Published papers

Purpose: To evaluate the efficacy, sensitivity and specificity of confocal microscopy (CM) parameters: meibomian gland (MG) acinar longest diameter (MGALD), MG acinar shortest diameter (MGASD), inflammatory cell density (ICD), and MG acinar unit density (MGAUD) in the diagnosis of MG dysfunction (MGD). Design: Prospective, controlled, single-center study. Participants: Twenty MGD patients (9 males, 11 females; mean age, 63.5±16.5 years) and 26 age- and gender-matched control subjects (13 males, 13 females; mean age, 53.2±15.7 years) were recruited. Methods: All subjects underwent slit-lamp examinations, tear film break-up time (BUT) measurements, assessment of tear evaporation rate from the ocular surface (TEROS), vital stainings, Schirmer test, meibography, MG expressibility, and CM of the MG. Data were compared between the 2 groups using the Mann-Whitney and chi-square tests. Main Outcome Measures: The correlation between the clinical findings of tear functions, vital staining scores, and the 4 CM parameters were tested by Spearman's correlation coefficient by rank test. Receiver operating characteristic curve technique was used to evaluate the sensitivity, specificity, and cutoff values of CM parameters. Results: The mean tear film BUT, vital staining scores, TEROS values, MG expressibility, and MG dropout grades by meibography were significantly worse in MGD patients compared with controls (P<0.001). The mean values of the MGALD, MGASD, ICD, and MGAUD in MGD patients were significantly worse than those observed in the controls with CM. All CM parameters showed a strong, significant correlation with tear functions, ocular surface vital stainings, MG expressibility, and MG dropout grades. The cutoff values for MGALD, MGASD, ICD, and MGAUD in the diagnosis of MGD were 65 μm, 25 μm, 300 cells/mm2, and 70 glands/mm2, respectively. The sensitivity and specificity values of these parameters under these cutoff values were 90% and 81% for MGALD, 86% and 96% for MGASD, 100% and 100% for ICD, 81% and 81% for MGAUD. Conclusions: Confocal microscopy has the potential to diagnose the simple MGD with high sensitivity and specificity. The CM-based diagnostic parameters correlated significantly and strongly with the status of the ocular surface disease. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2010 American Academy of Ophthalmology.

Prevalence of myopia is increasing worldwide. Outdoor activity is one of the most important environmental factors for myopia control. Here we show that violet light (VL, 360-400nm wavelength) suppresses myopia progression. First, we confirmed that VL suppressed the axial length (AL) elongation in the chick myopia model. Expression microarray analyses revealed that myopia suppressive gene EGR1 was upregulated by VL exposure. VL exposure induced significantly higher upregulation of EGR1 in chick chorioretinal tissues than blue light under the same conditions. Next, we conducted clinical research retrospectively to compare the AL elongation among myopic children who wore eyeglasses (VL blocked) and two types of contact lenses (partially VL blocked and VL transmitting). The data showed the VL transmitting contact lenses suppressed myopia progression most. These results suggest that VL is one of the important outdoor environmental factors for myopia control. Since VL is apt to be excluded from our modern society due to the excessive UV protection, VL exposure can be a preventive strategy against myopia progression.

The aim of the present study was to evaluate sleep and mood disorders in women aged 30-69 with dry eye disease (DED). All subjects underwent corneal examinations, with 890 completing a questionnaire regarding symptoms of DED and 213 completing both the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) questionnaires. Subjects were then divided into three groups based on age (younger [30-45 years], perimenopausal [46-55 years], and older [56-69 years]), and comparisons were made among groups in subjects with and without DED. PSQI scores were significantly worse in subjects with (6.1 +/- 2.9) than without (4.9 +/- 2.7) DED (P = 0.003) and, in the younger group, HADS scores were worse in those with (13.2 +/- 6.0) than without DED (9.7 +/- 6.0) (P = 0.020). In contrast, there were no differences in mood indices between those with and without DED in the other groups. PSQI score was significantly correlated with HADS rather than ocular findings. In conclusion, sleep quality had deteriorated in women with DED. However, mood problems contributed more to sleep quality than ocular status, especially in those with DED in the younger group.

The aim of the present study was to evaluate sleep and mood disorders in patients with irritating ocular diseases. The study design was a cross-sectional/case-control study conducted in six eye clinics. Out of 715 outpatients diagnosed with irritating ocular surface diseases and initially enrolled, 301 patients with dry eye disease (DED) and 202 age-matched control participants with other ocular surface diseases were analyzed. The mean Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) scores were 6.4 ± 3.2 and 11.1 ± 5.7 for severe DED (n = 146), 5.5 ± 3.3 and 9.8 ± 4.0 for mild DED (n = 155), 5.5 ± 3.1 and 9.5 ± 6.6 for chronic conjunctivitis (n = 124), and 5.0 ± 3.3 and 8.9 ± 5.3 for allergic conjunctivitis (n = 78). There were significant differences among these diagnostic groups for PSQI (P <0.05). Regression analysis of patients with DED revealed the PSQI and HADS scores were significantly correlated with the severity of DED (P <0.05). Our results demonstrate that sleep quality in patients with DED is significantly worse than in patients with other irritating ocular surface diseases and it is correlated with the severity of DED.

An understanding of corneal optics is important to optimize the visual outcome after eye surgery. Recent advances in the surgical techniques of lamellar keratoplasty have changed the strategies used for corneal transplantation. Lamellar keratoplasty has the advantage of having a lower rate of graft rejection, superior biomechanical properties, and reduced higher-order aberrations (HOAs) compared with penetrating keratoplasty; thus, the use of lamellar keratoplasty has increased over the last 15 years. However, some patients have poor postoperative visual acuity despite a clear cornea, and the reasons for the poor visual outcome are poorly understood. By combining corneal imaging technologies and the latest optical software, we proposed the concept of "parallelism of anterior and posterior surfaces in lamellar keratoplasty." In physiologically normal eyes, in which the anterior and posterior surfaces are parallel to each other, the posterior surface of the cornea compensates the HOAs of the anterior surface, and this is also true in eyes after penetrating keratoplasty. However, after lamellar keratoplasty, in which the anterior and posterior surfaces are independent and not parallel, irregularities in the posterior surface increase the HOAs of the anterior surface. This article introduces this concept to enhance our understanding of visual optics in eyes after penetrating and lamellar keratoplasties and how to apply this concept to surgery to improve and optimize patient visual outcomes.

© 2018 The Authors. PURPOSE. Sleep is an essential life habit and closely associated with lifespan, diabetes, hypertension, and mental health. Sleep disorders are a prominent, but overlooked problem in patients with dry eye disease (DED), characterized by a poor sleep index, short sleep duration, long sleep latency, and poor subjective sleep. DED and sleep disorders are more prevalent in women than men. Moreover, sleep quality in DED is worse than in other eye diseases, including glaucoma, retinal diseases, cataract, and allergic and chronic conjunctivitis. METHODS. We reviewed the literature for studies investigating sleep and health, eyes and sleep, and DED and sleep, in terms of systemic and eye health, especially in women. RESULTS. Two studies reported that approximately half of patients with DED suffer from poor sleep. The severity of mood disorders, including anxiety and depression, is correlated strongly with sleep disorders in DED, and the symptoms and signs of DED, especially pain, also are correlated with sleep quality. Sleep disorders are documented in primary Sjögren’s syndrome and an association with sleep apnea and depression is suggested. Primary Sjögren’s syndrome includes arthritis and other rheumatic disease causing pain and fatigue; however, how sicca contributes to sleep disorders is not known. CONCLUSIONS. Possible explanations for sleep disorders in DED may be depression, pain, and eye exposure at night. Reciprocal effects may be expected and consultation-liaison psychiatry is recommended for the management of sleep disorders in DED. Topical medication and lid heating also may be advantageous for sleep quality in DED.

Purpose: To evaluate the accuracy of intraocular lens (IOL) power calculations using ray tracing software in eyes after myopic laser in situ keratomileusis (LASIK). Methods: Twenty-four eyes of 17 cataract patients who underwent phacoemulsification and IOL implantation after myopic LASIK were analyzed retrospectively. The IOL power calculation was performed using OKULIX ray tracing software. The axial length was measured using the IOLMaster and keratometry data using TMS2N. The accuracy of the IOL power calculation using OKULIX was compared with those using the Camellin-Calossi, Shammas-PL, Haigis-L formulas and the double-K SRK/T formula using 43.5 diopters (D) for the Kpre. Results: The mean values of the arithmetic and absolute prediction errors were 0.63 ± 0.85 and 0.80 ± 0.68 D, respectively. The arithmetic prediction error by OKULIX was a significant hyperopic shift of the distribution of the postoperative refractive errors compared to the Camellin-Calossi, Shammas-PL and Haigis-L formulas (P < 0.05), and the absolute prediction error showed no significant difference with other formulas. The prediction errors using OKULIX were within ±0.5 D in 10 eyes (41.7 %) and within ±1.0 D in 18 eyes (75.0 %). The percentages of eyes within ±1.0 D using OKULIX were comparable to those obtained using the Camellin-Calossi, the Shammas-PL formulas and the double-K SRK/T formula using 43.5 D for the Kpre, and significantly (P < 0.05) higher than that obtained using the Haigis-L formula. Conclusions: IOL power calculations using OKULIX provided predictable outcomes in eyes that had undergone a previous myopic LASIK. © 2014 Japanese Ophthalmological Society.

Objective To assess the visual complaints, reasons, and patient satisfaction for multifocal intraocular lens (IOL) explantation. Design Retrospective observational case series. Methods This study evaluated 50 eyes of 37 patients who underwent multifocal IOL explantation followed by IOL implantation. Before and 3 months after IOL exchange surgery, we investigated the symptoms, reasons, patient demographics, clinical results, and patient satisfaction in eyes undergoing multifocal IOL explantation. Data collected included preoperative subjective and objective findings, reasons, IOL type, postoperative course, and patient satisfaction. Results The most common complaints for IOL explantation were waxy vision, followed by glare and halos, blurred vision at far, dysphotopsia, blurred vision at near, and blurred vision at intermediate. The most common reasons for IOL explantation were decreased contrast sensitivity, followed by photic phenomenon, unknown origin including neuroadaptation failure, incorrect IOL power, preoperative excessive expectation, IOL dislocation/decentration, and anisometropia. The axial length was 25.13 ± 1.83 mm. Of the explanted multifocal IOLs, 84% were diffractive and 16% were refractive. Monofocal IOLs accounted for 90% of the exchanged IOLs. Patient satisfaction was significantly improved from 1.22 ± 0.55 preoperatively to 3.78 ± 0.97 postoperatively, which was graded on a scale of 1 (very dissatisfied) to 5 (very satisfied) (Wilcoxon signed-rank test, P <.001). Conclusions Multifocal IOL explantation was required in some patients undergoing multifocal IOL implantation. IOL exchange surgery appears to be a feasible surgical option for dissatisfied patients with persistent visual symptoms after multifocal IOL implantation. © 2014 by Elsevier Inc. All rights reserved.

PURPOSE: Cataract surgery has potential systemic health effects. Gait speed is a potential health index of predicted life expectancy and incidence of severe illness. We thus measured quality of vision and gait speed before and after cataract surgery. DESIGN: A prospective clinical study. METHODS: We followed up 30 patients for 6 months following cataract surgery by implantation of a yellow soft acrylic lens. A 4-m gait speed was determined, and patients were evaluated before and after surgery using the National Eye Institute Visual Function Questionnaire (vision-related quality of life) as well as ophthalmological and systemic examinations. Life span was estimated on the basis of standard curves derived from a literature. RESULTS: Mean preoperative gait speed was 0.81 +/- 0.23 m/s, with significant increases recorded at 2 and 6 months after surgery to 0.85 +/- 0.20 and 0.91 +/- 0.22 m/s, respectively (P < 0.01, paired t test). According to patient survival determined by gait speed, life expectancy (years) before and 6 months after surgery was approximately 83.4 and 84.9, respectively, for men (1.5-year increase) and 88.8 and 89.8, respectively, for women (1.0-year increase). The mean preoperative 25-item Visual Function Questionnaire score was 59.2 +/- 16.3, and significant improvements were observed 2 months (76.2 +/- 13.9) and 6 months (78.6 +/- 14.4) after surgery (P < 0.001, vs preoperative score). CONCLUSION: In conclusion, cataract surgery improved quality of vision and gait speed for 6 months.

Background: Previously, we reported improvements in sleep quality and gait speed after implantation of a yellow-colored, blue light-blocking intra-ocular lens (IOL). This study evaluated systemic health parameters for 7 months after cataract surgery with implantation of a clear, ultraviolet (UV)-blocking IOL. Methods: A total of consecutive 71 patients (average age 74.1 years) underwent cataract surgery with the implantation of a clear, UV-blocking IOL. Participants were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the National Eye Institute Visual Function Questionnaire (VFQ-25) before and at 2 and 7 months after surgery. Four-meter gait speed was also determined. The metabolic parameters of serum glycated hemoglobin (HbA1c), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were tested. Results: The pre-operative and post-operative (2 and 7 months after surgery) results were 66.4±16.5, 79.5±12.6, and 81.0±13.0 for VFQ-25 score, 5.7±3.5, 5.1±3.1, and 4.8±2.9 for PSQI, and 0.90±0.22, 0.91±0.22, and 0.92±0.22 meters/sec for gait speed. Significant improvements following surgery were noted in the VFQ-25 score for all cases and in the PSQI for poor sleepers (preoperative PSQI >5.5) (P<0.05, paired t-test). The gait speed and metabolic parameters showed no significant changes. Conclusions: Cataract surgery with implantation of an UV-blocking clear IOL has the potential for improving circadian rhythm and systemic health parameters. © 2014 Mary Ann Liebert, Inc.

The results of visual simulation of the retinal images in eyes with three different multifocal intraocular lenses (IOLs) (apodized diffractive-refractive, full diffractive, and refractive) to evaluate optical performance and characteristics of the IOLs using an optical bench are described in this chapter. Because the optical characteristics of the tested multifocal IOLs differed markedly, careful consideration should be given to implantation of these multifocal IOLs based on the patients' lifestyles.

PURPOSE: In myopia, biometry including the axial length is important, along with the refractive data. We compared the rates of myopic regression 3 years after phakic intraocular lens (pIOL) implantation and laser in situ keratomileusis (LASIK) after matching the preoperative axial length in highly myopic eyes of Japanese patients. METHODS: This retrospective nonrandomized study included 133 eyes of 84 patients with myopia exceeding -6.00 diopters (D) who underwent implantation of two iris-fixated pIOLs (pIOL group, 66 eyes/46 patients) or myopic LASIK (LASIK group, 67 eyes/38 patients) who were followed for more than 3 years postoperatively. The patient age, preoperative refraction, and preoperative axial length were matched between the study groups. RESULTS: There were no significant differences preoperatively between the groups in age, intraocular pressure, refraction, keratometry, or axial length. The mean regression values after 3 years compared with the 1-month postoperative refractions were -0.12 ± 0.47 (SD) D in the pIOL group and -0.82 ± 0.69 D in the LASIK group (p < 0.001). The differences in the mean regression rates between 1 and 12 months, 12 and 24 months, and 24 and 36 months of follow-up were, respectively, 0.09 ± 0.38 D, -0.11 ± 0.35 D, and -0.11 ± 0.30 D in the pIOL group and -0.57 ± 0.84 D, -0.24 ± 0.47 D, and 0.00 ± 0.53 D in the LASIK group (p < 0.001, p = 0.07, p = 0.15, respectively). CONCLUSIONS: There was a significant difference in myopic regression 3 years postoperatively between the groups matched for preoperative axial length in Japanese patients. This result has the potential to elucidate myopia in the future. Copyright © 2014 American Academy of Optometry.

A number of three-dimensional (3D) video services have already been rolled out over IPTV. In 3D video services, there are concerns that visual fatigue still exists, so evaluation of visual fatigue induced by video compression and delivery factors is necessary to guarantee the safety of 3D video services. To develop an assessment method of visual fatigue, we conducted evaluation experiments designed for 3D videos in which the quality of the left and right frames differ due to encoding. We explain the results from our evaluation experiments of visual fatigue, that is, results of specific parameters of visual fatigue biomedical assessment methods. © 2013 Springer-Verlag Berlin Heidelberg.

Purpose: To propose the new anterior-posterior method (A-P method) that does not require historical data to calculate intraocular lens (IOL) power after laser in situ keratomileusis (LASIK) and to compare the accuracy of the method with other IOL formulas after LASIK. Setting: Keio University Hospital, Tokyo, Japan. Design: Case series. Methods: Eyes having phacoemulsification and IOL implantation after myopic LASIK were analyzed retrospectively. The A-P method is a modification of the double-K method using the SRK/T formula in which the estimated pre-LASIK keratometry (K) power calculated from the post-LASIK posterior sagittal power in the 6.0 mm zone is used for the preoperative K value in the double-K method and the post-LASIK anterior sagittal power is used for the postoperative K value. The accuracy of the A-P method was compared with that of other formulas that do not require preoperative data and with formulas that require preoperative data. Results: The median values of the arithmetic and absolute prediction errors using the A-P method were 0.16 diopter (D) and 0.54 D, respectively. The prediction errors using the A-P method were within ±0.50 D in 46.4% of eyes and within ±1.00 D in 75.0%. The percentage of eyes within ±1.00 D of the prediction errors with the A-P method was highest with the no-history methods. Conclusion: The A-P method may be a good option for calculating IOL power in eyes having cataract surgery after LASIK when preoperative LASIK data are unavailable. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.

Background: Gait speed and sleep quality are health indices related to longevity and mortality. In the present study, we measured sleep quality, quality of life, gait speed, and visual acuity before and after cataract surgery to evaluate the efficacy of the procedure on systemic health. Methods: The study was conducted on 155 patients (93 women; average age 74.8 years) undergoing cataract surgery with the implantation of a yellow soft acrylic lens. Patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the National Eye Institute Visual Function Questionnaire 25 (VFQ-25; vision-related quality of life) before and then 2 and 7 months after surgery. Four-meter gait speed was also determined. Results: Of the 155 patients, 68 (43.9%) were classified as poor sleepers (PSQI>5.5) prior to surgery. Significant improvements were noted in sleep 2 months after surgery (p<0.05, paired t-test), but thereafter the improvements were not significant. Prior to surgery, 117 patients (77.0%) were classified as slow walkers (speed<1.0 meter/s). Gait speed increased significantly in these patients 2 months after surgery (p<0.001, paired t-test). Multiple regression analysis revealed significant correlations between the preoperative VFQ-25 score and both PSQI (p<0.05) and gait speed (p<0.001). Postoperative increases in the VFQ-25 score were positively correlated with decreases in the PSQI (p<0.05). Improvements in visual acuity were correlated with improvements in the VFQ-25 score, but not with either PSQI or gait speed. Conclusion: Cataract surgery effectively improves sleep quality and slow gait speed. © 2013, Mary Ann Liebert, Inc.

PURPOSE: This study aimed to evaluate a newly designed compact accommodometer (CA) and compare this with a conventional accommodometer for measuring accommodation as a biomarker for aging and lifestyle. DESIGN: This is an observational case series. METHODS: Accommodative amplitude was measured using 2 different accommodometers in 114 patients. We obtained the data of the near-point accommodation amplitude. Subsequently, we used smoking habit as an example of lifestyle-related factor to evaluate its effect on the accommodative power. RESULTS: The first part of the study included 60 eyes of 60 men and 54 eyes of 54 women, with a mean (SD) age of 43.8 (12.9) years (range, 18-58 years). There was a consistency within each measuring method despite a significant difference between the 2 devices (P < 0.01). Measuring accommodation by CA was significantly faster than by conventional modality (190.9 +/- 58.1 seconds for CA and 371.8 +/- 123.6 seconds for D'ACOMO, P < 0.0001, paired t test). In the second part of the study, we found a significant correlation between age and accommodative amplitude both in smokers and in nonsmokers. The accommodative amplitude of the smoker group was significantly lower than that of the nonsmoker group (P < 0.001). CONCLUSIONS: Compact accommodometer may work as an alternative and convenient method in place of the conventional accommodometer for measuring accommodative amplitude as an aging biomarker. Lifestyle factors can affect the magnitude of accommodation, which can be measured by this newly developed CA.

Purpose : To report two cases who had received LASIK previously and who underwent cataract surgery with implantation of multifocal intraocular lens (IOL). Cases and Findings : Both were males aged 47 and 55 years respectively. LASIK had been performed 6 years and 2 years before respectively. Both cases were diagnosed with cataract in the right eye. Corrected visual acuity was 1.2 and 0.7 respectively. The affected eye was treated by cataract surgery and implantation of diffractive multifocal IOL. After surgery, near and far visual acuity with the naked eye was 1.2 and 1.0 in one case and 1.0 each in the other. Both patients expressed satisfaction with the outcome. Contrast sensitivity was at the lower limit of normal range in both cases. Conclusion : These two cases illustrate that refractive error and impaired visual function may result following implantation of multifocal IOL after LASIK. We advocate due explanation to obtain informed consent in such cases.

Purpose: To evaluate the predictability of total postoperative spherical aberration after aspheric intraocular lens (IOL) implantation using preoperative corneal spherical aberration. Setting: Keio University Hospital, Tokyo, Japan. Methods: Corneal and ocular higher-order aberrations (HOAs) were analyzed preoperatively and postoperatively in eyes having cataract extraction with aspheric IOL implantation. The predicted postoperative total spherical aberration Z(4,0) was calculated by adding the preoperative corneal spherical aberration and the labeled spherical aberration of the IOL. The prediction error of the postoperative total spherical aberration was calculated by subtracting the predicted postoperative total spherical aberration from the postoperative total spherical aberration. Surgically induced corneal spherical aberration was calculated by subtracting the postoperative from the preoperative corneal spherical aberration. Results: There were no statistically significant differences between preoperative and postoperative corneal spherical aberration, 3rd-order aberration, or HOAs. The prediction error of the postoperative total spherical aberration was within ±0.05 μm in 9 (24.3%) of the 37 eyes evaluated and within ±0.10 μm in 18 eyes (48.6%). Statistically significantly correlations were found between the surgically induced corneal spherical aberration and prediction error of postoperative total spherical aberration, the preoperative corneal spherical aberration and surgically induced corneal spherical aberration, and the preoperative corneal spherical aberration and prediction error of postoperative total spherical aberration. Conclusions: Predictability of postoperative ocular spherical aberration after cataract surgery with aspheric IOL implantation was insufficient because of the surgically induced corneal spherical aberration. Considering surgically induced corneal spherical aberration could improve the predictability of postoperative ocular spherical aberration. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2010 ASCRS and ESCRS.

PURPOSE.: To prospectively investigate the effects of passive cigarette smoke exposure on the ocular surface and tear film in soft contact lens (SCL) wearers. METHODS.: Twelve right eyes of 12 SCL wearers without any ocular or systemic diseases and 10 right eyes of 10 subjects who never wore CLs were examined before and 2 h after 5 min of passive cigarette smoke exposure in a controlled smoke chamber. Tear evaporation rate measurement, tear film break-up time (TBUT) examination, ocular surface fluorescein, rose bengal stainings, and Schirmer I test were performed at each visit. RESULTS.: The mean tear evaporation rates, TBUTs, and vital staining scores were significantly worse in CL wearers compared with healthy control subjects. TBUTs showed significant worsening after passive smoke exposure in both groups. The mean tear evaporation rate and vital staining scores showed a significant increase with brief passive smoke exposure in subjects not wearing CLs but not in CL wearers. CONCLUSION.: Even brief passive exposure to cigarette smoke is associated with adverse effects on the ocular surface as evidenced by an increase in tear instability and damage to the ocular surface epithelia in SCL wearers and non-CL wearers. Copyright © 2010 American Academy of Optometry.