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The purpose of this study was to derive new formulas to provide an optimal surgical procedure and optimal amount of recession-resection (RR) surgery in intermittent exotropia (IXT) with a disparity in angle of deviation depending on the fixation distance. The records of 117 consecutive patients with IXT who underwent RR surgery between March 2008 and December 2011 at Okayama University Hospital were retrospectively examined. Multivariable linear regression analysis was performed using the observed corrective angle of deviation at distance or near fixation as the dependent variable, and amounts of lateral rectus muscle (LR) recession (mm) and medial rectus muscle (MR) resection, and age at surgery (years) as independent variables. Two simultaneous formulas were derived: corrective angle of deviation at distance fixation (°)=1.8×recession (mm)+1.6× resection (mm)+0.15×age (years)-6.6, and corrective angle at near fixation (°)=1.5×recession (mm)+1.7× resection (mm)+0.18×age (years)-3.8. Comparisons of coefficient values of the formulas between distance and near fixation revealed that LR recession was more affected by the corrective angle in distance than near fixation. MR resection was more affected at near than distance fixation. We found that our new formulas estimated the appropriate amount of unilateral RR surgery.

Background To detect significant factors associated with excessive postoperative exo-drift in young patients with intermittent exotropia who had undergone unilateral lateral rectus muscle recession and medial rectus muscle resection. Methods We retrospectively examined the records of 64 consecutive patients Results Younger patients (P = 0.007), and those with larger preoperative exo-deviation at distance (P = 0.033), a lower incidence of peripheral fusion at distance (P = 0.021) or a greater postoperative initial eso-deviation (P = 0.001), were significantly more likely to have an excessive postoperative exo-drift (> 20 prism diopters). Univariate analysis revealed significant associations between excessive postoperative exo-drift and age at surgery (P = 0.004), preoperative exo-deviation at distance (P = 0.017) and postoperative initial eso-deviation at distance (P P = 0.008) was significantly associated with postoperative exo-drift. Conclusions Postoperative exodrift in unilateral RR is predicted by the initial postoperative eso-deviation, which may offset the overcorrection. However, the exo-drift is greater in cases with a large preoperative exo-deviation and/or at a younger age, and should be followed carefully.

We used spectral-domain optical coherence tomography (SD-OCT) to compare the foveal and parafoveal structures of 19 subjects aged 16-58 years (8 men, 11 women): 6 amblyopic patients with eccentric fixation, 5 amblyopic patients with central fixation, and 8 visually normal controls. We obtained foveal horizontal line scans using SD-OCT on all of the patients and controls. The total and layer thicknesses at foveal areas were analyzed. The mean (SD) ages of individuals in the eccentric fixation, central fixation, and control groups were 43.0 (13.9), 42.2 (16.3), and 38.5 (15.5) years, respectively. We observed no significant differences in the foveal or parafoveal retinal thicknesses at 500 and 1,500 μm from the foveal center among the 3 groups or between the amblyopic and fellow eyes. No significant differences were observed in the thickness of the ganglion cell complex layer or outer retinal layer at 500 and 1,500 μm from the foveal center among the three groups or between the two eyes. Overall, our SD-OCT analyses revealed no characteristic structural change in foveal regions in amblyopic eyes irrespective of the fixation behavior.

We report a case of congenital multiple ocular motor nerve palsy combined with splitting of the lateral rectus muscle (LR). A 59-year-old Japanese female was investigated for worsening esotropia after corrective surgery. She presented with left hypertropia (35Δ) and esotropia (45-50Δ). Orbital magnetic resonance imaging (MRI) showed reduced belly sizes in the superior rectus, inferior rectus, and superior oblique muscles and splitting of the LR, extending from the origin to the belly, in the left eye. Splitting of the LR belly was detected on MRI in a case of congenital multiple ocular motor nerve palsy.

Purpose This study aimed to investigate the characteristics of the extraocular muscles and the orbital connective tissue pulleys in Japanese patients with age-related distance esotropia (ARDE) and high myopia using magnetic resonance imaging (MRI). Methods This was a retrospective case-series study. High-resolution coronal MRI scans of 12 orbits were obtained in 6 patients with ARDE and high myopia (age range: 51–69 years). We analyzed the images to determine the positions of the rectus muscle pulleys relative to the center of the globe, the integrity of the lateral rectus-superior rectus muscle (LR-SR) band, and the LR angle (the angle between the major axis of the LR and the vertical plane). Results The distance esotropia ranged from 4 to 25∆, and 3 cases exhibited vertical deviations. The mean (±standard deviation (SD)) axial length was 28.5 (± 1.6) mm. The mean positions of the medial rectus muscle pulley and LR pulley were 1.3 mm inferior and 1.4 mm inferior, respectively, to those seen in the normal control group in our previous study (P = 0.002 and P = 0.05, respectively). All 12 orbits had abnormal elongated LR-SR bands, and 8 orbits (67%) displayed ruptured LR-SR bands. The LR angle (mean±SD; 18.8° ± 8.5°) increased significantly with the inferior displacement of the LR pulley (R2 = 0.77, P = 0.0002). Conclusions Inferior displacement of the LR pulley and abnormal LR-SR bands were seen in Japanese ARDE patients with high myopia, as was found in ARDE patients without high myopia. The LR angle might be useful for judging the degree of LR pulley displacement.

Purpose To describe our surgical outcomes using a novel muscle transposition procedure, or double-under muscle transposition (DUT), in the treatment of paralytic strabismus. Methods In this surgery, the split halves of the superior and inferior rectus muscles opposite the paralyzed muscle are disinserted, crossed under both the remaining half and the paralyzed muscle, and anchored at opposite corners of the insertion of the paralyzed muscle. The medical records of consecutive patients who underwent DUT were retrospectively reviewed. Outcome measures were angle of deviation and duction deficit. Results Seven patients were included. Diagnoses included WEBINO (n = 1), rupture of the medial rectus muscle (n = 1), and abducens nerve palsy (n = 5). DUT alone was performed in 3 patients; DUT combined with antagonist muscle recession, in 4 patients. One patient underwent the surgery bilaterally. Mean follow-up was 17 ± 18+ months (range, 7-57). Preoperative angles of distance deviation ranged from 25Δ to 142Δ in magnitude. All except a single patient had duction limitation of grade −5. The mean change in distance deviation for DUT alone for each operated eye was 60Δ ± 6Δ (53Δ-65Δ); for combined surgery, 69Δ ± 23Δ (range, 52Δ-103Δ). Final mean angle of deviation at distance was +2Δ ± 3Δ (−4Δ to 0Δ), although an additional surgery was required for large overcorrections in 2 patients. Duction limitation improved in all patients. One patient experienced a postoperative vertical deviation. Conclusions DUT may be an alternative for patients with severely paralytic strabismus not likely to resolve with previously reported muscle transposition surgeries. Overcorrection may occur in some cases.

In retinitis pigmentosa (RP), peripheral visual-field loss starts in early stages, whereas central vision loss occurs in advanced stages. Sensory strabismus gradually occurs in RP. We investigated the relationship between ocular deviation and visual function and explored for sensory strabismus risk factors in 119 consecutive patients with RP at various stages. We assessed ocular deviation at far and near distances, that is the central visual field, using the mean deviation (MD) value and visual acuity (VA), and the residual binocular field area, using Goldmann perimetry (GP), in 33 patients. The horizontal ocular deviation at near distance was >10° in 30% patients and correlated with residual visual function. Although there was no effective cut-off value for central visual function, a cut-off residual GP area of 40 cm2 distinguished patients with a larger from those with a smaller horizontal ocular deviation at far distance (P = 0.04). Our findings suggest that visual function is negatively associated with ocular deviation in patients with RP and that the sensory strabismus risk is relatively high for patients with a binocular visual field 2. Thus, screening for ocular alignment may be necessary for patients with RP-associated severe vision loss as part of their comprehensive care.

Strabismologists are eager to identify preoperative or intraoperative strabismus surgery outcome predictors because of the variable effects in each patient. Conjunctival closure position recession after rectus muscle recession is effective for correcting large angle strabismus. The elasticity of the conjunctiva and Tenon’s capsule is important for strabismus surgery management. In this longitudinal study, we evaluated the prognosis of conjunctiva and Tenon’s capsule thickness (CTT) near the limbus 1 year after strabismus surgery with a limbal conjunctival incision using swept-source anterior segment optical coherence tomography with multiple B-scan averaging. Also, we identified preoperative and/or intraoperative parameters associated with corrective effects 1 year after surgery in 15 consecutive treatment-naïve patients with exotropia or esotropia who underwent recession and resection. The 1-year CTT was greater than the preoperative CTT on the resection side (269 ± 111 vs 183 ± 53 μm, P P = 0.02). The corrective effect of surgery (1.6 ± 0.3°/mm) was most strongly correlated with preoperative CTT on the recession side (P = 0.005, β = −0.73). Hence, CTT on the recession side may provide adjunctive information for strabismus treatment.

Purpose. Several studies have indicated morphological changes in the choroid in amblyopia cases. This study investigates whether choroidal vasculature was different among amblyopic and fellow eyes in unilateral amblyopia patients and healthy eyes, using en face images acquired via swept-source optical coherence tomography (SS-OCT). Design. Prospective, observational case-control study. Methods. This study included 14 consecutive patients with unilateral amblyopia and 22 age- and axial length-matched healthy eyes. Using SS-OCT, we obtained en face images of choroidal vasculature midway through the subfoveal inner and total choroid, corresponding to the vasculature of the choriocapillaris and Sattler’s layer (inner choroid) and Haller’s layer (outer choroid), respectively. We analyzed the en face images of the inner and outer choroidal vascular areas in 3 × 3 mm squares adjusted from 6 × 6 mm squares, using Littmann’s magnification correction, after binarization of the images as a portion of the whole area. Results. The outer choroidal vascular areas were larger in both amblyopic and fellow eyes than in healthy eyes (both P<0.001), although there were no significant differences in inner (56.35 ± 2.46% and 56.27 ± 3.75%, respectively) or outer (61.49 ± 4.95% and 61.48 ± 3.73%, respectively) choroidal vascular area between amblyopic and fellow eyes (P=0.98 and 0.91, respectively). An outer choroidal vascular area of 59% was set as an appropriate cutoff value for distinguishing patients from controls. Conclusions. The outer choroidal vascular area was larger in both amblyopic eyes and fellow eyes compared to healthy eyes. Our findings may help clarify the etiology of amblyopia.

PURPOSE To analyse the disc-fovea angle (DFA) by age group and to compare sex differences in each age group in a large cohort population. METHODS This community-based cross-sectional cohort study included 9682 eyes of 9682 volunteers (aged 30-75 years). We measured the DFA, which is the angle between a horizontal line and a line connecting the fovea with the centroid of an optic disc on fundus photographs of the right eye. We manually marked the fovea and surrounded the optic disc. The centroid of an optic disc and the DFA was automatically calculated using originally developed software. We compared the DFA between age groups in 10-year increments and investigated sex differences of DFA in each age group. RESULTS Overall mean DFA was 6.32 ± 3.53°. The DFA of older subjects was significantly larger than that of younger subjects (p

To ascertain whether conventional treatment can improve visual function in adults with amblyopia. Sixteen patients aged 21–67 years old were instructed to wear glasses for refractive correction and to patch the non-amblyopic eye for at least 1 h per day. Visual acuity, measured with crowded optotypes for distance and near acuity, was checked every 3 months, and followed for a mean (SD) of 14.1 (4.2) months. Prognostic factors related to the subsequent results, an improvement of 3 or more lines logMAR in distance visual acuity, were evaluated. Of 16 patients, 5 (31 %) improved 3 or more lines of distance and 5 (31 %) in near acuity. The mean improvement in distance was 2.4 lines logMAR (95 % CI 1.4–3.5) and 2.4 lines logMAR for near acuity (95 % CI 1.5–3.3). Patients aged under 45 years (p = 0.0357) and with severe amblyopia (p = 0.0337), defined as a corrected distance visual acuity of worse than −0.699 logMAR, were associated with a good response. Conventional treatment may improve the visual acuity of amblyopic eyes even in adult patients.

To investigate the seasonal variations in myopia progression and axial elongation in Japanese children. Ninety-two children who were enrolled in a myopia-control trial and wearing single vision or progressive addition lenses were included in the analyses (mean ± SD age 11.4 ± 1.7 years, mean spherical equivalent refractive error −4.40 ± 1.38 D). Refractive error and axial length were measured every 6 months for 1.5 years by non-cycloplegic autorefraction and partial coherence interferometer, respectively. Myopia progression and axial elongation for each 6-month interval were calculated by subtracting the measure at the end of the interval from that at the beginning. Seasons were classified as summer, winter or others, based on mid-day of the 6-month period between visits. Myopia progression was not significantly influenced by the season. After adjusting study groups (type of spectacles), years and age at the baseline, the mean (±SE) myopia progression was 0.35 ± 0.04 D for summer, 0.28 ± 0.06 D for winter and 0.38 ± 0.04 D for the others. In contrast, axial elongation was significantly influenced by the season, and the mean axial elongation was 0.137 ± 0.010 mm for summer, 0.170 ± 0.013 mm for winter and 0.163 ± 0.008 mm for the others. The seasonal variation in axial elongation, however, was smaller than that previously reported overseas. In Japanese children myopia progression did not slow in summer. Although axial elongation slightly decreased in summer, myopia progression seems to be fairly stable throughout the year.

The utility value was compared among 3 surgical interventions, and the validity of the time trade-off (TTO) method was evaluated by analyzing the correlations of the utility value with the results of the Visual Function Questionnaire-14 (VF-14) and other variables. The subjects were 127 patients aged 40-85 years who were surgically treated between January 2008 and March 2010, including 26 patients with glaucoma, 50 with cataracts, and 51 with comitant strabismus. The scores on VF-14 and utility values determined using TTO were calculated retrospectively. The mean value (SD) of the utility gain was 0.096 (0.105) for glaucoma, 0.101 (0.105) for comitant strabismus, and 0.167 (0.237) for unilateral and 0.245 (0.167) for bilateral cataracts, indicating significant postoperative improvements in the utility value. A significant correlation was observed between the utility value and the postoperative VF-14 scores of the bilateral cataracts, and the postoperative visual acuity of the better eye of the unilateral cataract. The mean value of the quality-adjusted life years was 2.181 for bilateral and 1.424 for unilateral cataracts, 1.132 for strabismus, and 0.870 for glaucoma with an annual discount rate of 3%. The gain of utility value was highest in bilateral cataracts, and lowest in glaucoma, and thus the TTO analysis was considered to be highly valid for cataract surgery.

Idiopathic superior oblique muscle palsy presents, as quantitative phenotypes, vertical deviation and cyclodeviation in eye alignment on clinical testing, and superior oblique muscle hypoplasia on imaging. We determined ARIX and PHOX2B polymorphisms as genotypes, and analyzed phenotype-phenotype and genotype-phenotype correlations in 37 patients with idiopathic superior oblique muscle palsy. Vertical deviations were measured at upright position of the head and head tilt for 30° to either side, and angles of objective excyclodeviations were determined by image analysis on fundus photographs. Cross-sectional areas of the superior oblique muscle near the eye globe-optic nerve junction were measured by image analysis on coronal sections of magnetic resonance imaging to calculate the paretic-side/normal-side ratios. Among the phenotypes, the increase in vertical deviations elicited by head tilt to the paretic side, the decrease in vertical deviations elicited by head tilt to the normal side and the difference of angles of objective excyclodeviations between the paretic side and normal side were significantly correlated inversely with the paretic-side/normal-side ratios of the cross-sectional areas of the muscle (r=-0.43 with P=0.0084, r=-0.34 with P=0.038, and r=-0.43 with P=0.009, respectively, n=37, Pearson's correlation test). Fifteen patients with ARIX and/or PHOX2B polymorphisms had significantly greater paretic-side/normal-side ratios of the muscle compared with 20 patients without the polymorphisms (P=0.017, n=35, Mann-Whitney U-test). The patients with ARIX and/or PHOX2B polymorphisms had less hypoplastic superior oblique muscles.

To determine the position of rectus muscle pulleys in Japanese eyes and to evaluate the effect of oblique muscle surgery on rectus muscle pulleys. Quasi-coronal plane MRI was used to determine area centroids of the 4 rectus muscles. The area centroids of the rectus muscles were transformed to 2-dimensional coordinates to represent pulley positions. The effects of oblique muscle surgery on the rectus muscle pulley positions in the coronal plane were evaluated in 10 subjects with cyclovertical strabismus and, as a control, pulley locations in 7 normal Japanese subjects were calculated. The mean positions of the rectus muscle pulleys in the coronal plane did not significantly differ from previous reports on normal populations, including Caucasians. There were significant positional shifts of the individual horizontal and vertical rectus muscle pulleys in 3 (100%) patients with inferior oblique advancement, but not in eyes with inferior oblique recession and superior oblique tendon advancement surgery. The surgical cyclorotatory effect was significantly correlated with the change in the angle of inclination formed by the line connecting the vertical rectus muscles (p = 0.0234), but weakly correlated with that of the horizontal rectus muscles. The most important factor that affects the pulley position is the amount of ocular torsion, not the difference in surgical procedure induced by oblique muscle surgery.

Endothelial glycocalyx (GCX) has been reported as a protective factor for vascular endothelial cells (VEC) in diabetes and hypertension. However, the involvement of GCX impairment in ocular vasculopathy remains unclear. We evaluated the changes in the GCX thicknesses of the retinal and choroidal capillaries in rats with diabetes and hypertension by cationic colloidal iron staining using a transmission electron microscope. In the control group, the mean (standard error of the mean) thicknesses of retinal and choroidal GCX were 60.2 (1.5) nm and 84.3 (3.1) nm, respectively. The diabetic rats showed a significant decrease of GCX thickness in the retina, but not in the choroid, compared to controls (28.3 (0.3) nm, p＜0.01 and 77.8 (1.4) nm, respectively). In the hypertensive rats, both retinal and choroidal GCX were significantly decreased compared to the control values (10.9 (0.4) nm and 13.2 (1.0) nm, respectively, both p＜0.01). Moreover, we could visualize the adhesion of leukocytes and platelets on the luminal surface of VEC, at the site where the GCX was markedly degraded. These findings suggest that the GCX prevents adhesion of leukocytes and platelets to the VEC surface, and this impairment may lead to ocular vasculopathy in diabetes and hypertension.

To determine whether relative peripheral refraction (RPR) in strabismic children is different from that in normal children.We recruited 25 consecutive patients with comitant horizontal strabismus (mean ± SD age, 10.1 ± 2.6 years) as subjects and 37 children who had no ophthalmic disease except for refractive errors as controls. Cycloplegic refraction was performed with an autorefractometer while the subjects looked at one of five targets horizontally aligned within ± 30°. RPR was calculated by subtracting refraction in the primary position from that obtained at each gaze position.Children with either esotropia or exotropia had small myopic RPR on average, whereas the controls showed significant hyperopic RPR. In children with exotropia, a wide intersubject difference in RPR was found in the nasal retina. These profiles of RPR were observed in both dominant and nondominant eyes.The results of this study indicate that children with horizontal strabismus have different RPR than normal controls. Defocus in the peripheral retina associated with the misalignment of the eyes during near work might be the reason for the differences, considering the visual regulation mechanism of eye shape.

The data for 94 consecutive patients with intermittent exotropia of basic type, ranging from 20 to 40 prism diopters (delta), who preoperatively wore neutralizing prisms for 3 to 5 days, were studied retrospectively. The surgery in 43 patients in whom the amount of increase of angle was 4delta or less was based on the original angle (Group A), while that in 51 patients in whom the magnitude of increase was 5delta or more was based on the increased angle of deviation (Group B). Patients with initial deviation less than 30delta and patients younger than 7 years of age showed an increase of deviation with prism correction. There were no significant differences in surgical results between the two groups at 1 year, and at 3 years; although at 3 years satisfactory motor alignment and binocular function for single vision at distance was higher in Group B than that in Group A.

We have designed a new type of retinal prosthesis using polyethylene films coupled with photoelectric dye molecules that absorb light and convert photon energy to electric potentials. An extruded-blown film of high-density polyethylene was used as the original polyethylene film. Recrystallized film was made by recrystallization from the melting of the original polyethylene film. A photoelectric dye,2-[2-[4-(dibutylamino)phenyl]ethenyl]-3-carboxymethylbenzothiazolium bromide, was coupled to the two types of polyethylene films through amide linkages. Samples of the original dye-coupled film, the dye-coupled recrystallized film, and the dye-uncoupled plain film were implanted in the subretinal space of normal adult rats. Frozen sections were cut from the eyes enucleated at 1 week or 1 month and were either stained with hematoxylin and eosin, stained immunohistochemically for glial fibrillary acidic protein (GFAP), or processed for in situ apoptosis detection. The results revealed that retinal tissue damage was negligible with no inflammatory cells and few apoptotic cells. GFAP was significantly up-regulated in retinal sites with the implantation of all types of polyethylene films at 1 week, compared with the adjacent retinal sites (P < 0.005, analysis of variance). The GFAP up-regulation was also present at 1 month for the plain film and dye-coupled recrystallized film (P < 0.05). Glial cell encirclement around the films increased significantly between 1 week and 1 month (P = 0.023, two-factor analysis of variance) but was not significantly different among the three types of polyethylene films (P = 0.4531). These results showed evidence of glial reactions to the photoelectric dye-coupled polyethylene films implanted into the subretinal space of rat eyes and also proved their basic biological safety.

To report the 1-year results of macular hole surgery with triamcinolone acetonide (TA)-assisted internal limiting membrane (ILM) peeling and to compare those with results of indocyanine green (ICG)-assisted ILM peeling.In a nonrandomized, retrospective, interventional case series, 40 eyes of 39 consecutive patients with idiopathic full-thickness macular holes underwent macular hole surgery with TA-assisted ILM peeling. Surgical results 1 year after surgery, including changes in best-corrected visual acuity (BCVA) and macular hole closure, were evaluated. Moreover, we compared the results for these 40 eyes (TA group) with those for 27 eyes of 27 consecutive patients who had undergone macular hole surgery with 0.25% ICG-assisted ILM peeling (ICG group).In the TA group, macular holes were closed in 39 (98%) of 40 eyes. Mean BCVA +/- SD significantly improved from 0.78 +/- 0.31 logarithm of the minimal angle of resolution (logMAR) preoperatively to 0.20 +/- 0.30 logMAR (P0.001). BCVA improved byor =0.2 logMAR in 37 eyes (93%). BCVA was 20/40 or better in 33 (83%) of 30 eyes. In the ICG group, macular holes were closed in all 27 eyes (100%), and mean BCVA +/- SD significantly improved from 0.81 +/- 0.4 logMAR preoperatively to 0.34 +/- 0.2 logMAR 1 year postoperatively (P0.001). BCVA improved byor =0.2 logMAR in 22 eyes (81%). BCVA was 20/40 or better in 16 (59%) of 27 eyes. Significant differences between groups were seen in mean BCVA 1 year after surgery (P = 0.049) but not in BCVA of 20/40 or better (P = 0.17) or change in BCVA byor =0.2 logMAR (P = 0.05).TA is useful as an adjuvant for ILM peeling in macular hole surgery, and BCVA 1 year after surgery might be more favorable when compared with ICG-assisted ILM peeling.

To investigate the structural basis of three cases of apparent superior oblique (SO) palsy caused by extraocular muscle (EOM) pulley heterotopy. Three subjects were diagnosed as having decompensated idiopathic left SO palsy on the basis of misalignment in diagnostic gaze positions, response to the head tilt test, and results of the Hess screen test. Magnetic resonance imaging of the orbits in coronal planes was used to determine SO muscle size and contractility and to define the rectus EOM pulley locations. Orbit 1.8 computer simulation was performed for each subject by using measured rectus pulley locations. Simulated binocular alignment was compared with the measurements. The maximal SO cross sections of both eyes of each subject were similar, and exhibited similar contractile thickening from supraduction to infraduction. The superior rectus muscle pulleys in three eyes exhibited significant temporal displacement, while the lateral rectus muscle pulleys in five eyes and the medial rectus muscle pulleys in two eyes were displaced significantly inferiorly compared with published norms. Simulations based on observed pulley position abnormalities alone predicted measured Hess screen data better than did simulations incorporating SO weakness, either alone or combined with other structural abnormalities. Heterotopy of the rectus EOM pulleys may be associated with cyclovertical strabismus that simulates SO palsy.

Purpose: Lags of accommodation in ametropic children are often evaluated through spectacle lenses (over-refraction). This study investigated the validity of over-refraction when using an autorefractor. Methods: Using an autorefractor (Shin-Nippon SRW-500/Grand-Seiko WV-500), refractive readings were obtained in 25 cyclopleged eyes (mean ± S.D. refraction: −3.44 ± 3.56 D, range: from −10.56 to +0.25 D) while placing spherical lenses of different power (from −5.00 to +5.00 D) in front of the eye at a vertex distance of 12 mm. Based on the refractive readings with and without the lens, and the lens power, measurement errors were estimated. Similarly, the measurement errors were estimated also in model eyes of −10.00, −4.75, 0.00 and +10.00 D. The results were compared with ray-tracing simulations based on the internal specifications of the autorefractor. Results: Measurement errors were found unless the power of the spectacle lens was equal to the refractive error of the eye. When the spectacle lens power was greater (less myopic or more hyperopic) than the refraction of the eye, the measurement error was negative in sign and greater than −0.3 D. It follows that, when an accommodative response is measured in myopic subjects, the refractive reading usually becomes more myopic than the refraction of the eye including the accommodative response; hence, the accommodative response is overestimated, and the lag of accommodation is underestimated. Conclusions: The autorefraction through spectacle lenses involved systematic measurement errors. The extent of the errors is usually small but needs to be taken into account in a comparative study of accommodative responses among different refractive groups.

Photoelectric dyes, which absorb light and convert photon energy to electric potentials, were shown to stimulate retinal neurons in culture. One of these dyes coupled with polyethylene film surface, as a prototype of retinal prostheses, could induce intracellular calcium elevation in chick embryonic retinal tissues. In this study, we used retinal cells from chick embryos in which no photoreceptor outer segments yet developed, and assessed cell adhesiveness and response to the original and modified types of our retinal prostheses. Extruded-blown film of high density polyethylene was used as the original polyethylene film. Polyethylene film surface was modified either by coupling with type 1 collagen or by crystallization from the melt of the original polyethylene film. A photoelectric dye, 2-[2-[4-(dibutylamino)phenyl]ethenyl]-3-carboxymethylbenzothiazolium bromide, was coupled to these different types of polyethylene films through amide linkage. Retinal cells from chick embryos at the 12-day embryonic stage were cultured on the surface of dye-coupled films. The response of retinal cells to the dye-coupled films was observed by calcium imaging. Cell types, either neurons or glial cells, were detected by immunocytochemical staining and also observed by scanning electron microscopy (SEM). Intracellular calcium elevation was observed in cells, including both neurons and glial cells, on the surface of the original dye-coupled film, collagen-coated dye-coupled film, and dye-coupled recrystallized film, in contrast with no response of cells cultured on the dye-uncoupled plain film. Retinal neurons grew upon colonies of glial cells settling on the surface of all different types of the films. The number of retinal neurons on the collagen-coated dye-coupled film and dye-coupled recrystallized film was significantly larger than the number of neurons on the dye-uncoupled plain film (P = 0.0004, analysis of variance; P

To determine the influence of the lag of accommodation (LOA) on the accommodative convergence to accommodation (AC/A) ratio measured by the far-gradient method in strabismic patients. The AC/A ratio was measured with a distance target viewed with and without −3.00 diopter (D) addition lenses in 63 patients with different types of strabismus (age range, 7–34 years; range of strabismic angle, −60 to +40 prism diopters; refractive error range, −7.33 to +6.63 D). The LOA for the same lens was measured with an open-view-type autorefractometer. The stimulus AC/A ratio and the AC/A ratio adjusted by the individually measured LOA (adjusted AC/A ratio) were compared. The mean ± SD of the LOA to the −3.00 D lenses was 1.06 ± 0.43 D. The mean adjusted AC/A ratio was 41% greater than the stimulus AC/A ratio. The LOA differed widely among patients (0.13 to 2.14 D), and a large LOA tended to appear in myopic or young patients. The AC/A ratio obtained using the conventional far-gradient method is significantly biased by the LOA, and thus does not always represent the actual relationship between accommodation and vergence control systems. Jpn J Ophthalmol 2006;50:438–442 © Japanese Ophthalmological Society 2006

To search for the mechanism of the effect of trehalose on the ocular surface applied as eye drops, we observed trehalose-treated and dried corneal epithelial surfaces of porcine eyes with atomic fo...

To determine the validity and usefulness of a newly developed measurement method of static ocular counterrolling (s-OCR) that eliminates false-torsion factors and to test the Jampel hypothesis that s-OCR does not exist. A lightweight measurement device, consisting of a video camera, a coaxial light source, and a laser pointer projecting a fixation target on the wall, was fixed to a subject's head by means of a mouthpiece. In 11 healthy adults (mean age: 30 ± 15 years), digital images of the right eye were captured while the subject kept his head tilted at a randomly selected angle ranging from 0° to 50°. By a frame-by-frame analysis of movements of the corneal light reflex and the iris patterns, OCR was evaluated. Torsional eye movement in the opposite direction to head tilt was found in all subjects. The amount of torsion continuously increased until the head-tilt angle reached 40°. The average (± SD) amplitude of a fitted sine curve was 7.6 ± 3.2° (range: 4.3°–10.3°), and the individual amplitude was significantly larger than the test–retest repeatability of the measurement (±1.7°). The measurement method used in this study provided good test–retest repeatability and ease of application. The characteristics of torsional eye movements that we observed after minimizing the false-torsion factors agree with previous reports supporting the existence of s-OCR. Jpn J Ophthalmol 2005;49:497–504 © Japanese Ophthalmological Society 2005

Purpose: To clarify how the downward deviation of progressive addition lenses (PALs) reduces their near-addition effect in schoolchildren participating in a myopia control trial. Methods: Among 95 schoolchildren wearing PALs for 6 months (age range: 6–12 years; refractive error range: −6.00 to −1.25 D), facial images were captured with a digital still camera placed 60 cm in front of the eyes while he or she was looking ahead with natural head posture. The vertical deviations of PALs from their ideal position (mm) were evaluated by analysing these images. Results: The mean (±SD) downward deviations of PALs for the right and left eyes were 3.7 ± 2.3 and 3.7 ± 2.0 mm, respectively, and the largest downward deviation was 10.2 mm. For simulations using the average downward deviation, the near-addition effect of PALs was reduced to 30 and 63% of the expected value at the 10° and 20° downward eye positions, respectively. Conclusions: The downward deviation of PALs is a significant factor in reducing their therapeutic effect for near-addition. To ensure the proper alignment of PALs in children, the conventional spectacle-frame-fitting procedure is not sufficient, and repeated confirmation using a testing method similar to that used in this study is required.

To identify ARIX gene and PHOX2B gene polymorphisms in patients with congenital superior oblique muscle palsy, 3 exons of the ARIX gene and PHOX2B gene were sequenced by genomic DNA amplification with polymerase chain reaction (PCR) and direct sequencing in 31 patients with congenital superior oblique muscle palsy and in 54 normal individuals. A family with a father and one daughter each having congenital superior oblique muscle palsy was also included in this study. Eleven patients with congenital superior oblique muscle palsy had heterozygous nucleotide changes in the ARIX gene, including 4 patients reported on previously. One patient with atrophy of the superior oblique muscle had a new change of T-4G in the promoter region of the ARIX gene. The other 6 patients had a heterozygous nucleotide change of G153A in the 5'-untranslated region (UTR) of the exon 1 of the ARIX gene. These nucleotide changes of the ARIX gene, taken together, had a significant association with congenital superior oblique muscle palsy(P = 0.0022). One patient and 5 patients had heterozygous nucleotide changes of A1106 C and A1121 C in exon 3 of the PHOX2B gene, respectively, while these changes were absent in the normal individuals. Two patients had both the G153A change in the 5'-UTR of exon 1 of the ARIX gene and the A1121 C change in exon 3 of the PHOX2B gene. In conclusion, the polymorphisms of the ARIX gene and PHOX2B gene may be genetic risk factors for the development of congenital superior oblique muscle palsy.

To evaluate with a synoptophore slant perception induced by binocular cyclodisparities in normal subjects and to argue for the possibility of abnormal slant perception in patients with cyclo-vertical strabismus.A vertical line with cyclodisparities that ranged from 0 degrees to +/- 10 degrees was presented to 17 normal subjects (mean +/- SD age, 28.4 +/- 5.6 years; 11 men and 6 women) with a synoptophore, and the perceived slant of the line in the pitch plane was measured by a matching method. Cyclodisparity thresholds for top-away and top-forward slants were also evaluated by the method of limits in a separate experiment.An incyclodisparity induced top-forward, while an excyclodisparity induced top-away, slant perception. The maximum slant angle was 37 degrees on average at a cyclodisparity of 10 degrees , and the mean slant gain (perceived angle/geometrically calculated angle) was 64 +/- 13%. The mean cyclodisparity thresholds for top-away and top-forward slants were -1.1 degrees and 0.6 degrees , respectively.The slant perception induced by cyclodisparities was reasonably assessed with the synoptophore. The cyclodisparity thresholds obtained in this experiment were much lower than the cyclodeviation range of the patients, indicating that a considerable number of patients may have abnormal slant perception once they achieve sensory fusion.

Photoelectric dyes, which absorb light and convert photon energy to electric potentials, have been previously shown to stimulate retinal neurons in culture. In this study, a photoelectric dye was coupled to a polyethylene film surface and tested in vitro using retinal tissues from chick embryos at the 12-day embryonic stage, at which time outer segments of retinal photoreceptor cells have not yet developed. Carboxyl moieties were introduced to a polyethylene film surface by fuming nitric acid, and then a photoelectric dye, 2-[2-[4-(dibutylamino)phenyl]ethenyl]-3-carboxymethylbenzothiazolium bromide, was coupled to the film through amide linkage. Intracellular calcium elevation was observed with Fluo-4 in retinal tissues placed on the dye-coupled polyethylene film, in contrast to retinal tissues which had no contact with the film. The response was inhibited by calcicludine, a voltage-gated calcium channel blocker, and also by extracellular calcium depletion. The photoelectric dye, coupled to the polyethylene film surface, absorbed light under a dissecting microscope and stimulated neurons in retinal tissues, showing that the dye-coupled film could be used as a prototype of retinal prostheses.

Theoretically, the catalytic decomposition of methane (CH 4 → C + 2H 2 ) followed by the oxidations of the deposited carbon with CO 2 and O 2 ((1/2)C + (1/2)CO 2 → CO, (1/2)C + (1/2)O 2 → (1/2)CO 2 ) give just an over-all reaction CH 4 + (1/2)O 2 → 2H 2 + CO (Δ H 1073 = −20 kJ/mol), requiring no energy input with zero CO 2 -emission. The catalytic performances of Ni/SiO 2 , Ni/TiO 2 , Ni/Al 2 O 3 and Pd–Ni/SiO 2 for the repeated decomposition of methane and oxidation of the formed carbon nanofibers with O 2 have been studied in detail. Ni/TiO 2 , Ni/Al 2 O 3 and Pd–Ni(1:3)/SiO 2 were found to be promising catalysts because the catalytic activities completely lost during precedent decomposition of methane could be recovered repeatedly by the oxidation of the formed carbon nanofibers with O 2 . All the carbons fibers that formed on supported-Ni catalysts were oxidized at >753 K. Temperatures higher than 773 K were needed for complete oxidative removal of carbon fibers on Pd–Ni/SiO 2 . The apparent activation energies for the oxidation of the carbon fibers did not differ much (150–170 kJ/mol) for all the catalysts. The activation energies for the carbon fibers after Ni-elimination treatment gave similar values. These results indicated that the catalysts did not contribute to the oxidation of the carbon nanofibers.

To evaluate the convergence accommodation to convergence (CA/C) ratio in strabismic patients and to clarify its clinical implications.Seventy-eight consecutive patients (mean age: 12.9 +/- 6.0 years) with intermittent exotropia and decompensated exophoria who showed binocular fusion at least at near viewing were recruited. The CA/C ratio was estimated by measuring accommodative responses induced by horizontal prisms with different magnitudes under accommodation feedback open-loop conditions. The CA/C ratios were compared with accommodative convergence to accommodation (AC/A) ratios and other clinical parameters.A linear regression analysis indicated that the mean (+/-SD) CA/C ratio was 0.080 +/- 0.043 D/prism diopter or 0.48 +/- 0.26 D/meter angle. There was no inverse or reciprocal relationship between CA/C and AC/A ratios. The patients with lower CA/C ratios tended to have smaller tonic accommodation under binocular viewing conditions and larger exodeviation at near viewing.The CA/C ratio, like the AC/A ratio, is an independent parameter that characterizes clinical features. A lower CA/C may be beneficial for the vergence control system to compensate for ocular misalignment with minimum degradation of accommodation accuracy.

Purpose To evaluate the transposition of the anterior superior oblique insertion as a treatment for cyclovertical diplopia accompanied by an awareness of tilted image perceived with the affected eye induced from limited macular translocation (LMT). Design Observational case series. Methods Transposition of the anterior part of the superior oblique tendon combined with or without vertical muscle surgery on the affected eye was retrospectively studied in seven patients. Clinical outcome was assessed for binocular and monocular vision. A successful result was defined as restoration of single binocular vision (SBV) at distance and near examined with the Bagolini test with disappearance of a tilted image perceived in the affected eye. Results Six of seven patients (86%) became unaware of tilted image, and three patients (43%) obtained successful results after the strabismus surgery. Of these three patients with successful results, one (33%) patient recognized metamorphopsia, whereas two (67%) of the three patients with unfavorable results reported metamorphopsia. Patients with successful results showed a visual acuity of 20/25 or better in the affected eye and a significantly smaller difference in visual acuity between the two eyes than those patients with unfavorable surgical results (0.133 logarithm of the minimal angle of resolution for SBV(+) vs 0.675 logarithm of the minimal angle of resolution for SBV(-); P = .0255). Conclusions The relatively low success for restoration of SBV indicates that strabismus surgery is recommended for patients whose difference in visual acuity between the two eyes is small and who have a high level visual acuity of the affected eye.

To study the clinical relevance of sequence alterations in the optineurin gene (OPTN) among Japanese patients with open-angle glaucoma, including both primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG).Genomic DNA was isolated from 83 patients with open-angle glaucoma (55 with POAG and 28 with NTG) and 58 control subjects. The 13 exons of OPTN corresponding to the coding region were amplified by polymerase chain reaction and directly sequenced. Clinical factors were compared between glaucoma patients with and without a certain nucleotide change.The reported heterozygous mutations, c.458GA(Glu50Lys) in exon 4 and c.691_692insAG in exon 6, were not found in any glaucoma patients or control subjects. The reported c.603TA(Met98Lys) in exon 5 was significantly more prevalent in the POAG (8/55, 14.5%, p=0.0147) and NTG (4/28, 14.2%, p=0.0369) patients, and even in both the POAG and NTG patients combined (12/83, 14.4%, p=0.0149, Fisher exact probability test), than in the control subjects (1/58, 1.7%). The rates of the reported c.1944GA(Arg545Gln) in exon 16 were not significantly different between open-angle glaucoma patients (3/83, 3.6%) and control subjects (4/58, 6.8%). In addition, a heterozygous change, c.412GA(Thr34Thr) in exon 4 was found in 18 (21.6%) open-angle glaucoma patients and seven (12.0%) control subjects. Another heterozygous change, c.457CT(Thr49Thr), in exon 4 was found only in three POAG patients. The 18 open-angle glaucoma patients with c.412GA showed significantly larger cup-to-disc ratios (p=0.0178, Mann-Whitney U test), significantly more deteriorated mean deviations of the visual field in the left eye at the final visit (p=0.0076), and a significantly higher rate of surgery and/or laser history (p=0.0321, Fisher exact probability test) than the 65 open-angle glaucoma patients without the nucleotide change.Met98Lys is a risk-associated alteration for open-angle glaucoma, including POAG and NTG, in the Japanese population as initially reported. The amino acid-preserving polymorphism, c.412GA, may be a genetic risk factor for the progression of open- angle glaucoma in this Japanese population.

A novel oligodendrocyte (OL)-specific cDNA was isolated from brain capillary endothelial cells and characterized. The cDNA encodes a protein of 1099 amino acids that contains a signal peptide and a transmembrane domain. The protein was expressed in mature OLs in vivo and in vitro cell cultures and was thus designated as mature OL transmembrane protein (MOLT). RT-PCR analysis showed that MOLT mRNA was expressed in brain, lung, pancreas, and testis. A polyclonal antibody raised against a part of the mouse MOLT reacted specifically with multipolar OLs possessing radially oriented processes that penetrated into the gray matter. More cells were detected in the white matter, and these had longitudinally oriented processes. In a rat OL lineage culture system, oligodendrocyte precursor cells did not initially produce MOLT mRNA and protein, but when they begun to differentiate into mature OLs, they started expressing MOLT. Consequently, MOLT may function as OLs become mature and may serve as a cell-surface marker for OL differentiation.

Purpose: To elucidate the genetic or environmental background for clinical features in the three major types of comitant strabismus. Methods: Interview based on a questionnaire asking background factors such as family history of strabismus and abnormalities in pregnancy and delivery was conducted with 101 consecutive patients with infantile esotropia (5–180 months of age), 83 with accommodative or partially accommodative esotropia (6–201 months of age), and 143 with intermittent exotropia (3–216 months of age) seen during 7 months from May to November 1998. The clinical features of strabismus obtained from medical records were analyzed statistically by logistic regression to determine their relation with these background factors. Results: In infantile esotropia, patients with family history of strabismus had a significantly higher chance of showing latent nystagmus (odds ratio, 3.553; 95% confidence interval [CI], 1.077–11.717; P = .0373, logistic regression analysis). In a subgroup of 40 patients with infantile esotropia whose birth followed no abnormalities in pregnancy or delivery, patients with family history of strabismus had a significantly higher chance of showing inferior oblique muscle overaction (odds ratio, 7.714; 95% CI, 1.246–47.761; P = .0280), dissociated vertical deviation (odds ratio, 6.667; 95% CI, 1.176–37.787; P = .0321), and latent nystagmus (odds ratio, 7.333; 95% CI, 1.168–46.060; P = .0336). In accommodative or partially accommodative esotropia and intermittent exotropia, no relation was found between the clinical features and the background factors. Conclusions: Inferior oblique muscle overaction, dissociated vertical deviation, and latent nystagmus in infantile esotropia might have a genetic background.

To arrive at an understanding of the differences in gene and protein expression between human lateral and medial rectus muscle tissue excised from strabismic patients.Resected fragments of the lateral and medial rectus muscles obtained during strabismus surgery were frozen under liquid nitrogen and pulverized by a Freezer/Mill system. Radiolabelled cDNA was synthesized from polyA+ RNA and hybridized with a gene array nylon membrane (Atlas Human 1.2 Array) to detect the difference in gene expression between the lateral and medial rectus muscles. Based on the gene array results, tissue inhibitor of metalloproteinases (TIMP)-1 and 2, matrix metalloproteinase (MMP)-2, and bone morphogenetic protein (BMP)-4 were measured in solubilized muscle tissues by enzyme immunoassay and normalized by unit length of resection.The resected lateral rectus muscle had significantly smaller amounts of TIMP-1, TIMP-2 and BMP-4 but larger amounts of MMP-2 compared to the medial rectus muscle (P0.001, Mann-Whitney U test). The amounts of TIMP-1 in the muscle when the lateral and medial rectus were combined were positively correlated with TIMP-2 and BMP-4, while the amounts of TIMP-2 positively correlated with BMP-4 (P0.001, Spearman rank correlation test). The amounts of BMP-4 in both muscles increased significantly with age (P = 0.0003).Resected tissue from the lateral and medial rectus muscles had different levels of expression of TIMP-1 and 2, MMP-2, and BMP-4. These molecular differences may underlie different characteristics of the two extraocular muscles and may also influence the process of wound healing after strabismus surgery.

Using RT-PCR-based cDNA cloning, we identified novel splice variants of amphiphysin I, termed amph Ir, that are expressed specifically in retina. In comparison with the prototype amphiphysin I, amph Ir contained two novel insertions (inserts A and B) and one deletion. Insert A is only 9 bp in length but appears to be a determinant for the retina-specific expression. In contrast, insert B is a large domain of 1740 bp and two shorter transcripts with 3′-truncated insert B were also expressed. All the insert sequences were present as unidentified exons in the amphiphysin I gene on human chromosome 7. Western blot analysis of various rat tissues with anti-insert B antibody confirmed the presence and tissue specificity of the variant proteins.

Purpose. To identify risk factors for diabetic choroidopathy in patients with type 2 diabetes. Methods. Forty-five consecutive patients with diabetic retinopathy underwent simultaneous indocyanine green angiography (ICG) and fluorescein angiography using a double detector and confocal scanning laser ophthalmoscopy in both eyes. Choroidal vascular abnormalities were evaluated by comparing the angiographic findings derived from the two methods. We analyzed the association between the presence of abnormal choroidal lesions evident on ICG angiography and several risk factors. Results. Choroidal abnormalities evident on ICG angiography but not on fluorescein angiography included hypofluorescent spots in 72 eyes (80%) of 40 patients (89%), small hyperfluorescent spots in 61 eyes (68%) of 35 patients (78%), and large hyperfluorescent spots in 32 eyes (36%) of 21 patients (47%). The severity of diabetic retinopathy was significantly associated with the presence of hypofluorescent spots (P=0.002, Cochran–Armitage test) in both eyes and with the small hyperfluorescent spots in the right eyes (P=0.047, Cochran–Armitage test). Glycosylated hemoglobin levels were significantly associated with the large hyperfluorescent spots in the right eyes (P=0.003, Fisher's exact probability test), and the treatment regimen was significantly associated with the small hyperfluorescent spots in the left eyes (P=0.048, chi-square test). Conclusion. These data suggest that risk factors influencing the prevalence of diabetic choroidopathy in patients with type 2 diabetes mellitus may include severity of diabetic retinopathy, degree of diabetic control and treatment regimen.

To investigate the ability of patients with strabismus and/or amblyopia to see 3D images.A questionnaire survey conducted for children aged 6 to 19 years and adults aged 20 to 39 years on their experience of viewing 3D images (movies, motion attractions, television, games), asking whether they could see stereoscopically, with or without adverse effects. A retrospective investigation of ophthalmological examinations was followed.Of 507 cases, 342 had had the experience of veiwing 3D images. In 212 (62%) cases of strabismus and/or amblyopia, stereopsis was lacking in 17 to 18% of the subjects for movies, in 6 to 7% for attractions, in 32% in children and 50% in adults for television and 23% in children and 17% in adults for games. Adults complained of a higher rate of adverse effects, 65% for movies and 75% for games, as compared with 34% for movies and 26% for games in children(p0.01). The lack of stereopsis for games and movies was higher in the subgroup of Fly (-) and convergence insufficiency (p0.05).Since many patients with strabismus and/or amblyopia found some difficulty in stereoscopic viewing, precise examinations for stereopsis and convergence are needed to assess individual aptitude for 3D viewing.

Purpose: The effect of mechanical stretch was examined on cultured retinal pigment epithelial (RPE) cells in order to observe changes in their production of tissue inhibitor of metalloproteinase-1 (TIMP-1) and vascular endothelial growth factor (VEGF) in response to physiological strain. Methods: Bovine RPE cells in near-confluent culture were exposed to mechanical stretch of the bottom of a 6-cm petri dish at the maximum magnitude of 4500 microstrain and at a cycle of 30 seconds for 72 hours. TIMP-1 and VEGF levels in the medium following 24, 48, and 72 hours of cyclic stretch were measured by enzyme immunoassay. Results: The growth of RPE cells during the 72-hour period of stretching did not show a significant difference from that of nonstretched control cells. RPE cells in the stretched group produced a significantly larger amount of TIMP-1 at 48 and 72 hours after stretch, compared with nonstretched control ( P = .044 and P = .027, respectively, Student t -test). The levels of VEGF produced by RPE cells were not significantly different between the stretched group and nonstretched control group. Conclusions: The secretion of TIMP-1 by bovine RPE cells was enhanced by cyclic mechanical stretch. Mechanical strain is one factor in regulating the secretion of TIMP-1 by RPE cells.