Comparisons of size of foveal avascular zone area among children with posterior microphthalmos, high hyperopia, and normal eyes.

PURPOSE: To determine the area of the surface foveal avascular zone (FAZ) in children with posterior microphthalmos (PM), high hyperopia, and normal eyes using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: Thirty-six children were studied including 6 cases 12 eyes of PM (mean age 9.5 ± 5.2 years), 15 cases 30 eyes of high hyperopia (6.9 ± 1.5 years), and 15 cases 30 eyes of healthy individuals (8.7 ± 1.7 years). The B- and C-scan images in all children were recorded by OCT and OCTA with a scanning area of 3.0 × 3.0 mm centered on the fovea. All images were corrected for axial length differences, and the area of the FAZ surface and central macular thickness (CMT) was measured manually and compared. RESULTS: The area of FAZ in the PM group was 0.007 ± 0.003 mm2, which was significantly smaller than that in the high hyperopia eyes at 0.286 ± 0.108 mm2 and healthy eyes at 0.318 ± 0.129 mm2 (both P < 0.001). The CMT in the PM group was 401.58 ± 33.60 mm, which was significantly thicker than in the high hyperopia eyes at 202.93 ± 12.28 mm and the normal eyes at 204.43 ± 18.76 mm. The area of the FAZ and CMT in the hyperopia group did not differ significantly from that of the normal healthy eyes. CONCLUSION: These findings indicate that patients with PM have a hypoplastic macular region, which must be considered in any treatment of these eyes.

Refractive changes with post-rotatory nystagmus in healthy individuals.

PURPOSE: Post-rotatory nystagmus has been used to detect autism spectrum disorders in clinical settings. Although previous studies have focused on eye movements, they did not evaluate the change in ocular refraction during post-rotatory nystagmus. This study aimed to evaluate the changes in ocular refraction during post-rotatory nystagmus in healthy individuals. METHODS: A total of 34 healthy volunteers (mean age ± standard deviation, 20.9 ± 0.6 years) participated in this study. The ocular refraction during post-rotatory nystagmus was measured using MR-6000 (Tomey Inc.) on quick mode with a sampling rate of 30 Hz under noncycloplegic and cycloplegic conditions. The amplitude of post-rotatory nystagmus was calculated on the basis of the anterior eye images, while the ocular refraction measurements were simultaneously recorded. The accommodative convergence per accommodation ratio was calculated using the heterophoria method. Video oculography was performed to measure the angle of convergence during post-rotatory nystagmus. RESULTS: The changes in ocular refraction during post-rotatory nystagmus were significantly greater under the noncycloplegic condition than under the cycloplegic condition. The changes in ocular refraction during the post-rotatory nystagmus were significantly and positively correlated with the amplitude of post-rotatory nystagmus under the noncycloplegic condition. The angle of convergence during post-rotatory nystagmus was significantly higher under the noncycloplegic condition than under the cycloplegic condition. The changes in the angle of convergence were significantly and positively correlated with the predicted accommodative convergence. CONCLUSIONS: These findings suggest that the accommodation was functional during the post-rotatory nystagmus to compensate for the retinal image slip, and the accommodative convergence can help weaken the nystagmus.

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy.

BACKGROUND AND AIMS: Direct percutaneous endoscopic jejunostomy (DPEJ) is an alternative method of enteral feeding to percutaneous endoscopic gastrostomy (PEG). Although long-term outcomes of PEG have been reported, little is known regarding the outcomes of DPEJ. METHODS: A retrospective cohort study was conducted including 115 and 651 consecutive attempts of DPEJ and PEG, respectively, in a total of 766 elderly patients between April 2004 and March 2019. Patients' clinical background, procedural and long-term outcomes, survival analysis, and cause of death were analyzed. RESULTS: Successful placement rates were 93.9% and 97.1% for DPEJ and PEG, respectively. There was no significant difference in procedure-related adverse events (AEs) between the DPEJ and PEG groups. Rates of pneumonia, vomiting, and upper GI bleeding were significantly lower, whereas those of fistula enlargement and ileus were significantly higher in the DPEJ group as long-term AEs. The median survival periods were 694 and 734 days for DPEJ and PEG, respectively, with no significant differences between the 2 groups. Multivariate analysis revealed that age 80 years old or older, C-reactive protein level of 1.0 mg/dL or higher, and the presence of diabetes were independent risk factors for mortality after DPEJ. Respiratory tract infection was the primary cause of death in both groups. CONCLUSIONS: DPEJ is considered a safe and feasible method of access for enteral feeding as well as PEG. Although the survival period after DPEJ may be expected to be as long as that with PEG, DPEJ-specific AEs should be kept in mind on long-term feeding.

Effect of color information on the diagnostic performance of glaucoma in deep learning using few fundus images.

PURPOSE: The purpose of this study was to evaluate the accuracy of the convolutional neural network (CNN) model in glaucoma identification with three primary colors (red, green, blue; RGB) and split color channels using fundus photographs with a small sample size. METHODS: The dataset was prepared using color fundus photographs captured with a fundus camera (VX-10i, Kowa Co., Ltd., Tokyo, Japan). The training dataset consisted of 200 images, and the validation dataset contained 60 images. In the preprocessing stage, the color channels for the fundus images were separated into red (red model), green (green model), and blue (blue model) using OpenCV on Windows. All images were resized to squares with a size of 512 × 512 pixels for preprocessing before input into the model, and the model was fine-tuned with VGG16. RESULTS: The diagnostic performance was significantly higher in the green model [area under the curve (AUC) 0.946; 95% confidence interval (CI) 0.851-0.982] than in the RGB model (AUC 0.800; 95% CI 0.658-0.893; P = 0.006), red model (AUC 0.746; 95% CI 0.601-0.851; P = 0.002), and blue model (AUC 0.558; 95% CI 0.405-0.700; P < 0.001). CONCLUSION: The present study showed that the green digital filter is useful for structuring CNN models for automatic discrimination of glaucoma using fundus photographs with a small sample size. The present findings suggest that preprocessing, when creating the CNN model, is an important step for the identification of a large number of retinal diseases using color fundus photographs.

A mutation in transcription factor MAFB causes Focal Segmental Glomerulosclerosis with Duane Retraction Syndrome.

Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage renal disease in children and adults. Genetic factors significantly contribute to early-onset FSGS, but the etiologies of most adult cases remain unknown. Genetic studies of monogenic syndromic FSGS exhibiting extra-renal manifestations have uncovered an unexpected biological role for genes in the development of both podocytes and other cellular lineages. To help define these roles, we studied two unrelated families with FSGS associated with Duane Retraction Syndrome, characterized by impaired horizontal eye movement due to cranial nerve malformation. All four affected individuals developed FSGS and Duane Retraction Syndrome in their first to second decade of life, manifested as restricted abduction together with globe retraction and narrowed palpebral fissure on attempted adduction. Hypoplasia of the abducens nerves and hearing impairment occurred in severely affected individuals. Genetic analyses revealed that affected individuals harbor a rare heterozygous substitution (p.Leu239Pro) in MAFB, a leucine zipper transcription factor. Luciferase assays with cultured monocytes indicated that the substitution significantly reduced transactivation of the F4/80 promoter, the known MAFB recognition element. Additionally, immunohistochemistry indicated reduced MAFB expression in the podocytes of patients. Structural modeling suggested that the p.Leu239Pro substitution in the DNA-binding domain possibly interferes with the stability of the adjacent zinc finger. Lastly, podocytes in neonatal mice with p.Leu239Pro displayed impaired differentiation. Thus, MAFB mutations impair development and/or maintenance of podocytes, abducens neurons and the inner ear. The interactions between MAFB and regulatory elements in these developing organs are likely highly specific based on spatiotemporal requirements.

An Elderly Patient Developed Ulcerative Colitis after SARS-CoV-2 mRNA Vaccination: A Case Report and Review of the Literature.

An 86-year-old man presented to our hospital with symptoms of diarrhea and bloody stool, which had manifested two weeks after receiving his third severe acute respiratory syndrome coronavirus 2 mRNA vaccination. Colonoscopy revealed diffuse, rough-surfaced mucosa extending from the ascending colon to the rectum. Despite attempting probiotic treatment, the patient's condition did not improve, leading to admission. Endoscopic findings at admission worsened. Based on endoscopic and histopathological findings, the patient was diagnosed with ulcerative colitis. Corticosteroids and 5-aminosalicylic acid were administered, and the clinical symptoms improved. Subsequently, the disease worsened during steroid tapering, and filgotinib was added, leading to steroid-free remission.

Capacitance Determination for the Evaluation of Electrochemically Active Surface Area in a Catalyst Layer of NiFe-Layered Double Hydroxides for Anion Exchange Membrane Water Electrolyser.

The determination of the electrochemically active surface area (ECSA) of a catalyst layer (CL) of a non-precious metal catalyst is of fundamental importance in optimizing the design of a durable CL for anion exchange membrane (AEM) water electrolysis, but has yet to be developed. Traditional double layer capacitance (Cdl), measured by cyclic voltammetry (CV), is not suitable for the estimation of the ECSA due to the nonconductive nature of Ni-based oxides and hydroxides in the non-Faradaic region. This paper analyses the applicability of electrochemical impedance spectroscopy (EIS) compared to CV in determining capacitances for the estimation of the ECSA of AEM-based CLs in an aqueous KOH electrolyte solution. A porous electrode transmission line (TML) model was employed to obtain the capacitance-voltage dependence from 1.0 V to 1.5 V at 20 mV intervals, covering both non-Faradic and Faradic regions. This allows for the identification of the contribution of a NiFe-layered double hydroxide (LDH) catalyst and supports in a CL, to capacitances in both non-Faradic and Faradic regions. A nearly constant double layer capacitance (Qdl) observed in the non-Faradic region represents the interfaces between catalyst supports and electrolytes. The capacitance determined in the Faradic region by EIS experiences a peak capacitance (QF), which represents the maximum achievable ECSA in an AEMCL during reactions. The EIS method was additionally validated in durability testing. An approximate 30% loss of QF was noted while Qdl remained unchanged following an eight-week test at 1 A/cm2 constant current density, implying that QF, determined by EIS, is sensitive to and therefore suitable for assessing the loss of ECSA. This universal method can provide a reasonable estimate of catalyst utilization and enable the monitoring of catalyst degradation in CLs, in particular in liquid alkaline electrolyte water electrolysis systems.

[Viewing 3D stereoscopic images in children and adults with and without strabismus: multicenter study in Japan].

PURPOSE: To investigate the ability of patients with strabismus and/or amblyopia to see 3D images. METHODS: A questionnaire survey conducted for children aged 6 to 19 years and adults aged 20 to 39 years on their experience of viewing 3D images (movies, motion attractions, television, games), asking whether they could see stereoscopically, with or without adverse effects. A retrospective investigation of ophthalmological examinations was followed. RESULTS: Of 507 cases, 342 had had the experience of veiwing 3D images. In 212 (62%) cases of strabismus and/or amblyopia, stereopsis was lacking in 17 to 18% of the subjects for movies, in 6 to 7% for attractions, in 32% in children and 50% in adults for television and 23% in children and 17% in adults for games. Adults complained of a higher rate of adverse effects, 65% for movies and 75% for games, as compared with 34% for movies and 26% for games in children(p < 0.01). The lack of stereopsis for games and movies was higher in the subgroup of Fly (-) and convergence insufficiency (p < 0.05). CONCLUSIONS: Since many patients with strabismus and/or amblyopia found some difficulty in stereoscopic viewing, precise examinations for stereopsis and convergence are needed to assess individual aptitude for 3D viewing.

Analysis of smooth pursuit eye movements in a clinical context by tracking the target and eyes.

In the evaluation of smooth pursuit eye movements (SPEMs), recording the stimulus onset time is mandatory. In the laboratory, the stimulus onset time is recorded by electrical signal or programming, and video-oculography (VOG) and the visual stimulus are synchronized. Nevertheless, because the examiner must manually move the fixation target, recording the stimulus onset time is challenging in daily clinical practice. Thus, this study aimed to develop an algorithm for evaluating SPEMs while testing the nine-direction eye movements without recording the stimulus onset time using VOG and deep learning-based object detection (single-shot multibox detector), which can predict the location and types of objects in a single image. The algorithm of peak fitting-based detection correctly classified the directions of target orientation and calculated the latencies and gains within the normal range while testing the nine-direction eye movements in healthy individuals. These findings suggest that the algorithm of peak fitting-based detection has sufficient accuracy for the automatic evaluation of SPEM in clinical settings.

Retrospective analyses of complications associated with transcutaneous replacement of percutaneous gastrostomy and jejunostomy feeding devices.

BACKGROUND: Feeding device replacement is often required for long-term maintenance after initial percutaneous endoscopic gastrostomy or jejunostomy placement. Although there are several case reports on serious complications of gastrostomy device replacement, there are few reports of an overall analysis of the complications associated with feeding device replacement. OBJECTIVE: To evaluate the frequency and variety of complications of transcutaneous replacement of feeding devices. DESIGN: A retrospective study. SETTING: Single center: Nishimino Kosei Hospital. PATIENTS: This study involved 363 consecutive patients undergoing a total of 1265 percutaneous gastrostomy or jejunostomy device replacements from March 2000 to September 2010. INTERVENTION: A new replacement device was inserted through the ostomy tract by using an obturator after traction removal of the previous device. Endoscopic treatments were performed in the cases of fistula disruption or hemorrhage. MAIN OUTCOME MEASUREMENTS: Complications and their outcomes. RESULTS: Gastrostomy and jejunostomy devices were replaced 1126 and 139 times, respectively. There were 16 complications (1.3% of total replacements) consisting of 10 cases of fistula disruption caused by misplacement of replacement devices into the peritoneal cavity, 4 cases of hemorrhage, and 1 case each of colocutaneous fistula and device breakage. Anticoagulation or antiplatelet medications were continued in all 4 hemorrhage cases but in only 27 of 347 (7.7%) complication-free cases (P < .0001). There were no replacement-related adverse events that required surgical repair. LIMITATIONS: A single center, retrospective analysis. CONCLUSION: Fistula disruption and hemorrhage were the most common complications associated with device replacement. In patients on anticoagulants, caution is necessary to avoid hemorrhage after replacement. It is also important to verify that the replaced device is located in the GI tract lumen before feeding.

[Cetuximab-associated skin ulceration in patient with metastatic colorectal cancer: a case report].

An 82-year-old female was diagnosed with rectal cancer. Hartmann's procedure was performed and a curative resection was successfully achieved. Postoperative staging according to the classification of the Japanese Society for Cancer of the Colon and Rectum(The 7th Edition)was stage III. She received adjuvant chemotherapy after surgery with tegafur(UFT 300 mg/body/day)orally for 6 months. One year after the surgery, paraaortic lymph node metastasis and a local recurrence were diagnosed. She was treated with modified FOLFOX6 chemotherapy combined with bevacizumab. After 13 courses of treatment with FOLFOX6 and bevacizumab, multiple lung metastases were found. Therefore, we changed the chemotherapy regimens to FOLFIRI plus cetuximab. After 18 weeks of this new treatment she had two skin ulcerations around her stoma, a known side effect associated with cetuximab. We stopped cetuximab and continued chemotherapy with FOLFIRI alone. Seven weeks after cetuximab withdrawal, her skin ulcer healed with the support of a dermatologist and a wound ostomy continence nurse. We reintroduced cetuximab in a chemotherapy regimen with a reduced dose. After two infusions of cetuximab, skin ulceration recurred. We stopped cetuximab again and continued chemotherapy with FOLFIRI. Nine weeks later we resumed cetuximab, but this time the skin ulcer did not occur, and we were able to continue the chemotherapy regimen with FOLFIRI and cetuximab.

Automatic Recording of the Target Location During Smooth Pursuit Eye Movement Testing Using Video-Oculography and Deep Learning-Based Object Detection.

Purpose: To accurately record the movements of a hand-held target together with the smooth pursuit eye movements (SPEMs) elicited with video-oculography (VOG) combined with deep learning-based object detection using a single-shot multibox detector (SSD). Methods: The SPEMs of 11 healthy volunteers (21.3 ± 0.9 years) were recorded using VOG. The subjects fixated on a moving target that was manually moved at a distance of 1 m by the examiner. An automatic recording system was developed using SSD to predict the type and location of objects in a single image. The 400 images that were taken of one subject using a VOG scene camera were distributed into 2 groups (300 and 100) for training and validation. The testing data included 1100 images of all subjects (100 images/subject). The method achieved 75% average precision (AP75) for the relationship between the location of the fixated target (as calculated by SSD) and the position of each eye (as recorded by VOG). Results: The AP75 for all subjects was 99.7% ± 0.6%. The horizontal and vertical target locations were significantly and positively correlated with each eye position in the horizontal and vertical directions (adjusted R2 ≥ 0.955, P < 0.001). Conclusions: The addition of SSD-driven recording of hand-held target positions with VOG allows for quantitative assessment of SPEMs following a target during an SPEM test. Translational Relevance: The combined methods of VOG and SSD can be used to detect SPEMs with greater accuracy, which can improve the outcome of clinical evaluations.

Clinical investigation of upper gastrointestinal hemorrhage after percutaneous endoscopic gastrostomy.

BACKGROUND: Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. PATIENTS AND METHODS: We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. RESULTS: Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement-related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement-related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. CONCLUSIONS: Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube.

[A case of cardiac sarcoidosis occurring during combination therapy by IFN alpha and ribavirin for chronic hepatitis C].

A 72-year-old woman received combination therapy with peginterferon alpha and ribavirin for treatment of chronic hepatitis C. Approximately 40 weeks after starting treatment, she developed an eruption in the left inner canthus and sarcoidosis was diagnosed after biopsy of the eruption. Combination therapy was discontinued, and further detailed examinations revealed bilateral hilar lymphadenopathy, uveitis, and complete atrioventricular block. A permanent cardiac pacemaker was implanted, and her sarcoidosis improved upon administration of corticosteroids.

Use of a Low-carbohydrate Enteral Nutrition Formula with Effective Inhibition of Hypoglycemia and Post-infusion Hyperglycemia in Non-diabetic Patients Fed via a Jejunostomy Tube.

Objective As direct jejunal feeding often causes great fluctuation in glucose levels, continuous or slow infusion is recommended for jejunal tube-fed patients. However, continuous feeding results in prolonged immobility and the loss of activities of daily living. We investigated whether or not intermittent feeding of a low-carbohydrate high-monounsaturated fatty acid (LC/HM) nutrient formula reduces glucose fluctuation in patients who have undergone jejunotomy. Methods Ten bed-ridden non-diabetic patients receiving enteral feeding via a jejunostomy tube were enrolled in this study. LC/HM formula and standard control formula were infused in cross-over order for each patient at a speed of 160 kcal/h. Blood glucose levels were monitored by a continuous glucose monitoring system during the investigation period. Results The mean and standard deviation of the glucose concentrations and mean amplitude of glucose excursion (MAGE) were markedly lower while receiving LC/HM formula than while receiving control standard formula (104 vs. 136 mg/dL, 18.1 vs. 58.1 mg/dL, 50.8 vs. 160 mg/dL, respectively). The post-infusion hyperglycemia [area under the curve (AUC) >140 mg/dL] and peak value of the glucose level were also significantly lower in patients fed LC/HM than the control (25.7 vs. 880 mg・h/dL and 153 vs. 272 mg/dL, respectively). Reactive hypoglycemia (AUC <70 mg/dL) was also significantly lower (0.63 vs. 16.7 mg・h/dL) and the minimum value of the glucose level higher (78.4 vs. 61.8 mg/dL) in patients fed LC/HM than the control. Conclusion The LC/HM formula is considered to markedly inhibit glycemic spikes and prevent rebound hypoglycemia in patients who receive enteral feeding after jejunostomy.

Inhibition of gastroesophageal reflux by semi-solid nutrients in patients with percutaneous endoscopic gastrostomy.

BACKGROUND: Aspiration is one of the major complications after percutaneous endoscopic gastrostomy (PEG). The administration of semi-solid nutrients by means of gastrostomy tube has recently been reported to be effective in preventing aspiration pneumonia. The effects of semi-solid nutrients on gastroesophageal reflux, intragastric distribution, and gastric emptying were evaluated. METHODS: Semi-solid nutrients were prepared by liquid nutrients mixed with agar at the concentration of 0.5%. The distribution of the administered radiolabeled liquid and semi-solid nutrients was monitored by a scintillation camera for 15 post-PEG patients. The percentage of esophageal reflux, the distribution of the proximal and distal stomach, and the gastric emptying time were evaluated. RESULTS: The percentage of gastroesophageal reflux was significantly decreased in semi-solid nutrients (0.82 +/- 1.27%) compared with liquid nutrients (3.75 +/- 4.25%), whereas the gastric emptying time was not different. The distribution of semi-solid nutrients was not different from liquid nutrients in the early phase, whereas higher retention of liquid nutrients in the proximal stomach was observed in the late phase. CONCLUSIONS: Gastroesophageal reflux was significantly inhibited by semi-solid nutrients. One of the mechanisms of the inhibition is considered to be an improvement in the transition from the proximal to distal stomach in semi-solid nutrients.

Incidence of side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in Japanese children: a multicenter study.

PURPOSE: To investigate the incidence rate and side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in children aged 15 years or under. METHODS: This prospective study had been conducted at 9 institutions between April 1, 2016 and March 31, 2017 in patients 15 years old or younger who received either atropine or cyclopentolate for refraction assessment. The investigation included patient's age, symptoms, and whether patients with side effects had any systemic diseases. RESULTS: A total of 811 patients (mean age ± SD, 4.6 ± 2.2 years) received atropine and 71 (8.8%) patients had side effects. Except in patients under two years old, 1% eye drops showed higher incidence rate of side effects than 0.5% and 0.25% eye drops. Side effects most frequently occurred following the initiation of the instillation on the first day. The symptoms included flush (29/71, 40.8%), fever (21/71, 30.0%), and both (11/71, 15.5%). A total of 2238 patients (5.7 ± 3.0 years) used cyclopentolate and 27 (1.2%) (4.0 ± 2.2 years) patients had side effects. The symptoms included drowsiness (10/27, 37.0%), red eye (4/27, 14.8%), fever (3/27, 11.1%), and flush (3/27, 11.1%). CONCLUSIONS: Atropine has a side effect incidence rate 7 times higher than the incidence rate of cyclopentolate. Flush and fever are the most common side effects of atropine and drowsiness is the main side effect of cyclopentolate. These findings should be noted when examining cycloplegic refraction to manage amblyopia and strabismus in children.

A case of acute gastroduodenitis with cytomegalovirus infection in a healthy adult.

A 33-year-old man with epigastralgia was admitted. Upper gastrointestinal endoscopy revealed gastric fold hypertrophy, mucosal hemorrhage, and widespread erosion in the stomach and aphthoid erosion in the duodenum. The presence of intranuclear inclusion bodies positively stained with anti-cytomegalovirus antibody from the biopsy specimens indicated that the gastroduodenitis was related to cytomegalovirus (CMV) infection. He recovered within 2 weeks without antiviral therapy. Duodenal involvement of CMV infection is fairly rare in immunocompetent hosts.

Evaluation of newly-developed aniseikonia testing method based on space eikonometry.

BACKGROUND: We have developed a new aniseikonia testing method based on the space eikonometry (ATSE) principle. The purpose of this study was to compare aniseikonia obtained by the ATSE to that of the conventional new aniseikonia tests (NAT), which is commonly used in Japan. METHODS: Thirty normal subjects (mean age: 22.8 years) without ocular disease except for refractive errors were studied. All of the subjects had normal binocular single vision with stereopsis. We excluded subjects with refractive errors greater than 1.00 D cylinder or anisometropia (spherical equivalent) greater than 1.00 D. We simulated overall aniseikonia of five and 10 per cent with afocal size lenses (HOYA, Tokyo, Japan) placed in the optical path of the fully corrected right eye. We measured aniseikonia three times with either the ATSE or NAT and the averages were used for the statistical analyses. RESULTS: The mean and standard deviation (SD) of aniseikonia determined by the ATSE was 5.1 ± 0.8 per cent with the five per cent afocal lens and 10.1 ± 0.8 per cent with the 10 per cent afocal lens. Aniseikonia was 2.8 ± 1.3 per cent with the five per cent afocal lens and 6.0 ± 2.5 per cent with the 10 per cent afocal lens by the NAT. The mean error was + two per cent of the theoretical value by the ATSE and -42 per cent by the NAT for both afocal lenses. CONCLUSION: We recommend the use of the new ATSE for quantitative determination of aniseikonia, as it is more accurate than the NAT.