Psychometric properties of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), Japanese version

BACKGROUND: The importance of evaluating the outcomes of health care from the standpoint of the patient is now widely recognized. The purpose of this study is to develop and test a Japanese version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). METHODS: A Japanese version was developed with a previously standardized method. The questionnaire and optional items were completed by 245 patients with cataracts, glaucoma, or age-related macular degeneration, by 110 others before and after cataract surgery, and by a reference group (n = 31). We computed rates of missing data, measured reproducibility and internal consistency reliability, and tested for convergent and discriminant validity, concurrent validity, known-groups validity, factor structure, and responsiveness to change. RESULTS: Based on information from the participants, some items were changed to 2-step items (asking if an activity was done, and if it was done, then asking how difficult it was). The near-vision and distance-vision subscales each had 1 item that was endorsed by very few participants, so these items were replaced with items that were optional in the English version. For example, more than 60% of participants did not drive, so the driving question was excluded. Reliability and validity were adequate for all subscales except driving, ocular pain, color vision, and peripheral vision. With cataract surgery, most scores improved by at least 20 points. CONCLUSION: With minor modifications from the English version, the Japanese NEI VFQ-25 can give reliable, valid, responsive data on vision-related quality of life, for group-level comparisons or for tracking therapeutic outcomes

Effects of topical latanoprost on optic nerve head circulation in rabbits, monkeys

PURPOSE. To evaluate the effect of topically administrated latanoprost on optic nerve head (ONH) circulation in Dutch rabbits, cynomolgus monkeys, and normal humans. METHODS. The ONH tissue blood velocity (NB ONH ) was determined using the laser speckle method. Latanoprost (0.005%, 30 l) was instilled into one eye, and vehicle into the other eye as a control. In rabbits, NB ONH was measured for 90 minutes after a single instillation and before and after a 7-day once-daily instillation regimen. In monkeys, NB ONH was measured before and after 1, 4, and 7 days of a once-daily instillation regimen. The effect of intravenous indomethacin on the latanoprostinduced NB ONH change was also studied in rabbits and monkeys. In humans, the time-course changes in NB ONH were measured for 4.5 hours before and after a 7-day once-daily instillation regimen. Intraocular pressure (IOP) and systemic parameters were simultaneously studied in each experiment. All measurements were performed by investigators masked to the experimental condition. RESULTS. Latanoprost significantly increased NB ONH 10% to 19% in treated eyes after a single instillation (P ϭ 0.035) or 7-day instillation regimen (P ϭ 0.035) in rabbits, after a 4-day (P ϭ 0.035) or 7-day (P ϭ 0.035) instillation regimen in monkeys, and after a 7-day (P ϭ 0.013) instillation regimen in humans, whereas there were no significant changes in the vehicletreated eyes in any of the experiments (P Ͼ 0.5). Pretreatment with indomethacin (5 mg/kg) abolished the NB ONH increase but not the IOP reduction in latanoprost-treated eyes in rabbits and monkeys. IOP remained unchanged in both eyes in rabbits (P Ͼ 0.4), whereas it significantly decreased only in latanoprost-treated eyes in monkeys (P Ͻ 0.05) and humans (P Ͻ 0.05). CONCLUSIONS. Topical latanoprost significantly increased ONH blood velocity only in treated eyes in rabbits, monkeys, and humans. This effect was independent of the IOP-reducing effect of latanoprost and probably was associated with local penetration of the drug and the production of endogenous prostaglandins. (Invest Ophthalmol Vis Sci. 2001;42:2957-2963 L atanoprost, a recently developed prostaglandin F 2␣ (PGF 2␣ )-related FP receptor agonist compound, 1 is one of the most potent ocular hypotensive eye drops in patients with glaucoma. 2-8 Although intraocular pressure (IOP) is consistently the major risk factor for glaucoma, recent studies indicate that impaired circulation in the optic nerve head (ONH) has a crucial role in glaucomatous optic neuropathy. -11 Previous studies have suggested that topically instilled timolol or betaxolol over a long period can accumulate in the periocular tissues and reach the retrobulbar space in sufficient concentration to have pharmacologic effects on the retrobulbar vessels. 12-14 PGF 2␣ has vasoconstricting or vasodilating effects, depending on its concentration, the nature of the vascular bed, or the animal species. 15-18 Latanoprost also has vasoconstricting effects at higher concentrations 20 Grunwald 21-23 and Gupta et al. In the present study, we examined the effects of not only a single instillation but also a 7-day once-daily instillation regimen of latanoprost on ONH circulation in rabbits, monkeys, and normal humans, by using the noninvasive laser speckle method. MATERIALS AND METHODS Instruments ONH circulation was evaluated using the laser speckle method

Time Course of Changes in Optic Nerve Head Circulation after Acute Reduction in Intraocular Pressure

PURPOSE. To study the time course of changes in circulation in the optic nerve head (ONH) after acute reduction in intraocular pressure (IOP) and to evaluate the effects of a calcium antagonist, a nitric oxide synthetase (NOS) inhibitor, indomethacin, and sympathetic nerve amputation on the changes in ONH circulation after reduction of IOP. METHODS. In anesthetized albino rabbits, acute reduction of IOP (acute increase in ocular perfusion pressure [OPP]) was manometrically achieved and normalized blur (NB), a quantitative index of tissue blood velocity obtained with the laser speckle method, was serially monitored for 30 seconds and 60 minutes. The effects of systemic administration of 1 g/kg per hour nilvadipine (a calcium antagonist), 300 g/kg N-nitro-Larginine (L-NAME, a nonselective NOS inhibitor), and 5 mg/kg indomethacin or sympathetic nerve amputation on the changes in NB after reduction of IOP were studied. RESULTS. During changes in IOP from 10 to 40 mm Hg and then back to 10 mm Hg, NB exhibited no significant change. During changes in IOP from 10 to 60 mm Hg and then back to 10 mm Hg, NB initially decreased with an increase in IOP to 60 mm Hg and then increased to baseline level when IOP was returned to 10 mm Hg. In the nilvadipine-treated rabbits, during changes in IOP from 10 to 40 mm Hg and back to 10 mm Hg and during the changes from 10 to 60 mm Hg and back to 10 mm Hg, NB decreased with increase in IOP to 40 or 60 mm Hg and then increased to slightly above the baseline when IOP returned to 10 mm Hg. L-NAME, indomethacin, and sympathetic nerve amputation each had little effect on the time course of change in NB. CONCLUSIONS. ONH circulation was stably maintained after reduction of IOP from 40 to 10 mm Hg but not after that from 60 to 10 mm Hg. The changes in NB after reduction of IOP occurred quickly and were partially impaired with a calcium antagonist, but not with the NOS inhibitor, indomethacin, or sympathetic nerve amputation. These findings suggest the importance of vascular smooth muscle in maintaining stable ONH circulation against reduction of IOP in a fashion nearly independent of NO, endogenous prostaglandins, and the sympathetic nervous system. (Invest Ophthalmol Vis Sci

Refractive errors in an elderly rural Japanese population: The Kumejima study.

The prevalence of refractive errors, which closely relates to visual function difficulties, several ocular disorders, and decreased quality of life, varies among countries and populations. One of the highest prevalence of myopia (spherical equivalent [SE] +0.5 D), refractive astigmatism (cylinder > 0.5 D), and anisometropia (difference in SE between eyes > 1.0 D) were 29.5%, 1.9%, 34.1%, 38.8%, and 15.5%, respectively. Myopia decreased with age up to 70 years old but increased slightly thereafter, whereas hyperopia increased up to 70 years old and was unchanged thereafter. The prevalence of astigmatism and anisometropia was higher in older subjects. The prevalence of myopia and high myopia was higher than most of white, Hispanic, and other Asian populations, while was considerably lower than in the urban city of Japan. The high prevalence of hyperopia should be associated with high prevalence of angle closure glaucoma in this island

Iridotrabecular Contact Observed Using Anterior Segment Three-Dimensional OCT in Eyes With a Shallow Peripheral Anterior Chamber

Citation: Mishima K, Tomidokoro A, Suramethakul P, et al. Iridotrabecular contact observed using anterior segment three-dimensional OCT in eyes with a shallow peripheral anterior chamber. Invest Ophthalmol Vis Sci

Topical nipradilol: effects on optic nerve head circulation in humans and periocular distribution in monkeys,”

PURPOSE. To investigate the effects of topical nipradilol on blood velocity in the optic nerve head (ONH) in normal humans and the ocular and periocular distribution of topically instilled nipradilol in monkeys. METHODS. In normal humans, 0.25% nipradilol was instilled in one eye and vehicle in the other twice daily for 7 days, and blood velocity in the ONH was measured by the laser speckle method. In monkeys, after a single instillation of 1% [ 14 C]nipradilol in one eye, distribution of radioactivity was evaluated by whole-head autoradiography. RESULTS. Twice-daily 7-day instillation of nipradilol temporarily but significantly increased human ONH blood velocity, in the ipsilateral eye only (P ϭ 0.005), independent of a reduction in the intraocular pressure. In monkeys, equivalent nipradilol concentration in the periocular tissue around the optic nerve insertion was higher on the ipsilateral side than on the contralateral side (140 Ϯ 25 ng/g and 42 Ϯ 10 ng/g, P ϭ 0.022, n ϭ 5). Radioactivity was higher in the periocular tissue behind the equator than around the optic nerve insertion on the ipsilateral side (P ϭ 0.004), but not on the contralateral side. The equivalent nipradilol concentration in the ipsilateral posterior retina-choroid was 636 Ϯ 92 ng/g, which was significantly higher than that on the contralateral control side (521 Ϯ 92 ng/g, P Ͻ 0.001). CONCLUSIONS. The ipsilateral increase in ONH blood velocity induced by topical nipradilol in humans was attributed to drug that penetrated locally. Whole-head autoradiographic study suggests that topically instilled nipradilol can rapidly reach the posterior periocular tissue at pharmacologic concentrations. (Invest Ophthalmol Vis Sci. 2002;43:3243-3250) G laucoma is a disease that primarily damages the optic nerve head (ONH). One of the major risk factors in glaucoma is chronically elevated intraocular pressure (IOP). 1 However, reports of the relation between a subtype of glaucoma and low blood pressure, 2 migraine, 3 and optic disc hemorrhage 4 or findings on the favorable effect of a Ca 2ϩ channel blocker on the visual field 5-8 suggest that not only an increase in IOP but disorders of the systemic and/or local circulation are involved in the development of glaucomatous ONH damage. 9 -11 There are two ways for antiglaucoma agents to modify circulation in the ONH. One is to increase ocular perfusion pressure (OPP) while decreasing IOP. It is not known, however, whether a chronic increase in OPP in fact causes a chronic change in blood flow in the ONH. 12-14 The other way is to effect direct, drug-mediated vascular dilatation. Several in vitro studies are available on the vasodilatory effects of antiglaucoma agents. The ophthalmic artery branches into the central retinal artery, posterior ciliary arteries, and anterior ciliary arteries. Short posterior ciliary arteries, separate from the posterior ciliary artery, penetrate the eye wall around the insertion of the optic nerve and are essential in supplying blood to the ONH. Nipradilol (3,4-dihydro-8-(2-hydroxy-3-isopropylamino)propoxy-3-nitroxy-2H-1-benzopyran, molecular weight: 326.35) is a newly developed antiglaucoma ophthalmic agent that has nonselective ␤-receptor and selective ␣ 1 -receptor blocking properties 22,23 with a nitric oxide (NO) donative action. 24 Topical instillation of 0.25% nipradilol lowers IOP as effectively as 0.5% timolol with a less systemic ␤-blocking effect. 25 In this study, we examined whether topically instilled nipradilol also influences blood velocity in the ONH in eight normal humans as a pilot study. Because the result suggested that the effect was attributable to local penetration of the drug, we examined the ocular and periocular distribution pattern of nipradilol after topical instillation, by analysis of whole-head autoradiographs in monkeys. METHODS The study of human ONH blood velocity was approved by the Ethics Review Committee of the University of Tokyo School of Medicine and the tenets of the Declaration of Helsinki were observed. Before admission into the study, each subject signed a written consent form after the nature of the study had been fully explained and routine eye examinations had been performed. Animal experiments were performed in accordance with the ARVO Statement for the Use of Animals in Ophthalmic Vision Research. Effects on ONH Circulation in Humans Eight young volunteers (20 -24 years of age) with no history of smoking, who had neither systemic nor ocular disease and only mild refractive errors, participated in the study. On the day on which measureFrom th

Glaucoma-induced optic disc morphometric changes and glaucoma diagnostic ability of Heidelberg Retina Tomograph II in highly myopic eyes.

PURPOSE: This study was performed to first investigate the morphological differences in the optic nerve head between highly myopic non-glaucomatous controls and highly myopic glaucomatous eyes in comparison with the differences between emmetropic non-glaucomatous controls and emmetropic glaucomatous eyes using confocal scanning laser ophthalmoscopy. Further, the ability of the apparatus in glaucoma diagnosis in highly myopic eyes was compared with that in emmetropic eyes. METHODS: Healthy subjects and age-matched patients with early-stage open-angle glaucoma were divided into two groups: emmetropic eyes (-1.0 to +1.0 diopters) and highly myopic eyes (-12.0 to -5.0 diopters).The participants were comprised of 65 emmetropic normal eyes, 59 emmetropic glaucomatous eyes, 62 highly myopic normal eyes, and 68 highly myopic glaucomatous eyes and eyes with pathologic myopia were carefully excluded. Confocal scanning laser tomographic parameters were compared among all subjects after adjustment for age and disc area. The ROC curves and sensitivity and specificity for glaucoma detection using several clinical methods were then compared between the emmetropic and highly myopic eyes. RESULTS: Rim area, cup/disc area ratio, mean cup depth, and cup shape measure of glaucoma eyes are significantly different from those of normal eyes in both highly myopic eyes and emmetropic eyes. Methodological overestimation of retinal nerve fiber layer cross sectional area due to optic disc tilting was suggested in the highly myopic eyes. The diagnostic performance of glaucoma using several discriminant methods significantly deteriorated in the highly myopic eyes. CONCLUSIONS: In the highly myopic glaucomatous eyes, confocal scanning laser tomographic parameters were significantly different from that of non-glaucomatous highly myopic eyes but diagnostic performance of glaucoma was deteriorated than that in emmetropic eyes. These findings demonstrate the utility and limitations of the apparatus in diagnosing glaucoma in highly myopic patients

ROC curves for diagnosis of glaucoma in emmetropic eyes.

<p>AUCs of FSM or RB Discriminant Function and MRA are 0.926(95%CI: 0.878–0.974), 0.904(0.849–0.958), and 0.934(0.887–0.981), respectively. FSM: Frederick S. Mikelberg discriminant function; RB: Reinhard O.W. Burk discriminant function; MRA: Moorfields regression analysis.</p

Demographic Data and HRT Parameters of the Subjects of Each Group in Global Analyses after Adjustment for Age and Disc Area.

<p>N: number of eyes.</p><p>Refraction: spherical equivalent refractive error.</p><p>MD: mean deviation of Humphrey Field Analyzer 24-2 SITA standard program.</p><p>OAG: open-angle glaucoma.</p>*<p>:<i>P</i><0.05 with Bonferroni’s correction between normal and OAG eyes within emmetropic or myopic eyes.</p><p>(<i>P</i> values are adjusted for age and disc area, except that of age and disc area.).</p

Sensitivity and Specificity of FSM or RB Discriminant Function and Moorfields Regression Analysis.

<p>FSM: Frederick S. Mikelberg discriminant function.</p><p>RB: Reinhard O.W. Burk discriminant function.</p><p>MRA 1: Moorfields regression analysis (only “outside normal limits” eyes were diagnosed as glaucomatous).</p><p>MRA 2: Moorfields regression analysis (“outside normal limits” and “border line” eyes were diagnosed as glaucomatous).</p