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Masahiko Ayaki, Akiko Hanyuda, Kazuno Negishi Department of Ophthalmology, Keio University School of Medicine, Tokyo, JapanCorrespondence: Masahiko Ayaki; Kazuno Negishi, Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, Email mayaki@olive.ocn.ne.jp; kazunonegishi@keio.jpPurpose: Risk factors for presbyopia have not been fully determined although previous studies suggested presbyopia was associate with age, dry eye, and retinal ganglion cell complex thickness (GCC). We accessed these signs and common ocular symptoms in the middle-aged population focusing on sex differences when women have drastic hormonal change.Methods: This cohort study consecutively enrolled 2743 patients aged 36– 45 years (n=1000), 46– 55 years (n=1000), and 56– 65 years (n=743). All underwent ocular surface tests and had near add power and GCC measured. Common ocular symptoms were asked using questionnaire.Results: Among female participants, visual symptoms (eye strain and photophobia) were more prevalent in the age group 46– 55, whereas non-visual symptoms (dryness, irritation, and pain) were not. We identified symptomatic presbyopia (near add power ≥ 1.5D) in 14.4%, 73.8%, and 97.8%, positive corneal staining in 29.1%, 23.8%, and 23.9%, and a mean GCC of 98.2 μm, 105.3 μm, and 89.6 μm in the age groups 36– 45, 46– 55, and 56– 65, respectively. Mean tear break-up time were 3.3, 3.5, and 3.3 seconds, respectively. Results indicated a large progression of presbyopia (P< 0.01) from the period of 36– 45 years onward and significantly increased GCC (P< 0.01) in women of age group 46– 55. No notable tendency was observed in symptoms and GCC for male participants.Conclusion: Visual symptoms in women were worse between 46 and 55 years than before or after these ages. The increase of symptomatic presbyopia and GCC may be contributing to visual symptoms in addition to menopausal transition symptoms in this age group.Keywords: presbyopia, sex difference, near add power, menopause, eye strain

Osama MA Ibrahim,1 Masahiko Ayaki,1,2 Erisa Yotsukura,1 Hidemasa Torii,1 Kazuno Negishi1 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Otake Eye Clinic, Kanagawa, JapanCorrespondence: Osama MA Ibrahim; Masahiko Ayaki, Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan, Tel +81-3-5363-2012, Fax +81-3-5363 3645 ; +81-3-5363-3087, Email osamaibrahim82@gmail.com; mayaki@olive.ocn.ne.jpPurpose: To investigate the relationship between dry eye disease (DED) and myopia in Japanese teenagers.Methods: This clinic-based, retrospective, cross-sectional study assessed DED condition in 10- to 19-year-old teenagers presenting at Japanese eye clinics. They included 106 high myopic patients (HM; mean age, 16.4 ± 2.2 years), 494 mild myopic patients (15.0 ± 2.6 years) and 82 non-myopic teenagers (NM; 13.8 ± 2.6 years). Subjective refraction and anisometropia were measured. Myopia grade was classified as HM (≤ − 6.00 D), MM (> − 6.00 D, < − 0.50 D), or NM (≥ − 0.5 D). The presence of DED-related symptoms including dryness, irritation, pain, fatigue, blurring and photophobia were assessed through a questionnaire. Tear film break-up time (BUT) and fluorescein corneal staining were investigated. Comparison among three groups and regression analysis of myopic error and other variables were conducted.Results: Anisometropia and astigmatic error were greatest in the HM group compared with the other groups (p < 0.001). The HM group reported less photophobia (p < 0.001) and less pain (p = 0.039) compared with the NM group. Regression analysis revealed that myopic error was correlated with astigmatic error (β = − 0.231, p < 0.001), anisometropia (β = − 0.191, p < 0.001), short BUT (β = − 0.086, p = 0.028) and the presence of diagnosed DED (β = − 0.112, p = 0.003). Dryness (β = − 0.127 p = 0.004), photophobia (β = 0.117, p = 0.002) and pain (β = 0.084, p = 0.034) correlated with myopic error.Conclusion: This study associated clinical findings of DED in HM teenagers. The present results suggest DED might be associated with myopia, possibly in a reciprocal relationship.Keywords: myopia, astigmatism, anisometropia, dry eye, tear break-up time

Kento Yokobori,1,&ast; Masahiko Ayaki,1,2,&ast; Motoko Kawashima,1 Hidemasa Torii,1 Erisa Yotsukura,1 Sachiko Masui,1 Kazuno Negishi1 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Otake Eye Clinic, Yamato City, Kanagawa, Japan&ast;These authors contributed equally to this workCorrespondence: Masahiko Ayaki, Email mayaki@olive.ocn.ne.jpPurpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study.Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively.Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048).Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.Keywords: cataract surgery, dry eye, eyelid hygiene, functional visual acuity, higher order aberration, meibomian gland dysfunction, visual maintenance ratio

Kazuno Negishi,1 Sachiko Masui,1 Masahiko Ayaki,1,2 Hidemasa Torii,1 Erisa Yotsukura,1 Yasuyo Nishi1 1Department of Ophthalmology, Keio University School of Medicine, Shinjuku‑Ku, Tokyo, Japan; 2Otake Clinic Moon View Eye Center, Yamato-City, Kanagawa, JapanCorrespondence: Kazuno Negishi, Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑Ku, Tokyo, 160‑8582, Japan, Tel +81-3-3353-1211, Fax +81-3-3359-8302, Email kazunonegishi@keio.jpPurpose: To compare the clinical results achieved with the enhanced monofocal intraocular lenses (IOLs) with those of the monofocal IOL and investigate factors affecting the distance, intermediate, and near vision.Patients and Methods: Patients were included who underwent bilateral consecutive cataract surgeries using the same IOLs with follow-up to 1 month postoperatively. Refractions, monocular UDVA and CDVA, and binocular distance-corrected functional visual acuity at 5 meters (BDCFVA), at 66 centimeters (BDCIFVA) and at 40 centimeters (DCNVA) were assessed. Multiple regression analysis was used to assess the factors affecting binocular BDCFVA, BDCIFVA, and BDCNFVA. Subjective symptoms were assessed using the Near Activity Visual Questionnaire (NAVQ) and visual analogue scale (VAS).Results: Sixty patients (120 eyes) implanted with the Tecnis Eyhance IOL (30 patients, 60 eyes) or the Tecnis monofocal IOL (30 patients, 60 eyes) were included. The Tecnis Eyhance IOL provided significantly better binocular BDCIFVA than the Tecnis monofocal IOL in patients under 70 years of age. Multiple regression analysis showed that age was the only factor affecting distance and intermediate visual function in eyes with the Tecnis Eyhance IOL; gender, pupillary diameter, axial length, and average keratometry were not significant. There were no significant differences in subjective symptoms.Conclusion: The comprehensive cohort analysis did not confirm the advantage on the intermediate vision of the Tecnis Eyhance IOL. Younger age may be an important factor to benefit from the unique optical characteristics of this IOL.Keywords: presbyopia correcting intraocular lens, intermediate vision, functional visual acuity, age

Masahiko Ayaki,1,2,&ast; Kazuno Negishi1,&ast; 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Otake Eye Clinic, Kanagawa, Japan&ast;These authors contributed equally to this workCorrespondence: Masahiko Ayaki, Email mayaki@olive.ocn.ne.jpPurpose: We aimed to determine the seasonal variation in the tear meniscus level on strip meniscometry and its association with ocular parameters and symptoms. In Japan, there are four distinct seasons characterized by marked differences in temperature and humidity, which may contribute to an observed seasonality of ocular surface symptoms.Methods: We conducted a cross-sectional study in two Japanese clinics and recruited first-visit patients for 3 years. Tear strip meniscometry, tear break-up time (BUT), Schirmer test, and corneal staining were examined, and major ocular symptoms (dryness, irritation, pain, fatigue, blurred vision, and photophobia) were determined through interviews.Results: The 1196 participants had a mean age of 58.9± 15.2 years; 37.1% were of male sex. Strip meniscometry values and BUT revealed significant seasonality with one-way analysis of variance. The mean strip meniscometry value (mm) was 2.15± 2.59 in spring (p=0.025 vs winter), 2.37± 2.79 in summer (p< 0.001), 2.38± 2.80 in fall (p< 0.001), and 1.64± 2.29 in winter. Regression analysis indicated that strip meniscometry levels were correlated with BUT (p< 0.001), Schirmer test values (p< 0.001), corneal staining scores (p=0.022), and presence of dryness (p< 0.001).Conclusion: Strip meniscometry values exhibited distinct seasonality, being lowest in winter when the ambient condition is dry and cool, and were correlated with BUT, Schirmer test values, corneal staining scores, and the presence of subjective dryness.Keywords: dry eye, seasonality, strip meniscometry, Schirmer test, tear break-up time

Shinichiro Matsuguma,1 Kazuno Negishi,1 Motoko Kawashima,1 Ikuko Toda,2 Masahiko Ayaki,1 Kazuo Tsubota1,2 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Minamiaoyama Eye Clinic, Tokyo, Japan Purpose: The purpose of this study was to assess patients’ satisfaction and change in subjective happiness after laser-assisted in situ keratomileusis (LASIK). Patients and methods: This was a retrospective cross-sectional study of 307 patients (mean age, 34.3 years; range, 20–63 years) who underwent bilateral LASIK surgery and ocular examinations, including subjective refraction and visual acuity axial length measurements at Minamiaoyama Eye Clinic. Patients also completed questionnaires on their satisfaction with the surgery, and on the subjective happiness scale (SHS) within 1 month before and 1 month after surgery. A multiple regression analysis was performed to determine the independent predictors of the SHS score. Results: In total, 91.2% of the patients were satisfied with surgery (very satisfied: n=155; satisfied: n=125). The SHS score increased postoperatively from 5.2±0.9 to 5.3±0.9 (P

Masahiko Ayaki, Motoko Kawashima, Miki Uchino, Kazuo Tsubota, Kazuno Negishi Department of Ophthalmology, Keio University, Shinjuku, Tokyo, Japan Purpose: The purpose of this study was to evaluate the influence of seasons on the signs and symptoms of dry eye disease (DED). Methods: This is a cross-sectional, case-control study, and participants were non-DED subjects (n=1,916, mean age 54.4±14.4 years) and DED patients (n=684, 54.2±12.1 years) visiting six eye clinics at various practices and locations in Japan. We evaluated the signs and symptoms of DED and the seasons with the most severe results were compared to those with the least severe results in both groups. Main outcome measures were differences in the severity of the signs and symptoms of DED between the most and least severe seasons. Results: The majority of DED symptoms were most severe during spring and least severe in summer. Significant differences between these two seasons were found for irritation (P=0.001), pain (P=0.007), blurring (P=0.000), and photophobia (P=0.007) in the DED group. Superficial punctate keratopathy (P=0.001) and tear break-up time (BUT; P=0.000) results also indicated that DED was most severe in spring. In contrast, fewer patients had low Schirmer test results in spring, although this was not statistically significant (P=0.061). Conclusion: Our results demonstrated that the severity of DED is seasonal, which may explain the increase of short BUT-type DED cases observed in spring when air pollen counts are highest. Keywords: dry eye disease, seasonality, tear break-up time, cornea, ocular surface, tear production, hay fever, air pollen, allergic conjunctivitis

Masahiko Ayaki,1 Ikuko Toda,2 Naoko Tachi,3 Kazuno Negishi,1 Kazuo Tsubota11Department of Ophthalmology, Keio University School of Medicine, 2Department of Ophthalmology, Mimamiaoyama Eye Clinic, Tokyo, 3Eye Center, Shinseikai Toyama Hospital, Imizu, JapanPurpose: Dry eye disease (DED) is potentially associated with sleep and mood disorders. This study evaluated sleep quality in patients with DED using a questionnaire-based survey before and after topical eyedrop treatment. The effectiveness of sleep and ophthalmic services in assisting with sleep problems in patients with eye disease was also assessed.Methods: Seventy-one consecutive patients with DED visiting eight general eye clinics in various locations answered a questionnaire containing the Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. Photophobia and chronotype (morningness/­eveningness) were also evaluated with two representative questions from established questionnaires (National Eye Institute Visual Function Questionnaire-25 and Morningness/Eveningness questionnaire). Follow-up evaluation was conducted by interview or mail 3–10 months after the initial evaluation. A sleep service was established in two eye clinics to identify possible ocular diseases related to sleep and mood disorders; it comprised a questionnaire, sleep diary, actigram, medical interviews, visual field testing, retinal ganglion cell layer thickness measurement, and DED examination.Results: Patients with newly diagnosed DED exhibited a greater improvement in sleep after DED treatment compared with patients with established DED. Improvement in Pittsburgh Sleep Quality Index was significant (P

Masahiko Ayaki, Motoko Kawashima, Kazuno Negishi, Kazuo Tsubota Department of Ophthalmology, Keio University School of Medicine, Tokyo, JapanPurpose: We aimed to explore the prevalence of probable sleep and mood disorders in eye clinic visitors.Methods: This was a cross-sectional study. The participants were outpatients at six eye clinics from January through March, 2014. Outpatients were invited to complete a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). A final diagnosis was made, and patients were classified into six diagnostic groups. The main outcome measures were the scores of the PSQI and HADS among the diagnostic groups. Results: A total 1,000 outpatients participated, and 730 patients (mean age 59.5±19.0 years; 487 females) were analyzed after exclusion of children and patients diagnosed with healthy eyes, acute injury, or unilateral pseudophakia. The mean PSQI and HADS scores across all patients were 5.3±3.1 and 9.2±6.2, respectively. For the diagnostic groups, the mean PSQI and HADS scores, respectively, were 5.7±3.3 and 10.2±6.0 for dry eye (n=247), 5.4±3.2 and 9.2±5.7 for bilateral cataracts (n=159), 5.3±3.3 and 8.0±5.3 for bilateral pseudophakia (n=99), and, 5.0±3.1 and 9.8±6.6 for glaucoma (n=109). Overall, 37.3% of patients were poor sleepers (PSQI ≥6), and 45.5% had possible mood disorders (HADS ≥10). Stepwise regression analysis revealed that the PSQI and HADS scores were significantly correlated with both age (P

Hideki Kobara,1 Hirohito Mori,1 Kazi Rafiq,2 Shintaro Fujihara,1 Noriko Nishiyama,1 Maki Ayaki,1 Tatsuo Yachida,1 Tae Matsunaga,1 Johji Tani,1 Hisaaki Miyoshi,1 Hirohito Yoneyama,1 Asahiro Morishita,1 Makoto Oryu,1 Hisakazu Iwama,3 Tsutomu Masaki1 1Department of Gastroenterology and Neurology, 2Department of Pharmacology, 3Life Science Research Center, Faculty of Medicine, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan Abstract: Advances in endoscopic submucosal dissection include a submucosal tunneling technique, involving the introduction of tunnels into the submucosa. These tunnels permit safer offset entry into the peritoneal cavity for natural orifice transluminal endoscopic surgery. Technical advantages include the visual identification of the layers of the gut, blood vessels, and subepithelial tumors. The creation of a mucosal flap that minimizes air and fluid leakage into the extraluminal cavity can enhance the safety and efficacy of surgery. This submucosal tunneling technique was adapted for esophageal myotomy, culminating in its application to patients with achalasia. This method, known as per oral endoscopic myotomy, has opened up the new discipline of submucosal endoscopic surgery. Other clinical applications of the submucosal tunneling technique include its use in the removal of gastrointestinal subepithelial tumors and endomicroscopy for the diagnosis of functional and motility disorders. This review suggests that the submucosal tunneling technique, involving a mucosal safety flap, can have potential values for future endoscopic developments. Keywords: submucosal endoscopy, submucosal tunneling method, natural orifice transluminal endoscopic surgery, peroral endoscopic myotomy, gastrointestinal subepithelial tumor, functional and motility disorders

Masahiko Ayaki,1 Atsuo Iwasawa,2 Yoshimi Niwano31Department of Ophthalmology, International University of Health and Welfare, Mita Hospital, Tokyo, 2Department of Bioengineering, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama, 3Laboratory for Redox Regulation, Tohoku University Graduate School of Dentistry, Sendai, JapanPurpose: Anti-inflammatory eyedrops are often used in the treatment of corneal epithelial disorders. In the present study, we evaluated the cytotoxicity of six anti-inflammatory eyedrops in four ocular surface cell lines.Methods: The cytotoxicity of six commercially available anti-inflammatory ophthalmic solutions (ie, diclofenac, bromfenac, pranoprofen, betamethasone, and fluoromethorone) was assessed in three corneal cell lines and one conjunctival cell line. Cell viability was determined by the 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide and neutral red assays after exposing the cells to 10, 30, and 60 minutes of onefold, twofold, and tenfold dilutions of the drugs. Cytotoxicity was compared using the cell viability score (CVS), an integrated cytotoxic parameter that takes various factors into account, such as dilution by tear fluid or concentration by evaporation, drug exposure time, and ocular surface cell type.Results: Based on the CVS scores, the order of the anti-inflammatory eyedrops tested from least to most cytotoxic, with the active ingredient %CVS50, and %CVS40/80 for each solution given in parentheses, was as follows: Rinderon® (betamethasone, 100%, 100%) >0.02% Flumethoron® (fluoromethorone, 68%, 22%) = 0.1% Flumethoron® (fluoromethorone, 76%, 22%) >Bronuck® (0.1% bromfenac, 53%, −8%) = Diclod® (0.1% diclofenac, 44%, −15%) = Niflan® (pranoprofen, 50%, −19%). Rinderon® exhibited the least toxicity of all the anti-inflammatory eyedrops tested. Eyedrops containing non-steroidal anti-inflammatory drugs exhibited greater cytotoxicity than those containing steroids with benzalkonium at comparable concentrations. Concentration was the most significant factor affecting cell viability.Conclusion: The cytotoxicity of the anti-inflammatory eyedrops evaluated in the present study depended on both the pharmaceutical components and preservatives. The CVS is a concise indicator of drug cytotoxicity.Keywords: benzalkonium chloride, toxicity, cornea, cell viability score, anti-inflammatory drug

We herein report a case of sporadic intra-abdominal desmoid-type fibromatosis in which contrast-enhanced ultrasonography (US) combined with superb microvascular imaging (SMI) was useful for preoperative diagnosis. 18-Fluorodeoxyglucose positron emission tomography performed for systematic screening for lung cancer revealed an abnormal accumulation in the abdominal cavity. Transabdominal US showed a tumor with a mixture of hypoechoic and hyperechoic areas. Contrast-enhanced US combined with SMI revealed dendritic blood flow signals and no abnormal vascular network within the tumor. Macroscopic examination of the resected specimen revealed a white tumor with relatively clear boundaries. Microscopic examination revealed spindle cells with poor atypia proliferating in bundles with collagenous stromal cells. Immunohistochemistry showed nuclear localization of beta-catenin within the tumor cells. From these findings, we finally diagnosed intra-abdominal desmoid-type fibromatosis. Contrast-enhanced US combined with SMI is useful for diagnosing intra-abdominal desmoid-type fibromatosis., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Objective Gastrointestinal (GI) disorders such as functional dyspepsia (FD), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD) can exhibit overlapping GI symptoms, including abdominal pain and alterations in bowel habits. The symptoms of GI disorders are commonly considered to be triggered and exacerbated by fatty food intake. Therefore, this study aimed to compare the food preferences of patients with GI disorders. Methods Forty food images (including fatty and light foods) and 20 animal images were selected to evaluate food preferences. The preference score was assessed using a visual analog scale ranging from 1 to 100. GI symptoms were evaluated using the GI Symptom Rating Scale (GSRS), and correlations between the GSRS and preference scores were investigated. Results Overall, 22 healthy controls and 23, 29, 27, and 20 patients with FD, IBS, GERD, and IBD, respectively, were enrolled. The preference score for all foods in patients with FD was significantly lower than that in healthy controls and those with IBS, GERD, and IBD (52.9 vs. 66.5 vs. 68.5 vs. 69.1 vs. 70.7, p<0.01). The score of fatty foods was lower in patients with FD than in healthy controls and those with IBS, GERD, and IBD (43.8 vs. 72.3 vs. 77.5 vs. 77.4 vs. 80.7, p<0.01), whereas that of light foods and animal images was not different among the groups. No significant correlation was found between the preference score and symptom severity. Conclusions Patients with FD had a negative preference for foods, particularly fatty foods, independent of the severity of GI symptoms.

Purpose: The purpose of this study was to explore risk factors for symptomatic presbyopia, defined as near add power ≥1.50 diopters, in patients with glaucoma., Methods: Treated glaucoma (n = 56), untreated glaucoma (n = 21), and control individuals (n = 376), aged 40 to 55 years at first visit, were enrolled in the study, and near add power, retinal thickness, and visual field were examined. The association between near add power and ocular parameters and the odds ratios (ORs) for symptomatic presbyopia were investigated. Survival analysis for symptomatic presbyopia was conducted., Results: Age, astigmatic power, mean deviation, and ganglion cell complex thickness were associated with near add power. The OR for symptomatic presbyopia was significant for age (OR = 1.51), astigmatism (OR = 1.01), mean deviation (OR = 0.72), ganglion cell complex thickness (OR = 0.98), treated and untreated glaucoma (OR = 2.09), and use of glaucoma eye drops (OR = 3.33). Survival analysis showed that the treated glaucoma group reached the near add power endpoint of ≥1.50 D (symptomatic presbyopia) significantly earlier than the other two groups, and there was no difference between the control and untreated glaucoma groups., Conclusions: Glaucoma patients treated with eye drops may start near correction earlier., Translational Relevance: Symptomatic presbyopia may develop earlier in patients with glaucoma, and our findings could further contribute to better management and understanding of presbyopia with glaucoma.

Background and study aims Until recently, autoimmune gastritis (AIG) was usually diagnosed at late stages based on typical endoscopic findings, including corpus-dominant advanced atrophy. Early-stage AIG prior to complete gastric atrophy had rarely been diagnosed due to a lack of knowledge about its endoscopic characteristics. The present study sought to identify the endoscopic characteristics of early-stage AIG, enabling its early diagnosis. Patients and methods The clinical and endoscopic findings of 12 patients diagnosed with early-stage AIG between 2016 and 2021 were retrospectively evaluated. Patients were included if they were: (1) positive for serum anti-parietal cell antibody; (2) diagnosed with histological early-stage AIG; and (3) endoscopically positive for folds on the greater curvature of the gastric corpus. Results Two characteristic endoscopic findings of early-stage AIG were identified: longitudinal alignment of pseudopolyps (i.e., a bamboo joint-like appearance) and swelling of gastric areas with erythema (i.e., a salmon roe-like appearance). Conclusions Endoscopic findings characteristic of early-stage AIG include a bamboo joint-like appearance and a salmon roe-like appearance. Studies in large numbers of patients with long-term follow-up are needed to confirm these findings., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Purpose: The purpose of this cohort study was to investigate the association between the prevalence of abnormal ocular examination results and the common visual symptoms of eye strain, blurred vision and photophobia., Methods: Consecutive first-visit outpatients with best-corrected visual acuity better than 20/30 in both eyes were enrolled and those with a history of intra-ocular lens implantation and glaucoma were excluded. Dry eye-related examinations and retinal thickness measurement were conducted. The odds ratio (OR) was calculated with logistic regression analyses of ocular data in relation to the presence of visual symptoms., Results: A total of 6078 patients (3920 women, mean age 49.0 ± 20.4 years) were analyzed. The prevalence of each symptom was 31.8% for eye strain, 22.5% for blurred vision and 16.0% for photophobia. A significant risk factor for eye strain was short tear break-up time (TBUT) (OR 1.88), superficial punctate keratitis (SPK) (OR 1.44), and thickness of ganglion cell complex (GCC) (OR 1.30). Risk factors for blurred vision were short TBUT (OR 1.85), SPK (OR 1.24) and GCC (OR 0.59). Risk factors for photophobia were short TBUT (OR 1.77) and SPK (OR 1.32). Schirmer test value, peripapillary nerve fiber layer thickness and full macular thickness were not associated with the tested symptoms., Conclusion: The current study successfully identified female gender, short TBUT, and SPK as significant risk factors for eye strain, blurred vision, and photophobia with considerable ORs., Competing Interests: The authors declare no competing financial interests., (Copyright: © 2023 Ayaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Time-restricted eating has been increasingly recognized as a promising option to reduce food intake and combat obesity. Especially in Asian countries such as Japan, because of the wide variety of food choices available, a dietary approach that emphasizes meal timing can be more practical and easier to implement and adhere to, compared with approaches that focus on specific dietary content, such as low-fat or low-carbohydrate diets., Objectives: We aimed to identify eating patterns among Japanese men and women using a smartphone application (app) called "Taberhythm." In addition, we sought to evaluate the relationship of breakfast eating habits with lifestyle behaviors and body mass index, and determine whether sex differences were present., Methods: A total of 3369 smartphone users were eligible to participate in this observational study. Users recorded 1 mo of lifestyle logs using the app; 254 participants (178 women, 38 ± 12 y old, body mass index 23.3 ± 4.9 kg/m 2 ) had sufficient records to calculate daily fasting duration and sleep duration, and were eligible for the analyses., Results: Fasting duration was ∼12.6 h and was longer in women than men, among participants who never skipped breakfast. Breakfast skipping was associated with longer screen time, and more frequent snacking, only in men. Men with irregular breakfast eating patterns had a longer duration of fasting after awakening that was associated with obesity., Conclusions: We investigated eating patterns among Japanese people using a smartphone app and revealed that skipping breakfast was more deleterious in men than in women., (© 2023 The Author(s).)

Purpose: The aim of this study was to explore the association between myopia and dry eye (DE)-related ocular parameters., Methods: We recruited a total of 460 patients (mean age, 73.6 years; 40.2% men) and performed DE-related, axial length (AL) and retinal examinations. Statistical analysis revealed a significant sex difference in AL, strip meniscometry value, corneal staining score, corneal endothelial cell density, ganglion cell complex (GCC) thickness, and full macular thickness. AL was strongly age- and sex-dependent, so subsequent analyses were stratified by sex., Results: Among DE-related parameters, strip meniscometry value (ß = -0.167, p = 0.033) and corneal endothelial cell density (ß = -0.139, p = 0.023) were correlated with AL in women but not in men. Regarding retinal parameters, GCC thickness and full macular thickness were correlated with AL in women but not in men., Conclusion: The current results suggest a relationship between tear production and AL in elderly women and support the hypothesis that there may be a common upstream factor including the parasympathetic nervous system in the association between tear production and AL or DE and myopia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ayaki, Torii, Yotsukura and Negishi.)

Melanosis coli (MC) is an acquired colorectal disorder visualized as colonic mucosa pigmentation. Disease severity is confirmed based on MC depth, shape, and coloration, although the clinical course is not fully understood. This study sought to clarify characteristics of MC development and disappearance and to investigate its clinical course and severity. Contributors to MC grade progression were explored. This study reviewed MC cases discovered via colonoscopy at a single institution over a 10-year period. Of all 216 MC cases, 17 developing and 10 disappearing cases were detected. Anthranoid laxative use was a key factor: 29.4% of the developing cases had used such agents before the initial MC diagnosis, whereas 40% of disappearing cases had discontinued anthranoids prior to detection of MC disappearance. Among 70 grade I cases, progression to grade II occurred in 16 cases during a mean follow-up of 3.67±2.1 years (rate of progression=22.8%). Males more commonly showed progressive than stable grade I cases, and the probability of progression was higher for male than for female cases. An association between anthranoid administration and MC presence was presumed, and grade I MC was found to progress in severity over 5 years., Competing Interests: No potential conflict of interest relevant to this article was reported.

Two adult cases of acute gastric mucosal lesions (AGML) caused by Helicobacter pylori infection were confirmed by spontaneous eradication during the follow-up period. The clinical course of the initial infection by H. pylori in adults with AGML remains unclear, whether it is transient or progresses to a persistent infection. In these two reported cases, gastric biopsies at the time of the onset revealed the presence of H. pylori; however, serum H. pylori antibodies performed at the same time were negative. Retesting for H. pylori serum antibody, after six months in one and after two months in the other, was negative, confirming spontaneous eradication.

Esophageal achalasia is classified into three subtypes according to manometric findings. Since several factors, including clinical characteristics and treatment response, have been reported to differ among the subtypes, the underlying pathogenesis may also differ. However, a comprehensive understanding regarding the differences is still lacking. We therefore performed a systematic review of the differences among the three subtypes of achalasia to clarify the current level of comprehension. In terms of clinical features, type III, which is the least frequently diagnosed of the three subtypes, showed the oldest age and most severe symptoms, such as chest pain. In contrast, type I showed a higher prevalence of lung complications, and type II showed weight loss more frequently than the other types. Histopathologically, type I showed a high loss of ganglion cells in esophagus, and on a molecular basis, type III had elevated serum pro-inflammatory cytokine levels. In addition to peristalsis and the lower esophageal sphincter (LES) function, the upper esophageal sphincter (UES) function of achalasia has attracted attention, as an impaired UES function is associated with severe aspiration pneumonia, a fatal complication of achalasia. Previous studies have indicated that type II shows a higher UES pressure than the other subtypes, while an earlier decline in the UES function has been confirmed in type I. Differences in the treatment response are also crucial for managing achalasia patients. A number of studies have reported better responses in type II cases and less favorable responses in type III cases to pneumatic dilatation. These differences help shed light on the pathogenesis of achalasia and support its clinical management according to the subtype.

Purpose: The aim of this cohort study was to describe the change in ocular surface signs and symptoms before and during the COVID-19 pandemic, and to associate changes with potential pandemic-related events., Methods: First-visit patients from 2019 to 2021 were examined for corneal staining, lacrimal function and refraction. We assessed the presence of seven common ocular symptoms. Patients with glaucoma and macular disease were excluded. Dry eye (DE) was diagnosed according to the criteria of the Asia Dry Eye Society., Results: The mean age of 3,907 participants was 59.6±18.6y and 63.8% were female. Mean age and the prevalence of diagnosed DE and shortened tear break-up time decreased from 2019 to 2021. The prevalence of eye fatigue, blurring and photophobia decreased in 2020., Conclusions: The prevalence of diagnosed DE did not increase among first-visit patients during the pandemic compared with 2019, despite many survey results suggesting that DE may have worsened due to frequent masking, increased screen time, mental stress, and depression under quarantine and social infection control. It might be considered however, that many elderly DE patients might have refrained from consulting an ophthalmologist and possibly delayed treatment of DE during the pandemic., Competing Interests: The authors have declared that no competing interests exist.

The severity and distribution of melanosis coli differ among individuals, and the related factors remain unknown. Additionally, their clinical implications have not been sufficiently demon-strated. Thus, we aimed to detect clinical factors related to the severity and range of melanosis coli and elucidate the associations between the grade, location, and detection rate of colorectal neoplasms. Colonoscopy cases performed at our institution from January 2011 to February 2021 were included. Melanosis coli was classified into mild and severe grades. Clinical characteristics and neoplasm detection rates were compared between the mild and severe MC groups and between the right-sided and whole-colon melanosis coli groups. Overall, 236 MC (mild, n  = 143; severe, n  = 93) cases, of which 50 were right-sided, 5 were left-sided, and 181 were whole-colon melanosis coli cases, were enrolled. The proportion of anthranoid users was higher in the severe melanosis coli group than in the mild melanosis coli group. The adenoma detection rate was higher in the severe melanosis coli and whole-colon melanosis coli groups. The prevalence of neoplasms measuring 5-9 mm and >9 mm was higher in the severe melanosis coli group ( p <0.01 and p  = 0.04). Severe melanosis coli due to anthranoid usage is associated with colorectal adenoma development., Competing Interests: No potential conflicts of interest were disclosed., (Copyright © 2022 JCBN.)

Background: To date, no in-depth studies have focused on the impact of various clinical characteristics of esophageal squamous cell carcinoma (ESCC), including its association with subjective symptoms, on patient prognosis. We aimed to investigate the clinical factors that affect the prognosis of patients with ESCC and to clarify how subjective symptoms are related to prognosis., Methods: We retrospectively evaluated the clinical records of 503 consecutive patients with ESCC from April 2011 to December 2019. Six established prognostic factors for ESCC (body mass index, alcohol drinking, cigarette smoking, sex, clinical stage, and age) and subjective symptoms were used to subgroup patients and analyze survival differences. Next, the patients were divided into two groups: a symptomatic group and an asymptomatic group. In the symptomatic group, differences in the incidence of subjective symptoms according to tumor size, tumor location, macroscopic tumor type, and clinical stage were examined. Finally, subjective symptoms were divided into swallowing-related symptoms and other symptoms, and their prognosis was compared., Results: Multivariate Cox regression analysis identified sex [hazard ratio (HR) 1.778; 95% CI 1.004-3.149; p = 0.049], TNM classification (HR 6.591; 95% CI 3.438-12.63; p < 0.001), and subjective symptoms (HR 1.986; 95% CI 1.037-3.803; p = 0.0386) as independent risk factors for overall survival. In the symptomatic group, the mean time from symptom onset to diagnosis was 2.4 ± 4.3 months. The incidence of subjective symptoms differed by clinical stage, and the prognosis of patients with swallowing-related symptoms was significantly worse than that of patients with other symptoms., Conclusion: The results of this study suggest that screening by upper gastrointestinal endoscopy, independent of subjective symptoms (especially swallowing-related symptoms), may play an important role in the early detection and improvement of prognosis of ESCC, although further validation in a large prospective study is needed., (© 2022. The Author(s).)

Purpose: Presbyopia is a serious burden in the aged population, however, the factors affecting its progression have not been fully determined. The aim of this study was to explore the association between the time of starting to wear presbyopic eyeglasses and lifestyle, in participants aged from 40 to 59 years., Methods: We selected the sample to be representative of sex and age for the age group 40 to 59 years . Participants completed a web-based survey on presbyopia-related questions, symptomatic dry eye, sleep habits, Pittsburgh Sleep Quality Index, subjective happiness scale (SHS), and other lifestyle-related questions including marital status, income, screen time, sun exposure, family history of myopia, and the frequency of regular visits to medical services., Results: We found 529 participants (26.5%) used near correction, with a mean age for first near correction of 47.8±4.8 years. An earlier commencement of near correction correlated with hyperopia ( P = 0.013), late wake-up time ( P = 0.010), a poor subjective sleep quality score ( P = 0.019), and a low annual income score ( P = 0.025), after adjusting for age and sex. Stratification by income demonstrated the low-income group exhibited more dry eye, later wake-up time, longer sleep latency, longer sleep duration, worse sleep efficacy, lower SHS score, and a higher prevalence of living alone compared with the high-income group. The usage of corrective devices did not differ between the two groups., Conclusions: The current study suggests a healthy sleep habit may delay the need for near correction, in addition to myopia. Shift work and circadian rhythm disruption might exacerbate presbyopia progression., Competing Interests: KT is employed by Tsubota Laboratory, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ayaki, Negishi, Kawashima and Tsubota.)

Purpose: To evaluate the association of strip meniscometry tear meniscus volume measurement with signs and symptoms related to dry eye., Methods: This cross-sectional study enrolled 2234 consecutive outpatients and used dry eye symptomatology and related ocular surface examinations, including the Schirmer test, fluorescein tear film break-up time (BUT), corneal fluorescein vital staining and strip meniscometry. The strip meniscometry cut-off was estimated using a receiver operating characteristic analysis. The subjective symptoms consisted of six binarized items: dryness, fatigue, photophobia, pain, irritation, and blurring. The clinical signs were also binarized by the cut-off in each test. The presence of all signs and symptoms were then analyzed using Hayashi's quantification theory type III analysis., Results: The mean age of the participants was 59.3 ± 17.3 years. The mean values for Schirmer test, BUT, corneal fluorescein staining, and strip meniscometry were 13.6 ± 9.6 mm, 3.1 ± 2.1 seconds, 0.40 ± 0.66, and 2.4 ± 2.7 mm, respectively. The Schirmer test was negatively correlated with age (r = -0.152; P < 0.01), whereas the BUT and strip meniscometry were not. All pairs of Schirmer test, BUT, and strip meniscometry had significant correlations, but the greatest correlation was found between BUT-strip meniscometry (r = 0.238; P < 0.01). An strip meniscometry cut-off length of 2.5 mm (area under the curve = 0.618) was calculated. Hayashi's analysis found high similarity among the presence of signs by strip meniscometry, BUT. and corneal fluorescein staining, and three nonvisual symptoms (pain, irritation, and dryness) had a distinct similarity., Conclusions: Strip meniscometry results using the cut-off of 2.5 mm could be a useful clinical indicator for the initial screening of dry eye., Translational Relevance: This large-scale case-control study further confirmed tear strip meniscometry with the new cut-off is a useful tear function examination for dry eye; it is a 5-second noninvasive procedure and associated with clinical symptoms and corneal parameters.

The aim of this retrospective chart review study was to evaluate the 5-year trend of ocular surface examination results in participants who visited the eye clinic from 2015 to 2019, underwent corneal and lacrimal examinations, refraction, and intra-ocular pressure measurements, and reported six dry eye-related symptoms. A total of 1468 patients were analyzed. Tear break-up time (BUT) decreased continuously for five consecutive years: 4.76 ± 1.84 s in 2015, 4.57 ± 1.70 s in 2016 (p = 0.999, vs 2015), 4.35 ± 2.06 s in 2017 (p = 0.662), 3.83 ± 2.18 s in 2018 (p < 0.001), and 3.63 ± 2.10 s in 2019 (p < 0.001). The decrease of BUT was more prominent in women than men (p < 0.001) and the correlation coefficient between calendar year and BUT was greater in women than men (p = 0.002). Schirmer test value, strip tear meniscometry value, and corneal staining score did not exhibit significant changes. Prevalence of blurring, photophobia, and pain increased toward 2019 among symptoms surveyed (eye fatigue, blurring, photophobia, dryness, irritation, and pain) and regression analysis indicated blurring (p < 0.001), photophobia (p < 0.001), and pain (p < 0.001) were correlated with BUT. In conclusion, BUT decreased continuously for five consecutive years from 2015 to 2019 and was associated with dry-eye related symptoms., (© 2022. The Author(s).)

We herein describe three patients whose endoscopic images from over 15 years prior to their diagnosis of autoimmune gastritis (AIG) were available for review. All patients had corpus-dominant atrophic gastritis at the time of the diagnosis of AIG. Previous endoscopic images without severe atrophy showed erythema restricted to the fundic mucosa. These findings are suggestive of ongoing gastritis in patients with AIG. Initial endoscopy in Patient 2 showed multiple hyperplastic polyps that decreased in size and number over the course of 15 years. In this patient, circular wrinkle-like patterns and remnant oxyntic mucosa were visible after the atrophy had become quite prominent.

We report 3 Japanese cases with increased colonic 18-fluorodeoxyglucose (FDG) uptake in association with melanosis coli. Case 1: A 56-year-old woman received 18-FDG positron emission tomography (PET) for comprehensive medical checkup. Case 2: A 79-year-old man received FDG-PET for follow-up evaluation for intestinal cancer. Case 3: A 51-year-old woman received FDG-PET for medical checkup. Each showed increased cecal and/or ascending colonic uptake without any colonic wall changes. Colonoscopy detected melanosis coli where FDG uptake was demonstrably increased. Neither malignancy nor inflammatory response was confirmed. Succeeding follow-ups showed neither malignant nor inflammatory lesions in any of the patients., (© 2022 Published by Elsevier Inc. on behalf of the AGA Institute.)

Purpose: The contributory factors and symptoms for presbyopia progression have not been fully determined. The purpose of the study was to compare presbyopia progression in subjects with short and normal tear breakup time and to explore the severity of common ocular symptoms associated with presbyopia progression., Method: We conducted a clinic-based, retrospective, cross-sectional study. Inclusion criteria were bilateral phakic patients aged 40-69 years with best-corrected distance visual acuity better than 20/30, and exclusion criteria were the use of glaucoma eye drops, any disease affecting vision, or history of ocular surgery. We measured the binocular near add power and compared the results using Kaplan-Meier analysis. Association between near add power and ocular symptoms was explored., Results: There were 1411 participants (mean age of 50.1 years). There were no significant differences in age, intraocular pressure, spherical equivalent, astigmatism, or anisometropia between the sexes. Kaplan-Meier analysis indicated that women with short tear breakup time reached the endpoint (near add power of +3.00 D) significantly earlier than those with normal tear breakup time ( P = 0.043; Cox-Mantel test). Eye fatigue was most severe in the group with an add power of 1.25-2.00 D. Near add power was correlated with hyperopia, astigmatic errors, and anisometropia., Conclusions: This study suggests an exacerbation of presbyopia progression in women with short tear breakup time. Eye fatigue was most severe in those with an add power of 1.25-2.00 D., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Masahiko Ayaki and Kazuno Negishi.)

Objective Recent studies have found higher rates of autoimmune diseases, such as celiac disease, Crohn's disease, and ulcerative colitis, in patients with eosinophilic esophagitis (EoE) than in the general population. This study investigated the concomitant rate of autoimmune disease among Japanese patients with EoE and evaluated the clinicopathological characteristics of EoE patients with autoimmune disease. Methods The medical records of patients diagnosed with EoE between April 1, 2016, and June 30, 2020, were reviewed. We analyzed the concomitant rate of autoimmune diseases in patients with EoE and compared the clinical and histological differences between patients with and without autoimmune disease. Results Sixty-four patients with EoE were enrolled. Of them, 1 had ulcerative colitis (1.6%), 1 had autoimmune polyendocrine syndrome type 2 (1.6%), and 6 had endometriosis (28.5% of women, 44.4% of reproductive-aged women). No significant differences in the clinical course or histological findings were found between EoE patients with and without autoimmune diseases. No complications, including stenosis, were seen in EoE with autoimmune disease, and most patients with EoE and autoimmune diseases were responsive to proton pump inhibitors (PPIs). Conclusion In this study, 8 out of 64 patients with EoE had an autoimmune-related disease, including ulcerative colitis (n=1, 1.6%), autoimmune polyendocrine syndrome type 2 (n=1, 1.6%), or endometriosis (n=6, 44.4% of women of reproductive age), which is higher than that previously reported in the general population. Further investigations are required to clarify the relationship between EoE and autoimmune diseases.

Purpose: The aim of this cohort study was to evaluate the development and progression of presbyopia and the status of dry eye-related symptoms from 2017 to 2020, to assess the impact of the COVID-19 pandemic., Methods: Near add power at 30 cm was measured in 339 participants aged between 40 and 55 from 2017 to 2021 at Japanese eye clinics. Regression analysis of near add power and age was analyzed to compare 2017 with later years up to the pandemic. The prevalence of dry eye-related signs and six common symptoms were compared., Results: The number and mean age (y) of participants were 183 (48.6±4.1) in 2017, 46 (51.3±7.5) in 2019, and 110 (49.2±3.7) in 2020-21, respectively. The mean progression rate of near add power (D/y) was 0.13 for 2017, 0.09 for 2019 (P = 0.028, vs 2017), and 0.08 for 2020-21 (P<0.001, vs 2017). The slope (rate of presbyopia progression) became flatter from 2017 to 2021 and the estimated near add power at the age of 40 increased from 2017 to 2020-2021, implicating presbyopia developed earlier and worsened during the study period. The 2017 values were comparable with previous studies described in 1922 and 2019. The standardized correlation coefficient between age and near add power was 0.816 for 2017, 0.671 for 2019 (P = 0.084, vs 2017), and 0.572 for 2020-21 (P<0.001, vs 2017). Multiple regression analysis revealed age and COVID-19 pandemic were significantly correlated with near add power. The prevalence of dryness irritation, and pain was greater in 2020-21 than in 2017 with no difference in the prevalence of eye fatigue, blurring, and photophobia. There was no difference in the prevalence of short tear break-up time and positive corneal staining among 2017, 2019 and 2020-21., Conclusion: Estimated presbyopia developed earlier and progressed slower from 2017 to 2021, the COVID-19 pandemic. Stress and rapid digitalization related to strict infection control and quarantine might be contributing factors., Competing Interests: The authors have declared that no competing interests exist.

Presbyopia treatments using various modalities have been developed recently; however, no standard criteria exist for the diagnosis and treatment endpoint. This study assessed the relationship between the near visual acuity (NVA) and the subjective symptoms of phakic presbyopia and determined the numerical NVA threshold to diagnose phakic presbyopia and evaluate the effectiveness of presbyopia treatment. The binocular distance, NVA with habitual correction, and monocular conventional VA were measured. Patients were asked about their awareness of presbyopia and difficulty performing near tasks. This prospective observational study included 70 patients (mean age, 56 years; range, 32-77). Most patients became aware of presbyopia in their late forties, although some had difficulty with vision-related near tasks before becoming aware of presbyopia. Eighty three percent of patients (20/24) experienced difficulty with near vision-related tasks even with excellent NVA at 40 cm with habitual correction of 0.0 logMAR (20/20 in Snellen VA). In conclusion, the current study showed that patients became aware of presbyopia in their late forties, although some had difficulty with near vision-related tasks before becoming aware of presbyopia. Further investigation should include the proposal of appropriate diagnostic criteria for presbyopia and better management for patients with presbyopia.

The purpose of this study was to evaluate the short-term efficacy and safety of cataract surgery for patients with iris-fixated phakic intraocular lenses (pIOLs). This study included 96 eyes of 91 patients. The changes in the logMAR uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective spherical equivalent (SE), astigmatism, and endothelial cell density (ECD) were collected retrospectively. The intraoperative and postoperative complications also were investigated to assess the surgical safety. The preoperative UCVA and BCVA improved significantly at month 1 postoperatively, respectively ( p < 0.001 for both comparisons). The efficacy and safety index at month 1 postoperatively were 1.02 ± 0.56 and 1.31 ± 0.64, respectively. The SE at month 1 postoperatively was significantly ( p < 0.001) higher compared to preoperatively, whereas the subjective astigmatism did not differ significantly ( p = 0.078). The ECD significantly decreased at month 1 ( p < 0.001). The most common postoperative complication was intraocular pressure elevation exceeding 25 mmHg in 10.4% of eyes, which was controlled with medications in all cases until month 1 postoperatively. No intraoperative complications developed. Cataract surgeries for patients with iris-fixated pIOLs were performed safely with good visual outcomes.

White globe appearance (WGA) is defined as a microendoscopic white lesion with a globular shape underlying the gastric epithelium and is considered a marker of gastric cancer. We recently reported that endoscopically visualized white spot (WS) corresponding to WGA appeared on the nonatrophic mucosa of patients with acid-suppressing agents (A-SA) use. We evaluated patients undergoing routine esophagogastroduodenoscopy and divided the patients into an A-SA group ( n = 112) and a control group ( n = 158). We compared the presence of WS in both groups. We also compared WS-positive- ( n = 31) and -negative ( n = 43) groups within the A-SA group regarding these patients' backgrounds and serum gastrin concentrations. Comparing the A-SA group with controls, the prevalence of WS was significantly higher (31/112 vs. 2/158; p < 0.001). The number of patients with high serum gastrin concentrations was significantly higher in the WS-positive group (18/31) vs. the WS-negative group (5/43) ( p < 0.001). Within the A-SA group, the prevalence of WS was also significantly higher in patients taking potassium-competitive acid blockers vs. proton-pump inhibitors (21/31 vs. 10/31, p < 0.001). The WS-positive group had a significantly greater percentage of patients, with a high serum gastrin level ( p < 0.001). WS may be associated with hypergastrinemia and potassium-competitive acid blockers.

We herein report two patients with early-stage autoimmune gastritis who did not exhibit complete atrophy. Endoscopic examinations showed no manifestations of severe atrophic gastritis, but revealed a mosaic pattern with slight swelling of the areae gastricae restricted to the corpus in both patients. In the patient in case 2, upper gastrointestinal barium X-ray radiography revealed a slightly protruded irregular areae gastricae throughout the gastric body, except for in the antrum. Our findings emphasize the need for clinicians to recognize that autoimmune gastritis might be present in the absence of severe atrophic gastritis; this can aid in the identification of the early stages of autoimmune gastritis.

Introduction: Demodex mites are microscopic arthropods that have been shown to be responsible for chronic blepharitis. Although many reports have demonstrated positive effects of lid hygiene on demodicosis, some have produced conflicting results. We retrospectively evaluated the effect of lid margin cleansing with a novel lid hygiene detergent, Eye Shampoo, in patients with ocular demodicosis., Methods: Outpatient clinic notes recorded over a 24-month period between June 30, 2016, and June 29, 2018, at Keio University Hospital in Japan were reviewed to identify patients diagnosed with ocular demodicosis who started cleansing their lid margins with Eye Shampoo at least once daily as a lid hygiene therapy., Results: Five patients diagnosed with ocular demodicosis who started cleansing their lid margins using Eye Shampoo for lid hygiene were identified. In four cases, Demodex mites were successfully eliminated, and ocular conditions were ultimately improved with no recurrence. Active Demodex mites were still noted after 3 months of lid hygiene therapy in one case; further observation of this case was not available. There were no adverse effects of Eye Shampoo in any of these cases., Conclusion: Lid hygiene therapy using Eye Shampoo successfully eliminated Demodex mites, a common pathogen of refractory obstructive meibomian gland dysfunction.

Purpose: The aim of this study was to explore the status of quality of life between the ages 40-59 in relation to presbyopia and dry eye., Methods: Near add power and preferred contact lens power were examined in 219 participants at three clinics. 2000 participants completed a web-based survey on presbyopic symptoms, symptomatic dry eye, sleep quality, and subjective happiness., Results: Mean preferred corrected visual acuity was less than 20/20 in women (vs men, P<0.01) who were more often prescribed under-corrected contact lenses, whereas men preferred full correction. According to the annual progression rate of near add power in men (0.1468D/year), the estimated difference in presbyopia progression between men and women was 0.75 years in the right eye, and 1.69 years in the left eye, implying men might suffer presbyopia earlier than women due to higher myopic power of daily use contact lenses. The web-based survey revealed that men reported lower subjective happiness than women (P<0.001) and earlier onset of presbyopic symptoms by 1.1-1.7 years (P<0.05). Men received their first reading glasses 0.8 years earlier than women (P = 0.066). Multiple regression analysis demonstrated that awareness of presbyopic symptoms, visual burden, and dry eyes were significantly correlated with poor sleep quality and subjective happiness., Conclusion: Presbyopia and dry eye were significantly associated with sleep quality and subjective happiness in middle-adulthood., Competing Interests: The authors have declared that no competing interests exist.

Coronavirus disease 2019 (COVID-19) has had a global effect on people's lifestyles. Many people have become physically inactive and developed irregular eating patterns, which leads to unhealthier lifestyles and aggravation of lifestyle-related diseases; these in turn increase the severity of COVID-19. Prior to the COVID-19 pandemic, we developed a smartphone application called "Taberhythm" to investigate eating patterns, physical activity, and subjective feelings of happiness. We aimed to compare lifestyle data before and during the first phase of the COVID-19 pandemic to objectively assess lifestyle changes during quarantine. A total of 464 smartphone users (346 women, 35 ± 12 years old, body mass index [BMI] 23.4 ± 4.5) participated in Period A (January 7 to April 28, 2019) and 622 smartphone users (533 women, 32 ± 11 years old, BMI 23.3 ± 4.0) participated in Period B (January 6 to April 26, 2020). Compared with Period A, there was a sharp decline in physical activity during Period B (4642 ± 3513 vs. 3814 ± 3529 steps/day, p<0.001), especially during the final 9 weeks in both periods (4907 ± 3908 vs. 3528 ± 3397 steps/day, p<0.001); however, there were large variations in physical activity among participants. We found a surprising trend during Period B toward increased happiness among women aged 30-50 years, the group most affected by stay-at-home policies that led to working from home and school closure. Moreover, daily eating duration declined in this population. Additionally, there was a positive association of happiness with steps per day in Period B (ρ = 0.38, p = 0.02). Despite the many negative effects of the COVID-19 pandemic, subjective feelings of happiness among middle-aged Japanese women tended to increase, which indicates that some favorable lifestyle changes that could be adopted during quarantine in the ongoing COVID-19 pandemic., Competing Interests: The CEO and an employee of Oishi Kenko Incorporated had central roles in the conceptualization of the study (TN) and in the collection and analysis of data (AH). TN has received directors’ compensation from this company. AH has received a salary as a full-time employee of Oishi Kenko Incorporated. This does not alter our adherence to PLoS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare. The app was developed as a research tool; in the future, the app will be used to support users in maintaining healthier daily eating rhythms.

We evaluated the pupil reaction to blue and white light stimulation in 70 eyes with cataract and in 38 eyes with a selective blue-light filtering intra-ocular lens. The diameter of the pupil before stimulation was set as baseline (BPD) and, after a stimulus duration of 1 s, the post-illumination pupillary response (PIPR) was measured using an electronic pupillometer. The BPD showed no significant difference among three grades of nuclear sclerosis (NS). In contrast, the PIPRs differed significantly among the NS grades eyes including with and without subcapsular cataract (SC) and IOL eyes for white light (p < 0.05, Kruskal-Wallis test), but not for blue light. Subcapsular opacity did not affect the BPD or PIPR in all cataract grades for either light stimulus. The tendency of larger PIPR in the pseudophakic eyes than the cataract eyes for both lights, however significant difference was found only for white light (p < 0.05 for white light, p > 0.05 for blue light). Our study demonstrates retention of the PIPR for blue light, but not for white light in cataract eyes. We also confirmed that the pupillary response in pseudohakic eyes with a selective blue light-filtering intra ocular lens was greater than that in cataractous eyes for white light.

Purpose: The aim of this study was to investigate the association of dry eye disease (DED)-related signs and symptoms with two tear function tests., Methods: This was a clinic-based, cross-sectional study with recruitment of consecutive participants. Schirmer test (ST), tear strip meniscometry (SM), and fluorescein tear breakup time were measured and corneal staining score was examined in outpatients at three clinics. Seven subjective symptoms were assessed by interview, including dryness, irritation, pain, lacrimation, fatigue, blurring, and photophobia. Statistical analyses included regression analysis and comparison tests., Results: The mean age of the 210 participants was 61.2 ± 15.2 years (range, 12-91 years), with 135 women (64.3%) in the cohort. The mean ST value was 12.9 ± 9.3 (0-35) mm, and SM was 2.5 ± 1.6 (0-10) mm, with no difference between women and men. SM values were lower in the presence of irritation ( P = 0.046) and photophobia ( P = 0.011). Regression analysis revealed ST and SM values were strongly correlated (β = 0.255, P < 0.001). SM was significantly correlated with breakup time (β = 0.149, P = 0.032), whereas there was no correlation between ST and DED-related signs and symptoms., Conclusions: SM was correlated with DED-related symptoms and breakup time, whereas ST was not. A low SM value could be an alternative clinical parameter to determine tear film-oriented therapy., Translational Relevance: Tear strip meniscometry could be a useful tear function examination on a routine clinical basis since it is a 5-second noninvasive procedure and associated with subjective symptoms and the value of the conventional Schirmer test., Competing Interests: Disclosure: K. Negishi, None; M. Ayaki, None; M. Uchino, None; K. Takei, None; K. Tsubota, Tsubota Laboratory (P), (Copyright 2020 The Authors.)

Laser-assisted in situ keratomileusis (LASIK) contributes to increased patient happiness one month after surgery; however, longer term effects are unknown. We performed a retrospective cross-sectional study on 472 patients who underwent bilateral LASIK surgery to measure happiness and satisfaction with LASIK, and to identify affecting factors. Patients completed questionnaires on satisfaction with the surgery and the subjective happiness scale (SHS) before, and 1, 3, 6, and 12 months after surgery. Multiple regression analyses were performed to determine independent predictors of SHS and satisfaction scores. Mean SHS increased at one month but was similar to baseline levels by six months. The SHS of older patients was greater than younger ones at baseline and at one and three months, while satisfaction among the older group was poorer at one and three months. Multiple regression analyses revealed that the decrease in SHS score from one month to three months correlated with baseline SHS, SHS at one month, uncorrected distance visual acuity (UDVA), and age. Regression analysis revealed SHS at six months correlated with preoperative SHS, SHS at one month, and satisfaction at six months. Satisfaction at final visit correlated with age, UDVA, anisometropia, and with SHS at each visit. We conclude that happiness and satisfaction were age- and UDVA-dependent, and anisometropic patients report poorer satisfaction scores.

The purpose of this study was to investigate the changes in patient subjective happiness and satisfaction with cataract surgery and evaluate the association between satisfaction and types of cataract. This study surveyed 247 participants (mean age, 67.9 years) and they completed questionnaires on their satisfaction with the surgery, the subjective happiness scale (SHS) and the Pittsburgh Sleep Quality Index (PSQI) before and after surgery. The SHS increased postoperatively from 4.6 ± 0.7 to 4.8 ± 0.7 (P = 0.007) and 83.4% of patients were satisfied with the surgical results and the average satisfaction score was 4.2 out of a possible 5.0. Multiple regression analysis showed that patient satisfaction was significantly associated with the postoperative SHS (β = 0.380; P < 0.001), the postoperative PSQI (β = -0.041; P = 0.035) and the presence of a posterior subcapsular cataract (PSC) (β = 0.277; P = 0.026). This study clarified that cataract surgery may improve both visual function and patient happiness and that patient satisfaction was affected by postoperative sleep quality and the disappearance of a PSC.

Purpose: The purpose of this study was to explore the effects of factors affecting depth perception of moving objects using a modified three-rods test, which can be used at longer distances than the conventional one, and to compare differences in the results between binocular and monocular vision., Methods: This study included 24 volunteers (10 women, 14 men; mean age, 35.2 years; standard deviation, 6.8 years; range, 22-56 years). We measured depth perception using a modified three-rods test under eight different conditions and investigated the factors affecting depth perception using a linear-effect model., Results: The results identified test distance, binocularity, masking, and direction of movement as significant factors affecting depth perception of a moving object., Conclusions: The current study successfully determined factors affecting depth perception using the three-rods test with a moving object and the results should contribute to further clinical and social applications of the three-rods test., (© 2020 The Author(s).)