Daily light exposure profiles and the association with objective sleep quality in patients with Parkinson's disease: The PHASE study.

STUDY OBJECTIVES: Light information crucially influences sleep initiation and continuity. The purpose of this study was to compare daily light exposure between patients with Parkinson's disease (PD) and non-PD older adults and evaluate the association of daily light exposure with objective sleep measures in patients with PD. METHODS: In this cross-sectional study of 189 outpatients with PD and 1101 community-dwelling older adults (controls), daily light exposure was measured using wrist light meters during the daytime and light meters set in the bedrooms during the nighttime, and objective sleep quality was measured by wrist actigraphy. RESULTS: The median duration of exposure to ≥ 1000 lux light was significantly shorter in patients with PD than in controls. The median nighttime light intensity was higher in patients with PD than in controls. Among patients with PD, multivariable analysis suggested that the highest quartile of exposure to ≥ 1000 lux light during the daytime was linked to significantly higher sleep efficiency (SE) by 8.0% and shorter wake after sleep onset (WASO) by 36.9 minutes than the lowest quartile. During the nighttime, the highest quartile of mean light intensity had significantly lower SE by 6.8%, longer WASO by 24.1 minutes, longer sleep onset latency, and higher fragmentation index, than the lowest quartile. Importantly, daytime and nighttime light levels were independently associated with objective sleep measures. CONCLUSIONS: The present study illustrated that greater daytime light exposure and lower nighttime light exposure are significantly associated with better objective sleep measures in patients with PD.

Post-Illumination Pupil Response and Sleep Quality in Patients With Glaucoma: The LIGHT Study.

Purpose: This study aimed to investigate whether intrinsically photosensitive retinal ganglion cell function evaluated using post-illumination pupil response (PIPR) in patients with glaucoma is associated with sleep quality. Methods: This cross-sectional study measured the PIPR in 138 patients with glaucoma (mean age, 70.3 years) using pupil diameter after red and blue light exposure. The net PIPR change was classified into three groups according to tertiles (i.e., low, intermediate, and high groups), with lower net PIPR change indicating lower intrinsically photosensitive retinal ganglion cell (ipRGC) function. Subjective and objective sleep qualities were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and actigraphy, respectively, with a total PSQI score of ≥6 indicating sleep disturbance. Results: The prevalence of subjective sleep disturbance significantly increased with decreasing tertile groups of net PIPR change (P = 0.036). Subgroup analysis obtained the same results in the severe glaucoma group (P = 0.004) but not in the non-severe glaucoma group. In the severe glaucoma group, multivariable logistic regression analysis adjusted for potential confounders showed a higher odds ratio for subjective sleep disturbance in the low-tertile group of net PIPR compared with the high-tertile group (odds ratio = 6.22; 95% confidence interval, 1.76-21.90; P = 0.004). Significant associations between PIPR and objective sleep quality (total sleep time, sleep efficiency, and wake after sleep onset) were found in the severe glaucoma group (P = 0.015, P = 0.013, and P = 0.015, respectively). Conclusions: The PIPR in patients with glaucoma was significantly associated with decreased sleep quality, independent of potential confounders.

Circadian blood pressure variability and asymmetric dimethylarginine in patients with glaucoma: cross-sectional study of The LIGHT cohort.

OBJECTIVE: Glaucoma is reportedly associated with asymmetric dimethylarginine (ADMA) and circadian blood pressure (BP) variability, including night-time SBP. We determined whether ADMA level is associated with night-time SBP in patients with glaucoma. METHODS: In this cross-sectional study, we measured the serum ADMA level and ambulatory BP of 163 patients with glaucoma and 705 participants without glaucoma. Based on the tertiles of serum ADMA level, the patients were divided into three groups: low, intermediate, and high-ADMA. Night-time SBP was determined based on ambulatory BP measured every 30 min for 48 h. The nondipper BP pattern was defined as having a night-time mean SBP decline of less than 10% relative to the mean daytime SBP. RESULTS: In the glaucoma group, the night-time SBP in the high-ADMA group was significantly higher than in the low-ADMA group (123.0 and 114.4 mmHg, respectively; P  = 0.003). Multivariable analysis adjusted for the potential confounders showed the night-time SBP, and the odds ratio for nondipper in the high-ADMA group were also significantly higher than in the low-ADMA group ( P  = 0.030 and P  = 0.021, respectively). Significant associations between continuous serum ADMA levels with night-time SBP and nondipper were also found ( P  = 0.002 and 0.006, respectively). In the control group, however, no significant associations were found between serum ADMA levels and night-time SBP and nondipper. A significant interaction effect of the serum ADMA levels and glaucoma on nondipper was found ( P  = 0.004). CONCLUSION: Serum ADMA level was significantly associated with the disturbance of circadian BP variability in patients with glaucoma.

Association Between Postillumination Pupil Response and Glaucoma Severity: A Cross-Sectional Analysis of the LIGHT Study.

Purpose: This study determines whether the functional and structural severity of glaucoma is associated with intrinsically photosensitive retinal ganglion cell (ipRGC) function. Methods: This cross-sectional study assessed 148 eyes from 148 patients with glaucoma (mean age 70.5 years). The ipRGC function was assessed by postillumination pupil response (PIPR) using the pupil diameter after exposure to blue and red light. Main outcome measures were as follows: six-second PIPR amplitude, net PIPR, and net PIPR change. Functional and structural glaucoma severities were evaluated using visual field mean deviation (MD) and the circumpapillary retinal nerve fiber layer (RNFL) thickness, respectively. Results: Multivariable analysis adjusting for age, sex, body mass index, hypertension, diabetes, oral medication use, cataract surgery, axial length, and topical alpha2-adrenergic receptor agonist use showed that worsening in visual field MD was significantly associated with higher blue six-second PIPR amplitude (regression coefficient per -1 dB worsening, 0.25; 95% confidence intervals [CI], 0.14, 0.37; P < 0.001). The thinner RNFL thickness was significantly associated with higher blue six-second PIPR amplitude, lower Net PIPR change, and lower net PIPR (blue six-second PIPR amplitude: regression coefficient per 10-µm thinning, 1.29; 95% CI, 0.72, 1.87; P < 0.001; net PIPR change: regression coefficient, -0.70; 95% CI, -1.26, -0.14; P = 0.015; net PIPR: regression coefficient, -0.03; 95% CI, -0.05, -0.001; P = 0.044). No significant association was found between glaucoma severity and red six-second PIPR amplitude. Conclusions: Our findings revealed a significant association between functional and structural glaucoma severity and impaired ipRGC function independent of potential confounders.

Lower Cognitive Function in Patients With Functionally and Structurally Severe Glaucoma: The LIGHT Study.

PRECIS: This cross-sectional study of 172 patients with glaucoma showed that functional and structural glaucoma damage was significantly associated with cognitive impairment independent of age and visual acuity. PURPOSE: The aim of this study was to determine whether functional and structural glaucoma damage is associated with cognitive function. PATIENTS AND METHODS: This was a cross-sectional analysis comprising 172 patients with glaucoma with a mean age of 70.6 years. Functional glaucoma severity was evaluated according to the visual field mean deviation (MD) (severe, MD ≤-12 dB; mild, MD >-12 dB), and structural glaucoma severity was determined based on circumpapillary retinal nerve fiber layer thickness. The main outcome measure was cognitive impairment defined by a Mini-Mental State Examination (MMSE) score of ≤26 and MMSE-blind score of ≤16. RESULTS: The prevalence of patients with cognitive impairment (MMSE score ≤26) was significantly higher in the severe glaucoma group than in the mild glaucoma group (33.3% vs. 15.7%; P=0.010, respectively). Similar results were obtained in the analyses with MMSE-blind score of ≤16 (14.7% vs. 1.4%; P=0.003, respectively). Multivariable logistic regression analysis adjusted for potential confounders, including age, body mass index, education, visual acuity, hypertension, diabetes, and depressive symptoms, indicated a higher odds ratio (OR) for cognitive impairment (MMSE score ≤26) in patients with severe glaucoma than in those with mild glaucoma (OR, 2.62; 95% confidence interval, 1.006-6.84; P=0.049) and in relation to a 10-µm thinning of the retinal nerve fiber layer (OR, 1.42; 95% confidence interval, 1.05-1.93; P=0.025). CONCLUSION: Functional and structural glaucoma damage was significantly associated with lower cognitive function independent of age and visual acuity in a glaucoma cohort.

Association Between the Asymmetric Dimethylarginine Levels and Glaucoma Severity: A Cross-Sectional Analysis of the LIGHT Study.

Purpose: Asymmetric dimethylarginine (ADMA), a potent endogenous inhibitor of nitric oxide synthase, may be involved in the pathophysiology of glaucoma by dysfunctioning nitric oxide and oxidative stress. The purpose of this study was to determine whether the serum ADMA level is associated with the severity of glaucoma. Methods: One hundred twenty-five patients with glaucoma (mean age 69.4 years) were analyzed in this cross-sectional study. The severity of glaucoma was determined by the visual field mean deviation in the worse eye; severe, a mean deviation ≤ -12 dB; and mild, a mean deviation > -12 dB. The serum ADMA levels were classified into three groups according to tertiles; low (T1), intermediate (T2), and high group (T3). Results: The mean serum ADMA levels in the severe glaucoma group was significantly higher than that in the mild glaucoma group (0.41 vs. 0.39 µmol/L; P = 0.031). A significantly higher prevalence of patients with severe glaucoma was found in the T3 group than that in the T1 group (T1, 44.7% and T3, 68.2%; P = 0.018). In the multivariable logistic regression analysis adjusted for the potential confounders, e.g., age, sex, obesity, smoking, hypertension, diabetes, and renal function, the odds ratio for severe glaucoma in the T3 group was significantly higher than that in the T1 group (odds ratio 3.02; 95% confidence interval 1.04 to 8.79; P = 0.043). Conclusions: A significant association between higher serum ADMA levels and severe glaucoma was found, and this association remained significant after adjusting for the potential confounders.

Effects of visual impairment on mobility functions in elderly: Results of Fujiwara-kyo Eye Study.

The aim of this study was to determine whether there is a significant association between a visual impairment (VI) and mobility functions in an elderly Japanese cohort. The subjects of this study were part of the Fujiwara-kyo Eye Study, a cross sectional epidemiological study of elderly individuals conducted by Nara Medical University. Participants were ≥70-years who lived in the Nara Prefecture. All underwent comprehensive ophthalmological examinations, and a VI was defined as a best-corrected visual acuity (BCVA) worse than 20/40 in the better eye. The associations between the BCVA and walking speed and one-leg standing time were determined. The medical history and health conditions were evaluated by a self-administered questionnaire. A total of the 2,809 subjects whose mean age was 76.3 ± 4.8 years (± standard deviation) were studied. The individuals with a VI (2.1%) had significantly slower walking speeds and shorter one-leg standing times than that of the non-VI individuals (1.5±0.4 vs 1.7±0.4 m/sec, P<0.01; 17.1±19.6 vs 27.6±21.3 sec, P<0.01, respectively). Univariate logistic regression found that the odds ratio (OR) for the slower walking speed (<1 m/sec) in the VI individuals was significantly higher at 7.40 (3.36-16.30;95% CI, P <0.001) than in non-VI individuals. It was still significantly higher at 4.50 (1.87-10.85;95% CI, P = 0.001) in the multivariate logistic regression model after adjusting for the BCVA, age, sex, current smoking habit, and health conditions. Our results indicate that the walking speed and one-leg standing times were significantly associated with VI.

Decreased melatonin secretion in patients with glaucoma: Quantitative association with glaucoma severity in the LIGHT study.

Glaucoma may be associated with circadian disruption due to its association with a loss of intrinsically photosensitive retinal ganglion cells. Clinical evidence demonstrating an association between glaucoma and circadian disruption is limited, and no large-scale studies have been performed. The purpose of this cross-sectional study was to determine whether the presence and severity of glaucoma is correlated with the urinary 6-sulfatoxymelatonin levels as a circadian rhythm parameter. We measured the level of urinary 6-sulfatoxymelatonin excretion (UME) in 118 glaucoma patients and 395 control participants without glaucoma. The UME in the glaucoma group was significantly lower than that of the control group without glaucoma (3.05 and 3.24 log ng/mg creatinine, respectively; P = .010). Next, we examined association of the severity of glaucoma and melatonin levels. In stratification analysis of the glaucoma groups, multivariable linear regression analyses adjusted for potential confounders indicated significantly lower UME by 0.30 log ng/mg creatinine in patients with functional severe glaucoma (visual field mean deviation ≤ -6 dB) compared with mild glaucoma (mean deviation > -6 dB; P = .040) and lower UME by 0.05 log ng/mg creatinine with each 10 µm thinning of the circumpapillary retinal nerve fiber layer thickness as the index of structural severity of glaucoma (P = .011). In conclusion, significant association between glaucoma and lower urinary 6-sulfatoxymelatonin was found. In addition, patients with functional and structural severe glaucoma were significantly associated with lower urinary 6-sulfatoxymelatonin levels. Our results indicate the possibility of a circadian disruption in patients with glaucoma.

Effects of Cataract Surgery on Melatonin Secretion in Adults 60 Years and Older: A Randomized Clinical Trial.

Importance: Cataract surgery, which increases perception of light, may increase melatonin secretion. Melatonin secretion has been associated with depression, diabetes, cognitive impairment, and breast cancer. To date, no evidence from a randomized clinical trial exists to support this cataract surgery hypothesis. Objective: To determine whether cataract surgery modifies the melatonin secretion at 3 months after cataract surgery in 169 adult patients. Design, Setting, and Participants: A parallel-group randomized clinical trial was conducted at a single referral center from July 1, 2014, to June 30, 2017. Data were analyzed from January 1, 2018, to March 31, 2019. Patients were aged 60 years or older, had no history of cataract surgery, and had cataracts with grade 2 or higher nuclear opacifications based on the Lens Opacities Classification System III. Analyses were based on intention to treat. Interventions: Patients were randomized 1:1:1:1 to receive cataract surgery using artificial clear intraocular lens (IOL) or yellow IOL. Group 1 received prompt surgery with clear IOL, group 2, prompt surgery with yellow IOL, group 3, delayed surgery with clear IOL, and group 4, delayed surgery with yellow IOL. The intervention group consisted of groups 1 and 2, and the control group consisted of groups 3 and 4. Main Outcomes and Measures: Urinary melatonin excretion in the intervention group was measured at 3 months after surgery, and urinary melatonin excretion in the control group was measured before delayed surgery. Results: Of the 169 randomized patients, 97 were men (57.4%). The mean (SD) age was 75.7 (6.7) years. Mean urinary melatonin excretion was calculated as standardized urinary concentration, the ratio of urinary concentration to urinary creatinine concentration (nanograms per milligram of creatinine), in the intervention group after cataract surgery. Mean urinary melatonin excretion was significantly higher than in the control group (adjusted mean difference of creatinine concentration, 0.159 log ng/mg, 95% CI, 0.045-0.273; P = .007) independent of baseline urinary melatonin excretion and potential confounders. Subgroup analysis comparing group 1 with group 3 revealed that concentration of urinary melatonin excretion in patients who received clear IOLs was higher than the control group by creatinine concentration 0.212 log ng/mg (95% CI of the difference, 0.058-0.365; P = .008). However, the difference between patients in group 2 and group 4 was not significant (adjusted mean difference for creatinine excretion, 0.083 log ng/mg, 95% CI, -0.087 to 0.253; P = .33). The difference of concentration of mean urinary melatonin excretion between patients in group 1 and those in group 2 was not significant (95% CI of the difference for creatinine concentration, -0.19 to 0.40 log ng/mg; P = .48). Conclusions and Relevance: The findings in this study support the hypothesis that cataract surgery increases melatonin secretion. The effect of clear IOLs vs yellow IOLs on these outcomes was not shown to be different. Trial Registration: UMIN-CTR Identifier: UMIN000014559.

Cataracts and Subclinical Carotid Atherosclerosis in Older Adults　- A Cross-Sectional Study of the HEIJO-KYO Cohort.

BACKGROUND: Decreased light reception because of cataracts leads to potential circadian misalignment, resulting in exacerbation of atherosclerosis; however, little is known about the association between cataracts and atherosclerosis in populations.Methods and Results:In this cross-sectional study, cataracts were graded using slit lamp biomicroscopy with the Lens Opacities Classification System III and carotid atherosclerosis was assessed based on carotid intima-media thickness (IMT) measured using ultrasonography of the common carotid artery in 442 elderly participants (mean age, 70.0 years). Cataract was defined as nuclear cataract grade ≥3.0, cortical cataract grade ≥2.0, or posterior subcapsular cataract grade ≥2.0 in both eyes. The mean and maximal carotid IMT was 0.86±0.15 mm and 1.07±0.29 mm, respectively. In multivariable analysis adjusted for potential confounders, the mean and maximal carotid IMT were significantly greater in the cataract group than in the non-cataract group by 0.04 mm (95% confidence interval (CI), 0.01-0.06) and 0.07 mm (95% CI, 0.01-0.12), respectively. Logistic regression analysis adjusted for confounders revealed a significantly higher odds ratio for carotid atherosclerosis (maximal carotid IMT ≥1.1 mm) in the cataract group than in the non-cataract group (odds ratio, 1.78; 95% CI, 1.14-2.78). CONCLUSIONS: Cataracts may be independently associated with subclinical carotid atherosclerosis in the elderly population, indicating a need for further prospective studies.

Increased Nighttime Blood Pressure in Patients with Glaucoma: Cross-sectional Analysis of the LIGHT Study.

PURPOSE: To determine whether the presence of glaucoma is associated significantly with nighttime blood pressure (BP) and dipping pattern. DESIGN: Observational, cross-sectional study. PARTICIPANTS: We assessed 109 glaucoma patients (mean age, 71.0 years) from the Longitudinal Study of Biological Circadian Rhythms in Glaucoma Patients: Home Testing of Circadian Intraocular Pressure and Biological Parameters (LIGHT) study and 708 healthy control participants without glaucoma (mean age, 70.8 years) from a community-based cohort. METHODS: All of the glaucoma patients and healthy control participants underwent ophthalmic examinations. The ambulatory BP was measured every 30 minutes for 48 hours. The daytime and nighttime periods were based on the sleep diary entries. A nondipper pattern of BP was defined as a decrease in the mean nighttime systolic BP by less than 10% of the mean daytime systolic BP. MAIN OUTCOME MEASURES: Nighttime BP and dipping pattern. RESULTS: After adjusting for potential confounders, multivariable linear regression analyses indicated that nighttime systolic BP was significantly higher by 4.1 mmHg (95% confidence interval [CI], 1.0-7.2; P = 0.01) in the glaucoma group than in the control group. The prevalence of the nondipper pattern was significantly higher in the glaucoma group (45.0%) than in the control group (27.5%; P < 0.001). Multivariable logistic regression analyses indicated a significantly higher odds ratio (OR) for the nondipper pattern in the glaucoma group than in the control group (OR, 1.96; 95% CI, 1.26-3.05; P = 0.003). CONCLUSIONS: The presence of glaucoma was associated significantly with increased nighttime BP and the nondipper pattern of the BP independent of potential confounders such as aging, obesity, and diabetes. Further prospective studies are needed to determine whether the glaucoma severity and progression are associated with the nighttime BP.

Diminished circadian blood pressure variability in elderly individuals with nuclear cataracts: cross-sectional analysis in the HEIJO-KYO cohort.

The present study aimed to determine the relationship between cataract subtypes and circadian blood pressure (BP) variability in elderly individuals. In this cross-sectional study of a community-based cohort, we assessed bilateral lens opacity using slit lamp photographs of 458 elderly individuals (mean age, 69.1 years). Cataract status was defined as a bilateral Lens Opacities Classification System III grade of ≥3 for nuclear cataract, ≥2 for cortical cataract, and ≥2 for posterior subcapsular cataract (PSC). Ambulatory BP monitoring was performed at 30-min intervals for 48 h. A nondipper pattern of BP was defined as a <10% decline in the mean nighttime systolic BP relative to the mean daytime systolic BP. The prevalence of nondipper patterns was 42.4% and 25.9% in the groups with nuclear cataracts (n = 66) and without cataracts for both eyes (n = 290), respectively. Multivariable logistic regression analysis adjusted for potential confounders revealed a significantly higher odds ratio (OR) for nondipper pattern in the group with nuclear cataract than in that without cataract (OR, 1.81; 95% confidence interval, 1.01-3.24; P = 0.047) but not in the group with cortical cataract (P = 0.61) or PSC (P = 0.95). In conclusion, circadian BP variability was significantly diminished in elderly individuals with nuclear cataracts but not in those with cortical cataracts or PSCs. These associations were independent of daytime light exposure, physical activity, and known risk factors of cataracts, such as aging, obesity, and diabetes.

Association between glaucomatous optic disc and depressive symptoms independent of light exposure profiles: a cross-sectional study of the HEIJO-KYO cohort.

BACKGROUND: Glaucoma may cause physiological and behavioural circadian misalignment because of the loss of intrinsically photosensitive retinal ganglion cells, the primary receptors of environmental light. Although studies have suggested a high prevalence of depression in patients with glaucoma, it is unclear whether the association is independent of the light exposure profiles as an important confounding factor. METHODS: In this cross-sectional study of a community-based cohort of 770 elderly individuals (mean age, 70.9 years), glaucomatous optic discs were assessed using fundus photographs and depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS). Daytime and night-time ambient light exposures were objectively measured for 2 days. RESULTS: Depressive symptoms (GDS score ≥6) were observed in 114 participants (prevalence, 14.8%) and glaucomatous optic discs were detected in 40 participants (prevalence, 5.2%). The prevalence of depressive symptoms was significantly higher in the group with glaucomatous optic disc than in the group without it (30.0% vs 14.0%, respectively; p=0.005). Multivariable logistic regression analysis adjusted for potential confounding factors, including daytime and night-time light exposures, revealed that the OR for depressive symptoms was significantly higher in the group with glaucomatous optic disc than in the group without it (OR 2.45, 95% CI 1.18 to 5.08; p=0.016). CONCLUSIONS: In this general elderly population, glaucomatous optic disc was significantly associated with higher prevalence of depressive symptoms independent of a number of potential confounding factors, including daily light exposure profiles.

Case of progressive hyperopia due to flattening of cornea.

PURPOSE: To report a case that had a progressive decrease in the visual acuity caused by a progressive increase in the hyperopia due to a flattening of the cornea. OBSERVATIONS: A 50-year-old woman complained of decreased vision in both eyes. Her decimal best-corrected visual acuity was 1.2 in the right and 0.5 in the left eyes, and the refractive error (spherical equivalent) was +3.75 diopters (D) for the right eye and +6.5 D for the left eye. Slit-lamp examinations showed clear corneas but Descemet's folds and fine pigmentations and opacities were present beneath the corneal epithelium in both eyes. Analysis of the corneal shape by anterior segment optical coherence tomography showed that the corneas were flattened, and the corneal refractive power was decreased in both eyes. The large values of the higher-order aberration in the cornea and total eye displayed bilateral irregular astigmatism. She obtained good vision by wearing hard contact lenses but her refractive power continued to decrease for at least 1 year. CONCLUSIONS: and Importance: We report a rare case of progressive hyperopia and irregular astigmatism due to a flattening of the cornea. Folds were present in Descemet's membrane but the cornea was not edematous.

Iris metastasis preceding diagnosis of gastric signet ring cell adenocarcinoma: a case report.

BACKGROUND: A case of iris metastasis preceding the diagnosis of gastric signet ring cell adenocarcinoma is very rare. To report the findings in a patient who presented with an iris tumor that was later identified to have metastasized from a gastric signet ring cell adenocarcinoma. CASE PRESENTATION: A-74-year-old woman presented with visual disturbance and an increased intraocular pressure (IOP) in the right eye. She had no history of systemic cancer. She was initially diagnosed with acute iritis from diabetes mellitus and secondary glaucoma. She underwent trabeculectomy because of the uncontrolled IOP. After the IOP was controlled, she presented thick iris with corectopia, iris hemorrhage, and white, frog spawn-like mass resembling fibrin in the anterior chamber. An analysis of an iris biopsy suggested that the iris mass was an adenocarcinoma. Examination by esophagogastroduodenoscopy revealed advanced gastric signet ring cell adenocarcinoma as the primary source for the iris tumor. CONCLUSIONS: We recommend that patients with acute iritis with atypical iris mass resembling fibrin and secondary glaucoma should be examined comprehensively for systemic tumors.

Effect of cataract surgery on cognitive function in elderly: Results of Fujiwara-kyo Eye Study.

PURPOSE: To determine whether there is a significant association between prior cataract surgery and cognitive function in an elderly Japanese cohort. SETTING: Nara Medical University, Nara, Japan. DESIGN: The Fujiwara-kyo Eye Study was a cross-sectional epidemiological study. METHODS: The subjects were ≥ 68-years who lived in the Nara Prefecture and responded to recruitment notices. All of the subjects received comprehensive ophthalmological examinations, and answered questionnaires on their socio-demographic and medical history including prior cataract surgery. The association between prior cataract surgery and cognitive function was determined. RESULTS: A total of the 2764 subjects whose mean age was 76.3±4.8 years (±standard deviation) was studied. Of these, 668 individuals (24.2%) had undergone cataract surgery. Of these, 150 (5.4%) had dementia as determined by the Mini-Mental State Examination (MMSE) score ≤23, and 877 individuals (31.7%) had mild cognitive impairment (MCI; MMSE score 24-26). The subjects who had prior cataract surgery had significantly lower odds ratio (OR) of having MCI (OR = 0.78, 95% confidence interval; CI 0.64-0.96, P = 0.019) than those who had not had cataract surgery after adjusting for age, sex, body mass index, education, hypertension, diabetes, depression, and history of stroke. The OR was still lower when the visual acuity was also added to the adjusted factors (OR 0.79, 95% CI 0.64-0.97, P = 0.025). However, prior cataract surgery did not contribute significantly to the low OR for dementia. CONCLUSIONS: Cataract surgery may play a role in reducing the risk of developing MCI independently of visual acuity but not for dementia.

Macular retinoschisis in eyes with glaucomatous optic neuropathy: Vitrectomy and natural course.

PURPOSE: Our purpose was to determine the effectiveness of vitrectomy in resolving the macular retinoschisis in an eye with glaucomatous optic neuropathy and also to determine the natural course of macular retinoschisis. METHODS: This was a retrospective case series of patients who were diagnosed with macular retinoschisis and glaucomatous optic neuropathy. Fourteen eyes of 13 patients were studied. Patients with high myopia, vitreomacular traction syndrome, and the pit macular syndrome were excluded. RESULTS: There were three men and ten women, and 12 had unilateral and one had bilateral macular retinoschisis. Vitrectomy was performed for a serous retinal detachment, macular hole, or severe visual loss in five eyes. The mean follow-up time was 68.8 months in these five eyes, and the macular retinoschisis was resolved and the best-corrected visual acuity (BCVA) at the final visit was significantly improved in all eyes (P = 0.007). However, two of these fiv e eyes developed a macular hole and required a second vitrectomy. Of the nine eyes without treatment with a mean follow-up time of 29.0 months, the BCVA at the final visit remained unchanged from the baseline BCVA in all eyes. The macular retinoschisis was resolved or reduced in three eyes without treatment. CONCLUSIONS: Vitrectomy was effective for the resolution of macular retinoschisis in eyes with glaucomatous optic neuropathy and serous retinal detachment or macular hole or severe reduction of the BCVA. Macular retinoschisis can be resolved without a reduction of the BCVA in some cases without treatment.

Cataract Surgery and Visual Acuity in Elderly Japanese: Results of Fujiwara-kyo Eye Study.

The aim of this study was to determine the presence of prior cataract surgery and best-corrected visual acuity (BCVA) in an elderly Japanese cohort. The Fujiwara-kyo Eye Study was a prospective, population-based, cross-sectional epidemiological study. The subjects were ≥68 years who lived in the Nara Prefecture and responded to recruitment notices. All of the subjects underwent comprehensive ophthalmological examinations, and the sociodemographic information and medical history, including prior cataract surgery, were obtained by answers to a questionnaire. The associations between the BCVA, age, sex, and history of cataract surgery were determined. A total of 2,873 subjects whose mean age was 76.3 ± 4.9 (mean ± standard deviation) years were studied. The mean BCVA was -0.020 ± 0.14 logarithm of the minimum angle of resolution units, and it was significantly better in the group with education ≥13 years (p < 0.01). Overall, 24.2% of the subjects had undergone cataract surgery, and 41.7% of the subjects ≥80 years had undergone cataract surgery. The incidence of prior cataract surgery increased with increasing age (p < 0.001 for trend). The mean BCVA of eyes with cataract surgery was significantly better than that of eyes without cataract surgery in subjects ≥80 years (p < 0.01). Visual acuity was generally good in this cohort of elderly Japanese subjects. In this cohort, 24.2% of the subjects had undergone cataract surgery, and the subjects ≥80 years had better BCVA than those without cataract surgery.

Long-term outcomes of intravitreal injection of bevacizumab for choroidal neovascularization associated with choroidal osteoma.

PURPOSE: To describe the outcomes of intravitreal injections of bevacizumab for choroidal neovascularization (CNV) associated with choroidal osteoma. METHODS: Retrospective consecutive case series. Three eyes of three patients were studied. All patients were treated with intravitreal injections of bevacizumab for CNV associated with choroidal osteoma. Best-corrected visual acuity, central foveal thickness, tumor thickness on spectral domain optical coherence tomography, and subretinal pigmentation around the CNV were evaluated. RESULTS: The mean number of intravitreal injections of bevacizumab was 2.0 (range 1-3). The mean follow-up time was 56.0 months (range 25-99 months). The mean LogMAR visual acuity worsened from 0.1 to 0.6. LogMAR visual acuity loss of 0.7 or worse occurred in two of three eyes. CNV was located in the subfoveal area in two eyes, and CNV was located in the juxtafoveal area in one eye. The mean central foveal thickness decreased from 407 µm to 251 µm. The mean tumor thickness decreased from 709 µm to 608 µm. All eyes had subretinal pigmentation around the CNV. CONCLUSION: Intravitreal injections of bevacizumab for subfoveal CNV associated with decalcified choroidal osteoma resulted in poor visual acuity.