Wavefront analysis of eye with monocular diplopia and cortical cataract.

PURPOSE: To determine whether higher-order aberrations can explain the monocular diplopia reported by a patient. DESIGN: Observational case report. METHODS: A patient complaining of monocular diplopia was examined with the Hartmann-Shack aberrometer to determine if the higher-order wavefront aberrations could account for the diplopia. The patient had a mild cortical cataract, and measurements were made before and after lensectomy. In addition, the retinal image was simulated using Zernike polynomials. RESULTS: Spherical aberration (0.20 microm for 4-mm pupil) and secondary astigmatism (-0.12 microm) were increased in the eye. The simulated retinal image had a double configuration that was approximately the same as the subjective image reported by the patient. After cataract surgery, the diplopia disappeared, and the spherical aberrations and secondary astigmatism were considerably decreased. CONCLUSIONS: The monocular diplopia probably stemmed from the combined effects of spherical aberration and secondary astigmatism caused by the cortical cataract.

Diagnosing dry eye using a blue-free barrier filter.

PURPOSE: To investigate the benefit of the blue-free barrier filter (BF filter) in diagnosing dry eye. DESIGN: Nonrandomized clinical comparison. METHODS: Fifty-three eyes with Sjögren syndrome (n = 42) or keratoconjunctivitis sicca (n = 11) were enrolled. Fluorescein staining was performed in temporal and nasal conjunctiva, and staining was scored with (BF score) and without the filter (FL score) from 0 to 3. Rose bengal staining was also scored (RB score) similarly. RESULTS: With FL scores of 0, 1, or 2, the BF score was significantly higher: 0.85 +/- 0.37 (P =.031), 1.74 +/- 0.65 (P =.001), and 2.65 +/- 0.48 (P =.001), respectively; with a FL score of 3, the BF score was 3 at all sites. The BF score was superior to the FL score in 66.6% of cases when the FL score was 0 and 1 and in 65.2% when the FL score was 2, but not when the FL score was 3. When the RB score was 0, 1, or 2, the BF score was higher: 1.88 +/- 0.92, 1.78 +/- 0.79, and 2.57 +/- 0.50, respectively (P =.001 for all); when the RB score was 3, the BF score was 2.97 +/- 0.16. The BF score was superior to the RB score in 75.5% of cases when the RB score was 0 and 1 and in 57.8% when the FL score was 2, but not in cases with a RB score of 3. CONCLUSIONS: The BF filter detects damaged conjunctival epithelium stained with fluorescein. Using the filter was beneficial in mild-to-moderate cases, not in severe cases. The BF filter allows diagnosis of dry eye even at the initial stage that is undetectable by conventional observation.

Development of bilateral, nonarteritic anterior ischemic optic neuropathy in an eye with diabetic papillopathy.

BACKGROUND: Diabetic papillopathy and anterior ischemic optic neuropathy are different clinical entities with different prognoses. We describe a case of diabetic papillopathy that developed into bilateral nonarteritic anterior ischemic optic neuropathy (AION). CASE: A 58-year-old woman with diabetes mellitus had bilateral disc elevation. Goldmann perimetry showed altitudinal hemianopsia in the left eye. The early phase of fluorescein angiography showed hypoperfusion in the superior segment of the left optic disc indicating AION in the left eye. OBSERVATIONS: During the follow-up period, the visual field of the left eye was further constricted and that of the right eye also developed signs of AION, suggesting that bilateral anterior ischemic optic neuropathy had developed. After steroid pulse therapy, her vision recovered slightly, but the visual field remained constricted in both eyes. The optic discs had a low cup/disc ratio. CONCLUSIONS: Our findings demonstrated that diabetic papillopathy can precede the development of nonarteritic anterior ischemic optic neuropathy.

Effect of internal lubricating agents of disposable soft contact lenses on higher-order aberrations after blinking.

PURPOSE: To investigate whether the polymer composition of disposable soft contact lenses affects sequential changes in higher-order aberrations (HOAs). METHODS: Fifteen subjects who wore disposable soft contact lenses with dryness-related symptoms and 15 non-contact lens wearers were enrolled in this study. Ocular HOAs were measured for 60 seconds in each subject wearing a disposable etafilcon A lens (conventional lens) or a disposable etafilcon A lens with polyvinyl pyrrolidone (PVP) (lens with PVP) after 1 hour of contact lens wear. During the measurement, subjects were forced to blink every 10 seconds. The aberration data were analyzed in the central 4-mm diameter up to the sixth-order Zernike polynomials. Total HOAs, the fluctuation index (FI), and the stability index (SI) of the total HOAs over time were compared between the two groups. The subjective ocular dryness also was scored. RESULTS: In symptomatic wearers of disposable soft contact lenses, the total HOAs, the FI, and the SI with the lens with PVP were significantly (P=0.013, P=0.014, P=0.019, respectively) lower than with the conventional lens, whereas a significant (P=0.018) difference between the two lenses was observed only in the FI in non-contact lens wearers. Subjective ocular dryness with the lens with PVP significantly decreased compared with the conventional lens in both groups. CONCLUSIONS: Sequential measurement of HOAs may be a useful objective method to evaluate the effect of internal lubricating agents of disposable soft contact lenses on optical quality.

Effect of simultaneous oblique muscle surgery in foveal translocation by 360 degrees retinotomy.

PURPOSE: To assess the effect of simultaneous oblique muscle surgery during foveal translocation surgery with 360 degrees retinotomy in patients with neovascular maculopathy. METHODS: Foveal translocation with 360 degrees retinotomy was performed on 31 eyes of 31 patients with neovascular maculopathy (21 with age-related macular degeneration 9 with myopic neovascular maculopathy, and 1 with idiopathic neovascular maculopathy). All eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Visual acuity, binocular vision, and degree of cyclotorsion were assessed pre- and postoperatively. The angles of retinal and global rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS: With a mean postoperative follow-up of 10.0 months, vision improved (>0.2 log MAR units) in 13 eyes, was unchanged in 9 eyes, and worsened (>0.2 log MAR units) in 9 eyes. Ten of 31 eyes (32%) had a final visual acuity of 20/50 or better. Eleven patients had binocular fusion, 13 patients showed suppression, and 7 patients developed diplopia that was managed by spectacles with prisms or by secondary muscle surgery. The mean retinal and global rotations were 30.3 degrees and 23.7 degrees, respectively. The average size of the choroidal neovascular membrane was 1.3 disc diameters (DD), while the average shift of the fovea was 1.5 DD. After the primary surgery, six eyes developed retinal detachment, two eyes macular hole, and three eyes proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. CONCLUSION: Foveal translocation with 360 degrees retinotomy is effective in restoring vision in 40% of patients with neovascular maculopathy. Simultaneous oblique muscle surgery was effective in rotating the globe by about 20 degrees, corresponding to to a foveal shift of 1.5 DD. While the development of torsional diplopia is generally prevented by simultaneous oblique muscle surgery, the relatively high incidence of surgical complications with this procedure should be taken into account.

Foveal sensitivity and fixation stability before and after macular translocation with 360-degree retinotomy.

PURPOSE: To evaluate the functional changes of the fovea by scanning laser ophthalmoscopy (SLO) fundus perimetry after macular translocation with 360-degree retinotomy, and to determine whether the preoperative macular function estimated by the sensitivity of the fovea and the stability of fixation can predict visual acuity after the surgery. METHODS: Macular translocation with 360-degree retinotomy and simultaneous torsional muscle surgery were performed on 25 eyes of 25 patients with choroidal neovascularization. The index of foveal sensitivity (Isens) and the index of fixation stability (Ifix) before and after surgery were calculated from the microperimetric data. The preoperative Isens and Ifix were compared with postoperative Isens and Ifix, respectively. The correlations of preoperative Isens and Ifix with the visual acuity after the translocation surgery (VApost) were calculated. RESULTS: Isens increased in 14 (56%) of 25 eyes. Ifix improved in 10 (40%) of 25 eyes. The preoperative Isens and VApost were moderately correlated (r = 0.434, P = 0.0295), while the preoperative Ifix and VApost were highly correlated (r = - 0.530, P = 0.0057). CONCLUSION: An increase in foveal sensitivity and an improvement in the fixation stability were demonstrated quantitatively by microperimetry. The preoperative foveal sensitivity and fixation stability were correlated with the postoperative visual acuity. Microperimetry using SLO can be used to investigate foveal function before and after the translocation and to predict the postoperative visual acuity.