Factors Associated with Reclosure of Posterior Capsule Aperture by Flat Opacifications with Pearls after Nd:YAG Laser Posterior Capsulotomy.

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.

Findings in pseudophakic eye that developed liquefied aftercataract-like substance one day after vitrectomy.

Purpose: To report our findings in a case that had an accumulation of a translucent fluid between the intraocular lens (IOL) and posterior lens capsule one day after vitrectomy for a vitreous hemorrhage. Observations: A 67-year-old woman was diagnosed with diabetes 20 years before the vitrectomy and was treated with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) 14 years earlier. She underwent cataract surgery with an implantation of an IOL 4 years earlier. She was referred to our hospital because of a vitreous hemorrhage, and we performed uneventful vitrectomy. However, the day after the operation, a translucent liquid substance that resembled liquefied aftercataract was observed in the lens capsule bag. With time, the liquid substance became cloudy. The opacification progressed for two years after the vitrectomy, and her visual acuity decreased. We then performed neodymium: YAG (Nd: YAG) laser posterior capsulotomy, and the cloudy liquid dispersed into the vitreous and the visual acuity improved. Conclusions and importance: Our findings indicate that liquified aftercataract-like substance can form after vitrectomy in a pseudophakic eye. We suggest that the aqueous humor might flow into the space behind the IOL during or just after the vitrectomy and was trapped behind the IOL optics. Then, the proliferating lens epithelial cells might be dissolved forming the white liquid substance immediately after the surgery.

Management of Postoperative Inflammation and Dry Eye After Cataract Surgery.

Surgical intervention is the most effective treatment for decreased vision resulting from cataracts. Although the current procedures for cataract surgery are safe and effective, it is well known that several complications can develop after surgery. Postoperative cystoid macular edema (CME) is a well-known complication, and prophylactic medications such as steroids and/or nonsteroidal antiinflammatory drugs are routinely used for its prevention. Ocular surface abnormalities, such as dry eye, have also been reported to develop after cataract surgery. However, the causative mechanisms for postoperative dry eye have not been definitively determined. At present, there are no prophylactic medications that are commonly used to prevent the development of postoperative dry eye. Although nonsteroidal antiinflammatory drugs are very effective in reducing the incidence and degree of postoperative CME, it is known that they can cause adverse side effects, including ocular surface abnormalities. Thus, perioperative medications must be carefully selected to improve surgical outcomes and patient satisfaction. Here, we summarize the results of recent studies on postoperative dry eye and CME that can develop after cataract surgery. We suggest appropriate combinations of medications that can be used to minimize these postsurgical complications.

8K ultra-high-definition microscopic camera for ophthalmic surgery.

BACKGROUND: We have developed a new compact lightweight 8K ultra-high-definition (UHD; 7,680×4,320 pixels) camera and started medical application with an ophthalmic surgical microscope which is interchangeable with the conventional high-definition (1,920×1,080 pixels)/4K UHD (3,840×2,160 pixels) microscopic camera. METHODS: We did a feasibility study to apply our 8K UHD microscope in cataract surgery, glaucoma surgery and vitreous surgery using pig cadaver eyes. The 8K UHD microscope comprises a surgical microscope, a camera adaptor with relay lenses, an 8K UHD camera and an 8K UHD LCD to share the 8K UHD images with all surgical staff in real time. RESULTS: In ophthalmic surgeries, higher resolution images than conventional microscopic cameras were obtained with 8K UHD LCD equivalent to the observation through the microscopic eye pieces. CONCLUSION: Based on the results of this feasibility study, clinical trials on human ophthalmic surgery using the new 8K UHD microscopic camera should be conducted in the near future.

Steam-like clouding observed on anterior surface of intraocular lens developed soon after implantation.

PURPOSE: To report our findings in three cases of a clouding of the anterior surface of an implanted intraocular lens that developed within 14 days after implantation. OBSERVATIONS: Three eyes were implanted with the same model IOL and a steam-like clouding developed on the anterior surface of the IOL. The clouding occurred on days 4, 7, and 14 after the implantation in an area of the IOL that was in contact with the aqueous humor. The clouding was accompanied by a reduction of vision in all cases but without any other abnormalities such as inflammation. The clouding was resolved by irrigation and aspiration of the anterior chamber in 2 cases at 2 and 34 days after the onset, and a spontaneous disappearance in 1 case at 14 days after the onset of the clouding. After the disappearance of the clouding, the visual acuity improved, and there were no recurrences. The solution used to irrigate the anterior chamber was collected and examined to confirm the absence of cellular materials. Elemental analyses confirmed that sodium and chloride were the predominant ions. The IOL implanted was the XACT lens (Advanced Vision Science, USA) which is a hydrophobic acrylic IOL and is characterized by having higher water content compared to other IOLs. In addition, it is packaged in 0.9% saline to maintain the pre-hydrated condition. These aspects may be related to the cause of the clouding. This IOL was implanted in 3271 eyes in our clinic, and 3 of them (0.09%) developed this clouding. CONCLUSIONS AND IMPORTANCE: We report our findings in 3 eyes that developed a clouding on the anterior surface of the lens soon after implantation. The clouding was localized to the area in contact with the aqueous. The cause of the clouding was not determined.

Conjunctival Goblet Cell Density Following Cataract Surgery With Diclofenac Versus Diclofenac and Rebamipide: A Randomized Trial.

PURPOSE: To determine the effects of topical diclofenac or betamethasone with concomitant application of topical rebamipide on the conjunctival goblet cell density in eyes after cataract surgery. DESIGN: Randomized clinical trial. PARTICIPANTS: Eighty patients who were scheduled for cataract surgery. METHODS: Patients were randomized into 4 groups according to the postoperative topical drugs to be given; Group A, diclofenac alone; Group B, diclofenac and rebamipide; Group C, betamethasone alone; and Group D, betamethasone and rebamipide. Impression cytology was performed before and at 1 month after the surgery, and the mean density of goblet cells was determined. RESULTS: The mean (± SD) density of goblet cells before the surgery in Group A was 257.0 ± 188.7 cells/mm2, and it decreased significantly to 86.5 ± 76.7 cells/mm2 at 1 month after the surgery (P = .002). In Group B, the goblet cell density was not statistically different between before (238.5 ± 116.6 cells/mm2) and at 1 month after the surgery (211.3 ± 184.4 cells/mm2, P = .55). In Groups C and D, the mean density of goblet cells was decreased at 1 month after the surgery, but the decreases were not significant (P = .11 and P = .52, respectively). CONCLUSION: After cataract surgery with postoperative topical diclofenac, the conjunctival goblet cell density was significantly reduced, and this reduction was blocked by the concomitant use of topical rebamipide. These results suggest that the concomitant use of topical rebamipide with nonsteroidal anti-inflammatory drugs is beneficial, especially in cases with postoperative dry eyes.

Influence on ocular surface after cataract surgery and effect of topical diquafosol on postoperative dry eye: a multicenter prospective randomized study.

PURPOSE: To investigate influences of 3% diquafosol sodium ophthalmic solution (DQS) on ocular surface after cataract surgery and effects on postoperative dry eye. DESIGN: This study had two consecutive prospective study phases. The former was an observational study from before cataract surgery to 4 weeks after surgery and the latter was a randomized open-label study from 4 to 8 weeks after surgery. METHODS: Subjects were 433 eyes of 433 patients undergoing cataract surgery with intraocular lens implantation. Dry eye examination of tear breakup time (BUT), corneal and conjunctival fluorescein staining scores, total subjective symptom score (12 symptoms), and Schirmer I test were conducted before surgery and 4 weeks after surgery. Patient demographics and these examination results were used to analyze risk factors to predict postoperative dry eye. In a randomized study, 154 eyes diagnosed with dry eye postoperatively were applied either DQS or artificial tears (AT) six times daily for 4 weeks. The data of the examinations were compared. RESULTS: At 4 weeks after surgery, BUT was shortened significantly (P=0.036), fluorescein staining score increased significantly (P=0.012), but total subjective symptom score was significantly improved (P<0.001). The majority of postoperative dry eye was shortened BUT type (53.1%). The dry eye prevalence after surgery decreased (55.7%) compared with before surgery (69.7%). Females and the patient with dry eye symptoms before surgery had significant risk factors for postoperative dry eye. In a randomized study, BUT was significantly prolonged in the DQS group (P=0.015), but not in the AT group. Fluorescein staining score was significantly improved in both groups (P<0.001). Total subjective symptom score was significantly decreased in the AT group (P<0.001), but not in the DQS group. CONCLUSION: Our study suggests that cataract surgery has harmful effects on tear film stability and ocular surface, and DQS has a capability to improve them.

An Endovascular Cannulation Needle with an Internal Wire for the Fragmentation of Thrombi in Retinal Vein Occlusion.

PURPOSE: We report a newly developed device to fragment thrombi in retinal vein occlusion. METHODS: The new instrument consists of a 23-gauge (G) pipe and a 37-G needle with an internal wire. A total of 40 porcine eyes were used; 20 eyes for experiments in the branch retinal vein (BRV group) and 20 eyes for experiments in the central retinal vein (CRV group). We placed 25-G 3-port trocars, and core vitrectomy was performed. Another 23-G scleral incision was performed for insertion of the needle. The needle pierced the retinal vein at a distance of three- to four- or one-disc diameters from the optic disc (BRV or CRV group, respectively), and the internal wire was advanced toward the disc. The success rates of needle piercing and cannulation of the internal wire were recorded in each group. In the CRV group, the cannulation was deemed successful when the tip reached inside the optic disc. Real-time optical coherence tomography imaging also was performed using the Zeiss Rescan 700 device in porcine eyes. Histologic examination of the retinal vessel inserted with the internal wire was performed. RESULTS: The success rates of needle piercing into the BRV and CRV were 85% and 95%, respectively. The success rates of cannulation of the internal wire into the BRV and CRV were 85% and 0%, respectively. The process of cannulation was recorded successfully with the Rescan 700. Histologic examination showed no damages to the endothelial cell layer. CONCLUSIONS: The needle and internal wire intended to be used for recanalization of BRV occlusion were successfully pierced and cannulated into the BRV. TRANSLATIONAL RELEVANCE: This newly developed device could become a treatment modality for retinal vein occlusion to fragment thrombi that present treatment methods cannot reach and remove directly.

Decreased visual acuity resulting from glistening and sub-surface nano-glistening formation in intraocular lenses: A retrospective analysis of 5 cases.

BACKGROUND: To report on five patients with decreased visual acuity due to glistening and severe sub-surface nano-glistening (SSNG) formation within their intraocular lenses (IOLs). DESIGN: Case reports and analysis of extracted IOLs. PARTICIPANTS AND SAMPLES: We report improved visual acuity when IOLs with severe glistening and SSNG were exchanged for clear IOLs in five patients. METHODS: Case reports. MAIN OUTCOME MEASURES: The main outcome measure was visual acuity. The secondary outcome measure was light transmission. Explanted IOLs were subjected to investigation. Pre- and postoperative slit lamp images of the anterior eye and microscopic images of the extracted IOLs were taken and compared. Light transmission of the IOL was measured using a double beam type spectrophotometer. An integrated value of the percentage light transmittance in the visible light spectrum was calculated. RESULTS: We report on five patients whose visual acuity improved when IOLs were exchanged because of severe glistening and SSNG. All of the affected IOLs were MA60BM (Alcon, Forth Wroth Texas, USA) and the original implantation had occurred over a range of 6-15 years prior to the IOL exchange. Light transmission was decreased in all affected lenses compared to a similar control IOL. CONCLUSIONS: Although only a few reports of cases in which glistening and SSNG have progressed to the level of decreased visual function have been published, the likelihood is that this phenomena will increase as the severity and incidence of these inclusions have been shown to increase with time. Appropriate evaluations of visual function in such patients are needed and consideration should be given to IOL exchange in symptomatic patients.

Late-onset toxic anterior segment syndrome.

UNLABELLED: We describe 6 cases that developed intraocular inflammation between 42 days and 137 days after implantation of an acrylic foldable intraocular lens (IOL) (ISert model 251) and failed to respond to antibiotic treatment. One eye required a vitrectomy and IOL removal, 2 eyes required irrigation of the capsule, and 5 eyes required systemic administration of steroids. The healing process took 30 to 108 days after onset. Simultaneous with our cases was an epidemic outbreak of sterile anterior segment inflammation with the same characteristics associated with the same IOL. The clinical features indicated late-onset toxic anterior segment syndrome. Analysis of the outbreak strongly suggested that toxicity of the aluminum used in the IOL production process was the cause. This contamination risk exists even with modern manufacturing technology. FINANCIAL DISCLOSURE: Mr. Shibuya is an employee of Hoya Corporation Medical Division. No other author has a financial or proprietary interest in any material or method mentioned.

Effects of topical diquafosol pretreatment on intraoperative corneal wetting.

PURPOSE: To examine the effects of pretreatment with diquafosol 3.0% ophthalmic solution on corneal surface wetting during cataract surgery with intraocular lens (IOL) implantation in cases of senile cataract. SETTING: Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. DESIGN: Prospective randomized single-masked comparative study. METHODS: Phacoemulsification and IOL implantation were performed in eyes with senile cataract. After a 2-week washout period, patients were randomly assigned to receive 1 drop of diquafosol 3.0% ophthalmic solution or artificial tears 6 times daily for 4 weeks before surgery. The main outcome measure, termed the corneal wetting property, was the time between when a clear image of the operating microscope light source appeared just after the corneal surface was irrigated with a balanced salt solution and the time at which that image began to blur. RESULTS: The study enrolled 51 patients (76 eyes). The mean time to corneal wetting was 50.1 seconds ± 10.8 (SD) in the diquafosol group and 45.3 ± 9.2 seconds in the artificial tears group. The difference between the 2 groups was statistically significant (P<.029). CONCLUSION: Four-week pretreatment with diquafosol 3.0% ophthalmic solution in patients with senile cataract scheduled for cataract surgery with IOL implantation was effective in enhancing the intraoperative corneal surface wetting property, which suggests improved optical clarity during surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

New side-view imaging technique for observing posterior chamber structures during cataract surgery in porcine eyes.

BACKGROUND: To develop a side-view imaging technique for observing the dynamic behavior of posterior chamber structures (PCSs) in porcine eyes which mimics closed-eye cataract surgery in humans. METHODS: Enucleated porcine eyes were placed into liquid nitrogen for 5 seconds and immediately bisected at about a 45-degree angle to the equatorial plane. The anterior portion was attached firmly to a glass slide with superglue and sprinkled with wheat flour. Phacoemulsification and aspiration (PEA) was performed as in humans on 10 consecutive porcine eyes. The movements of the PCSs were monitored through the glass slide with a high-resolution video camera set below the cut surface of the eye. The intraocular pressure (IOP) was monitored during the surgery. The highest IOP, operation time, and volume of irrigation fluid of 10 whole eyes were compared to that obtained from the bisected eyes glued to a glass slide. In a second set of experiments, the strength of the seal between the bisected eye and the glass slide was tested in three sets of eyes: 1) frozen eye fixed with superglue with wheat flour for 3 min; 2) frozen eye fixed with superglue for 3 min; and 3) non-frozen eye fixed with superglue for 30 min. The highest IOP that led to a disruption of the seal was compared among the three groups. RESULTS: PEA was successfully performed on 9 of 10 (90%) eyes with the movements of the PCSs clearly observed. The average maximum intraocular pressure of the 9 bisected eyes was 55.8 ± 4.7 mmHg and that for the 10 unbisected eyes was 55.3 ± 5.0 mmHg (P = 0.650). The frozen eye fixed with superglue in combination with wheat flour (Group 1) had the strongest sealing strength with an average IOP at the breaking point of 117.3 ± 36.2 mmHg. CONCLUSIONS: Our side-view imaging technique can be used to evaluate the changes of the PCSs during intraocular surgery and for surgical training of new residents.

Nepafenac 0.1% versus fluorometholone 0.1% for preventing cystoid macular edema after cataract surgery.

PURPOSE: To compare a topical nonsteroidal antiinflammatory drug (nepafenac 0.1%) and a topical steroidal antiinflammatory drug (fluorometholone 0.1% ) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract extraction with foldable intraocular lens (IOL) implantation. SETTING: Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. DESIGN: Randomized double-masked single-center clinical trial. METHODS: Patients were randomized to receive nepafenac 0.1% eyedrops or fluorometholone 0.1% eyedrops for 5 weeks after phacoemulsification with foldable IOL implantation. The incidence and severity of CME were evaluated by fluorescein angiography, retinal foveal thickness on optical coherence tomography, and BAB disruption on laser flare-cell photometry. RESULTS: Thirty patients received nepafenac and 29 patients, fluorometholone. Five weeks postoperatively, the incidence of fluorescein angiographic CME was significantly lower in the nepafenac group (14.3%) than in the fluorometholone group (81.5%) (P<.0001). The fovea was thinner in the nepafenac group than in the fluorometholone group at 2 weeks (P=.0266) and 5 weeks (P=.0055). At 1, 2, and 5 weeks, anterior chamber flare was significantly less in the nepafenac group than in the fluorometholone group (P<.0001, P<.0001, and P=.0304, respectively). The visual acuity recovery from baseline was significantly greater in the nepafenac group (80.0%) than in the fluorometholone group (55.2%) (P=.0395). There were no serious side effects in either group. CONCLUSION: Nepafenac was more effective than fluorometholone in preventing angiographic CME and BAB disruption, and results indicate nepafenac leads to more rapid visual recovery.

Changes in areas of capillary nonperfusion after intravitreal injection of bevacizumab in eyes with branch retinal vein occlusion.

PURPOSE: : To study the effect of an intravitreal bevacizumab (IVB) on the retinal ischemia in eyes with a branch retinal vein occlusion. METHODS: : Fluorescein angiography was performed before and 1 month after the IVB (1.25 mg/0.05 mL) in 58 consecutive eyes of 58 patients with macular edema secondary to a branch retinal vein occlusion. The area of capillary nonperfusion was measured on an early-phase fluorescein angiography image by an area measurement program, and the area was expressed relative to the optic disk area (DA). A blockage of the fluorescence by the retinal hemorrhage was distinguished from nonperfusion by comparisons with retinal photographs. RESULTS: : Thirty-seven of 58 eyes did not have any capillary nonperfusion before the IVB, and capillary nonperfusion developed in 3 of these 37 eyes 1 month after the IVB. The area of nonperfusion in these 3 eyes was 0.13, 0.47, and 0.60 DA. Twenty-one of the 58 eyes had capillary nonperfusion before the IVB, and the mean (±SD) area of nonperfusion was 3.45 ± 4.66 DA before the IVB and 3.45 ± 5.19 DA 1 month after the IVB. This change was not significant (P = 0.36). An increase in the area of capillary nonperfusion of >1.0 DA after the IVB was seen in only 1 of all 58 eyes. CONCLUSION: : These results suggest that the incidence of a significant increase in the area of capillary nonperfusion (>1 DA) during the 1 month after the IVB is very low in eyes with branch retinal vein occlusion.

Miyake-Apple view of inner side of sclerotomy during microincision vitrectomy surgery.

PURPOSE: To examine the inner surface of the sclerotomy during microincision vitrectomy surgery by Miyake-Apple view. METHODS: The anterior half of porcine eyes was attached to a transparent acrylic plate with cyanoacrylate glue. Then, either a 23-gauge or a 25-gauge trocar-cannula was inserted through the sclera obliquely. The inner surface of the entrance site was observed posteriorly by Miyake-Apple view. These images were compared with the endoscopic view of two patients who underwent vitreous surgery for an epiretinal membrane. RESULTS: When the trocar-cannula was inserted obliquely, the Miyake-Apple view showed that the ciliary epithelium at the sclerotomy site was stretched. When the trocar-cannula was inserted vertically, the ciliary epithelium was folded, and the folds remained even after the trocar was removed. Vitreous strands were seen incarcerated into the sclerotomy site. In human eyes, a folding of the ciliary epithelium was not clearly seen with the endoscopic view but the incarcerated vitreous was seen. CONCLUSION: The Miyake-Apple view provided a precise, in vivo, observation of the inner surface of the entry site. It disclosed the morphological stress on the ciliary epithelium by the sclerotomy.

Decreased visual function due to high-level light scattering in a hydrophobic acrylic intraocular lens.

PURPOSE: To investigate the effects of light scattering from the surface of hydrophobic acrylic intraocular lenses (IOLs) on visual function. METHODS: A 67-year-old man was implanted with an IOL (MA60BM) in January 1998, but became aware of decreased visual function in May 2008. Observation with a slit lamp revealed light scattering throughout the entire optic of the IOL, which was extracted and replaced. Postoperative visual function improved at 1 month. The cause of light scattering was investigated with a focus on water permeating the IOL material. To confirm the effect of light scattering on visual function, light transmission of the extracted IOL was measured in physiological saline at 33 °C, and the simulated retinal image was evaluated in a model eye. RESULTS: Observation of the extracted IOL showed light scattering from the optic surface layer, the main cause of which was phase-separated water within the IOL material. Light transmission in the extracted IOL was 16.3% lower than that in an unused IOL in the visible range. Moreover, the simulated retinal image was hazy compared to that of the unused IOL. CONCLUSION: Severe surface light scattering from an IOL optic may decrease visual function.

Economic cost of visual impairment in Japan.

OBJECTIVE: To quantify the total economic cost of visual impairment in Japan. METHODS: A prevalence-based approach was adopted using data on visual impairment, the national health system, and indirect costs to capture the economic impact of visual impairment in 2007. RESULTS: In 2007, visual impairment affected more than 1.64 million people in Japan and cost around yen 8785.4 billion (US $72.8 billion) across the economy, equivalent to 1.7% of Japan's gross domestic product. The loss of well-being (years of life lost from disability and premature mortality) cost yen 5863.6 billion (US $48.6 billion). Direct health system costs were yen 1338.2 billion (US $11.1 billion). Other financial costs were yen 1583.5 billion (US $13.1 billion), including productivity losses, care takers' costs, and efficiency losses from welfare payments and taxes. Community care was the largest component of other financial costs and was composed of paid and unpaid services that provide home and personal care to people with visual impairment. The findings of this study are in line with those of similar studies in Australia and the United States. CONCLUSIONS: Visual impairment imposes substantial costs on society, particularly to individuals with visual impairment and their families. Eliminating or reducing disabilities from visual impairment through public awareness of preventive care, early diagnosis, more intensive disease treatment, and new medical technologies could significantly improve the quality of life for people with visual impairment and their families, while also potentially reducing national health care expenditure and increasing productivity in Japan. The results of this study should provide a first step in helping policymakers evaluate policy effects and to prioritize research expenditures.

Prevalence of visual impairment in the adult Japanese population by cause and severity and future projections.

PURPOSE: To present a comprehensive estimate of the total number of people with visual impairment in the adult Japanese population by age, gender, severity and cause, and to estimate future prevalence based on population projections and expected demographic changes. METHODS: Definitions of visual impairment used in this study were based on the United States criteria. Total visual impairment was calculated as the sum of low vision and blindness. The prevalence estimates were based on input from a number of Japanese epidemiological surveys, census material and official population projections. RESULTS: There were an estimated 1.64 million people with visual impairment in 2007 in Japan. Of these, 187,800 were estimated to be blind. The prevalence of visual impairment in Japan increased with age and half of the people with visual impairment were aged 70 years or older. The leading causes of visual impairment in Japan were glaucoma (24.3%), diabetic retinopathy (20.6%), degenerative myopia (12.2%), age-related macular degeneration (10.9%), and cataract (7.2%). These five major causes comprised three-quarters of all visual impairment. The prevalence of visual impairment was projected to increase from 1.3% of the population in 2007 to 2.0% by 2050. CONCLUSIONS: This comprehensive study presents the prevalence of total visual impairment in the adult Japanese population. The projected increases in the prevalence of visual impairment over time reflect the demographic changes of a declining and aging Japanese population. These projections highlight that the burden of disease due to visual impairment and imposed on society is likely to increase.