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 diopters [D], 41.8%) has been reported in an urban city (Tajimi) in central Japan. Here, we assess refractive conditions in a rural southwestern island (Kumejima) of Japan, where a high prevalence of glaucoma, especially angle-closure glaucoma, has been found. In Kumejima, the prevalence of myopia (SE < -0.5 D), high myopia (SE < -5 D), hyperopia (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.

Prevalence of and risk factors for cornea guttata in a population-based study in a southwestern island of Japan: the Kumejima study.

OBJECTIVE: To examine the prevalence of and risk factors for cornea guttata in a rural southwestern island of Japan. DESIGN: Cross-sectional, population-based study. All residents of Kumejima Island, Japan, located in southwestern Japan (eastern longitude, 126° 48'; northern latitude, 26° 20'), 40 years or older were asked to undergo a comprehensive questionnaire and ocular examination, including noncontact specular microscopy of corneal endothelial cells. Of the 4632 residents, 3762 (81.2%) underwent the examination. The presence of guttata was determined when round or oval dark areas were observed in the specular microscopy images. Cornea guttata was graded from 0 to 4 depending on the total area of dark spots observed on the specular microscopy images. Diagnosis of primary cornea guttata was the main outcome measure. RESULTS: Of the 3060 eligible residents, 124 (4.1%; 95% confidence interval, 3.4%-4.8%) had cornea guttata in at least 1 eye. Logistic regression analysis with adjustment for age and/or sex indicated that older age, female sex, and thinner central corneal thickness were associated with an increased risk of cornea guttata. CONCLUSIONS: The prevalence of cornea guttata is 4.1% among residents 40 years or older in Kumejima by specular microscopic criteria only, which is lower than the prevalence reported in the Reykjavik, Iceland, study. A higher prevalence may have been determined if slitlamp biomicroscopy findings had been included. Older age, female sex, and a thinner cornea were independently associated with a higher risk of cornea guttata.

Intraocular pressure and related systemic and ocular biometric factors in a population-based study in Japan: the Kumejima study.

PURPOSE: To examine the distribution of intraocular pressure (IOP) and its related systemic and ocular biometric factors in a population-based study in a southwestern island of Japan. DESIGN: Cross-sectional, population-based study. METHODS: All residents of Kumejima Island, Japan, located in southwestern Japan (eastern longitude, 126 degrees 48 minutes and northern latitude 26 degrees 20 minutes), 40 years of age and older were asked to undergo a comprehensive questionnaire and ocular examination, including measurement of IOP with Goldmann applanation tonometry. RESULTS: Of the 4632 eligible residents, 3762 (81.2%) underwent the examination. In 2838 non-glaucomatous subjects from whom reliable measurements of IOP were obtained, the mean IOPs +/- standard deviation in all, men, and women were 15.1 +/- 3.1 mm Hg (n = 2838), 15.2 +/- 3.1 mm Hg (n = 1450), and 15.1 +/- 3.0 mm Hg (n = 1388), respectively, with no significant intersex difference (P = .63). Multivariate regression analysis demonstrated that higher IOP was significantly correlated with younger age (P < .001), higher body mass index (P < .001), higher systolic blood pressure (P < .001), history of diabetes mellitus (P = .001), thicker central corneal thickness (P < .001), steeper corneal curvature (P < .001), and longer axial length (P < .018), but not with anterior chamber depth and the Shaffer angle width grade. CONCLUSIONS: Younger age, higher body mass index, higher systolic blood pressure, diabetes, thicker central corneal thickness, and steeper corneal curvature were significantly correlated with higher IOP. The present results confirm that IOP is associated with systemic and ocular biometric factors and may define specific subgroups most likely to have an elevated IOP.

Corneal endothelial cell density and associated factors in a population-based study in Japan: the Kumejima study.

PURPOSE: To examine the distribution of corneal endothelial cell density (ECD) and relating factors in ophthalmologically normal Japanese in a population-based setting. DESIGN: Cross-sectional, population-based study. METHODS: All residents of Kumejima Island, Japan, located in southwestern Japan (eastern longitude 126 degrees 48' and northern latitude 26 degrees 20'), aged 40 years and older, were asked to undergo a comprehensive questionnaire and ocular examination, including noncontact specular microscopy of corneal endothelial cells. RESULTS: Of the 4632 residents, 3762 (81.2%) underwent the examination. The mean ECD among all ophthalmologically normal participants (n = 2602), men (n = 1329), and women (n = 1273) was 2943 +/- 387 cells/mm(2), 2927 +/- 385 cells/mm(2), and 2959 +/- 389 cells/mm(2), respectively, with a significant inter-sex difference after adjusting for age (P = .001). Mean ECD was significantly lower in subgroups with a history of outdoor work compared to corresponding subgroups after adjusting for age and sex (P = .034). Linear regression analyses with an adjustment for age and/or sex showed that age was significantly negatively correlated with ECD with a slope of -7.43/mm(2)/year (P < .001), indicating a cell loss rate of 0.25% per year of age. Higher intraocular pressure was significantly correlated with lower ECD, with a slope of -9.87/mm(2)/mm Hg (P < .001). CONCLUSIONS: Mean ECD in ophthalmologically normal Japanese in Kumejima aged 40 years or older was 2943 cells/mm(2). Older age, male sex, higher intraocular pressure, and history of outdoor work were also identified as factors correlating with lower ECD.

Prevalence and risk factors of pterygium in a southwestern island of Japan: the Kumejima Study.

PURPOSE: To determine the prevalence and risk factors for pterygium in a Japanese population aged 40 years or older on Kumejima Island, Japan. DESIGN: Cross-sectional, population-based study. METHODS: All residents of Kumejima Island, Japan, located in Southwestern Japan (Eastern longitude 126 degrees, 48 feet and Northern latitude 26 degrees, 20 feet), aged 40 years and older were asked to undergo a comprehensive questionnaire and ocular examination. RESULTS: Of the 4,632 residents, 3,762 (81.2%) underwent the examination. The presence of pterygium could not be determined in 15 subjects. Of the 3,747 eligible subjects, 1,154 (30.8%; 95% confidence interval [CI], 29.3% to 32.3%) had pterygium in at least 1 eye and 491 subjects (13.1%; 95% CI, 12.1% to 14.3%) had pterygium in both eyes. In the logistic regression analysis, older age (P < .001), male gender (P = .024), hyperopic refraction (P = .001), lower intraocular pressure (P = .002), and outdoor job experience (P < .001) were independently associated with a higher risk of pterygium. CONCLUSION: The prevalence of pterygium is 30.8% among adult Japanese aged 40 years and older in Kumejima. Older age, male gender, hyperopic refraction, lower intraocular pressure, and outdoor job history were independently associated with a higher risk of pterygium.

[Deep lamellar keratoplasty in severe ocular surface disease].

PURPOSE: To demonstrate the efficacy and safety of deep lamellar keratoplasty(DLKP) in the treatment of corneal opacity in severe ocular surface disease. METHODS: A total of 12 eyes of 11 patients were analyzed in this retrospective case series. The original diseases were Stevens Johnson syndrome (SJS : 3 eyes), ocular ciccatricial pemphigoid(OCP : 2 eyes), thermal burns (2 eyes), limbal deficiency due to unknown cause (2 eyes), and corneal scarring due to trachoma (3 eyes). Cases with total limbal deficiency (6 eyes) were also treated with secondary or simultaneous limbal transplantation. Cataract surgery was also performed in 4 eyes following DLKP. RESULTS: DLKP was successfully done in all cases. One case with SJS experienced an immunological rejection against the limbal graft. Two eyes with SJS eventually developed ulcers that required therapeutic penefrating keratoplasty. Visual improvement was observed in 9 out of 12 eyes, of which 2 cases maintained a corrected visual acuity of 0.1 despite conjunctivalization of the ocular surface. CONCLUSION: DLKP is an effective means to treat stromal opacity in patients with ocular surface disease.