To evaluate the association between kindergarten type (public vs private) and screening-defined childhood myopia among Japanese preschool children, and to explore potential behavioral correlates of this association. Cross-sectional study. We analyzed data from 153 preschool children aged 3–6 years attending public (n=115) or private (n=38) kindergartens in urban Kawasaki City, Japan. Myopia was defined using non-cycloplegic refraction combined with age-specific visual acuity thresholds to reduce overestimation. Kindergarten type was the primary exposure. Prespecified covariates were age, sex, and parental myopia. Exploratory behavioral variables included weekday reading/writing time, screen time, and exercise time at kindergarten. Because only eight children had screening-defined myopia, penalized logistic regression was used. Myopia prevalence was 1.7
To quantify birefringence and depolarization features of myelinated retinal nerve fibers using polarization-sensitive optical coherence tomography and to evaluate their utility for noninvasive assessment. Retrospective observational case series. Seven eyes from 7 patients with clinically diagnosed myelinated retinal nerve fibers underwent polarization-sensitive optical coherence tomography. We quantified phase retardation (birefringence), polarimetric entropy (depolarization), and intensity within myelinated retinal nerve fibers and adjacent retinal nerve fiber layer. Optic-axis orientation maps were generated to infer myelin lamellar orientation relative to axons and to delineate depth-resolved lesion extent. Myelinated retinal nerve fibers showed significantly higher phase retardation and polarimetric entropy than adjacent retinal nerve fiber layer (p = 0.02 and 0.008, respectively). Retardation and entropy exhibited greater variability than intensity across lesions (p < 0.05). Optic-axis orientation within lesions was consistently near-perpendicular to the local nerve fiber direction (all seven lesions; overall mean angle, 81°). Within lesions, greater depolarization and birefringence were associated with stronger posterior shadowing independent of lesion thickness. Optic-axis images also revealed segments in which nonmyelinated retinal nerve fiber layer overlaid portions of the lesion. Elevated birefringence, increased depolarization, and optic-axis orientation perpendicular to axons constitute distinctive optical signatures of retinal myelination. These contrasts may allow polarization-sensitive optical coherence tomography to delineate lesion boundaries and internal heterogeneity in three dimensions more precisely than conventional optical coherence tomography, supporting differential diagnosis, phenotyping, and longitudinal monitoring.
To describe the characteristics and prevalence of macular dystrophy using a comprehensive national claims database in Japan. Population-based retrospective study using a nationwide claims database. Approximately 126 million individuals covered by Japan’s universal health coverage system were included. Health insurance claims from 2011 to 2020 stored in the National Database of Health Insurance Claims (NDB) of Japan were analyzed. Patients with macular dystrophy, including best vitelliform macular dystrophy (BVMD), Stargardt disease (STGD), cone/cone-rod dystrophy, or central areolar choroidal dystrophy (CACD), were identified using diagnostic codes recorded in the database. The population-based prevalence of diagnosed macular dystrophy was calculated, and age-standardized rates were derived using the WHO standard world population. Between 2011 and 2020, 1,268 patients with BVMD, 460 with STGD, 5758 with cone/cone–rod dystrophy, and 280 with CACD were identified in the NDB. As of October 1, 2020, the corresponding prevalence rates were 10.05, 3.65, 45.65, and 2.35 per 1,000,000 persons, respectively. This nationwide study provides updated epidemiological estimates of macular dystrophy in Japan. These findings may inform clinical management, healthcare planning, and future research on macular dystrophy.
To evaluate the safety profile of intravenous methylprednisolone (IVMP) in patients with thyroid eye disease (TED) and identify factors associated with major adverse events (AEs), focusing on age. Multicenter retrospective study. We reviewed 369 patients with active TED treated with IVMP. AEs occurring during or within 1 month of treatment were classified as mild, severe, or life-threatening. Logistic regression analyses identified factors associated with hyperglycemia, liver dysfunction, and severe/life-threatening AEs, with age-based comparisons (≥70 vs <70 years). For severe/life-threatening AEs, Firth’s penalized logistic regression was additionally performed as a sensitivity analysis. AEs occurred in 240 patients (65.0
Glaucoma is a leading cause of visual impairment in Japan. Because it is often asymptomatic in its early stages, many individuals with glaucoma remain unaware of their condition. To address this, we are promoting eye-care culture (memigaki bunka). As part of this initiative, we conducted a study to assess glaucoma awareness in Japan. Cross sectional, online panel survey. An online survey was conducted in Japan among men and women aged 30–69 years. Participants were stratified into four 10-year age groups (30–39, 40–49, 50–59, and 60–69 years) and by sex, with 100 men and 100 women recruited for each age group in each of the two study regions: (1) the cities of Sendai and Tomiya in Miyagi, and (2) all other 46 Japanese prefectures combined (excluding the 47th prefecture, Miyagi). The total sample comprised 1,600 participants, including 800 residents of Sendai/Tomiya and 800 residents of the remaining 46 prefectures. All participants answered the question: what do you know about glaucoma? using a 5-point Likert scale. Residents of Sendai and Tomiya demonstrated significantly higher glaucoma awareness than those from other regions (p = 0.01). Women showed higher awareness than men (p = 0.03). In a sex-stratified analysis, regional differences were observed among women (p = 0.03) but not among men (p = 0.18). Path analysis revealed that willingness to undergo paid eye examinations was associated with being female, being a driver, having a sense of fear of glaucoma, and understanding glaucoma (p < 0.05). Glaucoma awareness was relatively higher among participants from Sendai and Tomiya than among participants from the other 46 prefectures. Women demonstrated higher levels of awareness than men. Future public health efforts should focus on improving awareness among men to promote early detection and treatment of glaucoma.
Cataract surgery is among the most commonly performed types of surgery in Japan, but the actual surgical volume at the healthcare facility level remains unclear. This is partly because a substantial number of cataract surgical procedures are performed in clinics, making comprehensive investigation of relevant data difficult. This study used the National Database of Health Insurance Claims (NDB) to elucidate the number of surgical procedures, including outpatient procedures, performed at the facility level. Retrospective observational study. Using NDB data, we determined the number of cataract surgical procedures performed at the facility level over a 9-year period (fiscal years 2016–2024). We also analyzed the proportion of procedures performed in outpatient settings. Approximately 4,500 facilities performed cataract surgery each year, with the number of facilities increasing. Although variations were observed across prefectures, no systematic regional patterns emerged. In most regions, facilities typically performed 100–300 procedures per year. Many facilities operate entirely at outpatient settings, while others operate entirely at inpatient settings. Facility-level outpatient practice patterns varied substantially across procedure-volume categories. This descriptive pattern was observed across the 9-year period. These nationwide facility-level data provide an important baseline for understanding cataract surgery practice in Japan. These findings may support future research and health policy discussions on cataract surgery practice across healthcare facilities.
This substudy of the OPTIC-J trial analyzed magnetic resonance imaging (MRI) scans from a subset of Japanese patients to examine changes in orbital tissues after teprotumumab treatment vs placebo for active thyroid eye disease (TED). Post hoc exploratory. Volumes and inflammation/edema of extraocular muscles (EOMs) and orbital fat were measured before and after 24 weeks of teprotumumab treatment or placebo using MRI in patients enrolled at four of the 16 trial sites. Inflammation/edema in EOM and orbital fat were evaluated using the signal intensity ratio, based on T2 intensity in the cerebral white matter, and an ordinal grading scale (0–3), respectively. Key clinical outcomes included proptosis, diplopia, and clinical activity score (CAS). Mean (
To evaluate the short-term efficacy of intravitreal aflibercept 8 mg in patients with neovascular age-related macular degeneration (nAMD) who exhibited persistent or recurrent exudation two months after faricimab treatment during the maintenance phase following anti-vascular endothelial growth factor (VEGF) loading therapy. Retrospective observational study. Twenty-seven eyes with nAMD were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) biomarkers—including intraretinal fluid (IRF), subretinal fluid (SRF), and sub–retinal pigment epithelium (sub-RPE) fluid at the subfoveal and macular areas—were evaluated before and two months after treatment with faricimab and aflibercept 8 mg. Subgroup analyses were performed according to AMD subtype (typical nAMD vs. polypoidal choroidal vasculopathy [PCV]) and pachychoroid characteristics (pachychoroid vs. non-pachychoroid). BCVA did not show significant changes after either faricimab or aflibercept 8 mg treatment. However, aflibercept 8 mg resulted in a significant reduction in subfoveal SRF (from 44.4
PURPOSE:To conduct an exploratory randomized trial evaluating the efficacy of 0.01% atropine in schoolchildren with myopia ≤ -4.50 D. STUDY DESIGN:Open-label, randomized crossover pilot trial. METHODS:In this 24-month trial, 19 children were assigned to atropine/control (n = 9) or control/atropine (n=10) sequences, with crossover at 12 months. During the atropine periods, participants instilled 0.01% atropine nightly. Spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and 6, 12, 18, and 24 months. Twelve-month eye-level changes in periods (0-12 and 12-24 months) were analyzed using linear regression with treatment (atropine vs control) and period as fixed effects and participant-clustered robust standard errors. Mixed-effects models were used to describe trajectories. RESULTS:Baseline SER ranged from -11.02 to -4.50 D. Mean (±SD) 12-month SER progression was -1.02 ± 0.52 D/year under control and -0.75 ± 0.47 D/year under atropine, yielding an adjusted treatment effect of +0.26 D/year (95% CI, +0.08 to +0.45; p = 0.005; 26% inhibition). Mean AL elongation was +0.40 ± 0.18 mm/year under control and +0.34 ± 0.18 mm/year under atropine, with an adjusted difference of -0.05 mm/year (95% CI, -0.11 to +0.00; p = 0.065; 14% inhibition). Treatment-by-period interactions were not significant for either SER or AL, but rebound could not be excluded given the small sample size. CONCLUSIONS:In the present cohort, 0.01% atropine suppressed myopia progression over 12 months, with inhibition ratios similar to previous trials involving mild to moderate myopia. These findings support the feasibility of low-dose atropine for advanced myopia and justify full-scale trials.
To evaluate the real-world use, treatment outcomes, and tolerability of the fixed-dose combination of ripasudil 0.4
To clarify the clinical characteristics and etiologic diversity of pediatric lacrimal duct obstruction in children aged ≥1 year requiring surgical treatment under general anesthesia and to evaluate the outcomes of endoluminal lacrimal duct recanalization (ELDR). Retrospective observational study. All pediatric lacrimal surgical procedures performed under general anesthesia at our institution between 2011 and July 2025 were reviewed. All cases underwent dacryoendoscopic evaluation and treatment. Clinical characteristics, etiologies, and surgical outcomes were analyzed. The study included 245 patients (338 eyes). Thirty-four eyes (10.1
To develop and validate time-updated, corrected gestational age (CGA)–specific prediction models for identifying treatment-requiring retinopathy of prematurity (ROP) using routinely available systemic factors, and to assess longitudinal changes in predictor combinations and model performance with advancing CGA. Retrospective cohort study. Preterm infants who met institutional ROP screening criteria from a single tertiary center were included, excluding those with aggressive ROP. Multivariable logistic regression models were independently developed at CGA 28, 30, 32, and 34 weeks using routinely available systemic variables summarized from birth to each CGA. For each CGA-specific analysis, infants treated before the target CGA were excluded. Exhaustive subset selection based on the Akaike information criterion identified CGA-specific optimal predictor sets. Model performance was evaluated using stratified five-fold cross-validation with out-of-fold predictions, and discrimination was assessed by the area under the receiver operating characteristic curve (AUC). Predictor combinations selected by the optimal models differed across CGAs, indicating longitudinal changes in the predictive relevance of systemic factors. Growth-related and inflammatory indices were repeatedly selected, while overall predictor composition evolved with advancing CGA. Discrimination improved at later CGAs, with cross-validated AUCs of 0.650, 0.716, 0.809, and 0.842 at CGA 28, 30, 32, and 34 weeks, respectively. These findings suggest that CGA-specific prediction models may help characterize the evolving risk of treatment-requiring ROP. However, prospective multicenter validation and further refinement are required before clinical application.
PURPOSE:To evaluate the real-world use, treatment outcomes, and tolerability of the fixed-dose combination of ripasudil 0.4% and brimonidine 0.1% (RBFC) eye drops in patients with uveitic glaucoma (UG). STUDY DESIGN:Single-center retrospective case series. METHODS:Medical records of 39 eyes with open-angle UG treated with RBFC were reviewed. The outcome measures included changes in intraocular pressure (IOP) and glaucoma drug score (GDS) at 12 months, the proportion of eyes with an IOP reduction of ≥2 mmHg at 12 months, the relationship between the duration of UG and the change in IOP at 12 months, changes in IOP in eyes switched from ripasudil plus brimonidine, and adverse events. RESULTS:The median IOP significantly decreased from 19 mmHg at baseline to 14 mmHg at 12 months (p < 0.001), while the median GDS showed no significant change, from 3 at baseline to 4 at 12 months (p = 0.562). At 12 months, 64% of eyes achieved an IOP reduction of ≥2 mmHg. A positive correlation was observed between the duration of UG and the change in IOP at 12 months (rho = 0.539, p < 0.01). In the subgroup analysis restricted to eyes switched from ripasudil plus brimonidine eye drops to RBFC, IOP showed a decreasing trend (p = 0.057). No drug-related adverse events were observed, except for transient conjunctival hyperemia. CONCLUSION:This real-world study in patients with UG showed that RBFC achieves effective IOP control while reducing treatment burden, with good tolerability, supporting its continued use in UG management.
To investigate the association of hyperreflective foci (HRFs) with disease activity in treatment-naïve neovascular age-related macular degeneration (nAMD) and to compare the effects of anti-vascular endothelial growth factor (VEGF) therapy versus dual VEGF-A/angiopoietin-2 (Ang-2) inhibition on HRFs. Retrospective, single-center, interventional study This study included 72 eyes with treatment-naïve nAMD. Thirty-two consecutive eyes received aflibercept 2mg and 40 consecutive eyes received faricimab, each undergoing three monthly loading injections. HRF presence and area, central retinal thickness (CRT), best-corrected visual acuity (BCVA), and associated parameters were evaluated at baseline and after loading. HRFs were quantified using binarized spectral-domain optical coherence tomography (SD-OCT) images with automated assistance. At baseline, 45 eyes (62.5
PURPOSE:To investigate regional differences in the epidemiology and treatment of retinopathy of prematurity (ROP) from 2016 to 2023. STUDY DESIGN:Retrospective multicenter cohort study METHODS: Premature infants screened for ROP at a single tertiary referral center in each of five countries/regions (Taiwan, Hong Kong, Singapore, India, and Portugal) during the study period. Demographic characteristics, incidences of ROP and type 1 ROP, and treatment modalities were analyzed. Screening criteria followed local protocols. Logistic regression was used to assess trends, and intergroup comparisons were performed using Kruskal-Wallis and chi-square tests. RESULTS:A total of 15,031 premature infants were enrolled. Demographics varied significantly (p <0.001); India had the highest gestational age and birth weight, and the lowest proportion of very low birth weight and extremely low birth weight infants with type 1 ROP (p <0.001). Hong Kong had the lowest ROP incidence, while Singapore showed a significant increase over time (p = 0.003). Type 1 ROP rates were higher in Taiwan and India than in Hong Kong and Singapore, with a significant decline observed only in Taiwan (p = 0.005). Anti-Vascular Endothelial Growth Factor (Anti-VEGF) injections were increasingly preferred as initial treatment, with bevacizumab being the most frequently used (87.3%). CONCLUSION:From 2016 to 2023, ROP incidence and treatment showed significant regional differences. ROP increased in Singapore, while type 1 ROP decreased significantly in Taiwan. Although anti-VEGF therapy has become more common, laser treatment remains dominant in Hong Kong.
To evaluate the factors affecting uncontrolled intraocular pressure (IOP) in eyes with crystalline lens, intraocular lens (IOL) dislocation, or aphakia after pars plana vitrectomy (PPV) combined with the flanged intrascleral IOL fixation technique (ISF) (PPV-ISF), and to examine the risk of high IOP or glaucoma surgery after PPV-ISF. Retrospective observational cohort study This study investigated 100 eyes (97 patients) who underwent PPV-ISF at Osaka University Graduate School of Medicine between July 2020 and June 2022. We evaluated the association of the outcomes of postoperative IOP control with preoperative and postoperative factors. Uncontrolled IOP was defined as an increase in glaucoma eye-drop use or necessity of glaucoma surgery. The mean patient age was 67.9 ± 16.1 years. Among 100 eyes, 13 (13
PURPOSE:To investigate the characteristics of Terson syndrome (TS) among survivors of aneurysmal subarachnoid hemorrhage (aSAH). STUDY DESIGN:Retrospective study METHODS: Using the Japanese Diagnosis Procedure Combination database, we identified patients diagnosed with aSAH at admission between July 1, 2010 and March 31, 2023 in Japan. The prevalence of TS in aSAH survivors was examined, along with comparisons of patient backgrounds between survivors with TS and those without TS. We compared the characteristics and outcomes in patients with TS who underwent vitrectomy with those in patients who did not, and analyzed the laterality of the surgery. RESULTS:Among 143,058 patients with aSAH, 104,576 (73.1%) survived. TS was diagnosed in 860 (0.8%) survivors. The patients with TS were younger (mean [standard deviation, SD] age: 53.3 [11.4] vs 64.0 [14.6] years) than those without TS. Among the patients with TS, 243 (28.3%) patients underwent vitrectomy during hospitalization, with a median interval of 38 days from admission to surgery. Of the patients with TS who underwent vitrectomy, 160 (66.4%) and 81 (33.6%) patients underwent unilateral and bilateral vitrectomy, respectively. CONCLUSION:In this retrospective study, the prevalence of TS among aSAH survivors was less than 1%. Vitrectomy was performed in approximately one-third of the patients with TS, with one-third of these patients undergoing bilateral surgery during hospitalization.
