolution (logMAR) visual acuities in SJS patients with minimal corneal complications were significantly higher and the mean total composite NEI VFQ scores were lower compared to SS patients. The conventional and functional logMAR visual acuities and the mean ocular surface grading scores in SJS with aqueous deficiency were significantly higher and the mean total composite NEI VFQ scores were lower compared to SS patients. Strong correlations between best-corrected logMAR functional visual acuities and either ocular surface grading scores or the composite NEI VFQ-25 scores were observed. CONCLUSIONS The functional visual acuity examination reflects the severity of clinical ocular surface findings and vision-related quality of life more than the standard conventional visual acuity in SJS.
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McGinnigle S, Naroo SA, Eperjesi F. Evaluation of dry eye. Surv Ophthalmol 2012; 57:293-316. [PMID: 22726587 DOI: 10.1016/j.survophthal.2011.11.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/07/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022]
Abstract
Dry eye is a common yet complex condition. Intrinsic and extrinsic factors can cause dysfunction of the lids, lacrimal glands, meibomian glands, ocular surface cells, or neural network. These problems would ultimately be expressed at the tear film-ocular surface interface. The manifestations of these problems are experienced as symptoms such as grittiness, discomfort, burning sensation, hyperemia, and secondary epiphora in some cases. Accurate investigation of dry eye is crucial to correct management of the condition. Techniques can be classed according to their investigation of tear production, tear stability, and surface damage (including histological tests). The application, validity, reliability, compatibility, protocols, and indications for these are important. The use of a diagnostic algorithm may lead to more accurate diagnosis and management. The lack of correlation between signs and symptoms seems to favor tear film osmolarity, an objective biomarker, as the best current clue to correct diagnosis.
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Affiliation(s)
- Samantha McGinnigle
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
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Kaido M, Toda I, Ishida R, Konagai M, Dogru M, Tsubota K. Age-related changes in functional visual acuity in healthy individuals. Jpn J Ophthalmol 2011; 55:183-189. [DOI: 10.1007/s10384-011-0026-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
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Wakamatsu TH, Yamaguchi T, Negishi K, Kaido M, Matsumoto Y, Ishida R, Kojima T, Ibrahim OMA, Saiki M, Dogru M, Tsubota K. Functional visual acuity after neodymium:YAG laser capsulotomy in patients with posterior capsule opacification and good visual acuity preoperatively. J Cataract Refract Surg 2011; 37:258-64. [DOI: 10.1016/j.jcrs.2010.08.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/19/2010] [Accepted: 08/22/2010] [Indexed: 10/18/2022]
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Functional visual acuity measurement in cataract and intraocular lens implantation. Curr Opin Ophthalmol 2011; 22:31-6. [DOI: 10.1097/icu.0b013e3283414f36] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ridder WH, Tomlinson A, Huang JF, Li J. Impaired Visual Performance in Patients with Dry Eye. Ocul Surf 2011; 9:42-55. [DOI: 10.1016/s1542-0124(11)70009-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Association between clinical diagnostic tests and health-related quality of life surveys in patients with dry eye syndrome. Jpn J Ophthalmol 2010; 54:259-65. [PMID: 20700790 DOI: 10.1007/s10384-010-0812-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study was performed to assess the impact of dry eye on patients' quality of life (QOL) and to analyze the association between subjective symptoms and ocular surface findings of dry eye. METHODS The study population consisted of 158 patients with dry eye aged 20 years or older who visited any of the 15 medical care facilities enrolled in the study. The backgrounds and ocular findings of the patients were investigated, and their QOL was evaluated with the Japanese version of the 25-item National Eye Institute Visual Functioning Questionnaire (VFQ-25) and of the Medical Outcomes Study (MOS) 8-item Short-Form Health Survey (SF-8) to examine the association between subjective symptoms and ocular surface findings. RESULTS Of the patients enrolled, 15 were men and 143 were women, and their average age was 62.5 +/- 12.6 years. Sixty patients (38.0%) had comorbid Sjögren syndrome (SS). The results of Schirmer testing, fluorescein staining, and rose bengal staining for SS patients were significantly worse than those for the non-SS patients, but the VFQ-25 and SF-8 scores were not significantly different between the SS and non-SS patients. In the ocular surface findings, a weak association between the fluorescein staining scores and general vision scores, a subscale of the VFQ-25, was found. However, the ocular surface findings and VFQ-25/SF-8 results in the simple correlation analysis as well as in the multiple linear regression analysis showed no significant associations. CONCLUSIONS Ocular surface findings and QOL scores of patients with dry eye appear to disagree. Therefore, it is necessary to address subjective symptoms and QOL scores in addition to examination findings when evaluating dry eye.
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Liu H, Thibos L, Begley CG, Bradley A. Measurement of the time course of optical quality and visual deterioration during tear break-up. Invest Ophthalmol Vis Sci 2010; 51:3318-26. [PMID: 20107168 DOI: 10.1167/iovs.09-4831] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare changes in optical quality and visual performance that accompany tear break-up (TBU) during blink suppression. METHODS A three-channel optical system was developed that simultaneously measured refractive aberrations (Shack-Hartmann aberrometer), 20/40 letter contrast sensitivity (CS), and TBU (retroillumination, RI). Ten wearers of silicone hydrogel contact lenses were asked to keep one eye open for approximately 18 seconds, while CS, wavefront aberrations, and RI images were collected. The wavefront was reconstructed by zonal methods, and image quality was quantified with a series of metrics including RMS fit error. Novel metrics for quantifying TBU over the contact lens surface were developed by quantifying the contrast of the RI image and by using Fourier descriptors of the first Purkinje (PJ) image shape. RESULTS There was a full range of TBU over the lens surface, with four subjects showing TBU across the corneal center and one subject with TBU in the inferior peripheral pupil. Among the four subjects with central corneal TBU, RMS fit error, RI contrast, and PJ Fourier descriptors showed high correlation with CS (r(2) range, 0.9187-0.9414, 0.6261-0.975, and 0.4917-0.8986, respectively). Some of the general optical-quality metrics such as blur strength, neural sharpness, and area of modulation transfer function (MTF) also showed that change correlated with CS loss. CONCLUSIONS Optical metrics of tear quality and retinal image quality are associated with the decline in vision that occurs with TBU. The evidence supports the hypothesis that blurry vision symptoms reported by contact lens wearers are caused by poor quality of the retinal image due to TBU.
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Affiliation(s)
- Haixia Liu
- School of Optometry, Indiana University, Bloomington, Indiana 47405, USA.
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Ishioka M, Kato N, Takano Y, Shimazaki J, Tsubota K. The quantitative detection of blurring of vision after eyedrop instillation using a functional visual acuity system. Acta Ophthalmol 2009; 87:574-5. [PMID: 18507722 DOI: 10.1111/j.1755-3768.2008.01230.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yamaguchi T, Negishi K, Dogru M, Saiki M, Tsubota K. Improvement of functional visual acuity after cataract surgery in patients with good pre- and postoperative spectacle-corrected visual acuity. J Refract Surg 2009; 25:410-5. [PMID: 19507792 DOI: 10.3928/1081597x-20090422-02] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the changes in functional visual acuity in cataract surgery patients with good pre- and postoperative visual acuity. METHODS Functional visual acuity was evaluated in 13 eyes of 10 patients before and 1 month after phacoemulsification with implantation of acrylic intraocular lenses. Pre- and postoperative best spectacle-corrected visual acuities (BSCVA) were better than 20/25 in all patients. Low contrast visual acuity and Schirmer tests were also performed before and after surgery. RESULTS Mean pre- and postoperative logMAR BSCVA were -0.02 +/- 0.06 and -0.05 +/- 0.04, respectively (P > .05). Mean preoperative logMAR functional visual acuity improved from 0.29 +/- 0.17 to 0.092 +/- 0.13 postoperatively (P < .05). The visual maintenance ratio in functional visual acuity and low contrast visual acuity also improved significantly after cataract surgery (P < .05). CONCLUSIONS Measurement of functional visual acuity seems to be useful in the evaluation of timing of surgery, visual quality, and changes in kinetic vision after phacoemulsification surgery.
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Affiliation(s)
- Takefumi Yamaguchi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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