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Purpose: To investigate the clinical characteristics of eyes with cuticular drusen in Japanese individuals, while paying special attention to large colloid drusen (LCD)., Study Design: Retrospective case series., Methods: Eyes with cuticular drusen, from patients of 4 medical institutes in Japan, were investigated. Multimodal imaging findings were used to diagnose cuticular drusen. LCD was defined as cuticular drusen > 200 µm., Results: Twenty-four eyes from 12 patients (8 women, 4 men) were diagnosed with cuticular drusen. The mean age of all patients (n = 12) was 60.8 years. The mean age of patients without additional macular pathology (n = 5) was 55.4 years. Of the 7 patients with additional macular pathology, 6 (85.7%) exhibited age-related macular degeneration-associated macular pathology, including drusenoid pigment epithelial detachment (PED) (8 eyes from 4 patients), geographic atrophy (2 eyes from 1 patient), and occult choroidal neovascularization (1 eye). LCD were found in 6 eyes of 3 patients (25%), those with LCD were on average 53.7 ± 8.7 years old and those without 69.9 ± 14.1 years of age (P = 0.064, Mann-Whitney U test)., Conclusions: Cuticular drusen were predominantly seen in females, and drusenoid PED was most frequently seen in eyes with additional macular pathology. LCD were seen in 25% of eyes with cuticular drusen.

Purpose: To investigate whether the development of late age-related macular degeneration (AMD) in fellow eyes with pseudodrusen is associated with the pseudodrusen pattern in patients with unilateral exudative AMD., Study Design: Retrospective observational study., Methods: A retrospective analysis was performed on 73 patients with unilateral exudative AMD showing pseudodrusen in their fellow eyes. Eyes were classified according to pseudodrusen pattern, which was determined based on maximum pseudodrusen ribbon length., Results: During the mean follow-up period of 35.5±18.6 months, 21 (28.8%) eyes developed late AMD. Among these eyes, 15 (71%) developed exudative AMD and six (29%) developed geographic atrophy (GA). Development of late AMD in fellow eyes occurred with significantly more prevalence in patients showing a ribbon-dominant type pseudodrusen pattern in their fellow eye than dot-dominant type (P=0.0005, log-rank test). Cox-regression analysis revealed that development of late AMD in fellow eyes is associated with the presence of ribbon-dominant pseudodrusen in the fellow eyes (hazard ratio 4.15, 95% confidence interval (CI) 1.59-10.8), along with older age (hazard ratio 1.10, 95% CI 1.03-1.17), a history of smoking (hazard ratio 17.2, 95% CI 1.11-263), the presence of large soft drusen in the fellow eye. (hazard ratio 5.49, 95% CI 1.29-21.1) and retinal angiomatous proliferation (hazard ratio 5.02, 95% CI 1.90-13.2) CONCLUSIONS: Fellow eyes with ribbon-dominant pseudodrusen in patients with unilateral exudative AMD are likely to develop late AMD.

Anti-vascular endothelial growth factor agents reduce macular edema and improve vision in eyes with macular edema associated with retinal vein occlusion (RVO), including branch RVO (BRVO) and central RVO. However, not all eyes with resolved macular edema show satisfactory best corrected visual acuity. Photoreceptor impairment can mostly explain the vision loss in these cases. Photoreceptor damage can be caused by subretinal hemorrhage in the central fovea and hard exudates or their precursor derived from concentrated lipoproteins originating from leaky retinal vessel extravasation. The contribution of neuron impairment in the inner retina, including the impairment of bipolar and ganglion cells by ischemia, indicated by the presence of a non-perfusion area (NPA), to vision loss in eyes with BRVO is insignificant. This is because the papillomacular bundle area is usually spared from NPAs in BRVO cases.

Purpose: To study the reduction in light sensitivity in areas where impaired retinal perfusion was established by fluorescein angiogram (FA) in eyes with branch retinal vein occlusion (BRVO) that recovered from retinal edema and hemorrhage., Design: Retrospective observational case series., Methods: A study of the reduction in light sensitivity demonstrated by total deviation display of the Humphrey perimetry program 30-2 in 43 eyes from 42 patients with BRVO, whose perfusion status was assessed by FA images taken at least 6 months after disease onset. Each of the 15 retinal squares in the FA images, corresponding to the 15 Humphrey test points around the fixation point in the affected vertical hemisphere, was classified as either perfused, partially perfused, or non-perfused. Correlation between light sensitivity and perfusion status was investigated by three evaluators in a total of 645 squares, 15 squares from each of the 43 subject eyes., Results: In 459 retinal squares (71.2%) with complete agreement on the perfusion status among the three evaluators, light sensitivity was significantly different among retinal squares of perfused (median: - 4.0 dB, n = 258), partially perfused (median: - 8.0 dB, n = 41), and non-perfused (median: - 16.0 dB, n = 160) (P < .000001, Kruskal-Wallis test)., Conclusions: Light sensitivity is decreased in retinal areas exhibiting impaired perfusion, likely due to neuronal loss in the inner retinal layer in eyes with chronic BRVO.

Purpose: To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60 months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV)., Methods: We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12 months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present., Results: During the follow-up period (mean 44 ± 13 months, median 48 months), 46 eyes (75.4 %) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59 % at the 12-month visit, 41 % at the 24 month, 31 % at the 36 month, and 20 % at the 60-month visit. The median retreatment-free period was 15.0 [95 % confidence interval (CI) 7.4-22.7] months, and the mean period was 24.9 (95 % CI 19.3-30.6) months. Cox regression analysis revealed that older age (P = 0.010, hazard ratio 1.06, CI 1.02-1.11) and male gender (P = 0.043, hazard ratio 2.41, CI 1.03-5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits., Conclusions: About 80 % of eyes with PCV require retreatment within 5 years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.

Purpose: To investigate the various perimetric parameters that best predict reduction of best-corrected visual acuity (BCVA) to worse than 0.5 in the near future in eyes with retinitis pigmentosa (RP)., Methods: The most recent records obtained by Humphrey Field Analyzer (HFA) central 10-2 perimetry were studied for the right eyes of 123 patients (60 men and 63 women) with typical RP. The correlation between various parameters of perimetric sensitivity and BCVA was retrospectively studied. The receiver operating characteristic (ROC) curves were used to find the best parameter to discriminate eyes with BCVA ≥0.5 from those with BCVA <0.5., Results: Spearman rank correlation coefficients with logMAR BCVA were the highest for the foveal threshold (FT) and mean sensitivity of the test points within 1.4° of the fixation point (MS1.4). The ROC curve analysis revealed that the area under the curve was the largest for the MS1.4 among all the perimetric parameters for discriminating eyes with BCVA ≥0.5 from those with BCVA <0.5. The cutoff value of 30 dB showed 100 % specificity and 57 % sensitivity., Conclusions: The risk of vision decreasing below 0.5 in the near future may be predicted when the mean sensitivity within 1.4° of the fixation point in the HFA 10-2 reaches 30 dB in eyes with RP.

Purpose: To study the relationship between foveal sensitivity and visual acuity in eyes with macular disorders exhibiting macular thickening., Methods: We studied the relationship between foveal sensitivity, obtained as the "foveal threshold" by use of Humphrey perimetry, and best-corrected visual acuity, converted to the logarithm of the minimum angle of resolution (logMAR), for 117 eyes with epiretinal membrane (ERM), 197 eyes with retinal vein occlusion associated with macular edema (RVOME), and 158 eyes with central serous chorioretinopathy (CSC)., Results: Foveal sensitivity and logMAR correlated significantly for the eyes with ERM, RVOME, and CSC. Although mean foveal sensitivity was no different among the three diseases, mean logMAR was lower in eyes with CSC, i.e., visual acuity was better, than in those with ERM or RVOME (P < 0.001)., Conclusions: Light sense (foveal sensitivity) is related to spatial resolution (logMAR) at the center of the fovea, in eyes with ERM, RVOME, and CSC at different strengths depending on the disease. Less pronounced reduction of visual acuity compared with foveal sensitivity in eyes with CSC could explain the tendency of these patients to complain of dimness rather than acuity loss.

Purpose: To determine the best clinical measures of visual sensitivity for monitoring disease progression in eyes with retinitis pigmentosa (RP)., Methods: This survey retrospectively studied results from the Humphrey perimetry central 10-2 program for 123 eyes with RP with regard to the correlation between years affected by RP and clinical measures of visual dysfunction, including mean deviation (MD), average sensitivity of 12 test points (CENT12), average sensitivity of 4 central points (CEN4), foveal threshold (FT), and logarithm of the minimum angle of resolution (LogMAR)., Results: All these value correlated more highly with years of symptoms (P < 0.001 for all) than with years since diagnosis. The correlation coefficient with years of symptoms decreased in the order MD, CENT12, CENT4, FT, and LogMAR. The order differed for a subset of 66 eyes with advanced RP having -15 dB or lower MD, and decreased in the order FT, CENT4, LogMAR and CENT12., Conclusion: Progression in eyes with RP could be well assessed by use of the MD of the Humphrey central 10-2 program in general and by use of FT, CENT4, and CENT12 in cases of advanced RP.

Purpose: To study the recurrence of macular edema and the probability of retreatment with intravitreal bevacizumab (IVB) of eyes with macular edema associated with branch retinal vein occlusion (BRVO)., Methods: In this retrospective study of an interventional case series, the temporal profile of visual acuity and retinal thickness after individual IVB, either initial or repeated, was investigated for eyes with acute BRVO associated with symptomatic macular edema., Results: In a total of 95 IVB treatment sessions conducted on 37 eyes of 37 patients, 25 injections were completed with a follow-up period of 6 months or longer without any additional treatments. Fifty-eight IVB injections were followed by retreatment with IVB after an average interval of 119 days (range 42-308 days) since the preceding IVB injection. The remaining 12 injections were followed either by an insufficient follow-up period of less than 6 months or by laser treatment., Conclusions: Although retreatment with IVB because of recurrence of macular edema is common, in this study, the probability of retreatment with IVB was approximately 70% after each individual IVB injection, indicating that 4 injections is maximum for three-quarters of eyes with BRVO macular edema.

Purpose: To investigate the characteristics of eyes with polypoidal choroidal vasculopathy (PCV) which develop secondary classic choroidal neovascularization (CNV) after photodynamic therapy (PDT)., Methods: We retrospectively reviewed the records of 64 eyes of 64 PCV patients (43 men, 21 women; mean age ± standard deviation, 72.7 ± 8.6 years), who were followed-up for at least 1 year after the initial PDT. There was no evidence of classic CNV in any of the subject eyes on fluorescein angiography (FA) at the first PDT. Eyes which developed of secondary classic CNV after PDT were classified as the CNV group and the other eyes as the No-CNV group., Results: Secondary classic CNV developed after PDT in 10 (15.6%) of the 64 eyes. Six patients developed CNV within 1 year after the first PDT. Multivariate logistic regression analysis for the baseline factors related to CNV development, including age, gender, greatest linear dimension, and the lesion components, revealed that in the CNV group the age was significantly younger (p = 0.037) and the incidence of retinal edema was significantly greater (p = 0.041) than in the No-CNV group., Conclusions: Secondary classic CNV tends to develop after PDT in PCV eyes in younger patients with retinal edema.

Purpose: To investigate the relationship between anatomical changes and visual sensitivity in eyes with central serous chorioretinopathy (CSC)., Methods: Twenty-one eyes with CSC were retrospectively studied using optical coherence tomography (OCT) retinal maps, line scan mode, and the Humphrey perimetry central 10-2 program., Results: Total retinal thickness (TRT), including the neurosensory retina and subretinal fluid, correlated significantly with the sensitivity loss in the corresponding visual field in the central macula within a circle 6 mm in diameter. Differential analysis of the TRT, separating it into neurosensory retinal thickness (NRT) and subretinal thickness (SRT), revealed that only SRT correlated well with perimetric sensitivity at 1°, 3°, 5°, 7°, and 9° from the fovea along horizontal and vertical lines crossing at the fovea., Conclusions: Visual sensitivity measured with automated static perimetry is further attenuated by increasing distance between the photoreceptor and retinal pigment epithelium (RPE) in areas of serous retinal detachment in eyes with CSC.

Purpose: To investigate whether the baseline mean deviation (MD) of Humphrey perimetry has a predictive value for visual improvement after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV)., Methods: We retrospectively reviewed the records of 40 eyes of 39 PCV patients (28 men, 11 women) who underwent PDT. The follow-up period ranged from 12 to 42 months. Best-corrected visual acuity (BCVA) improved more than 0.2 logarithm of the minimum angle of resolution (logMAR) units at the final examination in 22 (55%) of the 40 eyes, which were classified into the "Improved group." The other 18 eyes with improvement of

Purpose: We studied the temporal aspects of retinal thickness in eyes with branch retinal artery occlusion (BRAO) to demonstrate the retinal thinning process subsequent to the acute stage of the disease., Methods: We studied the retinal thickness map obtained with optical coherence tomography (OCT) in nine eyes of nine patients with BRAO. Central foveal thickness and average retinal thickness in the superior or inferior sectors of the inner macula (IM) and outer macula (OM) were measured several times after the onset of BRAO., Results: All follow-up data combined from the eyes with the occluded branch artery on the same vertical side showed a common pattern of decrease in the retinal thickness in the affected superior or inferior sectors of the IM and OM, which was described by an exponential decay curve, whereas few changes were seen in central foveal thickness. The fitting of the reducing retinal thickness curves to an exponential decay curve led to the final estimated thickness in the affected sectors of 60% that of the control., Conclusion: The initially thickened retina in the vertical sectors of the macula in eyes with BRAO decreases exponentially to a final thickness of 60% of that the normal retina.

Purpose: Several characteristic personality types have been reported for glaucoma patients in previous studies. However, none of the previous studies used a common structural theory of personality. In this study, we conducted a multicenter cross-sectional case-control study using the recently established five-factor model of personality structure., Methods: Personality was evaluated using the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI), which is a questionnaire specifically designed to test the five-factor model of personality: neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C). Eligible questionnaires were obtained from 196 patients with primary open-angle glaucoma (POAG) (99 men, 97 women) and 223 reference subjects with no ocular disease except cataract (87 men, 136 women). The mean score of each NEO-FFI factor for POAG patients was compared to the scores for the reference subjects., Results: Compared with the reference subjects, the mean N score was significantly higher (P = 0.013), the mean scores for A and C were significantly lower (P = 0.007 and P = 0.001, respectively), and the mean E score tended to be lower (P = 0.055) in male POAG patients. The mean E score was significantly lower (P = 0.023) in female POAG patients., Conclusions: Characteristic personality traits were noted in POAG patients, and a more significant relationship was found between personality and glaucoma in men than in women.

Purpose: To study retrospectively the presenting visual acuity and the visual outcome in patients with central retinal artery occlusion (CRAO) and in patients with branch retinal artery occlusion (BRAO)., Methods: We studied the visual acuity and outcome in 23 patients (23 eyes) with CRAO and in 30 patients (30 eyes) with BRAO that met the inclusion criteria: a funduscopic appearance of retinal whitening, a delay in arterial dye filling in a fluorescein angiogram, the first examination in our hospital within 7 days of onset, and a minimum follow-up period of 90 days., Results: Both presenting acuity and final acuity were far worse in patients with CRAO than in patients with BRAO. A final acuity worse than 0.1 was observed in 14 of the 23 (61%) patients with CRAO and in only 1 of the 30 (3%) patients with BRAO. Only 5 of the 23 (22%) patients with CRAO and 24 of the 30 (80%) patients with BRAO showed a final acuity of 0.5 or better., Conclusion: Visual acuity in patients with CRAO is poor at presentation, and the prognosis is generally poor, with a few exceptions. In contrast, the visual acuity in patients with BRAO is far better both at presentation and at the final visit.

Background: The recovery of the visual field in eyes with central retinal artery occlusion (CRAO) has rarely been reported, because the patient has difficulty in central fixation during perimetry testing due to poor visual acuity. We describe the recovery of the central visual field in eyes with atypical CRAO., Cases: Two patients who showed sudden visual loss underwent ophthalmic examinations, including fluorescein fundus angiography and Humphrey central 30-2 perimetry., Observations: Both patients had good visual acuity at presentation, with normal retinal color in the area of the papillomacular bundle surrounded by a mild retinal whitening in one case and by scattered cotton-wool patches in the other. They were considered on the basis of angiographic findings to have central retinal artery occlusion. The mean deviation of the Humphrey central 30-2 perimetry gradually improved during the initial 70 days after the onset of symptoms in both patients., Conclusions: Although the mechanism remains to be clarified, a certain degree of visual field recovery may be seen in some cases of retinal artery occlusion. More patients with CRAO should be studied with follow-up perimetry.

Purpose: To predict future glaucomatous sensitivity loss using a perimetric color saturation test (PCST) that measures the color saturation discrimination threshold for six hues (red, yellow, green, green-blue, blue, and purple) at 9 degrees in horizontal and 3 degrees in vertical extrafoveal points., Methods: This new test was carried out on 31 patients (31 eyes) with early glaucoma or ocular hypertension. The sensitivity loss at the four points approximately 9.5 degrees apart from the fixation point was prospectively evaluated annually for 3 years using the Humphrey Field Analyzer (HFA) program central 30-2. The initial results of PCST and the total deviation (TD) in the follow-up HFA results were compared., Results: Twenty-seven patients (27 eyes) were followed up for 3 years. The color saturation threshold for six hues was correlated with the TD of HFA results at 108 points in the 27 eyes. The TD was -4 dB or better at the baseline measurement in 91 out of the 108 points. The averaged TD in the second and the third year in the follow-up period decreased below -4 dB in 10 of these 91 points, which were categorized as progression points in relation to the 81 nonprogression points. In the initial PCST, only the saturation threshold for purple was higher in the progression points when compared with the nonprogression points (P=.0004, Mann-Whitney U-test)., Conclusion: Future sensitivity loss is most likely at the points where the threshold of color saturation discrimination is increased for purple in eyes with early glaucoma or ocular hypertension.

Purpose: To study the visual prognosis in eyes with symptomatic retinal arterial macroaneurysm (RAM)., Methods: Medical records were retrospectively reviewed for 62 patients (65 eyes) with symptomatic RAM., Results: The median visual acuity at presentation was 0.4 for eyes with vitreous hemorrhage (n=6), 0.01 for eyes with premacular hemorrhage (n=9), 0.1 for eyes with submacular hemorrhage without premacular hemorrhage (n=16), 0.02 for eyes with submacular hemorrhage with premacular hemorrhage (n=16), and 0.3 for eyes with macular edema (n=18). The median value of the final visual acuity was 0.6 for vitreous hemorrhage, 0.7 for premacular hemorrhage, 0.1 for submacular hemorrhage without premacular hemorrhage, 0.1 for submacular hemorrhage with premacular hemorrhage, and 0.5 for macular edema., Conclusions: The visual prognosis for eyes with symptomatic RAM depends on the macular pathology. Eyes with vitreous hemorrhage or premacular hemorrhage recover good vision, while the vision in those with submacular hemorrhage with or without premacular hemorrhage generally remains poor. New interventions including submacular surgery or pneumatic displacement of submacular hematoma should be evaluated in a future study in terms of visual prognosis for these eyes.

Purpose: In a previous study we demonstrated that the progression of the disease retinitis pigmentosa (RP) can be readily monitored by the mean deviation (MD) measured by Humphrey central 10-2 perimetry, which assesses the sensitivity distribution in the macular area in eyes affected by RP. In the present study, we investigated whether the 10 degrees perimetric results could predict the time of declining visual acuity in eyes with RP in a cross-sectional study., Methods: Humphrey 10-2 perimetry results and visual acuity were studied in the right eyes of 69 patients with typical RP. Patients whose eyes had cataract, glaucoma, cystoid macular edema, or other complications affecting vision were excluded., Results: Eyes with an MD of -15 dB or greater had almost normal visual acuity. Various degrees of visual acuity loss were observed in eyes with an MD of less than -15 dB. In the 35 eyes with an MD of less than -15 dB, visual acuity correlated well with the corrected pattern standard deviation (CPSD), which is the measure of the degree to which the shape of the measured field departs from the age-corrected normal reference field., Conclusion: In the absence of complications, many eyes with RP may experience acuity loss after the field constriction reaches an MD of less than -15 dB. The CPSD may be used as an indicator of acuity because eyes showing a lower CPSD tend to have greater loss of acuity among eyes with an equivalent MD value.