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Purpose: To investigate the clinical characteristics of eyes with cuticular drusen in Japanese individuals, while paying special attention to large colloid drusen (LCD)., Study Design: Retrospective case series., Methods: Eyes with cuticular drusen, from patients of 4 medical institutes in Japan, were investigated. Multimodal imaging findings were used to diagnose cuticular drusen. LCD was defined as cuticular drusen > 200 µm., Results: Twenty-four eyes from 12 patients (8 women, 4 men) were diagnosed with cuticular drusen. The mean age of all patients (n = 12) was 60.8 years. The mean age of patients without additional macular pathology (n = 5) was 55.4 years. Of the 7 patients with additional macular pathology, 6 (85.7%) exhibited age-related macular degeneration-associated macular pathology, including drusenoid pigment epithelial detachment (PED) (8 eyes from 4 patients), geographic atrophy (2 eyes from 1 patient), and occult choroidal neovascularization (1 eye). LCD were found in 6 eyes of 3 patients (25%), those with LCD were on average 53.7 ± 8.7 years old and those without 69.9 ± 14.1 years of age (P = 0.064, Mann-Whitney U test)., Conclusions: Cuticular drusen were predominantly seen in females, and drusenoid PED was most frequently seen in eyes with additional macular pathology. LCD were seen in 25% of eyes with cuticular drusen.

Purpose: To investigate whether the development of late age-related macular degeneration (AMD) in fellow eyes with pseudodrusen is associated with the pseudodrusen pattern in patients with unilateral exudative AMD., Study Design: Retrospective observational study., Methods: A retrospective analysis was performed on 73 patients with unilateral exudative AMD showing pseudodrusen in their fellow eyes. Eyes were classified according to pseudodrusen pattern, which was determined based on maximum pseudodrusen ribbon length., Results: During the mean follow-up period of 35.5±18.6 months, 21 (28.8%) eyes developed late AMD. Among these eyes, 15 (71%) developed exudative AMD and six (29%) developed geographic atrophy (GA). Development of late AMD in fellow eyes occurred with significantly more prevalence in patients showing a ribbon-dominant type pseudodrusen pattern in their fellow eye than dot-dominant type (P=0.0005, log-rank test). Cox-regression analysis revealed that development of late AMD in fellow eyes is associated with the presence of ribbon-dominant pseudodrusen in the fellow eyes (hazard ratio 4.15, 95% confidence interval (CI) 1.59-10.8), along with older age (hazard ratio 1.10, 95% CI 1.03-1.17), a history of smoking (hazard ratio 17.2, 95% CI 1.11-263), the presence of large soft drusen in the fellow eye. (hazard ratio 5.49, 95% CI 1.29-21.1) and retinal angiomatous proliferation (hazard ratio 5.02, 95% CI 1.90-13.2) CONCLUSIONS: Fellow eyes with ribbon-dominant pseudodrusen in patients with unilateral exudative AMD are likely to develop late AMD.

Anti-vascular endothelial growth factor agents reduce macular edema and improve vision in eyes with macular edema associated with retinal vein occlusion (RVO), including branch RVO (BRVO) and central RVO. However, not all eyes with resolved macular edema show satisfactory best corrected visual acuity. Photoreceptor impairment can mostly explain the vision loss in these cases. Photoreceptor damage can be caused by subretinal hemorrhage in the central fovea and hard exudates or their precursor derived from concentrated lipoproteins originating from leaky retinal vessel extravasation. The contribution of neuron impairment in the inner retina, including the impairment of bipolar and ganglion cells by ischemia, indicated by the presence of a non-perfusion area (NPA), to vision loss in eyes with BRVO is insignificant. This is because the papillomacular bundle area is usually spared from NPAs in BRVO cases.

Purpose: To study the reduction in light sensitivity in areas where impaired retinal perfusion was established by fluorescein angiogram (FA) in eyes with branch retinal vein occlusion (BRVO) that recovered from retinal edema and hemorrhage., Design: Retrospective observational case series., Methods: A study of the reduction in light sensitivity demonstrated by total deviation display of the Humphrey perimetry program 30-2 in 43 eyes from 42 patients with BRVO, whose perfusion status was assessed by FA images taken at least 6 months after disease onset. Each of the 15 retinal squares in the FA images, corresponding to the 15 Humphrey test points around the fixation point in the affected vertical hemisphere, was classified as either perfused, partially perfused, or non-perfused. Correlation between light sensitivity and perfusion status was investigated by three evaluators in a total of 645 squares, 15 squares from each of the 43 subject eyes., Results: In 459 retinal squares (71.2%) with complete agreement on the perfusion status among the three evaluators, light sensitivity was significantly different among retinal squares of perfused (median: - 4.0 dB, n = 258), partially perfused (median: - 8.0 dB, n = 41), and non-perfused (median: - 16.0 dB, n = 160) (P < .000001, Kruskal-Wallis test)., Conclusions: Light sensitivity is decreased in retinal areas exhibiting impaired perfusion, likely due to neuronal loss in the inner retinal layer in eyes with chronic BRVO.

Purpose: To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60 months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV)., Methods: We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12 months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present., Results: During the follow-up period (mean 44 ± 13 months, median 48 months), 46 eyes (75.4 %) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59 % at the 12-month visit, 41 % at the 24 month, 31 % at the 36 month, and 20 % at the 60-month visit. The median retreatment-free period was 15.0 [95 % confidence interval (CI) 7.4-22.7] months, and the mean period was 24.9 (95 % CI 19.3-30.6) months. Cox regression analysis revealed that older age (P = 0.010, hazard ratio 1.06, CI 1.02-1.11) and male gender (P = 0.043, hazard ratio 2.41, CI 1.03-5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits., Conclusions: About 80 % of eyes with PCV require retreatment within 5 years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.

Purpose: To investigate the various perimetric parameters that best predict reduction of best-corrected visual acuity (BCVA) to worse than 0.5 in the near future in eyes with retinitis pigmentosa (RP)., Methods: The most recent records obtained by Humphrey Field Analyzer (HFA) central 10-2 perimetry were studied for the right eyes of 123 patients (60 men and 63 women) with typical RP. The correlation between various parameters of perimetric sensitivity and BCVA was retrospectively studied. The receiver operating characteristic (ROC) curves were used to find the best parameter to discriminate eyes with BCVA ≥0.5 from those with BCVA <0.5., Results: Spearman rank correlation coefficients with logMAR BCVA were the highest for the foveal threshold (FT) and mean sensitivity of the test points within 1.4° of the fixation point (MS1.4). The ROC curve analysis revealed that the area under the curve was the largest for the MS1.4 among all the perimetric parameters for discriminating eyes with BCVA ≥0.5 from those with BCVA <0.5. The cutoff value of 30 dB showed 100 % specificity and 57 % sensitivity., Conclusions: The risk of vision decreasing below 0.5 in the near future may be predicted when the mean sensitivity within 1.4° of the fixation point in the HFA 10-2 reaches 30 dB in eyes with RP.

Purpose: To study the relationship between foveal sensitivity and visual acuity in eyes with macular disorders exhibiting macular thickening., Methods: We studied the relationship between foveal sensitivity, obtained as the "foveal threshold" by use of Humphrey perimetry, and best-corrected visual acuity, converted to the logarithm of the minimum angle of resolution (logMAR), for 117 eyes with epiretinal membrane (ERM), 197 eyes with retinal vein occlusion associated with macular edema (RVOME), and 158 eyes with central serous chorioretinopathy (CSC)., Results: Foveal sensitivity and logMAR correlated significantly for the eyes with ERM, RVOME, and CSC. Although mean foveal sensitivity was no different among the three diseases, mean logMAR was lower in eyes with CSC, i.e., visual acuity was better, than in those with ERM or RVOME (P < 0.001)., Conclusions: Light sense (foveal sensitivity) is related to spatial resolution (logMAR) at the center of the fovea, in eyes with ERM, RVOME, and CSC at different strengths depending on the disease. Less pronounced reduction of visual acuity compared with foveal sensitivity in eyes with CSC could explain the tendency of these patients to complain of dimness rather than acuity loss.

Purpose: To determine the best clinical measures of visual sensitivity for monitoring disease progression in eyes with retinitis pigmentosa (RP)., Methods: This survey retrospectively studied results from the Humphrey perimetry central 10-2 program for 123 eyes with RP with regard to the correlation between years affected by RP and clinical measures of visual dysfunction, including mean deviation (MD), average sensitivity of 12 test points (CENT12), average sensitivity of 4 central points (CEN4), foveal threshold (FT), and logarithm of the minimum angle of resolution (LogMAR)., Results: All these value correlated more highly with years of symptoms (P < 0.001 for all) than with years since diagnosis. The correlation coefficient with years of symptoms decreased in the order MD, CENT12, CENT4, FT, and LogMAR. The order differed for a subset of 66 eyes with advanced RP having -15 dB or lower MD, and decreased in the order FT, CENT4, LogMAR and CENT12., Conclusion: Progression in eyes with RP could be well assessed by use of the MD of the Humphrey central 10-2 program in general and by use of FT, CENT4, and CENT12 in cases of advanced RP.

Purpose: To study the recurrence of macular edema and the probability of retreatment with intravitreal bevacizumab (IVB) of eyes with macular edema associated with branch retinal vein occlusion (BRVO)., Methods: In this retrospective study of an interventional case series, the temporal profile of visual acuity and retinal thickness after individual IVB, either initial or repeated, was investigated for eyes with acute BRVO associated with symptomatic macular edema., Results: In a total of 95 IVB treatment sessions conducted on 37 eyes of 37 patients, 25 injections were completed with a follow-up period of 6 months or longer without any additional treatments. Fifty-eight IVB injections were followed by retreatment with IVB after an average interval of 119 days (range 42-308 days) since the preceding IVB injection. The remaining 12 injections were followed either by an insufficient follow-up period of less than 6 months or by laser treatment., Conclusions: Although retreatment with IVB because of recurrence of macular edema is common, in this study, the probability of retreatment with IVB was approximately 70% after each individual IVB injection, indicating that 4 injections is maximum for three-quarters of eyes with BRVO macular edema.

Purpose: To investigate the characteristics of eyes with polypoidal choroidal vasculopathy (PCV) which develop secondary classic choroidal neovascularization (CNV) after photodynamic therapy (PDT)., Methods: We retrospectively reviewed the records of 64 eyes of 64 PCV patients (43 men, 21 women; mean age ± standard deviation, 72.7 ± 8.6 years), who were followed-up for at least 1 year after the initial PDT. There was no evidence of classic CNV in any of the subject eyes on fluorescein angiography (FA) at the first PDT. Eyes which developed of secondary classic CNV after PDT were classified as the CNV group and the other eyes as the No-CNV group., Results: Secondary classic CNV developed after PDT in 10 (15.6%) of the 64 eyes. Six patients developed CNV within 1 year after the first PDT. Multivariate logistic regression analysis for the baseline factors related to CNV development, including age, gender, greatest linear dimension, and the lesion components, revealed that in the CNV group the age was significantly younger (p = 0.037) and the incidence of retinal edema was significantly greater (p = 0.041) than in the No-CNV group., Conclusions: Secondary classic CNV tends to develop after PDT in PCV eyes in younger patients with retinal edema.

Purpose: To investigate the relationship between anatomical changes and visual sensitivity in eyes with central serous chorioretinopathy (CSC)., Methods: Twenty-one eyes with CSC were retrospectively studied using optical coherence tomography (OCT) retinal maps, line scan mode, and the Humphrey perimetry central 10-2 program., Results: Total retinal thickness (TRT), including the neurosensory retina and subretinal fluid, correlated significantly with the sensitivity loss in the corresponding visual field in the central macula within a circle 6 mm in diameter. Differential analysis of the TRT, separating it into neurosensory retinal thickness (NRT) and subretinal thickness (SRT), revealed that only SRT correlated well with perimetric sensitivity at 1°, 3°, 5°, 7°, and 9° from the fovea along horizontal and vertical lines crossing at the fovea., Conclusions: Visual sensitivity measured with automated static perimetry is further attenuated by increasing distance between the photoreceptor and retinal pigment epithelium (RPE) in areas of serous retinal detachment in eyes with CSC.

Purpose: To investigate whether the baseline mean deviation (MD) of Humphrey perimetry has a predictive value for visual improvement after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV)., Methods: We retrospectively reviewed the records of 40 eyes of 39 PCV patients (28 men, 11 women) who underwent PDT. The follow-up period ranged from 12 to 42 months. Best-corrected visual acuity (BCVA) improved more than 0.2 logarithm of the minimum angle of resolution (logMAR) units at the final examination in 22 (55%) of the 40 eyes, which were classified into the "Improved group." The other 18 eyes with improvement of

Purpose: We studied the temporal aspects of retinal thickness in eyes with branch retinal artery occlusion (BRAO) to demonstrate the retinal thinning process subsequent to the acute stage of the disease., Methods: We studied the retinal thickness map obtained with optical coherence tomography (OCT) in nine eyes of nine patients with BRAO. Central foveal thickness and average retinal thickness in the superior or inferior sectors of the inner macula (IM) and outer macula (OM) were measured several times after the onset of BRAO., Results: All follow-up data combined from the eyes with the occluded branch artery on the same vertical side showed a common pattern of decrease in the retinal thickness in the affected superior or inferior sectors of the IM and OM, which was described by an exponential decay curve, whereas few changes were seen in central foveal thickness. The fitting of the reducing retinal thickness curves to an exponential decay curve led to the final estimated thickness in the affected sectors of 60% that of the control., Conclusion: The initially thickened retina in the vertical sectors of the macula in eyes with BRAO decreases exponentially to a final thickness of 60% of that the normal retina.

Purpose: Several characteristic personality types have been reported for glaucoma patients in previous studies. However, none of the previous studies used a common structural theory of personality. In this study, we conducted a multicenter cross-sectional case-control study using the recently established five-factor model of personality structure., Methods: Personality was evaluated using the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI), which is a questionnaire specifically designed to test the five-factor model of personality: neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C). Eligible questionnaires were obtained from 196 patients with primary open-angle glaucoma (POAG) (99 men, 97 women) and 223 reference subjects with no ocular disease except cataract (87 men, 136 women). The mean score of each NEO-FFI factor for POAG patients was compared to the scores for the reference subjects., Results: Compared with the reference subjects, the mean N score was significantly higher (P = 0.013), the mean scores for A and C were significantly lower (P = 0.007 and P = 0.001, respectively), and the mean E score tended to be lower (P = 0.055) in male POAG patients. The mean E score was significantly lower (P = 0.023) in female POAG patients., Conclusions: Characteristic personality traits were noted in POAG patients, and a more significant relationship was found between personality and glaucoma in men than in women.

Purpose: To study retrospectively the presenting visual acuity and the visual outcome in patients with central retinal artery occlusion (CRAO) and in patients with branch retinal artery occlusion (BRAO)., Methods: We studied the visual acuity and outcome in 23 patients (23 eyes) with CRAO and in 30 patients (30 eyes) with BRAO that met the inclusion criteria: a funduscopic appearance of retinal whitening, a delay in arterial dye filling in a fluorescein angiogram, the first examination in our hospital within 7 days of onset, and a minimum follow-up period of 90 days., Results: Both presenting acuity and final acuity were far worse in patients with CRAO than in patients with BRAO. A final acuity worse than 0.1 was observed in 14 of the 23 (61%) patients with CRAO and in only 1 of the 30 (3%) patients with BRAO. Only 5 of the 23 (22%) patients with CRAO and 24 of the 30 (80%) patients with BRAO showed a final acuity of 0.5 or better., Conclusion: Visual acuity in patients with CRAO is poor at presentation, and the prognosis is generally poor, with a few exceptions. In contrast, the visual acuity in patients with BRAO is far better both at presentation and at the final visit.

Background: The recovery of the visual field in eyes with central retinal artery occlusion (CRAO) has rarely been reported, because the patient has difficulty in central fixation during perimetry testing due to poor visual acuity. We describe the recovery of the central visual field in eyes with atypical CRAO., Cases: Two patients who showed sudden visual loss underwent ophthalmic examinations, including fluorescein fundus angiography and Humphrey central 30-2 perimetry., Observations: Both patients had good visual acuity at presentation, with normal retinal color in the area of the papillomacular bundle surrounded by a mild retinal whitening in one case and by scattered cotton-wool patches in the other. They were considered on the basis of angiographic findings to have central retinal artery occlusion. The mean deviation of the Humphrey central 30-2 perimetry gradually improved during the initial 70 days after the onset of symptoms in both patients., Conclusions: Although the mechanism remains to be clarified, a certain degree of visual field recovery may be seen in some cases of retinal artery occlusion. More patients with CRAO should be studied with follow-up perimetry.

Purpose: To predict future glaucomatous sensitivity loss using a perimetric color saturation test (PCST) that measures the color saturation discrimination threshold for six hues (red, yellow, green, green-blue, blue, and purple) at 9 degrees in horizontal and 3 degrees in vertical extrafoveal points., Methods: This new test was carried out on 31 patients (31 eyes) with early glaucoma or ocular hypertension. The sensitivity loss at the four points approximately 9.5 degrees apart from the fixation point was prospectively evaluated annually for 3 years using the Humphrey Field Analyzer (HFA) program central 30-2. The initial results of PCST and the total deviation (TD) in the follow-up HFA results were compared., Results: Twenty-seven patients (27 eyes) were followed up for 3 years. The color saturation threshold for six hues was correlated with the TD of HFA results at 108 points in the 27 eyes. The TD was -4 dB or better at the baseline measurement in 91 out of the 108 points. The averaged TD in the second and the third year in the follow-up period decreased below -4 dB in 10 of these 91 points, which were categorized as progression points in relation to the 81 nonprogression points. In the initial PCST, only the saturation threshold for purple was higher in the progression points when compared with the nonprogression points (P=.0004, Mann-Whitney U-test)., Conclusion: Future sensitivity loss is most likely at the points where the threshold of color saturation discrimination is increased for purple in eyes with early glaucoma or ocular hypertension.

Purpose: To study the visual prognosis in eyes with symptomatic retinal arterial macroaneurysm (RAM)., Methods: Medical records were retrospectively reviewed for 62 patients (65 eyes) with symptomatic RAM., Results: The median visual acuity at presentation was 0.4 for eyes with vitreous hemorrhage (n=6), 0.01 for eyes with premacular hemorrhage (n=9), 0.1 for eyes with submacular hemorrhage without premacular hemorrhage (n=16), 0.02 for eyes with submacular hemorrhage with premacular hemorrhage (n=16), and 0.3 for eyes with macular edema (n=18). The median value of the final visual acuity was 0.6 for vitreous hemorrhage, 0.7 for premacular hemorrhage, 0.1 for submacular hemorrhage without premacular hemorrhage, 0.1 for submacular hemorrhage with premacular hemorrhage, and 0.5 for macular edema., Conclusions: The visual prognosis for eyes with symptomatic RAM depends on the macular pathology. Eyes with vitreous hemorrhage or premacular hemorrhage recover good vision, while the vision in those with submacular hemorrhage with or without premacular hemorrhage generally remains poor. New interventions including submacular surgery or pneumatic displacement of submacular hematoma should be evaluated in a future study in terms of visual prognosis for these eyes.

Purpose: In a previous study we demonstrated that the progression of the disease retinitis pigmentosa (RP) can be readily monitored by the mean deviation (MD) measured by Humphrey central 10-2 perimetry, which assesses the sensitivity distribution in the macular area in eyes affected by RP. In the present study, we investigated whether the 10 degrees perimetric results could predict the time of declining visual acuity in eyes with RP in a cross-sectional study., Methods: Humphrey 10-2 perimetry results and visual acuity were studied in the right eyes of 69 patients with typical RP. Patients whose eyes had cataract, glaucoma, cystoid macular edema, or other complications affecting vision were excluded., Results: Eyes with an MD of -15 dB or greater had almost normal visual acuity. Various degrees of visual acuity loss were observed in eyes with an MD of less than -15 dB. In the 35 eyes with an MD of less than -15 dB, visual acuity correlated well with the corrected pattern standard deviation (CPSD), which is the measure of the degree to which the shape of the measured field departs from the age-corrected normal reference field., Conclusion: In the absence of complications, many eyes with RP may experience acuity loss after the field constriction reaches an MD of less than -15 dB. The CPSD may be used as an indicator of acuity because eyes showing a lower CPSD tend to have greater loss of acuity among eyes with an equivalent MD value.

Using precise experimental methods, we evaluated the recovery from pressure-induced ischemia in rabbit retina using photopic electroretinography (ERG). The recovery was evaluated and documented in terms of the increasing amplitude and the decreasing delay of implicit time in the photopic ERG after inducing 30-, 60- and 90-minute ischemia. A ganzfeld dome was utilized to stimulate both the experimental and the control fellow eye. The changes in ERG parameters in the ischemic eye were assessed by comparison with the values simultaneously obtained in the fellow eye, which could minimize the effect of anesthesia. One hour after reperfusion, the implicit time returned to almost the same value as that in the fellow eye in eyes with 30-minute ischemia, while it showed significant delay in eyes with 60-minute ischemia. The amplitude was smaller than that in the fellow eye in eyes with both 30- and 60-minute ischemia. Photopic ERG was not recorded one hour after reperfusion in more than half the eyes with 90-minute ischemia.

The effects of panretinal photocoagulation (PRP) on photopic ERG were studied in normal pigmented rabbit eyes. Photopic ERGs were recorded before PRP and one day, one week and 4 weeks after PRP. Markedly reduced amplitude and delayed implicit time were observed one day after PRP. Four weeks after PRP, amplitude showed subtotal recovery while implicit time, showing tendency of reduction, was still significantly delayed. The delay in implicit time and the reduction in amplitude after PRP was probably due to serous retinal detachment and/or retinal edema caused by breakdown of the blood-retinal barrier. However, the findings at 4 weeks after PRP might be explained by the reduced number of photoreceptor cells; the mild decrease in the amplitude of photopic ERG might be caused by the reduced number of cones, while significantly delayed implicit time of the photopic ERG might be caused by reduced number of rods.

Clinical findings in 5 cases of active ocular toxoplasmosis were documented by fluorescein angiography. The diagnosis was based upon the ophthalmoscopic findings of white, fluffy, retinal exudative lesions with or without overlying vitreous inflammatory cells, and positive serologic tests for toxoplasma and responsiveness to clindamycin therapy. Three cases were considered as recurrent ocular toxoplasmosis and the other 2 cases, acquired ocular toxoplasmosis. Angiographic characteristics of these 5 cases of acute ocular toxoplasmosis consisted of the following: 1) hypofluorescence in the center of the hyperfluorescent lesion, 2) black silhouette of the artery corresponding to the arterial occlusion traversing the necrotic lesion, 3) venous dilation, venous wall staining and dye leakage from the vein, 4) optic disc staining and dye leakage. These angiographic findings reflect either tissue necrosis or hypersensitivity reaction and are helpful in the correct and prompt diagnosis of acute ocular toxoplasmosis.

A 56-year-old man, complaining of sudden visual loss in his left eye, demonstrated cream-colored retinal edema along a macular branch of the central retinal artery, overall delay of fluorescence in angiography and general depression of the central visual field, which were interpreted as the incomplete form of central retinal artery occlusion (CRAO) mimicking cilioretinal or branch retinal artery occlusion. After receiving paracentesis and fibrinolytic agents, the patient recovered his vision gradually, while the ophthalmoscopic findings progressed to show central retinal vein occlusion (CRVO) changes consisting of dilated and tortuous retinal veins and scattered intraretinal hemorrhages. The condition associated with the retinal edema indicated combined obstruction of the central retinal artery and the central retinal vein (combined CRAO/CRVO). Six months later, both the ocular fundus and the vision returned to normal. The similar cases in Japanese literature in which ophthalmoscopic findings of combined CRAO/CRVO was followed by aggravation of CRVO changes with or without recovery of vision were reviewed.

Photopic electroretinograms (ERGs) elicited with red or white flashes of various intensities under a bright background light were recorded in 119 eyes of 77 diabetic patients and 19 normal control eyes. The implicit time and amplitude of photopic ERGs were analyzed in relation to the stage of diabetic retinopathy, ie, diabetic eyes without retinopathy, eyes with mild nonproliferative diabetic retinopathy (mild NPDR), moderate NPDR, preproliferative diabetic retinopathy (PPDR) and proliferative diabetic retinopathy (PDR). The implicit time was significantly delayed in eyes with moderate NPDR, PPDR and PDR relative to eyes with mild NPDR, eyes without retinopathy or normal eyes. The delay of implicit time significantly increased as the severity of retinopathy progressed from mild NPDR to PPDR. The amplitude was reduced in PPDR and PDR, while the correlation with the severity of retinopathy was not so significant as with the delay of implicit time. These findings suggest that the photopic ERG implicit time can be a good indicator for the objective evaluation of the severity of diabetic retinopathy ranging from mild NPDR to PPDR, where retinal laser photocoagulation should be considered.

While the implicit time of cone responses in the electroretinogram (ERG) has been suggested to have some clinical implications in retinitis pigmentosa (RP), its evaluation is not always easy in cases of typical RP because of the small amplitudes of the responses. An intense flash stimulus would be expected to improve the recordability of photopic ERG, which represents the cone responses. However, the implicit time in normal eyes has been shown to be delayed with increased stimulus intensity. Therefore, we evaluated photopic ERGs to a white flash stimulus of 3 different intensities as well as to a red flash in 14 cases of typical RP. The recordability of the response to white flash improved with the increased intensity of the stimulus. Most RP cases showed prolonged implicit time compared with that in normal eyes to each flash stimulus. Some patients who showed exceptionally normal or mildly delayed implicit time were considered to have good prognosis since they had noticed night blindness at an older age and most of their rod response in ERG was recordable.

Colour stereophotographs of the optic disc and surrounding retina were assessed by a Humphrey analyser system in a series of Japanese individuals. When compared with 9 age- and sex-matched control eyes (9 controls), the 10 eyes of 10 patients with early open-angle glaucoma showed a significantly lower level of the mid-point of the neuroretinal rim relative to the level of the surface of the retina about 1/4 of a disc diameter beyond the disc edge. When the mid-point of the rim was related to the surface of tissue at the disc edge, the level of the former was significantly lower at the three measurement points on the nasal side and at 6 o'clock. In the 9 normal controls, the lower half of the neuro-retinal rim was at a significantly lower level than the upper half, relative to the surface of tissue at the disc edge. We conclude that saucerisation and/or recession of the neuro-retinal rim frequently accompanies glaucoma and we suspect it is an early sign of it.

Measurements of visual acuity were carried out preoperatively by laser interoferometry in 16 cataractous eyes of 13 patients with retinitis pigmentosa who were older than 60 years of age. Subsequently, all patients underwent uneventful extracapsular cataract extraction and posterior chamber intraocular lens implantation. Postoperative visual acuity, which was evaluated as the best acuity during the first postoperative year, was improved in all eyes and it correlated well with the preoperative acuity determined by laser interferometry. Laser interferometry can be useful in predicting postoperative acuity and deciding on cataract surgery for elderly cataractous patients with retinitis pigmentosa.

Photopic electroretinograms were elicited in anesthetized monkey eyes with stimulus light of various intensities under background light of different luminances. The b-wave implicit time was prolonged with increasing stimulus light intensity and shortened with brighter background luminance. While the change of anesthetic conditions produced by the addition of halothane (0.5% or 1.0%) mildly prolonged the implicit time, it affected neither the waveforms nor the relationship between the b-wave implicit time and background luminance.

An 11-year-old girl complaining of progressive visual loss in both eyes showed atrophic macular degeneration with yellowish white flecks around the fovea in both eyegrounds. Decreased vision, central scotoma with normal peripheral visual field, and angiographic dark choroid except for transmitted hyperfluorescence in the macula and at the flecks confirmed the diagnosis of fundus flavimaculatus with atrophic macula. Electroretinograms, however, revealed severely reduced cone responses associated with almost normal rod response, which led to the diagnosis of cone dystrophy. The rare combination of angiographic evidence of fundus flavimaculatus and electroretinographically diagnosed cone dystrophy was discussed.

Electroretinograms (ERGs) in 10 cases of cone dystrophy were studied with special respect to log(bp/bs) that represents the log of photopic ERG amplitude divided by scotopic ERG amplitude. Photopic ERGs were either greatly diminished or nonrecordable, and scotopic ERGs showed either normal or reduced amplitudes. All cases had a low value of log(bp/bs), less than the lower normal limit, indicating significantly greater impairment in cone function than in rod function. These results have proved log(bp/bs) to be helpful in confirming the diagnosis of cone dystrophy especially in cases with recordable photopic ERG and reduced scotopic ERG. Among other ERG parameters, the photopic ERG b-wave implicit time that was determined with averaging and digital amplification of the responses in 4 cases showed prolongation in 3 cases while normal in one case. Oscillatory potentials were nonrecordable or barely recordable in all cases.

Twenty-one cases of central pigmentary retinal dystrophy were compiled and their clinical features were described. On the basis of fluorescein fundus angiography, these cases were classified into three types according to the changes in the choriocapillaris. In Type 1, the choriocapillaris showed annular or bow-shaped atrophy around the vascular arcade in the posterior pole of the fundus, but little change in the foveal region. Type 2 exhibited round or irregularly shaped atrophy of the choriocapillaris in the center of the posterior pole of the fundus. Type 3 had no atrophy of the choriocapillaris and showed only hyperfluorescence in the posterior pole of the fundus, due to damage of the retinal pigment epithelium. These types differed from each other not only from the morphological point of view, but also in other clinical findings that included age of onset, progression of visual impairment, pattern of color vision defects or recordability of the electroretinogram. It was discussed that central pigmentary retinal dystrophy consists of heterogenous conditions.

A method was described to record the electroretinogram (ERG) in response to off- and on-stimuli, using Ganzfeld light stimulation. The rapid off-response representing the cone response was recorded with the off-stimuli with the light-dark ratio of 10:1 to maintain a constant photopic condition of 1.6 X 10(3) trolands (Zero log unit). The amplitude of the rapid off-response to completely extinguishing the background light was Vo and the amplitude elicited by intermediate intensities of off-stimuli was V. Vo-V was thought to represent the state of the receptor hyperpolarization, and it was correlated with the stimulus intensity (I) by Log (Vo-V) = nLog I + C; n averaged 0.84 +/- 0.15 in 12 normal subjects, and C was a constant. The scotopic b-wave was recorded by on-stimuli with the light-dark ratio of 1:100 and with the intensity less than -2.0 log units. The cone threshold was calculated using the criterion amplitude of the rapid off-response of 10 microvolts. The rod threshold was likewise computed with the criterion amplitude of the scotopic b-wave of 50 microvolts. The cone and rod sensitivities were determined in 5 patients with progressive cone (-rod) dystrophy and in 8 patients with central pigmentary retinal dystrophy. The cone sensitivity was markedly reduced in the former and the rod sensitivity was highly affected in the latter conditions. Separate evaluations of the cone and rod functions by the present technique will be clinically useful.

A new apparatus was developed for mapping the extrafoveal color vision, the perimetric color vision analyzer. A yellow test object with varying degrees of saturation is presented on a cathode ray tube color display in a random sequence at one of 10 points around the fixation spot. The background is a mosaic pattern consisting of gray spots of the same size and shape as the test object, with various luminances. Background patterns with or without a test object are presented alternately. The subject is instructed to press a key when he detects a yellow object in the background pattern. The luminance of the test object is in the same range as the background gray spots. Since the luminance of background spots is changed synchronously at random when the test object appears, the subject can detect the test object only by the difference in color saturation. The results show the color contrast sensitivity at every designated point in the central visual field. The clinical application of the perimetric color vision analyzer revealed extrafoveal color defects which could not be evaluated with conventional color vision tests. It also showed that in some chorioretinal and optic nerve disorders the topographic pattern of color contrast sensitivity disagrees with that of luminance contrast sensitivity measured with automated static perimetry.