Search

We developed an amblyopia-training device, which can be used easily and inexpensively under binocular conditions with polarizing films. The device uses two polarizing films: one is attached to the training target (such as monitors and books), while the other is attached to the lens of glasses that cover the healthy eye with the absorption axis rotated 90 degrees. This allows the target to be presented only to the amblyopic eye under binocular conditions. Amblyopia training with this device was performed for 1 h per day in 14 patients with anisometropic amblyopia. The training resulted in a significant improvement in visual acuity, and a significant correlation was observed between the improvement in visual acuity and the adherence rate, indicating the effectiveness of the device for amblyopia training under binocular conditions. [ABSTRACT FROM AUTHOR]

We evaluated amblyopia treatment, comparing training with glasses only and training with glasses and the Occlu-pad, a binocular open-type amblyopia training device. Forty-six children (4.8±1.1 years) diagnosed with anisometropic amblyopia, all wearing complete correction glasses, were treated either with glasses only, or with glasses in combination with the Occlu-pad (training time: 2 days a week, 30 minutes per day). We compared visual acuity scores at 3 and 6 months after treatment had started, and examined the compliance rate for the Occlu-pad training. Three months as well as 6 months after amblyopia treatment started, the “Occlu-pad treatment group” showed significantly improved visual acuity, compared to the “Glasses treatment group” (at both 3 and 6 months: p<0.0001). The compliance rate for using the Occlu-pad was 88.4±18.7% after 3 months and 69.6±19.5%, after 6 months. There was no significant correlation between the training time using the Occlu-pad and improvement in visual acuity (3 months: p=0.97; 6 months: p=0.55). The compliance rate for months 4 to 6 was significantly lower than that for months 1 to 3 (p=0.003). Amblyopia treatment using the Occlu-pad device in combination with glasses led to a better effect than treatment with glasses alone. [ABSTRACT FROM AUTHOR]

Target size and test distance effects on stereoacuity were investigated in 24 subjects using a three-dimensional monitor. Examination 1: Target Size Effects. The test distance was 2.5 m for 0.1°, 0.2°, 0.5°, and 0.9° target sizes; crossed parallax was presented in 22-second units. Average stereoacuity values for 0.1°, 0.2°, 0.5°, and 0.9° target sizes were 59.58±14.86, 47.66±13.71, 41.25±15.95, and 39.41±15.52 seconds, respectively. Stereoacuity was significantly worse with a 0.1° target than with 0.2°, 0.5°, and 0.9° target sizes (P=0.03, P<0.0001, and P<0.0001, resp.). Examination 2: Test Distance Effects. Test distances of 2.5, 5.0, and 7.5 m were investigated for a 0.5° target size; crossed parallax was presented in 22-second units. Average stereoacuity values at 2.5 m, 5.0 m, and 7.5 m test distances were 44.91±16.16, 34.83±10.84, and 24.75±7.27 seconds, respectively. Stereoacuity at a 7.5 m distance was significantly better than at distances of 2.5 m and 5.0 m (P<0.0001 and P=0.02, resp.). Stereoacuity at a 5.0 m distance was significantly better than at 2.5 m (P=0.04). Stereoacuity should be estimated by both parallax and other elements, including test distance and target size. [ABSTRACT FROM AUTHOR]

Purpose: In recent years, amblyopia treatment device that can be used with both eyes open have been reported. The Occlu-pad is a device that can present images of tablet terminals to one eye only under binocular open conditions. Till date, no study has reported the effectiveness of Occlu-pad training for anisometropic amblyopia in a series of cases. In the present study, we evaluated the effectiveness of the Occlu-pad for the management of anisometropic amblyopia without the use of occlusion therapy (eyepatch). Materials and Methods: We implemented Occlu-pad training for 22 children (mean age ± standard deviation: 4.7 ± 1.2 years) with anisometropic amblyopia. The visual acuity before treatment initiation was 0.25 ± 0.08. The difference in refraction between the healthy and amblyopic eyes was 3.10 ± 0.58 D. Results: The visual acuity at 3 months and 6 months after training initiation was 0.06 ± 0.09 and −0.04 ± 0.07, respectively; this indicates a significant improvement in vision. The compliance rates for Occlu-pad use during 0 − 3 months and 4 − 6 months after training initiation were 88.6% ± 18.9% and 73.2% ± 18.9%; these rates decreased significantly with time. Conclusions: Our findings suggest that the Occlu-pad is an effective tool for the management of anisometropic amblyopia in children. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of visual target blurring on accommodation.Methods: We evaluated the objective refraction values when the visual target (asterisk; 8°) was changed from the state without Gaussian blur (15 s) to the state with Gaussian blur adapted [0(without blur) → 10, 0 → 50, 0 → 100: 15 s each].Results: In Gaussian blur 10, when blurring of the target occurred, refraction value did not change significantly. In Gaussian blur 50 and 100, when blurring of the target occurred, the refraction value became significantly myopic.Conclusion: Blurring of the distant visual target results in intervention of accommodation. [ABSTRACT FROM AUTHOR]

Purpose: To measure the ocular deviation using a binocular open-view type pupillometer. Methods: Ocular deviation was measured using a phorometer, a binocular open-view type pupillometer, and the alternate prism cover test (APCT). The mean and confidence interval, and the difference between the two measurements were evaluated using a Bland-Altman Plot. Agreement between them was assessed using the intraclass coefficient (ICC). Results: The ocular deviation was −1.34±1.54° for the phorometer and −2.46±1.77° for APCT. The two measurements showed moderate agreement (ICC = 0.89). Conclusion: Binocular open-view type pupillometer can measure ocular deviation which is not influenced by the examiner. [ABSTRACT FROM AUTHOR]

This study used two different testing methods to examine vision in pediatric patients suspected of unilateral functional vision loss. Monocular vision in the affected eye was measured using both standard visual acuity testing methods and OccluPad-aided testing; the latter allows testing of visual acuity in a single eye under both-eyes-open condition. Visual acuity in the affected eye measured using the OccluPad was better than that measured using conventional methods. Additionally, the 24 included patients exhibited visual acuity of at least 20/20. Therefore, the OccluPad-aided visual acuity measurements may be more representative of the true visual acuity than the standard chart visual acuity measurements. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding the study on the impact of pupil dilation on objective refraction.

Isolated atherosclerotic popliteal lesions (IAPLs) have been considered challenging. This study aimed to investigate the efficacy of endovascular therapy (EVT) using the newer devices for IAPLs. This retrospective multicenter registry analyzed patients with lower extremity artery disease having IAPLs who underwent EVT using the newer devices between 2018 and 2021. The primary outcome was primary patency 1 year after EVT. A total of 392 consecutive patients undergoing EVT for IAPLs were enrolled. The Kaplan–Meier analysis showed that the primary patency and the freedom from target lesion revascularization were 80.9% and 87.8% 1 year after EVT, respectively. The multivariate Cox proportional hazards regression analysis showed that the clinical features that were independently associated with restenosis risk were drug-coated balloon (DCB) use for younger age (< 75 years old; adjusted hazard ratio, 3.08 [95% confidence interval 1.08–8.74]; P = 0.035), non-ambulatory status (2.74 [95% confidence interval 1.56–4.81]; P < 0.001), cilostazol use (0.51 [95% confidence interval 0.29–0.88]; P = 0.015), severe calcification (1.86 [95% confidence interval 1.18–2.94]; P = 0.007), and small external elastic membrane (EEM) area measured by intravascular ultrasound (IVUS) (< 30 mm2) (2.07 [95% confidence interval 1.19–3.60]; P = 0.010). From the univariate analysis, among patients treated with DCB, younger patients (n = 141) were associated with more comorbidities including smoking (P < 0.001), diabetes mellitus (P < 0.001), end-stage renal disease (P < 0.001), history of revascularization (P = 0.046) and small EEM area (P = 0.036), compared to older patients (n = 140). Moreover, smaller post-procedural minimum lumen area measured by IVUS after DCB dilatation was observed in younger patients (12 ± 4 vs. 14 ± 4 mm2, P = 0.033). This retrospective study demonstrated that the current EVT provided an acceptable 1-year primary patency rate in patients with IAPLs. The primary patency was lower following DCB in younger patients, likely due to the higher rates of comorbidities in this patient population. [ABSTRACT FROM AUTHOR]

Drug-eluting devices improved outcomes of endovascular therapy (EVT) for femoropopliteal lesions, but mainly for de novo lesions. Endovascular therapy for in-stent restenosis/occlusion (ISR/O) is challenging, and large trials and long-term data are not well reported.This study is a physician initiated, multicenter, and retrospective design. From 7 Japanese institutes, 3635 femoropopliteal cases were enrolled in the study. Among these, 346 cases of first ISR/O were studied. We defined drug-coated-balloon, drug-eluting stent, and covered stent as New devices. Balloon angioplasty and bare nitinol stent were included in the control group.The propensity score matching extracted 112 pairs. At 12 months, the primary patency rate was 80.3% in the new device group and 52.7% in the control group, and there was a significant intergroup difference (P = .004). However, at 36 months, the rate was 43.3% vs 39.2%, with no significant difference (P = .090). No baseline characteristics had any significant interaction effect (all P > .05).The New devices were more effective than the control group for ISR/O at 1 year, but caught up at 3 years. [ABSTRACT FROM AUTHOR]

In Japan, a lower maintenance dose of ticlopidine is used than in the United States and Europe. Therefore a lower maintenance dose of clopidogrel may also be considered appropriate in Japanese patients. The present randomized pilot study evaluated the efficacy and safety of 50 mg clopidogrel in Japanese patients who underwent drug-eluting stent (DES) implantation. A total of 200 patients with 277 lesions who underwent intravascular ultrasound-guided DES implantation were enrolled. The subjects were allocated to the 50- or 75-mg clopidogrel group. All patients received 100 mg aspirin daily before the procedure, and this continued indefinitely. The duration of clinical follow-up was 21.8 ± 5.7 months in the 75-mg group and 21.9 ± 6.1 months in the 50-mg group ( P = 0.96). During follow-up, no cardiac death, myocardial infarction, or stent thrombosis was observed in either group. Side effects of clopidogrel were observed in 4 patients (4.0 %) in the 75-mg group and in 4 patients (4.0 %) in the 50-mg group. Following this randomized pilot study, it may be justified to perform a large-scale randomized study comparing 50- and 75-mg dosing of clopidogrel in Japanese patients undergoing coronary stent implantation. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated endothelial dysfunction after sirolimus-eluting stent (SES) implantation. The present study evaluated the effect of pioglitazone on endothelial dysfunction after SES implantation in nondiabetic patients. A total of 50 nondiabetic patients who had undergone SES implantation were randomly assigned to the pioglitazone group (n = 25) or the control group (n = 25). Endothelial function was estimated by measuring the coronary vasoreactivity in the reference segment within 15 mm proximal and distal to the SES in response to intracoronary acetylcholine infusion (10−8 and 10−7 mol/L) at 9 months of follow-up. Endothelium-independent vasomotion was assessed after an intracoronary bolus of nitroglycerin. Changes in the coronary diameter in response to 10−8 and 10−7 mol/L acetylcholine in the segment proximal to the SES were not significantly different between the pioglitazone and control groups. In contrast, in the segment distal to the SES, vasoconstrictions to 10−8 (−3.0 ± 2.8% vs −7.1 ± 4.5%, p <0.01) and 10−7 mol/L acetylcholine (−6.2 ± 8.0% vs −13.1 ± 8.9%, p <0.01) were attenuated in the pioglitazone group compared to the control group. Endothelium-independent vasodilation to nitrate did not differ between the 2 groups. Multivariate analysis showed that pioglitazone was an independent predictor improving endothelial dysfunction after SES implantation. In conclusion, pioglitazone might improve endothelial dysfunction after SES implantation in nondiabetic patients. [ABSTRACT FROM AUTHOR]

There is little information about coronary artery endothelial dysfunction in patients with sleep apnea. We evaluated relation between severity of sleep apnea and coronary artery endothelial dysfunction. In all, 26 patients without significant coronary stenoses were enrolled. Endothelial function was estimated by measuring coronary vasoreactivity in response to acetylcholine infusion (10-7 mol/L) into coronary arteries. Vasoconstriction rate was defined as ([lumen diameter after isosorbide dinitrate injection - lumen diameter after acetylcholine injection]/lumen diameter after isosorbide dinitrate injection × 100). Vasoconstriction rate was calculated at each major coronary artery and the highest value was used for that patient. Overnight sleep study was performed and the apnea-hypopnea index (AHI) was calculated as the mean number of apneas and hypopneas per hour of sleep. There was significant correlation between AHI and vasoconstriction rate (P = .04). There is significant correlation between severity of sleep apnea and endothelial function of coronary arteries. [ABSTRACT FROM PUBLISHER]

Previous intravascular ultrasound (IVUS) studies have shown coronary artery atherosclerosis even in angiographically normal reference segment. However, IVUS has not been performed in all of the three major coronary arteries. A total of 50 patients with single-vessel disease underwent IVUS evaluation in the proximal two-thirds of the three major coronary arteries. Lumen and external elastic membrane cross-sectional areas were measured at 1-mm intervals. To compensate the difference in pullback length among coronary arteries, normalized total plaque and media volume (TPV) was calculated as TPV/number of slices in pullback × median number of slices in study population. Percent plaque and media volume (PPV) was calculated as TPV/Σ external elastic membrane cross-sectional area × 100. A cross section was defined as atherosclerotic if maximum intimal thickness exceeded 0.5 mm at any point in the vessel circumference. There was no significant difference in normalized TPV, PPV, and the incidence of abnormal intimal thickness between coronary arteries with and without significant stenosis. Frequency distribution of plaque burden was similar. Atherosclerosis is ubiquitous even in coronary arteries without angiographically significant stenosis. The extent of atherosclerosis is similar between coronary arteries with and without significant stenosis. [ABSTRACT FROM AUTHOR]

Whether endothelial dysfunction after sirolimus-eluting stent (SES) implantation is persistent has not been fully evaluated. Endothelial function was evaluated in 152 lesions that underwent follow-up coronary angiography after SES implantation. Lesions were classified into 2 groups according to the duration between SES implantation and follow-up: ≤12 months (n = 95) and >12 months (n = 57). Changes in coronary diameter in response to 10−8 mol/L (−2.4% ± 6.3% vs −4.9% ± 3.8%, P < .01) and 10−7 mol/L acetylcholine (Ach; −4.6% ± 7.6% vs −10.7% ± 9.1%, P < .001) in segment proximal to SES were significantly attenuated in the >12-month group than in the ≤12-month group. There were less changes in coronary diameter in response to 10−8 mol/L (−2.3% ± 4.6% vs −6.9% ± 5.0%, P < .001) and 10−7 mol/L Ach (−6.5% ± 11.4% vs −16.8% ± 10.5%, P < .001) in segment distal to SES in the >12-month group. Endothelial dysfunction may diminish long after SES implantation. [ABSTRACT FROM PUBLISHER]

Usefulness of higher (>300 mg) loading doses of clopidogrel has been demonstrated in studies from the United States and Europe. The present study evaluated platelet aggregation after the administration of a 450-mg loading dose of clopidogrel in Japanese patients undergoing coronary stenting. Platelet aggregation was serially measured at baseline, and 2, 4, 6, and 8 h after 450-mg clopidogrel loading in 25 patients undergoing coronary stenting. Platelets were stimulated with 5 and 20 μmol/l adenosine diphosphate (ADP) and aggregation was assessed by optical aggregometry. Platelet aggregation (5 μmol/l ADP 42.8% ± 13.5% and 20 μmol/l ADP 51.2% ± 11.6%) was significantly suppressed ≤4 h after 450-mg clopidogrel loading. There were no adverse events except one minor nasal bleed. The present study shows that platelet inhibition is achieved ≤4 h after the administration of a 450-mg clopidogrel loading dose in Japanese patients. [ABSTRACT FROM AUTHOR]

In the United States and Europe, patients with coronary stents are maintained on 75 mg clopidogrel. Because the maintenance dose of ticlopidine in patients with coronary stents is 100 mg twice daily in Japan and 250 mg twice daily in the United States and Europe, in Japanese patients a lower dose of clopidogrel may achieve an antiplatelet effect comparable to 200 mg ticlopidine. Platelet aggregation was evaluated in 104 consecutive patients on 50 mg clopidogrel plus aspirin ( n = 54) and 200 mg ticlopidine plus aspirin ( n = 50). Platelets were stimulated with adenosine diphosphate (5 and 20 μmol/l) and aggregation was assessed by optical aggregometry. There was no significant difference in platelet aggregation induced with 5 (37% ± 11% vs 38% ± 15%, not significant) and 20 μmol/l adenosine diphosphate (48% ± 13% vs 51% ± 12%, not significant) between 50 mg clopidogrel and 200 mg ticlopidine. In Japanese patients, there is the possibility that a maintenance dose of 50 mg clopidogrel on platelet inhibition is comparable to 200 mg ticlopidine. [ABSTRACT FROM AUTHOR]

There is little information about the relationship between balloon inflation time and sirolimus-eluting stent (SES) expansion. In this randomized intravascular ultrasound (IVUS) study, 92 de novo lesions in native coronary arteries that underwent SES implantation were enrolled. Sirolimus-eluting stent was implanted using an inflation pressure of 14 atm. Stent balloon was gradually inflated until 14 atm in 10 s. In the short inflation group, it was deflated immediately after an image of the balloon inflated at 14 atm was taken. Stent balloon inflation lasted 60 s in the long inflation group. Intravascular ultrasound was then performed. The long balloon inflation resulted in a larger stent cross-sectional area (4.9 ± 1.6 mm2 vs 4.3 ± 1.4 mm2, P < 0.05) and expansion (71% ± 13% vs 60% ± 13%, P < 0.001) compared to the short balloon inflation, although stent expansion was relatively low in both groups. The relatively longer balloon inflation time using an inflation pressure of 14 atm results in better SES expansion. However, in the majority of lesions, adequate stent expansion is not achieved even using long balloon inflation, if it is inflated at 14 atm. [ABSTRACT FROM AUTHOR]