National survey of amblyopia treatment in Japan: comparison with amblyopia treatment study results of the pediatric eye disease investigator group.

PURPOSE: To investigate the treatment policy for amblyopia in Japan as of 2017 through a survey of multiple facilities and to compare the findings with those obtained by the Amblyopia Treatment Study (ATS) of the Pediatric Eye Disease Investigator Group. STUDY DESIGN: Questionnaire survey study. SUBJECTS AND METHODS: A questionnaire was sent to 181 facilities where patients with amblyopia are being treated. The outcomes of the present survey were compared with the results of the ATS study, and the coincidence rates were evaluated. RESULTS: The questionnaire response rate was 68.0%. The treatment plan that showed the highest agreement between the outcomes of the ATS study and the present study was whether or not treatment was to be given to patients aged 10-15 years who had received no previous treatment; 90% of the facilities answered that they would provide treatment to such patients as well. The next highest agreement was the future treatment of amblyopia with stable visual acuity in the affected eye; 82.6% of the facilities responded that they would reduce the occlusion time. On the other hand, the lowest agreement rate was the follow-up period of the refractive correction for moderate anisometropic amblyopia. The ATS showed "4 months," whereas most of the facilities in the present survey replied "3 months." The agreement rate was 10.8%. CONCLUSION: The amblyopia treatment in Japan survey did not always agree with the research results of the ATS. Japanese ophthalmologists tend to make treatment plans for amblyopia according to their clinical experience.

Changes in Choroidal Thickness and Structure Induced by 1% Atropine Instillation in Children With Hyperopic Anisometropic Amblyopia.

PURPOSE: To investigate the effects of 1% atropine eye drops on the choroidal thickness and structure of amblyopic and fellow eyes in children with hyperopic anisometropic amblyopia. METHODS: This study included 16 children with hypermetropic anisometropic amblyopia. All patients received 1% atropine eye drops in both eyes twice a day for 7 days. In the subfoveal choroidal region, choroidal thickness, total choroidal area, luminal area, and stromal area were measured quantitatively using swept-source optical coherence tomography. The choroidal parameters of the amblyopic and fellow eyes were compared between the baseline and atropine conditions. RESULTS: There were no significant differences in all choroidal parameters of the amblyopic eye between baseline and atropine conditions. However, the subfoveal choroidal thickness in the fellow eye was significantly higher for the atropine condition than the baseline condition. This change was accompanied by a significant increase in both the luminal and stromal areas of the choroid. The median differences of subfoveal choroidal thickness between the conditions were larger for the fellow eye (6.46%) than the amblyopic eye (0.26%). CONCLUSIONS: The choroidal structural change induced by 1% atropine instillation was smaller for the amblyopic eye than the fellow eye in children with hyperopic anisometropic amblyopia. Mechanisms of choroidal thickness changes could be inhibited in amblyopic eyes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):39-45.].

Self-similar hierarchy of coherent tubular vortices in turbulence.

Energy transfers from larger to smaller scales in turbulence. This energy cascade is a process of the creation of smaller-scale coherent vortices by larger ones. In our recent study (Yoneda, Goto and Tsuruhashi 2022 Nonlinearity 35, 1380-1401), we reformulated the energy cascade in terms of this stretching process and derived the [Formula: see text] law of the energy spectrum under physically reasonable assumptions. In the present study, we provide a quantitative verification of these assumptions by using direct numerical simulations. We decompose developed turbulence in a periodic cube into scales by using the band-pass filter and identify the axes of coherent tubular vortices by the low-pressure method. Even when the turbulent kinetic energy and its dissipation rate temporally fluctuate about their temporal means, the total length of the vortices at each scale varies little with time. This result is consistent with our assumption of the temporal stationarity on the vorticity decomposition. The present numerical analysis also shows that the hierarchy of vortex axes is self-similar in a wide range of scales, i.e. in the inertial range and a lower part of the dissipation range and that the volume fraction occupied by the tubular vortices at each scale is independent of the scale. This article is part of the theme issue 'Mathematical problems in physical fluid dynamics (part 2)'.

[QUANTIFICATION OF CONJUNCTIVAL HYPEREMIA IN RABBITS USING ANALYSIS SOFTWARE].

BACKGROUND/PURPOSE: In a method evaluating conjunctival hyperemia using rabbits, it is common to visually grade the degree of vasodilation. However, this method is limited in evaluating consecutive value and in reproducibility. We quantified the degree of conjunctival hyperemia in rabbits as the area ratio of blood vessels by image analysis, and compared the vascular area percentage calculated by image analysis with the hyperemia score. METHODS: The conjunctiva was photographed before and after the instillation of 0.1% arachidonic acid using a digital medical scope VersaCam® (Nidek Co., Ltd.). Next, the area of the conjunctival blood vessels occupying the area of interest was calculated using hyperemia analysis software. The hyperemia score was visually graded for the degree of conjunctiva vasodilation. Furthermore, the hyperemia score and the vascular area ratio were compared. RESULTS: Fifteen minutes after the instillation of arachidonic acid, the area ratio of the blood vessels in the conjunctiva increased significantly and gradually decreased over time. This trend correlated with the hyperemia score. CONCLUSION: We found that the degree of conjunctival hyperemia in rabbits can be evaluated numerically and quantitatively. This method is considered to be useful for evaluating conjunctival hyperemia in allergic conjunctival diseases.

Choroidal vessel density in unilateral hyperopic amblyopia using en-face optical coherence tomography.

BACKGROUND: Structural changes of the choroid, such as choroidal thickening, have been indicated in amblyopic eyes with hyperopic anisometropia as compared to fellow or healthy eyes. The purpose of the present study was to investigate choroidal vascular density (CVD) in children with unilateral hyperopic amblyopia. METHODS: This study included 88 eyes of 44 patients with unilateral amblyopia due to hyperopic anisometropia with or without strabismus and 29 eyes of 29 age-matched normal controls. The CVD of Haller's layer was quantified from en-face images constructed by 3-dimensional swept-source optical coherence tomography images flattened relative to Bruch's membrane. The analysis area was a 3 × 3-mm square of macula after magnification correction. Relationships between CVD and other parameters [best-corrected visual acuity (BCVA), refractive error and subfoveal choroidal thickness (SFCT)] were investigated, and CVDs were compared between amblyopic, fellow, and normal control eyes. RESULTS: Mean CVD was 59.11 ± 0.66% in amblyopic eyes, 59.23 ± 0.81% in fellow eyes, and 59.29 ± 0.74% in normal control eyes. CVD showed a significant positive relationship with SFCT (p = 0.004), but no relationships with other parameters. No significant differences in CVD were evident among amblyopic, fellow, and normal control eyes after adjusting for SFCT (p = 0.502). CONCLUSIONS: CVD was unrelated to BCVA, and CVD did not differ significantly among amblyopic, fellow and normal control eyes. These results suggest that the local CVD of Haller's layer is unaffected in unilateral hyperopic amblyopic eyes.

Time course of conjunctival hyperemia induced by omidenepag isopropyl ophthalmic solution 0.002%: a pilot, comparative study versus ripasudil 0.4.

OBJECTIVE: We investigated the detailed time course of conjunctival hyperemia induced by omidenepag isopropyl ophthalmic solution 0.002% (omidenepag), a selective prostaglandin E2 receptor 2 agonist. METHODS AND ANALYSIS: We recruited 34 healthy subjects and administered omidenepag in the right eye and ripasudil 0.4% in the left eye. We evaluated conjunctival hyperemia using slit-lamp photography at baseline and after 15, 30, 60, 120, 180 and 360 min. The conjunctival hyperemia score was graded by three independent observers using a scale from 0 (none) to 3 (severe). We also evaluated conjunctival hyperemia by the pixel coverage of conjunctival blood vessels (per cent coverage) determined using a conjunctival hyperemia-analysing software. RESULTS: In omidenepag, the conjunctival hyperemia score and per cent coverage peaked at both 30 min (mean score±SD: 1.57±0.67 and 11.90%±3.66%, respectively) and then gradually decreased at 60 min (10.79%±3.32%) and 120 min (1.10±0.52) when they reached a level that was not significantly different from the baseline values. For ripasudil 0.4%, the peak time of the conjunctival hyperemia score and per cent coverage were both at 15 min (score: 2.42±0.54 and 15.26%±3.38%). The degree of conjunctival hyperemia was significantly higher for ripasudil 0.4% than that for omidenepag from 15 to 30 min in both the conjunctival hyperemia score and per cent coverage (p<0.007 by Bonferroni correction). CONCLUSION: Conjunctival hyperemia induced by omidenepag gradually peaks to moderate severity, though weaker compared with that induced by ripasudil 0.4%, and subsides relatively quickly.

Foveal avascular zone and macular vessel density after correction for magnification error in unilateral amblyopia using optical coherence tomography angiography.

BACKGROUND: To investigate the area of foveal avascular zone (FAZ) and macular vessel density (VD) after correction for magnification error in unilateral amblyopia using optical coherence tomography angiography (OCTA). METHODS: Participants comprised 15 patients with unilateral amblyopia due to anisometropia with or without strabismus (mean age, 9.8 ± 3.4 years; range, 6-17 years). OCTA images were obtained by using spectral-domain OCT with angiography software. The OCTA scanning protocol used was 3 × 3-mm volume scan centered on the fovea. OCTA images were corrected for magnification errors using individual axial length (AL), and an adjusted 2.3 × 2.3-mm square was derived as a region of interest. The FAZ area and VD in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) layers, foveal minimum thickness (FMT) were assessed using built-in OCTA software and ImageJ software (NIH, Bethesda, MD). RESULTS: LogMAR in the amblyopic eyes was significantly poorer than that of the fellow eye (p < 0.001). AL was significantly shorter in the amblyopic eye than in the fellow eye (p < 0.001). FAZ area of SCP in amblyopic eyes was significantly smaller than that of fellow eyes (p < 0.001). No significant differences were seen in FAZ area of DCP, VD of SCP, VD of DCP, and FMT between amblyopic and fellow eyes (p = 0.07, 0.43, 0.55, and 0.25, respectively). CONCLUSIONS: Our present study after magnification error correction found smaller FAZ area of SCP in the amblyopic eye compared with the fellow eyes, but there was no significant difference in the macular VD between the amblyopic and fellow eyes.

Severity Classification of Conjunctival Hyperaemia by Deep Neural Network Ensembles.

Conjunctival hyperaemia is a common clinical ophthalmological finding and can be a symptom of various ocular disorders. Although several severity classification criteria have been proposed, none include objective severity criteria. Neural networks and deep learning have been utilised in ophthalmology, but not for the purpose of classifying the severity of conjunctival hyperaemia objectively. To develop a conjunctival hyperaemia grading software, we used 3700 images as the training data and 923 images as the validation test data. We trained the nine neural network models and validated the performance of these networks. We finally chose the best combination of these networks. The DenseNet201 model was the best individual model. The combination of the DenseNet201, DenseNet121, VGG19, and ResNet50 were the best model. The correlation between the multimodel responses, and the vessel-area occupied was 0.737 (p < 0.01). This system could be as accurate and comprehensive as specialists but would be significantly faster and consistent with objective values.

Suprathreshold Motion Perception in Anisometropic Amblyopia: Interocular Speed Matching and the Pulfrich Effect.

SIGNIFICANCE: Our results indicate that the difference in perceived luminance between the amblyopic and fellow eyes that is present under dichoptic viewing conditions does not affect the perceived speed of suprathreshold motion stimuli. This finding provides a new insight into suprathreshold perception in amblyopia. PURPOSE: Interocular matching experiments indicate that dichoptically presented stimuli have a lower perceived luminance in amblyopic eyes relative to fellow eyes. This may be a consequence of interocular suppression. We investigated whether this effect extends to suprathreshold motion perception. METHODS: Participants with amblyopia and control observers matched the perceived speed of dichoptically presented random-dot kinematograms and the perceived luminance of gray patches. Control participants also performed the speed matching task with a neutral density filter over one eye to simulate a perceived luminance reduction. RESULTS: The amblyopia group exhibited lower perceived luminance in the amblyopic than in the fellow eye, as has previously been reported. However, interocular speed matching was veridical. For control observers, perceived speed was reduced in the eye with a neutral density filter relative to the nonfiltered eye. To assess whether the perceived luminance reduction in the amblyopic eye affected binocular function, we also measured the Pulfrich effect in the amblyopia group with equal luminance presented to each eye. No patients reported a spontaneous Pulfrich effect. CONCLUSIONS: The results suggest that suprathreshold speed perception is intact in the amblyopic eye when both eyes are open.

Evaluation of offset of conjunctival hyperemia induced by a Rho-kinase inhibitor; 0.4% Ripasudil ophthalmic solution clinical trial.

Glaucoma leads to irreversible blindness. Numerous anti-glaucoma eye drops have been developed. Unfortunately, many patients with glaucoma still suffer from progressive visual disorders. Recently, ripasudil hydrochloride hydrate, a selective Rho-associated protein kinase inhibitor, was launched for the treatment of glaucoma. However, adverse events, such as conjunctival hyperemia, are often noted in clinical trials using healthy subjects. Therefore, we investigated the onset, offset, and kinetic changes of conjunctival hyperemia induced by ripasudil ophthalmic solution in patients with open-angle glaucoma or ocular hypertension who had already been treated with anti-glaucoma eye drops other than ripasudil. Conjunctival hyperemia was evaluated by both clinical grading by 3 ophthalmic physicians and pixel coverage of conjunctival blood vessels determined by conjunctival hyperemia-analyzing software. Conjunctival hyperemia appeared within 10 min post-instillation in most of the participants. Clinical grade and pixel coverage increased significantly 10 min post-instillation and then decreased. In most of the participants, hyperemia resolved within 2 h. Median conjunctival hyperemia offset was 90 min. A tendency of monotonic increase was observed between clinical grade and pixel coverage. Taken altogether, hyperemia induced by ripasudil was transient in glaucoma patients who had already been treated with anti-glaucoma eye drops other than ripasudil.

Hyperemia Analysis Software for Assessment of Conjunctival Hyperemia Severity.

PURPOSE: We developed a hyperemia analysis software, which can quantitatively assess the degree of conjunctival hyperemia, and evaluated the reproducibility and reliability of its percent coverage. In addition, we compared the clinical grading and the percent coverage to examine the applicability of the software analysis. METHODS: We took images of the temporal conjunctiva with slit lamp microscopes. We used our hyperemia analysis software to detect blood vessels in the region of interest using its image processing capabilities and obtained a ratio of the area occupied by blood vessels to the rest of the area. In addition, we used the clinical evaluation criteria of the Japanese guidelines for allergic conjunctival diseases 2017 to clinically grade the hyperemia in each eye. Nine evaluators examined the images and graded the severity of hyperemia into four stages. We looked for a statistical correlation between the results of the hyperemia analysis software and the clinical grading. RESULTS: The percent coverage of the blood vessels in the region of interest calculated by the hyperemia analysis software correlated with the arithmetic average of our clinical grading (r = 0.953; 95% CI, 0.8470340-0.9862136). CONCLUSION: The percent coverage from our hyperemia analysis software reflects the clinical grading score, suggesting that our software can be used to obtain a detailed analysis of conjunctival hyperemia.

Effect of amblyopia treatment on choroidal thickness in hypermetropic anisometropic amblyopia using swept-source optical coherence tomography.

BACKGROUND: Recent studies using optical coherence tomography (OCT) have indicated that choroidal thickness (CT) in the anisometropic amblyopic eye is thicker than that of the fellow and normal control eyes. However, it has not yet been established as to how amblyopia affects the choroid thickening. The purpose of the present study was to investigate the effect of amblyopia treatment on macular CT in eyes with anisometropic amblyopia using swept-source OCT. METHODS: Thirteen patients (mean age: 6.2 ± 2.4 years) with hypermetropic anisometropic amblyopia were included in this study. Visual acuity (VA), axial length (AL), and CT were measured at the enrollment visit and at the final visit, after at least 6 months of treatment. CT measurements were corrected for magnification error and were automatically analyzed using built-in software and divided into three macular regions (subfoveal choroidal thickness (SFCT), center 1 mm, and center 6 mm). A one-way analysis of covariance using AL as a covariate was performed to determine whether CT in amblyopic eyes changed after amblyopia treatment. RESULTS: The average observation period was 22.2 ± 11.0 months. After treatment, VA (logMAR) improvement in the amblyopic eyes was 0.41 ± 0.19 (p < 0.001). SFCT, center 1 mm CT, and center 6 mm CT were significantly thicker in the amblyopic eyes compared with the fellow eyes both before and after treatment (p < 0.05 for all comparisons). There were no significant changes in SFCT, center 1 mm CT, or center 6 mm CT before and after treatment in the amblyopic (p = 0.25, 0.21, and 0.84, respectively) and fellow (p = 0.75, 0.84, and 0.91, respectively) eyes. The correlation between changes in logMAR versus changes in CT after treatment was not significant. CONCLUSIONS: Although VA in amblyopic eyes was significantly improved after treatment, the choroid thickening of anisometropic amblyopic eyes persisted, and there was no significant change found in the CT after the treatment. Our findings suggest that thickening of the CT in amblyopia is not directly related to visual dysfunction.

Clinical Severity Classification using Automated Conjunctival Hyperemia Analysis Software in Patients with Superior Limbic Keratoconjunctivitis.

PURPOSE: Digitization of clinical observation is necessary for assessing the severity of superior limbic keratoconjunctivitis (SLK). This study aimed to use a novel quantitative marker to examine hyperemia in patients with SLK. MATERIALS AND METHODS: We included six eyes of six patients with both dry eye disease and SLK (SLK group) and eight eyes of eight patients with Sjögren syndrome (SS group). We simultaneously obtained the objective finding scores by using slit-lamp examination and calculated the superior hyperemia index (SHI) with an automated conjunctival hyperemia analysis software by using photographs of the anterior segment. Three objective finding scores, including papillary formation of the superior palpebral conjunctiva, superior limbal hyperemia and swelling, and superior corneal epitheliopathy, were determined. The SHI was calculated as the superior/temporal ratio of bulbar conjunctival hyperemia by using the software. Fisher's exact test was used to compare a high SHI (≥1.07) ratio between the SLK and SS groups. P-Values < 0.05 were considered statistically significant. RESULTS: The SHI (mean ± standard deviation) in the SLK and SS groups was 1.19 ± 0.50 and 0.69 ± 0.24, respectively. The number of patients with a high SHI (≥1.07) was significantly higher in the SLK group than in the SS group (p < 0.05). The sensitivity and specificity of the SHI in the differential diagnosis between SS and SLK were 66.7% and 87.5%, respectively. An analysis of the association between the objective finding scores and SHI showed that the SHI had a tendency to indicate the severity of superior limbal hyperemia and swelling score in the SLK group. CONCLUSION: The SHI calculated using the automated conjunctival hyperemia analysis software could successfully quantify superior bulbar conjunctival hyperemia and may be a useful tool for the differential diagnosis between SS and SLK and for the quantitative follow-up of patients with SLK.

Time Course of Conjunctival Hyperemia Induced by a Rho-kinase Inhibitor Anti-glaucoma Eye Drop: Ripasudil 0.4.

PURPOSE: We investigated the detailed time course of conjunctival hyperemia induced by ripasudil 0.4%, a novel Rho-kinase inhibitor anti-glaucoma eye drop, in healthy subjects. METHODS: We recruited 51 healthy subjects and administered ripasudil 0.4% in their right eye. We evaluated conjunctival hyperemia using slit lamp photography and measured the intraocular pressure (IOP) using the Icare PRO Rebound Tonometer at baseline and after 5, 15, 30, 60, 90, and 120 min. The conjunctival hyperemia score was graded by three independent observers on a scale of 0 (none) to 3 (severe). Additionally, we analyzed the "percent coverage" of conjunctival hyperemia by using an automated hyperemia analysis software program; this program provides the pixel coverage of the conjunctival vessels in the region of interest. Dunnett and Steel multiple comparison tests were used, as appropriate, for the subsequent analyses. RESULTS: The conjunctival hyperemia score and percent coverage increased rapidly after the instillation of ripasudil 0.4%, peaking at 15 min (score: 1.83 ± 0.29 [mean ± SD]) and 5 min (11.6% ± 4.7%), respectively, and then gradually decreasing until 120 min (0.45 ± 0.22 and 4.7% ± 1.8%, respectively), when they reached a level that was not significantly different from the baseline values. The IOP decreased significantly compared to the baseline at 30, 60, and 90 min, based on the Dunnett test. CONCLUSION: Conjunctival hyperemia induced by ripasudil 0.4% peaks rapidly to moderate severity, but subsides relatively quickly.

Influence of the ultrasound transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle of healthy subjects.

[Purpose] This study aimed to assess the influence of ultrasound (US) transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle (RF) in healthy subjects. [Subjects and Methods] Fourteen healthy male subjects (20.8 ± 0.8 years) participated in this study. Transducer tilt was measured during US, with a digital angle gauge. Muscle thickness and echo intensity were measured in 4 transducer tilt conditions: reference angle; +3°; +6°; and +9° cranial from the reference angle. [Results] All differences in transducer tilt relative to the reference condition were larger than the minimal detectable change (MDC) of the reference condition. All differences in muscle thickness relative to the reference condition were not larger than the MDC of the reference condition. All differences in the echo intensity relative to the reference condition, except between the reference and the +3° condition, were larger than the MDC of the reference condition. [Conclusion] Our results indicated that an examiner should maintain a precise transducer tilt during repeated US measurements to quantify the minimal change in the echo intensity of the RF.

Association between glaucoma eye drops and hyperemia.

PURPOSE: We used an image analysis software program to quantitatively investigate conjunctival injection in patients treated with eye drops for glaucoma. METHODS: We compared 169 patients (89 men and 80 women) with a diagnosis of glaucoma. Photographs of the conjunctiva were taken on the temporal side of each patient's right eye using a slit lamp. We determined the mean pixel frequencies of the conjunctival blood vessels from the photographs. RESULTS: The ocular hyperemia of the patients being treated with prostaglandins was more severe than that of the patients being treated with beta-blockers or no eye drops. In multiple comparisons of each of the eye drops, the control group had a significantly lower degree of hyperemia than did the patients being treated with each of the various prostaglandin analogs (latanoprost, travoprost, tafluprost, and bimatoprost). Among the patients receiving prostaglandin, the percentage of those with hyperemia was highest in the bimatoprost users, followed in order by the travoprost, latanoprost, and tafluprost users. However, no significant differences were found among the different prostaglandin analogs in terms of the percentage of patients with hyperemia. CONCLUSION: Our software program may be useful for evaluating the hyperemic effects of eye drops used for glaucoma. The particular type of prostaglandin analog seems to determine the level of conjunctival hyperemia during ocular hypotensive medical treatment.

Development of automated conjunctival hyperemia analysis software.

Conjunctival hyperemia is observed in a variety of ocular inflammatory conditions. The evaluation of hyperemia is indispensable for the treatment of patients with ocular inflammation. However, the major methods currently available for evaluation are based on nonquantitative and subjective methods. Therefore, we developed novel software to evaluate bulbar hyperemia quantitatively and objectively. First, we investigated whether the histamine-induced hyperemia of guinea pigs could be quantified by image analysis. Bulbar conjunctival images were taken by means of a digital camera, followed by the binarization of the images and the selection of regions of interest (ROIs) for evaluation. The ROIs were evaluated by counting the number of absolute pixel values. Pixel values peaked significantly 1 minute after histamine challenge was performed and were still increased after 5 minutes. Second, we applied the same method to antigen (ovalbumin)-induced hyperemia of sensitized guinea pigs, acquiring similar results except for the substantial upregulation in the first 5 minutes after challenge. Finally, we analyzed human bulbar hyperemia using the new software we developed especially for human usage. The new software allows the automatic calculation of pixel values once the ROIs have been selected. In our clinical trials, the percentage of blood vessel coverage of ROIs was significantly higher in the images of hyperemia caused by allergic conjunctival diseases and hyperemia induced by Bimatoprost, compared with those of healthy volunteers. We propose that this newly developed automated hyperemia analysis software will be an objective clinical tool for the evaluation of ocular hyperemia.

A case of functional (psychogenic) monocular hemianopia analyzed by measurement of hemifield visual evoked potentials.

PURPOSE: Functional monocular hemianopia is an extremely rare condition, for which measurement of hemifield visual evoked potentials (VEPs) has not been previously described. METHODS: A 14-year-old boy with functional monocular hemianopia was followed up with Goldmann perimetry and measurement of hemifield and full-field VEPs. RESULTS: The patient had a history of monocular temporal hemianopia of the right eye following headache, nausea and ague. There was no relative afferent pupillary defect, and a color perception test was normal. Goldmann perimetry revealed a vertical monocular temporal hemianopia of the right eye; the hemianopia on the right was also detected with a binocular visual field test. Computed tomography, magnetic resonance imaging (MRI) and MR angiography of the brain including the optic chiasm as well as orbital MRI revealed no abnormalities. On the basis of these results, we diagnosed the patient's condition as functional monocular hemianopia. Pattern VEPs according to the International Society for Clinical Electrophysiology of Vision (ISCEV) standard were within the normal range. The hemifield pattern VEPs for the right eye showed a symmetrical latency and amplitude for nasal and temporal hemifield stimulation. One month later, the visual field defect of the patient spontaneously disappeared. CONCLUSIONS: The latency and amplitude of hemifield VEPs for a patient with functional monocular hemianopia were normal. Measurement of hemifield VEPs may thus provide an objective tool for distinguishing functional hemianopia from hemifield loss caused by an organic lesion.

Automated hyperemia analysis software: reliability and reproducibility in healthy subjects.

PURPOSE: To evaluate the reliability and reproducibility of automated software to analyze human bulbar hyperemia. METHODS: We enrolled 89 healthy volunteers in this study. A slit lamp was used to take pictures of the conjunctiva on the temporal side of each subject's right eye. Photographic conditions were standardized by using a single photographer. Images were transferred to software for automatic pixel value calculation in the green channel of the region of interest (ROI). We investigated optimal ROI size, mean ROI pixel frequency, percentage ROI blood vessel coverage, and data reproducibility. We also used this software to evaluate bimatoprost-induced hyperemia and hyperemia in allergic conjunctival diseases. RESULTS: The optimal ROI was found to be 400 vertical pixels by 300 horizontal pixels. Mean ROI pixel frequency was 5305 and % coverage was 4.4%. We confirmed the reproducibility of the analysis by comparing two images (r (2) = 0.7, P < 0.0001). Percentage blood vessel coverage increased in images of bimatoprost-induced hyperemia and hyperemia in allergic conjunctival diseases compared to the data from healthy volunteers. CONCLUSIONS: The software was simple to use and provided reproducible data. We established standard settings for the operation of the software. The use of our software will improve hyperemia evaluation, which is presently done using nonquantitative methods.

Soils on exposed Sunda shelf shaped biogeographic patterns in the equatorial forests of Southeast Asia.

The marked biogeographic difference between western (Malay Peninsula and Sumatra) and eastern (Borneo) Sundaland is surprising given the long time that these areas have formed a single landmass. A dispersal barrier in the form of a dry savanna corridor during glacial maxima has been proposed to explain this disparity. However, the short duration of these dry savanna conditions make it an unlikely sole cause for the biogeographic pattern. An additional explanation might be related to the coarse sandy soils of central Sundaland. To test these two nonexclusive hypotheses, we performed a floristic cluster analysis based on 111 tree inventories from Peninsular Malaysia, Sumatra, and Borneo. We then identified the indicator genera for clusters that crossed the central Sundaland biogeographic boundary and those that did not cross and tested whether drought and coarse-soil tolerance of the indicator genera differed between them. We found 11 terminal floristic clusters, 10 occurring in Borneo, 5 in Sumatra, and 3 in Peninsular Malaysia. Indicator taxa of clusters that occurred across Sundaland had significantly higher coarse-soil tolerance than did those from clusters that occurred east or west of central Sundaland. For drought tolerance, no such pattern was detected. These results strongly suggest that exposed sandy sea-bed soils acted as a dispersal barrier in central Sundaland. However, we could not confirm the presence of a savanna corridor. This finding makes it clear that proposed biogeographic explanations for plant and animal distributions within Sundaland, including possible migration routes for early humans, need to be reevaluated.