Relationship between Ocular Fatigue and Use of a Virtual Reality Device

PURPOSE: To investigate ocular fatigue after the use of a head-mounted display (HMD)-type virtual reality device.METHODS: Healthy adult volunteers were examined for ocular fatigue before and after watching videos for 10 min with an HMD-type virtual reality device. Subjective ocular fatigue was measured using a questionnaire. Objective fatigue was measured using the critical flicker fusion frequency (CFF), high frequency component of accommodative microfluctuation, and accommodation amplitude. The accommodation amplitude was measured using the push-up method and the dynamic measurement mode of the autorefractometer. Changes in the spherical equivalent were also measured.RESULTS: The questionnaire-based subjective ocular fatigue increased (p = 0.020) after use of the HMD device. In the dominant eye, the high frequency component of accommodative microfluctuation increased (p < 0.05). The accommodation amplitude using the push-up method was decreased in the nondominant eye (p = 0.007), and temporary myopia was observed (p < 0.05). However, there was no increase in ocular fatigue in the CFF or the accommodation amplitude using the dynamic measurement mode, which showed no significant difference before and after using the HMD device (p > 0.05).CONCLUSIONS: A subjective test and some objective tests suggested that use of the HMD-type virtual reality display increased ocular fatigue. However, no increase in ocular fatigue was measured using CFF nor in the accommodation amplitude using the dynamic measurement mode which was a limitation of the study. More studies with the aim to alleviate ocular fatigue after using HMD-type virtual reality devices are therefore needed.

Effectiveness of Cyclosporine-steroid Treatment after Cataract Surgery according to Dry Eye Severity

PURPOSE: To evaluate the effectiveness of topically administered 0.05% cyclosporine combined with a topical steroid in the early postoperative period after cataract surgery, and to compare the therapeutic efficacy according to the severity of dry eye. METHODS: One hundred and fifty-six patients who underwent unilateral cataract surgery and received topical cyclosporine 0.05% for 8 weeks combined with a fluorometholone 0.1% steroid for 4-weeks were classified into three groups according to preoperative dry eye level: the control group, non-dry eye (n = 78); group 1, level I dry eye (n = 38); and group 2, level II dry eye (n = 40). The best-corrected distance visual acuity, intraocular pressure, dry eye symptom questionnaire (ocular surface disease index), tear film break-up time (TBUT), and Schirmer test-I (STI) were evaluated. RESULTS: The preoperative score of dry eye symptoms improved significantly at one week postoperatively and continued to improve until postoperative 8-weeks in all groups, especially in group 2 compared with the control. Groups 1 and 2 showed significant improvement in the TBUT at one week, four weeks, and eight weeks postoperatively, compared to eight weeks postoperatively in the control; Group 2, especially, showed significant improvement in TBUT. There was no difference in STI value after cyclosporine-steroid treatment in the control group; however, a significant difference was observed at four weeks postoperatively in dry eyes. No significant differences in STI results were observed among the three groups. CONCLUSIONS: Use of topical cyclosporine 0.05% combined with a topical fluorometholone 0.1% steroid after cataract surgery is more effective in dry eyes level II than in non-dry eyes, especially those with TBUT and dry eye symptoms at eight weeks postoperatively.

Night Light Pollution and Ocular Fatigue

No abstract available.

Visual Fatigue Induced by Viewing a Tablet Computer with a High-resolution Display

PURPOSE: In the present study, the visual discomfort induced by smart mobile devices was assessed in normal and healthy adults. METHODS: Fifty-nine volunteers (age, 38.16 ± 10.23 years; male : female = 19 : 40) were exposed to tablet computer screen stimuli (iPad Air, Apple Inc.) for 1 hour. Participants watched a movie or played a computer game on the tablet computer. Visual fatigue and discomfort were assessed using an asthenopia questionnaire, tear film break-up time, and total ocular wavefront aberration before and after viewing smart mobile devices. RESULTS: Based on the questionnaire, viewing smart mobile devices for 1 hour significantly increased mean total asthenopia score from 19.59 ± 8.58 to 22.68 ± 9.39 (p < 0.001). Specifically, the scores for five items (tired eyes, sore/aching eyes, irritated eyes, watery eyes, and hot/burning eye) were significantly increased by viewing smart mobile devices. Tear film break-up time significantly decreased from 5.09 ± 1.52 seconds to 4.63 ± 1.34 seconds (p = 0.003). However, total ocular wavefront aberration was unchanged. CONCLUSIONS: Visual fatigue and discomfort were significantly induced by viewing smart mobile devices, even though the devices were equipped with state-of-the-art display technology.

The Variation of Choroidal Thickness and Refractive Error after Cataract Surgery

PURPOSE: To evaluate the effect of cataract surgery on subfoveal choroidal thickness (SCT) and investigate the relationship between the variation of SCT and refractive error. METHODS: We retrospectively reviewed the medical records of 47 patients (47 eyes) who underwent uneventful phacoemulsification cataract surgery from March 2012 to February 2014. SCTs were measured using spectral-domain optical coherence tomography performed before surgery and at 1 month, 3 months and 6 months postoperatively. We investigated the differences in target refraction (TR) and postoperative spherical equivalent (SE), intraocular pressure (IOP) and central macular thickness (CMT) at all follow-ups. RESULTS: Compared with preoperative measurements, SCT showed a significant increase of 5.9 ± 13.3 µm at postoperative 1 month and 7.6 ± 18.1 µm at postoperative 3 months (p = 0.004 and p = 0.006, respectively), but no significant differences at postoperative 6 months (p = 0.104). The correlation between the variation of SCT and the differences in postoperative SE and TR were not significant at 1 month and 6 months, but were positively significant at 3 months (r = 0.310, p = 0.034). The variation of SCT showed no significant correlations with the postoperative change in IOP and CMT. CONCLUSIONS: SCT significantly increased up to 3 months after cataract surgery. The variation of SCT may affect the postoperative refractive error.

Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery

PURPOSE: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.

Demographic Features of Idiopathic Macular Telangiectasia in Korean Patients

PURPOSE: To investigate the clinical and demographic features of idiopathic macular telangiectasia (MacTel) in Korean patients since the introduction of spectral domain optical coherence tomography (SD-OCT). METHODS: We reviewed medical records of patients who were diagnosed with MacTel from 2009 to 2013. All patients underwent fluorescein angiography and SD-OCT and were classified as type 1 or type 2 according to the classification system proposed by Yannuzzi. RESULTS: Over a period of 5 years, 4 (18.2%) patients were diagnosed with type 1 MacTel and 18 (81.8%) patients were diagnosed with type 2 MacTel. All patients with type1 MacTel were male, and their mean age was 51 +/- 8.6 years. Among patients with type 2 MacTel, 3 (16.7%) were male, 15 (83.3%) were female, and the mean age was 60 +/- 13.6 years. Whereas all type 1 MacTel patients had either metamorphopsia or mild scotoma, of the 18 patients with type 2 MacTel, only 4 (22.2%) had those symptoms, 10 (55.6%) complained of only mild visual impairment, and the other 4 (22.2%) had no symptoms. Intraretinal cystoid spaces were observed in 26 (72.2%) of 36 eyes with type 2 MacTel by SD-OCT. These cystoid spaces had irregular boundaries and did not correspond to angiographic leakages. CONCLUSIONS: Type 2 MacTel was most common in the present study. The wider availability of SD-OCT may have contributed to the diagnosis of type 2 MacTel. Type 2 MacTel may be more prevalent than type 1 in Koreans, which corresponds to the results of Western countries.

Demographic Features of Idiopathic Macular Telangiectasia in Korean Patients

PURPOSE: To investigate the clinical and demographic features of idiopathic macular telangiectasia (MacTel) in Korean patients since the introduction of spectral domain optical coherence tomography (SD-OCT). METHODS: We reviewed medical records of patients who were diagnosed with MacTel from 2009 to 2013. All patients underwent fluorescein angiography and SD-OCT and were classified as type 1 or type 2 according to the classification system proposed by Yannuzzi. RESULTS: Over a period of 5 years, 4 (18.2%) patients were diagnosed with type 1 MacTel and 18 (81.8%) patients were diagnosed with type 2 MacTel. All patients with type1 MacTel were male, and their mean age was 51 +/- 8.6 years. Among patients with type 2 MacTel, 3 (16.7%) were male, 15 (83.3%) were female, and the mean age was 60 +/- 13.6 years. Whereas all type 1 MacTel patients had either metamorphopsia or mild scotoma, of the 18 patients with type 2 MacTel, only 4 (22.2%) had those symptoms, 10 (55.6%) complained of only mild visual impairment, and the other 4 (22.2%) had no symptoms. Intraretinal cystoid spaces were observed in 26 (72.2%) of 36 eyes with type 2 MacTel by SD-OCT. These cystoid spaces had irregular boundaries and did not correspond to angiographic leakages. CONCLUSIONS: Type 2 MacTel was most common in the present study. The wider availability of SD-OCT may have contributed to the diagnosis of type 2 MacTel. Type 2 MacTel may be more prevalent than type 1 in Koreans, which corresponds to the results of Western countries.

Comparison of Nd:YAG Laser Capsulotomy Rates between Implantation of Two Different Aspheric Intraocular Lenses

PURPOSE: To compare neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy rates between 2 different aspheric intraocular lenses, SN60WF and MI-60, in patients who underwent cataract surgery. METHODS: This retrospective study included 404 eyes of 278 patients who were followed up for at least 6 months after cataract surgery. Gender, age, follow-up period and Nd:YAG laser capsulotomy rates between the 2 different intraocular lens groups were compared. RESULTS: The mean follow-up period was 28.1 months in the SN60WF group and 24.3 months in the MI-60 group and the mean age was 68.6 years and 71.3 years in each group, respectively. Follow-up period and age were significantly different between the 2 groups (p < 0.01). Nd:YAG laser capsulotomy rates were 5.6% (13 of 231 eyes) in the SN60WF group and 48% (83 of 173 eyes) in the MI-60 group. Nd:YAG laser capsulotomy rates were significantly higher in the MI-60 group (p < 0.01). Female gender and young age were associated with significantly increased Nd:YAG laser capsulotomy rates (p < 0.01); however, diabetes mellitus was not significantly associated with Nd:YAG laser capsulotomy rates. CONCLUSIONS: Nd:YAG laser capsulotomy rates were higher in the MI60 hydrophilic aspheric intraocular lens group than the SN60WF hydrophilic aspheric intraocular lens group.

Anaplastic Large Cell Lymphoma Involving Anterior Segment of the Eye

A 36-year-old woman was diagnosed with anaplastic large cell lymphoma (ALCL) by excisional biopsy of a left frontal skin lesion. During the first cycle of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone), the patient complained of right ocular pain and inflammation. Cytologic examination using aqueous humor revealed atypical lymphocytes, suggesting intraocular ALCL involvement. Acute angle closure developed in the anterior chamber due to rapid progression of ALCL, causing pupillary block. Laser and surgical interventions were attempted but failed to relieve the pupillary block. Finally, radiation therapy resolved the pupillary block to restore the anterior chamber and normalize intraocular pressure. This is the first case in the English literature of ALCL involving the iris to cause acute secondary angle closure.

Anaplastic Large Cell Lymphoma Involving Anterior Segment of the Eye

A 36-year-old woman was diagnosed with anaplastic large cell lymphoma (ALCL) by excisional biopsy of a left frontal skin lesion. During the first cycle of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone), the patient complained of right ocular pain and inflammation. Cytologic examination using aqueous humor revealed atypical lymphocytes, suggesting intraocular ALCL involvement. Acute angle closure developed in the anterior chamber due to rapid progression of ALCL, causing pupillary block. Laser and surgical interventions were attempted but failed to relieve the pupillary block. Finally, radiation therapy resolved the pupillary block to restore the anterior chamber and normalize intraocular pressure. This is the first case in the English literature of ALCL involving the iris to cause acute secondary angle closure.

Considering Spherical Aberration in Choosing the Wavefront Map for Laser Vision Correction

PURPOSE: To report the dynamic nature of human optical aberrations in the scotopic condition. METHODS: A total of 20 eyes who were candidates for laser vision correction were included in the present study. Repeated wavefront data were obtained using WavescanTM (AMO/VISX). From the wavefront analysis data, the sphere, astigmatism, average pupil size, spherical aberration, coma and trefoil were selected and used to investigate any correlation among the parameters. RESULTS: The sphere, spherical aberration, coma and pupil size showed a dynamic change in the scotopic condition. The spherical aberration and pupil size decreased by the amount of 0.10 +/- 0.04 microm and 0.55 +/- 0.37 mm as the sphere changed 1 D in myopic direction. There was significant positive correlation between the sphere and spherical aberration in 13 eyes of 9 patients (65%), between the sphere and pupil size in 5 eyes of 4 patients (25%), and between the sphere and coma in 3 eyes of 3 patients (15%). The spherical aberration decreased significantly in 4 eyes of 4 patients (20%) as the pupil size decreased. CONCLUSIONS: The optical aberration of human eyes showed a dynamic nature in the scotopic condition. In particular, there was significant correlation between the sphere and spherical aberration. The observed correlations have the potential to be used as helpful indicators to select the optimal wavefront data for the laser vision correction.

Histologic Analysis of the Myotoxic Change by Bupivacaine and Ricin mAb 35 on Extraocular Muscle in Rabbits

PURPOSE: To analyze the acute histologic change of extraocular muscles (EOM) induced by injection of bupivacaine or Ricin mAb 35. METHODS: The superior rectus and inferior rectus of white rabbits were injected with either bupivacaine (0.4 mg in 0.3ml) or Ricin mAb 35 (0.2 micro gram/kg in 0.3 ml). One, two, and four weeks after injection, the rectus muscles were harvested and the post-injection changes were histologically analyzed. RESULTS: Both the orbital and the global layers of EOM showed myotoxic changes induced by bupivacaine and Ricin mAb 35. However, the inflammation and destruction of myofiber by bupivacaine injection were localized to the injection site, whereas changes induced by Ricin mAb 35 were diffuse. Regenerating myofibers with a central nucleus were found at one week after myotoxin injection. Four weeks after injection, the acute changes induced by these two toxins were much recovered with prominent myofiber regeneration. Bupivacaine-induced myotoxic change was more prominent in the global layer in contrast to the more prominent damage in the orbital layer induced by Ricin mAb 35. CONCLUSIONS: We found that EOM have a superb ability to recover from the acute injury induced by bupivacaine or Ricin mAb 35 and that the two myotoxins cause unique damage including the predilection of muscle layers and the duration for which the damage persisted. Further investigation into the functional change during recovery from the myotoxin-induced injury of EOM is needed.

Comparison of Optic Nerve Head Measurements by Optical Coherence Tomography and Confocal Scanning Laser Ophthalmoscopy

PURPOSE: To evaluate the relationship between the optic disc measurements generated by TopSS(TM) and by OCT. METHODS: Sixty-two eyes of 34 patients, 52 non-glaucomatous and 10 glaucomatous eyes, were scanned with TopSS(TM) and OCT 3000(TM). The margin of optic disc were defined automatically in OCT 3000(TM). The relationship between the optic disc variables- disc area (DA), cup area (CA), neuroretinal rim area (NRRA), and cup-disc area ratio (CDAR)- from TopSS(TM) and OCT was evaluated and the relationship between these and the tilt of disc was assessed. The horizontal (HD) and vertical diameter (VD) of the disc were measured from TopSS(TM) and OCT , then the ratio (HD/VD) were compared. RESULTS: In non-glaucomatous eyes with tilt more than 4 degrees, OCT measured DA and NRRA larger, and CDAR smaller than those measured by TopSS(TM), but the CA showed no difference. In non-glaucomatous eyes with tilt less than 4 degrees, there were no significant differences between OCT and TopSS(TM). In glaucomatous eyes, the CA measured by OCT was greater than that measured by TopSS(TM) (p=0.013). The HD/VD measured by TopSS(TM) showed no difference from HD/VD measured by OCT (p=0.849), and significant difference from HD/VD measured by OCT in eyes with tilted more than 4 degrees (p=0.003). In glaucomatous eyes, HD/VD measured by TopSS(TM) showed difference from HD/VD measured by OCT (p=0.022). CONCLUSIONS: Although measurement of disc in TopSS(TM) and OCT are correlated, the discrepancy becomes prominent in eyes with tilted disc or in glaucomatous eyes. Therefore optic disc analysis by OCT needs to be interpreted cautiously in tilted disc and in glaucomatous eyes.

Chondroid Syringoma of The Eyelid

PURPOSE: Chondroid syringoma is a rare tumor of the skin which arises from apocrine and eccrine glands. We report a case of chondroid syringoma arising from upper eyelid. METHODS: A 73-year-old man with a slowly growing mass on the center of right upper eyelid. Ocular examination revealed a smooth, firm, well-circumscribed and pink colored nodule measuring 15 by 17 mm in the right upper lid. Well developed superficial vessels were found on the surface of the nodule. Neither tenderness nor ulceration was accompanied. Total excision of the tumor and upper lid reconstruction with posterior auricular skin graft were done. RESULTS: Histologic examination revealed numerous glandular structures which were composed of two layers of epithelium and were scattered in abundant fibromyxoid and chondroid stroma. The histopathological diagnosis was chondroid syringoma. CONCLUSIONS: Since chondroid syringoma may occur in the eyelid, and although uncommon, it should be included in the differential diagnosis of firm and nodular tumors. The surgeon should plan for complete excision to reduce the possibility of recurrence or malignant transformation.

Bilateral Pterygium and Corneal Keloid in a 9-Month-Old Child

PURPOSE: To report a case with bilateral corneal keloid after pterygium excision. METHODS: A-9-month-old girl presented with bilateral, fibrovascular pterygium which had been rapidly growing to the corneal center since 3 months of age. Seven months postoperatively, avascular, scar-like lesion recurred and was excised. This lesion recurred again 3 months later and phototherapeutic keratectomy was performed. However the mass grew rapidly and was excised surgically at the last follow up. RESULTS: Histopathologic study revealed the feature of corneal keloid such as epithelial layer with variable thickness, markedly increased thickness of stroma, irregularly arranged numerous collagen fibers, abundant fibroblasts and variable size of vascular proliferation. CONCLUSIONS: Pterygium in childhood and corneal keloid are rare entities. To the best of our knowledge, this is the first report of a corneal keloid in a child with bilateral pterygium.

Optical Coherence Tomography in the Evalution of Fitering Bleb after Trabeculectomy

PURPOSE: To demonstrate the usefulness of optical coherence tomography in the evaluation of the filtering bleb after trabeculectomy. METHODS: In three eyes of three patients, trabeculectomy was perfomed with the use of Mitomycin C (0.04%). In two eyes, encapsulated filtering bleb was suspected with elevated IOP. Optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) was performed in three eyes, and the features of the suspected encapsulated bleb and the normal functioning bleb were compared. RESULTS: The encapsulated filtering bleb was characterized by the formation of fluid filled space, which shows very low and homogenous reflectivity, surrounded by a thick wall with high reflectivity in both UBM and OCT. CONCLUSIONS: As the OCT is non-invasive and can obtain image without contact, it is useful to evaluate the filtering bleb at immediate post-operative time.