The eye serves as an important "window" that sensitively reflects neurological lesions. This article reviews the basic anatomy of the eyeball and optic nerve, and explains simple methods for evaluating visual acuity, pupils, ocular movements, color vision, visual fields, and the fundus that can be performed by neurologists in outpatient clinics and at the bedside. It also focuses on optic neuritis, which is closely associated with neurological disorders, outlining examination methods and key clinical precautions that can be undertaken by neurologists, as well as major ophthalmic adverse effects that may occur with drugs used to treat neurological diseases. Finally, the importance of early collaboration with ophthalmologists is emphasized.

PURPOSE:To investigate changes in eye alignment before and after ICL implantation in patients with myopia having corrected distance visual acuity (CDVA) of ≥0.0 logMAR. SUBJECTS AND METHODS:The medical records of 1012 patients without eye movement limitation who underwent bilateral ICL implantation were retrospectively reviewed a at the Eye Center of Sanno Hospital in Japan. RESULTS:Preoperatively, of 1012 patients, 30 (3.0%), 211 (20.8%), 771 (76.2%), and 126 (12.5%) demonstrated constant strabismus, intermittent strabismus, phoria, and binocular diplopia, respectively. Regarding horizontal strabismus without a vertical component, of 30 patients, 9 (30.0%) demonstrated exotropia and 2 (6.7%) exhibited esotropia. Vertical strabismus without a horizontal component was not observed. A combination of horizontal and vertical strabismus was observed in 19 (63.3%) patients. The rate of eye alignment classification agreement preoperatively and postoperatively was 98.7%, including 100%, 93.8%, and 100% in the constant strabismus, intermittent strabismus, and phoria groups, respectively. Of 1012 patients, 1.3% converted from intermittent strabismus to phoria (6.2% in the intermittent strabismus group). CONCLUSIONS:Uncomplicated ICL implantation under topical anesthesia was not associated with eye alignment in 98.7% of patients with myopia, and 0% transitioned to constant strabismus after ICL implantation.

STUDY OBJECTIVE:We aimed to compare intraoperative intraocular pressure (IOP) during prone spinal surgery using a horseshoe headrest versus pinned head-holder to identify the safer device, which causes a lower increase in IOP. DESIGN:A prospective cohort study. SETTING:Operating room. PATIENTS:Healthy adults (aged 49-78 years) with an American Society of Anesthesiologists classification of I/II. INTERVENTIONS:Prone spinal surgery using a horseshoe headrest (Hs group) or pinned head-holder (Pin group) during 2016-2018. MEASUREMENTS:Both groups were examined for IOP, anterior chamber angle, and fundus findings the day before surgery. The IOP was measured immediately after intubation until the end of surgery. Risk factors for increased IOP in prone positioning were examined. A linear mixed model was used to investigate the rate of IOP increase with operative time. MAIN RESULTS:The IOP in both groups was similar after 1 h and 2 h in the prone position and was highest at suture closure. The range of significantly elevated IOP varied in each group. The Pin group took longer to elevate IOP after prone positioning and recover IOP after supine positioning than the Hs group. The operative time and prone duration were significantly greater in the Pin group, with no significant IOP difference between the groups at all time points. The linear mixed model showed a high rate of IOP elevation up to 1 h in the prone position, after which the rate of IOP elevation decreased, with no significant IOP difference between the two groups at any time point. No risk factors for increasing IOP in the prone position were identified. CONCLUSIONS:No differences in intraoperative IOP according to the head fixation device were observed. Therefore, the incidence of postoperative visual impairment could be comparable between the devices if direct eye compression is avoided during surgery.

Introduction: We previously reported a case of a patient with bilateral congenital cataract identified in the Ogasawara village, Bonin Islands, Japan, on a visit by an ophthalmologist and describe its course over 17 years from initial surgery. Here, we report on a secondary intraocular lens (IOL) implantation that was subsequently performed at 22 years and 5 months of age. Methods: After cataract surgery at 7 months, the aphakic patient began amblyopia treatment using extended-wear soft contact lenses (SCLs). After 10 years of age, SCLs were chosen to achieve crossed monovision considering the cosmetic appearance when facing other people. At 22 years of age, a secondary IOL implantation was performed. Secondary implant in the patient considered appearance and postoperative vision without glasses, we selected the crossed monovision method using a monofocal IOL. The postoperative targeted refraction for the right (non-dominant eye) and left eyes (dominant eye) planed - 0.33D and - 2.25D, respectively. Results: At 3 months after surgery, the corrected distance visual acuity (CDVA) with IOLs for the right and left eyes was 20/16 and 20/60, respectively, and the binocular visual acuity was 20/16 for distant vision and 20/25 for near vision. The CDVA for the right eye was: 20/13 × IOL = sph-0.25D and that for the left eye was: 20/13 × IOL = sph -1.75D D/cyl -0.50D/Ax170°. Although the exotropia was complicated by dissociated horizontal deviation and dissociated vertical deviation, there were no significant changes in ocular position before and after surgery. The patient was satisfied with achieving independence from spectacles and SCLs. Conclusion: The use of the crossed monovision method with monofocal IOLs in this patient and defective binocular function created a visual environment with no inconvenience in everyday life after secondary IOL implantation. In terms of secondary implant after amblyopia treatment, the IOL type or postoperative targeted refraction must be chosen to maintain or improve the visual environment obtained with the amblyopia treatment.

Introduction: This study aimed to measure the intraocular pressure (IOP) of patients undergoing open surgery in the supine position (control group) and spine surgery in the prone position (spine group) to clarify IOP range and change by posture, determine the risk factors for increased IOP in the prone position, and reduce visual complications after surgery in the prone position. Methods: A prospective cohort study was conducted in healthy adults (34-83 years of age) with an American Society of Anesthesiologists classification I/II. The spine group was examined for IOP, anterior chamber angle (ACA), and fundus findings the day prior to surgery. On the day of surgery, IOP measurements were taken at fixed time points: immediately after intubation; at 0.5, 1, and 2 h after intubation; at suture closure; and at the end of surgery in the control group. In the spine group, they were taken immediately after intubation; at 0.5, 1, and 2 h after prone position; at suture closure; and immediately and 5 min after returning to the supine position. The risk factors for increased IOP in the prone position were examined. Results: The control group showed no significant changes in IOP within the normal range (<20 mmHg) during surgery. In the spine group, IOP was higher at each time point than immediately after intubation. IOP increased sharply above the normal range within 1 h after changing from the supine to the prone position and continued to gradually increase until suture closure. IOP decreased 5 min after the patient returned to the supine position. ACA, body mass index, blood loss, time in the prone position, and operative time were not risk factors for increased IOP in the prone position. Conclusions: Patients were constantly exposed to above-normal IOP during prone spinal surgery. However, neither group reported visual impairment. No risk factors were identified for increased IOP in the prone position.

PURPOSE:To compare the ability of imo binocular random single-eye test (BRSET) to detect visual field (VF) defects due to chiasmal and postchiasmal lesions (C/PCLs) with a Humphrey Field Analyzer (HFA) monocular test.STUDY DESIGN:Prospective multicenter study METHODS: This study enrolled 40 patients with C/PCLs and measured their VFs using both imo BRSET and HFA monocular test. The VFs were classified into three groups using the cluster criterion: 1) bitemporal group, 2) homonymous group, and 3) others. The agreement and correlation of VF results between imo and HFA were analyzed using the Bland-Altman plot and Spearman correlation coefficient.RESULTS:The VFs of 34 patients were analyzed and classified. There were 13 patients in the bitemporal, 6 in the homonymous, and 15 in the others group. BRSET showed a significantly shorter test duration than HFA. The imo systematically yielded a lower sensitivity than HFA. The average sensitivity at each test location correlated well between the perimeters in all groups, with the correlation coefficients ranging from 0.89 to 0.98. Bland-Altman plots showed wider limits of agreement in the affected quadrants compared to the unaffected quadrants in the bitemporal and homonymous groups. The fixation loss rate did not differ between the perimeters, but there were significant differences in the false positive and false negative rates between perimeters.CONCLUSION:BRSET detected VF defects due to C/PCLs as accurately as the HFA monocular test with a shorter test duration.

Purpose: To assess changes in eye alignment before and after cataract surgery.Subjects and methods: The medical records of 786 cataract patients without eye movement limitation who underwent bilateral cataract surgery under topical anesthesia with monofocal IOL placement were retrospectively reviewed at the Eye Center of Sanno Hospital in Japan.Results: Before cataract surgery, 121 of the 786 patients (15.4%) had constant strabismus, 263 (33.5%) had intermittent strabismus, and 402 (51.1%) had phoria. Among the 121 patients with constant strabismus on the preoperative exam, 64 (52.9%) had exotropia without vertical strabismus, 7 (5.8%) had esotropia without vertical strabismus, and 6 (5.0%) had vertical strabismus without a horizontal component. After surgery, 98 of the 786 patients (12.5%) had constant strabismus, 126 (16.0%) had intermittent strabismus, 562 (71.5%) had phoria. The rate of eye alignment agreement before and after surgery was 72.3% overall. We found that 17 patients (2.2%) who did not have constant strabismus preoperatively developed constant strabismus postoperatively, and all of these patients experienced binocular diplopia. Characteristics of patients at risk for constant strabismus and diplopia postoperatively included patients with vertical deviation preoperatively (intermittent or phoria).Conclusions: Uncomplicated cataract surgery under topical anesthesia did not influence eye alignment classification in 72.3% of patients; however, patients with vertical deviation preoperatively were more likely to transition to constant strabismus after surgery.

To evaluate the corneal refractive power at the age of 3 in children with a history of retinopathy of prematurity (ROP). 【Subjects and Methods】 Subjects were 62 eyes of 31 patients with ROP who had received a corneal refraction test at the age of 3 years. Gestational age was 27.5 ± 3.0 weeks and the average birth weight was 868.0 ± 416.2 g. Of 62, 51 eyes of 27 subjects had received retinal photocoagulation. According to the International Classification of ROP, the extent of the subjectʼs disease was classified into zone I, II, or III. As controls, 63 eyes of 44 participants who were born at full-term and had no ophthalmologic diseases other than ametropia were also included. Corneal refractive power and refractive error were measured under cycloplegic refraction using auto ref-keratometer Spherical for zone were also compared for controls.

Purpose. To assess the long-term clinical outcomes of conventional laser in situ keratomileusis (LASIK) for moderate to high myopia. Methods. We retrospectively examined sixty-eight eyes of 37 consecutive patients who underwent conventional LASIK for the correction of myopia (−3.00 to −12.75 diopters (D)). At 3 months and 1, 4, 8, and 12 years postoperatively, we assessed the safety, efficacy, predictability, stability, mean keratometry, central corneal thickness, and adverse events. Results. The safety and efficacy indices were 0.82±0.29 and 0.67±0.37, respectively, 12 years postoperatively. At 12 years, 53% and 75% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of −0.74±0.99 D occurred from 3 months to 12 years after LASIK (p<0.001). We found a significant correlation of refractive regression with the changes in keratometric readings from 3 months to 12 years postoperatively (Pearson correlation coefficient, r=-0.28, p=0.02), but not with the changes in central corneal thickness (r=-0.08, p=0.63). No vision-threatening complications occurred in any case. Conclusions. Conventional LASIK offered good safety outcomes during the 12-year observation period. However, the efficacy and the predictability gradually decreased with time owing to myopic regression in relation to corneal steepening.

The authors examined pupillary light reflexes to both red and blue stimuli using infrared video-pupillography in premature infants. Pupillary light reflexes were obtained in response to 470 nm blue and 635 nm red stimuli with varying intensities of 10 cd/m(2) and 100 cd/m(2). Red stimuli did not evoke a pupillary response in premature infants. However, blue stimuli produced a pupillary reflex, and the extent of the reaction was dependent on the intensity of the stimulus. These results suggest that in premature infants, the origin of light reflex may be mediated predominately by melanopsin-containing retinal ganglion cells.

We report the results of a new amblyopia treatment device used in 7 children with anisometropic amblyopia. The Occlu-pad was created by removing the polarizing film layer from the liquid crystal display screen of an iPad Air (Apple Inc, Cupertino, CA). Patients were asked to wear special glasses that contained a polarizing filter for their amblyopic eye and a light reduction filter for their normal eye and instructed to play an amblyopia training game displayed only to the amblyopic eye. In 5 patients corrected distance visual acuities in the amblyopic eyes improved after 2 months' treatment on average by 0.38 (logarithm of the minimum angle of resolution).

The purpose of this study was to compare central laminar thickness (LT) among patients with glaucomatous optic neuropathy (GON), patients with non-GON, and normal subjects using enhanced-depth imaging optical coherence tomography (EDI-OCT). Enrolled were 57 patients (n = 64 eyes), including 30 women and 27 men. Three groups were identified: GON (n = 18 eyes), non-GON (n = 16 eyes), and control (n = 30 eyes). The GON group comprised eyes with primary open-angle glaucoma (POAG) (n = 9) and normal-tension glaucoma (NTG) (n = 9). The non-GON group comprised eyes with demyelinating optic neuritis (n = 9), anterior ischemic optic neuropathy (AION) (n = 2), compressive ON (n = 2), Leber hereditary ON (n = 2), and traumatic ON (n = 1). GON and non-GON groups were further divided into mild, moderate, and severe subgroups. Inclusion in the GON group was based on mean deviations (MDs) of visual fields; inclusion in the non-GON group was based on critical flicker frequency (CFF) responses. Intraclass correlation coefficients (ICCs) were used to verify reproducibility of measurements. LTs of GON and non-GON group eyes were thinner than those of control group eyes (p < 0.01); LTs of GON group eyes were thinner than those of non-GON group eyes (p = 0.01). LTs of severe GON subgroup eyes were thinner than those of moderate and mild GON subgroup eyes (p < 0.001; p = 0.024, respectively). LTs of severe non-GON subgroup eyes were thinner than those of mild non-GON subgroup eyes (p = 0.002). These results show that EDI-OCT is valuable for documenting structural abnormalities in optic neuropathy (ON).