Relationship between vision-related quality of life and different types of existing visual fields in Japanese patients.

To investigate the vision-related quality of life (VRQOL) in relation to the type of existing visual field (EVF) in the presence of visual field defect. We evaluated the VRQOL of 95 patients by using Visual Function Questionnaire-25 (NEI VFQ-25). Patients fulfilled the following criteria: (1) they underwent a Goldmann perimetry (GP) test within 3 months of the initial visit, (2) the results of the GP test could be classified into three categories, and (3) the best-corrected decimal visual acuity (VA) was ≤0.3. The EVF was assessed by composite measurement of both eyes for the V-4e or I-4e isopters, as obtained using the GP test. We compared the VFQ-25 scores between three groups: (1) the "center and peripheral" group in which the EVF of the V-4e area was >30º and the I-4e area was <30º, (2) the "central VF" group in which the EVF of the V-4e area was <20º, and (3) the "central VF loss" group in which the central scotoma was >5º and the EVF of the V-4e area was >30º in peripheral vision. There were significant differences between the three groups (P = 0.02, ANOVA). The total score of the "central VF loss" group was significantly lower than those of the "center and peripheral" and "central VF" groups. The central vision influenced the VRQOL to a greater extent than peripheral vision.

Association between changes in visual acuity and vision-related quality of life in Japanese patients with low vision.

PURPOSE: To investigate the association between vision-related quality of life (VRQOL) and changes in visual acuity (VA). METHODS: We examined the VA in 100 patients for > 1 year and evaluated the degree of its impact on VRQOL using the National Eye Institute Visual Function (VF) Questionnaire (VFQ-25; Japanese version). Before determining VFQ-25, we monitored the changes in VA in these patients for 1 year and classified them into the following two groups depending on VA changes. Patients exhibiting a decline of > 3 steps in VA, as assessed by the logarithm of the minimum angle of resolution scale, were placed in the 'decline' group (47.0%) and patients exhibiting no change in VA were placed in the 'no change' group (53.0%). We compared the VFQ-25 scores between both groups in all patients with glaucoma (GLA) and macular degeneration (MD). RESULTS: The total score of the decline was 34.9 ± 13.6 and that of the no change group was 44.6 ± 13.9: the difference in the scores between both groups was statistically significant (p = 0.006). Similar results were obtained for patients with GLA and MD (p = 0.007 and 0.003, respectively). CONCLUSION: VRQOL differed between patients with constant VA and those with reduced VA, even though VA values were equal at a certain time point.

Comparison of Esterman disability scores obtained using Goldmann perimetry and the Humphrey field analyzer in Japanese low-vision patients.

PURPOSE: To compare the Esterman Disability Score (EDS) obtained with Goldmann perimetry (GP) testing and the Humphrey field analyzer (HFA) in low vision Japanese subjects. Subjects were also divided into groups by diagnosis to examine how disease influences EDS measurements. METHODS: The EDS was obtained using GP (GP-EDS) and the built-in testing program of the HFA (HFA-EDS). Tests were performed within 3 months of each other. Regression analyses were used to examine the relationship between GP-EDS and HFA-EDS. RESULTS: A total of 128 visually impaired subjects were included in this study. Subjects had low vision because of glaucoma (57 subjects), age-related macular degeneration (AMD, 17 subjects), retinitis pigmentosa (RP, 17 subjects), and other causes (37 subjects). The GP-EDS obtained was well-correlated with HFA-EDS (r = 0.87, P < 0.001) and it was possible to estimate HFA-EDS from GP-EDS. The GP-EDS was significantly lower than the HFA-EDS in eyes with glaucoma and RP. There was no significant difference between EDS values in eyes with AMD or other disease. CONCLUSION: The GP-EDS correlated well with the HFA-EDS. However, the relationship between the EDS measured with the two different testing modalities varies by disease.

[Evaluation of quality of life characteristics and grade of legal visual impairment].

PURPOSE: To evaluate the possible correlation between quality of life (QOL) characteristics and grades of legal visual impairment. MATERIALS AND METHODS: Quality of life characteristics associated with various causes of visual loss were investigated in 237 Japanese patients in the low-vision care clinic at Tokyo University Hospital, who had been issued the official ID and handbook for the physically handicapped. The main causes of vision loss were glaucoma (87 patients), macular degeneration (35) and diabetic retinopathy (34). Using a previously developed questionnaire, we assessed the correlation between the disability index (DI) as a quality of life characteristic, and the grade of legal visual impairment. RESULTS: Total DI was 1.24 +/- 0.43, showing a very significant correlation with Handicapped Handbook grades (r = -0.44, p < .0001). The correlation coefficients were -0.63 (p < 0.0001) for diabetic retinopathy, -0.50 (p = 0.002) for macular degeneration, and -0.16 (p = 0.14) for glaucoma patients. CONCLUSION: The needs of low-vision patients correlate with the grade of legal visual impairment and it is important to understand that the needs of low vision patients differ for each disease.

Ocular manifestations of congenital insensitivity to pain with anhidrosis.

PURPOSE: To describe ocular manifestations in Japanese patients with congenital insensitivity to pain with anhidrosis (CIPA), focusing particularly on the status of the ocular surface. DESIGN: Observational case series. METHODS: Eighteen patients with CIPA underwent applicable ophthalmologic examinations, including visual acuity, refraction, slit-lamp examination, fundus examination, tear breakup time, Schirmer 1 test, corneal sensitivity, and corneal topography. RESULTS: Superficial punctate keratopathy (SPK) was observed at the interpalpebral area in 23 (64%) of 36 eyes. Corneal opacity was observed in three eyes (8.3%). Tear breakup time was below the lower limit of the normal range in all examined eyes, and the value of Schirmer 1 test was above the lower limit of the normal range in most of the examined eyes. CONCLUSIONS: Superficial punctate keratopathy is observed in most cases of CIPA, which might predispose patients to corneal infection. Investigation of dry eye in patients with CIPA will provide unique opportunities to explore the critical roles of the autonomic sympathetic nervous system as well as the sensory nervous system in the physiology of tear production.

Relationship between vision-related quality of life in Japanese patients and methods for evaluating visual field.

PURPOSE: To investigate the relationship between methods used to evaluate the visual field (VF) and vision-related quality of life (VRQOL) in Japanese patients. METHODS: We evaluated the VRQOL of 50 patients using the National Eye Institute Visual Function Questionnaire 25 (VFQ-25). Patients meeting the following criteria were assessed: (1) a Goldmann perimetry (GP) test conducted within 3 months of the initial visit; (2) best-corrected decimal visual acuity (VA) of the better eye when VRQOL was measured was less than 0.3 but more than 0.05. The VF was estimated based on a composite measure of the V-4e isopters of both eyes, as measured by GP. We calculated the VF using the American Medical Association (AMA) score, the Esterman disability score (EDS), the functional field score (FFS), the composite VF area calculated with area measurement software, and SR, an evaluation method based on solid angles. We then studied the relationships between the VFQ-25 score and the VF scores. RESULTS: Only EDS correlated significantly with the VFQ-25 score (r = 0.34, P = 0.02); AMA scoring did not correlate with the VFQ-25 score. CONCLUSION: It is necessary to reexamine standard VF evaluation methods.

In vivo confocal microscopy of hereditary sensory and autonomic neuropathy.

PURPOSE: To observe the morphology of the corneal cells and corneal nerve fibers in patients with type IV or V hereditary sensory and autonomic neuropathy (HSAN) by in vivo confocal microscopy and elucidate the mechanism leading to the loss of corneal sensation in this disease. METHODS: In vivo confocal microscopy was performed on the central cornea of the right eye in 3 patients with HSAN (ages 17, 20, and 32 years), and their corneal morphology was compared with that of 3 healthy subjects (ages 28, 30, and 36 years). Corneal sensation was tested with a Cochet-Bonnet esthesiometer. RESULTS: The superficial epithelial cell density was lower in the HSAN patients compared with the healthy subjects (1525, 1225, and 1250/mm(2) vs. 2225, 1750, and 2500/mm(2)), but the basal epithelial cell density of the patients was similar to that of the healthy subjects. Nerve bundles were clearly observed in the sub-basal nerve plexus layer of the cornea in the healthy subjects, but were undetectable at the central cornea in the patients with HSAN. The corneal sensation of the patients with HSAN was much weaker than that of the healthy subjects (2.79, 40.30, and 132.50 g/mm(2) vs. 1.47, 1.47, and 1.47 g/mm(2)). CONCLUSIONS: Superficial keratopathy accompanied with neurotrophic keratopathy and tear film instability observed clinically agrees with the large keratinized cells in the superficial corneal epithelium by in vivo confocal microscopy in these patients. Our findings suggest that the loss of corneal nerves contributes to impairment of corneal sensation in patients with type IV or V HSAN.