Objective: To provide a historical precis of static ocular counterrolling.
Methods: Literature review
Results: In the 18^th century (1786), Hunter described dynamic ocular couterrolling in a book, called: "Observation on certain parts of the animal economy" . Until Nagal observed the existence of static ocular counterrolling in 1871 through his own astigmatism, which acts as a driving force in the Bielschowsky head tilt test, dynamic ocular counterrolling was not differentiated from static counterrolling. Halm then utilized static counterrolling to diagnose superior oblique palsy by observing vertical deviation on ipsi- and contralateral head tilt. In 1900, Hoffmann and Bielschowsky developed and utilized the phenomenon of static ocular counterrollung as a valuable tool to diagnose superior oblique muscle palsy, as well as other cyclo-vertical strabismus disorders.
Conclusion: The Bielschowsky head tilt test followed a long history leading up to its clinical use.

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Purpose: To elucidate how the Bielschowsky head tilt phenomenon, i.e., hypertropia of the paretic eye on ipsilesional head tilt, can be explained by decreased compensatory static ocular counterrolling (s-OCR).
Subjects and Methods: Thirty-three patients with superior oblique palsy and 11 control subjects were studied. With a head-mounted video camera, s-OCR was assessed by measuring the inclination angle of a line connecting the two centroids of the characteristic iris pattern and corneal reflex.
Results: The mean (SD) amplitude of s-OCR in the paretic eye calculated from the fitted regression sine curve against the ipsilesional head tilt angle was significantly decreased compared to that of contralateral head tilt [4.4° (2.1) for ipsilesional and 7.3° (2.7) for contralateral, p<0.0001], and was significantly smaller than that in normal controls [7.3° (1.7) for normal controls, p<0.0001]. No significant association was noted between hypertropia on ipsilesional head tilt and the amplitude of s-OCR in paretic eyes (r²=0.02, p=0.4061); however, the difference in hypertropia between ipsilesional head tilt and the head upright position were significantly correlated with the amplitudes of s-OCR in paretic eyes (r²=0.20, p=0.01).
Conclusions: Hypertropia on ipsilesional head tilt is nonspecific regarding the function of the superior oblique muscle of the paretic eye. Rather, the difference in hypertropia between ipsilesional head tilt and the head upright position is an alternative indicator of the superior oblique function of the paretic eye.

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Purpose: To elucidate how the Bielschowsky head tilt phenomenon, i.e., hypertropia of the paretic eye on ipsilesional head tilt, can be explained by the variation in the maximum superior oblique muscle size.
Subjects and Methods: Seventeen patients with superior oblique palsy and 14 control subjects were studied. Inferior (IO) and superior oblique (SO) muscles in coronal and sagittal planes on magnetic resonance imaging (MRI) were quantitatively analyzed. The maximum cross-sectional areas of the SO and IO muscles on central gaze were compared with paretic eye hypertropia on ipsilesional head tilt. Vertical deviation in the Bielschowsky head tilt test was measured using the alternate prism and cover test with head tilt at 30o to the shoulder during fixation on a target at a distance of 5m.
Results: The mean (SD) maximum cross-sectional area of the SO muscle was significantly smaller on ipsilesional than on contralateral [14.2 (6.8) mm² for ipsilesional and 19.2 (4.5) mm² for contralateral, p=0.004] and in the normal control [18.1(3.2) mm², p=0.01]. The mean (SD) IO cross-sectional area was 18.3 (3.5) mm² in normal subjects and 21.3 (7.9) mm² on ipsilesional and 22.0 (6.7) mm² on contralateral in the presence of superior oblique palsy. Oblique muscle cross-sectional area did not correlate with hypertropia on ipsilesional head tilt.
Conclusions: The maximum SO cross-sectional area does not account for the variation in the Bielschowsky head tilt phenomenon in superior oblique palsy. This finding indicates that the Bielschowsky head tilt phenomenon is nonspecific regarding superior oblique muscle function.

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  Papers written about phoria adaptation often discuss the modification of eye alignment as evidence for mechanisms that compensate for changes in the oculomotor system due to development, disease and injury. While clinicians often encounter patients with diplopia or other signs of ocular misalignment, most people, in fact, have nearly perfect eye alignment even when viewing far targets with one eye occluded. Evidence that good eye alignment is the result of adaptive mechanisms can be seen with the binocular misalignment that results from the monocular patching of one eye in normal subjects for extended periods of time. We have tested extensively the ability of subjects to adapt the alignment of their eyes in various viewing conditions that present binocular disparities in the context of different version, vergence and head postures. Our conclusion from these studies is that one of the primary functions of phoria adaptive mechanisms is to manage the parsing of extraocular muscle forces during everyday viewing situations. The concept of Hering’s law of equal innervation is an oversimplification of a very complex process in which the relative participation of the twelve extraocular muscles needs to vary with the distance and eccentricity of the object of interest as well as the pitch and roll angles of the head. We note also that the problem of maintaining good coordination of the eyes is exacerbated with dynamic eye and head movements. I will review our work on the adaptation of vertical phoria and cyclophoria in relation to orbital eye position and head posture.

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[in Japanese]

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  Visual development occurs rapidly in infants making them highly sensitive to visual deprivation. Refractive correction is necessary for every infant with significantly high refractive error during the critical period.
  In this article, current issues in prescribing spectacles for infants are covered. These include indications, essential examinations, suitable methods, keypoints and pitfalls in prescribing spectacles for infants. Issues in maintaining proper fitting of spectacles, and problems particular to infants are also described.

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  Glasses for junior and senior high school students need special consideration regard to adults because they are in growth perod even though they don’t need care foe amblyopia as for younger children. So we checked the changes of refraction error in junior and senior high school students and considered prescription precautions for them. We alse conducted a survey in the form of a questionnaire about predcription of glasses.
1. Changes of refractionerror in junior and senior high school students
  One hundred and nine students, sho were in the first grade of junior high school in 1983, were measured their both eyes opened refraction by Autoref R-1 (Cannon, Tokyo, Japan ) for six years until they graduated junior high scool. Myopic students over -4.00D at the first grade of junior had high possibility to have over -8.00D myopia at the last year of senior high school.
2. Measuring procedure
  The rate of hyperopia with cycloplegic refraction in junior high school was 18.4 %. Cycloplegics and fogging procedure should be used when necessary.
3. Prescription of glasses
  A questionnaire was sent to eleven institutions about how they prescript glasses. As the standard of visual acuity to start glasses there were no Tendency in hyperopia and the answers were from 0.5 to 1.5 . In myopia, all answers were under 0.7. For the standard of refractive error to start glasses, in hyperopia 45 % ansered over +3.00 D with cyclopegics, in myopia 55% were over -1.00D, in astigmatism 36 % were 1.00D to 1.50D. The standard corrected visual acuity was over 1.0 for hyperopia by 91% and for myopia 55% and astigmatism 64% answered with one eye over 0.8 For the first glasses 73% institutions selected full correction for hyperopia. 91% selected for myopia and 73% selected for astigmatism 0.25D to 0.50D under corrected lenses.
  Glasses for junior and senior high school students are useful tool to correct refractive error for better school life and daily activities. To prescribe glasses for theses ages, the knowledge about the changes of refraction and the consideration for not only myopic but alse hiperopia are necessary.

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  Recently, the progressive addtion lenses(PALs) with comfortable wear has been put to practical use. Both of development of PALs that can be used more comfortably and a more accurate, more detailed prescription are needed now at the time of face a super-aged society. It is important that the refractive power in the visual line of sight on PALs should correspond to the depth position of the object at the prescription and the adjustment of PALs. It is supposed that the refraction power distribution in PALs is designed based on the addition power, the length of progression, and the angle of convergence, etc. Furthermore, the individual differences of the wearer’s life style and physiological characteristics, that is, the combination of head and eye movements used to aim at an off-center point in space must be important factors. In order to estimate these factors, it seems that it is important to know what/which distance wearer look at through where of the PALs directly and personally. It has been confirmed that the frequently using area on PALs is different in a using condition and an individual physiological characteristic as a result of measuring and analyzing the distribution of visual line in various situations of daily life such as works with a word processor and a car driving. It is difficult to say that one kind of PALs is appropriate to all users, and is suggested the necessity of custom-made PALs matched to a usage and an individual characteristic. There are also some items that an almost equal value in a different working environment or a different wearer. They are useful as common data for prescription and adjustment of PALs.

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Purpose: To investigate the frequency and the detected age of associated clinical characteristics of infantile esotropia as determining factors in subsequent management.
Objects and methods: 89 children one year old or younger at the time of the initial visit, were followed up for at least two years. 84 children underwent surgery. We investigated the frequency and age of onset of inferior oblique muscle overaction (IOOA), dissociated vertical deviation (DVD), manifest-latent nystagmus (M-LN), optokinetic nystagmus (OKN) asymmetry and ambyopia. Moreover, we compared the pre- and post-operative rates of those associations, and the relationship between the size of the preoperative deviation and the age of onset of IOOA and DVD.
Results: (1)The frequency of the clinical characteristics was as followed: IOOA (73%), DVD (83%), M-LN (37%), OKN asymmetry (90%), amblyopia (30%). (2)The average age of the first detection was: IOOA 3.8years, DVD 4.1years, M-LN 4.5years, OKN asymmetry 0.7years, and amblyopia 2.6years. (3)The rate of post-operative detection of IOOA and DVD was as high as 84% and 92% respectively (p<0.01). (4)In the group of esotropia of more than 45 prism diopters the detected age of DVD was significantly less than in the group of esotropia of less than 40 prism diopters (p<0.05).
Conclusion: Understanding the clinical characteristics of infantile esotropia is of paramount significance for subsequent management. It is especially important to perform post-operative follow-up for amblyopia, IOOA and DVD.

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Purpose: To investigate natural course of ocular alignment and clinical characteristics of infantile esotropia cases that were not operated on because of some reason.
Methods: Between January 1985 and December 2003, we observed 152 cases of infantile esotropia who underwent no operation for at least 4 years. Change of ocular deviation, dissociated vertical deviation (DVD), amblyopia, refraction, and binocular function were determined.
Result: In 117 of 152 cases (77.0%), decrease of esodeviation was observed. 81 cases (53.3%) were esotropia (esotropic group), 53 cases (34.9%) were essentially straight eyes with tropias of less than ±5° (orthophoric group) and 18 cases (11.8%) were exotropia (exotropic group) at the last visit. Initial esodeviation of the exotropic group was significantly small compared with the esotropic group and the orthophoric group (p<0.05, p<0.01). DVD in the exotropic group and the orthophoric group was found less frequently than in the esotropic group (p<0.01, p<0.05). Normal retinal correspondence was more frequently seen in the exotropic group compared with other groups (p<0.001).
The presence of amblyopia and variable deviation were not statistically significant among groups. The refraction ranged from +10.0D to -8.25D(average +2.42±2.30D), hyperopia more than +3.0D was present in 48 cases (31.6%).
Conclusion: We should carefully decide the timing of surgery for infantile esotropia, especially those whose angle of deviation is small and unstable.

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  This paper reviewed prismatic treatment and its outcome for infantile esotropia in Jichi Medical University Hospital. We consider that prismatic treatment is one of the therapeutic option for infantile esotropia.

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  We report the case of a patient who had difficulties in performing daily activities over a period of years due to weakness of fusion after undergoing strabismus surgery and orthoptics for his unilateral superior oblique (SO) palsy.
  The patient was a 77-year-old male landscaper who developed right SO palsy and abnormal convergence in 2003. In 2004 after undergoing strabismus surgery at another hospital, he received treatment with orthoptic training and prisms. In the same year, severe difficulties in carrying out daily activities caused by diplopia resulted in his transfer to our hospital for treatment.
  On his first visit, binocularity using the Synoptophore test showed partial fusion and a weakness of fusion. He had esophoria-tropia of 4 prism diopters for near vision, esotropia of 16 prism diopters for distant vision and slightly hypertropia of the right eye and exocyclotropia.
  Four months after his first visit, the area of fusion became significantly narrower. Strabismus surgery (a 5.0 mm temporal transposition of the right superior rectus muscle and a 3.5 mm recession of the right lateral rectus muscle) was then performed to treat the excyclotropia and esotropia.
  Three years and five months after the surgery, he returned to our hospital complaining of a sudden worsening of diplopia. The angle of esotropia for distant vision had increased to 18 prism diopters, the area of fusion had narrowed both for upward and downward gaze. He showed abnormal eye movement in all directions, particularly upward. The eye movement tests revealed slow saccade and saccadic pursuit and an extended near point of convergence was observed. Bell’s phenomenon was present in the left eye. Blepharospasm was found in the left eye. An MRI showed the humming-bird sign, caused by atrophy of the dorsal midbrain. The patient was then referred to the department of neurology at another hospital. Four years after the surgery, eye movement was also restricted on downward gaze and the area of fusion had narrowed. The unilateral blepharospasm had become bilateral. He was diagnosed with progressive supranuclear palsy based on his mask-like face, ataxia with positive Romberg’s sign, and the MRI findings.
  Prism treatment is useful for most of acquired ocular movement disorders, however elderly patients with severe difficulties in performing daily activities with prisms are likely to develop complications that include supranuclear eye movement disorders, for which it is necessary to examine their eye movement and systemic condition.

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  A 10-month-old boy was referred to us because of the head tilting to the right side. He was suspected of a left congenital superior oblique palsy. At the first visit, visual acuity could not be measured and cycloplegic refractions were+2.0 D = cyl−1.00 DA×180 for the right eye and +1.5 D = cyl−0.75 DA×180 for the left eye. When the head was turned towards the left shoulder in the Bielschowsky’s head tilt test, increased right hypertropia was noticed. A brain MRI showed aplasia of the right inferior rectus muscle as well as hypoplasia of the left inferior rectus muscle. In the right eye, we performed the horizontal rectus muscle transposition by moving the medial and lateral rectus muscles to the insertion site of the inferior rectus muscle. Absence of the right inferior rectus muscle was confirmed during the surgery.
  After the procedure, his head position was normal. However, the procedure induced significant astigmatism in the right eye and he developed refractive amblyopia. At the age of 3, visual acuity and cycloplegic refraction were 0.3×+4.0 D = cyl−3.00 DA×180 for the right eye and 1.0×+1.0 D for the left eye. Refractive corrections by glasses and occlusion therapy were started, and visual acuity of 1.2 was obtained 18 months later.
  When the eye of the unaffected side appeared to be elevated in the Bielschowsky’s head tilt test, the possibility of congenital aplasia of the inferior rectus muscle should be considered. Although horizontal rectus muscle transposition is an effective procedure, it may induce astigmatism. Therefore, visual acuity and refractive errors should be closely followed after surgery.

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Purpose: To report two cases of constant exotropia who successfully obtained binocular function with decreasing the angle of strabismus by Fresnel membrane prism therapy and orthoptics.
Case 1: A 2-year-old girl was referred to us for exotropia which occurred at 6 months old. At first visit, her squint angle was 45 prism diopter (PD) with no convergence. Because her mother declined strabismus surgery, she was treated with Fresnel membrane prism and convergence practice for 5 years. Her eye position was exophoria with 14 PD base-in prism at 7 years old. She obtained fusion faculty.
Case 2: A one year and 5-month-old boy, whose mother noticed his left eye exotropia at 6 months old, was referred to us. At his first visit, his eye position was 40 PD base-in for near vision. The refractive errors were -5 diopters (D) in right eye and -10 D in left eye. His left eye showed tigroid fundus. After Fresnel membrane prism therapy and convergence practice for five years, the squint angle was gradually decreased. His eye position became 4 PD exophoria for near without prism and the steropsis was 100 seconds at 6 years old.
Conclusion: Prism therapy was effective for improving binocular function with decreasing squint angle in the two cases of constant exotropia. We concluded that prism therapy is one of the options for constant exotropia.

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Purpose: To report a case of "V" pattern constant exotropia whose squint changed to "A" pattern exotropia at 5 years after recession-resection of horizontal muscles.
Case: An 11 months old girl had constant exotropia with 50 prism diopter (PD) at her initial visit. Her eyes could not converge and had alternative fixation. She was slightly hypermetropic in both eyes. After 6 months’ unsuccessful convergence practice, we started to correct her exotropia with prism glasses. At 2 years and 8 months of age, "V" pattern exotropia was detected by synoptophore. Although her eyes showed slightly vertical deviations in the objective angle, ocular movement was normal with no over or under action of vertical muscles. After orthoptic training using synoptophore, "V" pattern was diminished but the angle of squint remained almost same. She underwent strabismus surgery with 8mm of lateral rectus recession and 6mm of medial rectus resection on her right eye at 4 years and 4 months old. After surgery, residual exodeviation was corrected by prism glasses and she was treated with orthoptic training. At 3 years and 6 months after surgery, dissociated vertical deviation was detected by synoptophore. At 5 years and 2 months after surgery, her squint changed to "A" pattern.
Conclusions: Since "A" pattern may convert to "V" pattern, secondary and tertiary eye position should be carefully observed on following up the A-V strabismus.

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  We examined whether the change in binocular vision by prism correction to neutralize deviation could influence body sway and center of pressure in adult patients with exotropia (XT). Subjects were 19 adult patients with XT (12 with intermittent XT and 7 with constant XT). Patients were asked to fixate on a target 2 meters away. Body sway and the center of pressure were measured by stabilometry at four occasions: before the application of Fresnel prism, immediately after the application, 15 and 60 minutes after the application. The ocular deviation was measured by the alternate prism cover test and the measurement was divided into two Fresnel prisms for the two eyes. By the binocular situation After the application of Fresnel prism about all patients, we classified into (A) binocular single vision (BSV) group, (B) no change group, (C) diplopia group and compared. In result, Enveloped area and Rectangular area slightly decreased in A group immediately after the application of Fresnel prism correction in comparison with before the application of Fresnel prism correction. In B and C groups no significant changes in the all stabilometoric parameters were observed in comparison with before the application of Fresnel prism correction. By the comparison of the quantity of change of each parameter between three groups, no significant differences were recognized. No significant changes of the center of pressure were observed in all groups.
  Based on our results, we could not conclude that change in binocular vision by prism correction to neutralize deviation can affect body sway and center of pressure in adult patients with XT.

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Purpose: To report the characteristic of essential infantile esotropia cases who were followed up without surgery because of decrease of esodeviation.
Methods: Subjects were 3 patients who were followed up only by wearing glasses and occlusion therapy at Satoh Eye Clinic and Okayama University Hospital, at ophthalmology Department from April 2006 to October 2008 (patients were less than 2 years old at the first visit and followed up for more than 4 years). All patients were examined for refractive error, ocular alignment, ocular motility, sensory status and stereoacuity. The angle of esotropia was measured with Hirschberg method, Krimsky method and alternating prism cover test. We also checked optokinetic nystagmus.
Results: The near esodeviation was 30-50PD at the first visit. The distance esodeviation was −4-20PD and the near one was 0-16PD at the final examination. The near esodeviation decreased 29.7PD on average. In all patients between the age of 1year 5months to 1year 11months the esodeviation either decreased or was unstable. Patients had common clinical characteristics such as dissociated vertical deviation, overaction of inferior oblique muscle in both eyes and optokinetic nystagmus asymmetry. One case had latent nystagmus and strabismic amblyopia.
Conclusion: All cases had clinical characteristics such as dissociated vertical deviation, overaction of inferior oblique muscle in both eyes and optokinetic nystagmus asymmetry. And all cases less than 2years old had decrease or instability of esodeviation. Children at this age should be carefully checked, especially in essential infantile esotropia cases.

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Aim: To examine refractive change with time in patients with hyperopic anisometropic amblyopia who obtained good visual outcome.
Subjects and methods: All patients were seen in pediatric ophthalmology outpatient clinic in Inouye Eye Hospital from December, 1988 to June, 2008. Eighty-six patients with hyperopic anisometropia having spherical difference between the two eyes exceeding 2 diopters and showing final improvement of better than 1.0, during follow-up. For three years or more were analyzed. Refraction under cyclopentrate was recorded. In the analysis of refraction with time, spherical and cylindrical powers were separately used. In this case, no shperical equivalent was calculated.
Results: The average age was five years and nine months. The spherical power significantly decreased in either amblyopic eye or healthy eye. Showing greater decreases than a healthy eye. Thus, refractive difference in anisomeropia decreased with time.
Conclusion: In hyperopic anisometropic amblyopia having good visual outcomes, decrease of the spherical power in amblyopic eye seemingly contributes to the visual improvement.

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Purpose: To determine the visual acuity, binocularity and related factors of these functions after treatment of bilateral refractive amblyopia with high grade hyperopia.
Method: From June 2002 through May 2007, 13 children with 26 eyes, aged less than 8 years at the initial visit, with hyperopia > +6.00dioptors (mean age: 4.8, mean refractive errors: +7.45D) were studied. Children were provided spectacle correction with cycloplegic refractive errors and visual acuity were measured by angular vision regularly. Binocularity was determined using synoptophore and Titmus Stereo Tests. The prognosis of visual acuity, time course of recovery of visual acuity and the final binocularity were investigated. Related factors included age, visual acuity, spherical equivalent, eye position at the initial visit and cortical vision after treatment.
Result: Visual acuity improved 20/20 in all patients and mean time course of recovery of visual acuity was 1.4 years. Binocularity was Grade III with synoptphore and 221sec with Titmus Stereo Tests. The severity of visual acuity and spherical equivalent at the initial visit were associated with the time course of recovery, such as, the worse and severer visual acuity and hyperopia at the initial visit were, the longer visual acuity improved. The association with eye position and binocularity was not significantly, however there was a trend down of binocularity in patients with esophoria.
Conclusion: Visual acuity after treatment of bilateral refractive amblyopia improved , but it was not easy the case to get a normal binocularity.

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Purpose: The purpose of this study was to investigate visual function care such as refractive error in children with Down syndrome.
Subject and Method: 149 children with Down syndrome (83 males and 66 females), who visited Osaka Medical College Ophthalmology Clinic in August/1993 to April/2008, served as subjects. Age at the first visit, ocular complication, refractive error, visual acuity target used, and lens prescription were investigated.
Result: Their age of the first visit were ranged between one month to 14 year old and 10 month old. Entropion, tessellated fundus, strabismus, cataract, and nystagmus were found as ocular complications beside refractive error. Their refractive errors with cycloplegia (spherical equivalent) were ranged between −12.75 D to + 9.00 D, 20.5% of −0.5D to +0.5D, 59.0% of hyperopia greater than +0.5D, 20.5% of myopia greater than −0.5D, 2.2% of high myopia greater than −6.0D, and 47.8% of astigmatism greater than 2D. Morizane dot card, picture visual acuity chart, and Landort’s ring were used for visual acuity measurement. Because of their mental retardation, picture visual acuity chart was used for 45.5% of the subjects. Visual acuity could not be measured with 6.0% of the subject older than 6 year old. Glasses were prescribed for 79 out of 139 subjects (56.8%). In addition to the glasses prescription, Moore-Johnson method or occlusion was prescribed for 8 subjects.
Conclusion: In this study, high myopia was found less than we expected probably because the subjects were younger than those in previous studies. Picture visual acuity chart was found to be the most useful for the examination. In addition to the testability, picture visual acuity chart was easier for the parents to understand their children’s visual status. The results, in which more than 50% of the subjects were prescribed glasses, indicated that it is important for children with Down syndrome to take ophthalmologic eye examination even if their examination can not be fully completed due to their mental retardation.

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  We performed visual acuity (VA) test, visual field test,and pattern reversal visually evoked response (PVER) on the patients suspected of psychogenic visual disturbance. In addtion to these tests, the stereotests were also performed.
  In this study, 30 subjects (2males, 28females) suspected of psychogenic visual disturbance were included. Their ages ranged from 7 to 14 years with a mean of 9.0 years. In the VA test, we first measured the uncorrected VA before the corrected VA was measured by the neutralization method. The visual field was assessed with the quantitative Goldmann kinetic perimeter. PVER was recorded under both transient and steady-state conditions. Stereoacuity was evaluated by the Titmus stereotests and Frisby stereotest. If the test result with the uncorrected VA was poor, the test would be performed with the neutralization method.
  About 70% of the subjects could obtain VA of 1.0 or better with the neutralization method. The results of Goldmann kinetic perimetry indicated that about 60% of the subjects had a normal visual field and 40% had an abnormal visual filed with field constriction or in a spiral pattern.Except one subject with slightly unstable responses, the other 29 subjects had normal transient and steady-state PVERs. As for the stereotest results,about 90% of the subjects showed stereopsis better than 100 seconds.
  Our results suggested that when the objective test such as PVER was not available for the diagnosis of psychogenic visual disturbance,stereotests together with VA and visual filed tests could be an effective diagnostic approach.

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[Purpose] To examine the effect of glass prism and Fresnel membrane prism on visual function.
[Subject and Method] Twenty eyes of 20 subjects without ocular abnormalities were examined. Age ranged from 21 to 47 years (average 28.8). We evaluated visual acuity ,contrast sensitivity using the CAT2000™ (NEITZ) and root mean square (RMS) value of high order aberration (coma like (S3) aberration, spherical like (S4) aberration and S3+S4 aberration) by the wavefront analyzer KR-9000PW™ (TOPCON). All subjects were tested under no prism, wearing 8 prism diopter (PD) glass prism and 8PD Fresnel membrane prism.
[Results] Visual acuity decreased significantly wearing Fresnel membrane prism compared with glass prism and no prism (p<0.001). Contrast sensitivity also decreased significantly wearing Fresnel membrane prism compared with glass prism and no prism (p<0.05). There were no significant difference between wearing glass prism and no prism in visual acuity and contrast sensitivity. In contrast, RMS value of S3 and S3+S4 aberration wearing glass prism were significantly larger than those in no prism. Wearing Fresnel membrane prism, RMS value of S3, S4 and S3+S4 were also significantly larger than those in no prism.
[Conclusion] These results suggested that wearing glass prism showed less effect on visual function compared with Frsenel membrane prism within a power of 8PD.

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[Purpose] The Hirschberg test is the most common procedure for the screening of abnormal eye position. But this method is usually difficult to evaluate the patient of infants. We report a new method of screening test for abnormal eye position using a digital camera. And we also indicate that this new method is significant in measuring and recording the deviation in the primary position and in the cardinal positions of gaze.
[Subjects and Methods] Subjects were 43 patients who were suspected to have the abnormal eye position at the first visit to our clinic. The age ranged from 2 months to 6.3 years, average 1.5 years. We ordered patient’s family to snap the pictures of patient according to the two types of illustration (one for baby, another for infants). In the illustrations, we showed how to photograph for recording the primary eye position and the cardinal positions of gaze. We evaluated the pictures by using the enlargement function of a digital camera.
[Results and Conclusions] At the first, 15 out of 43 patients were evaluated to have some abnormal eye positions, and 18 out of 43 patients not to have any abnormal eye positions. But other 10 patients could not be evaluated. After using our new method, 25 out of 43 patients could be evaluated to have some abnormal eye positions and 16 out of 43 patients could be evaluated as orthophoria. Only 2 patients could not be evaluated. Our new method is very useful as a screening test for the abnormal eye positions. Especially for the patients of baby and infant, we can easily evaluate and record whether or not the patients have some abnormal eye positions.

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  We provided a historical perspective of the Hirschberg test by reviewing the publications by Julius Hirschberg (1843-1925) and related articles on objective strabismometry. In 1885 and 1886, Hirschberg published three articles and proposed a new method for the objective measurement of ocular deviation using the location of a corneal light reflex. The deviation was defined with reference to the landmarks, i.e. the pupillary margin and corneal limbus, and its degree was classified into Stage I to V. Up to the present, the test which was later termed the Hirschberg test has been utilized worldwide without modification.
  Hirschberg appeared to have noticed a numerical relationship between the reflex displacement and ocular deviation angle. Although he did not discuss this issue in detail in his articles, a value of 8 degrees /mm was used as the conversion factor, the Hirschberg ratio. In the literature up to the 1960’s, the conversion factor was estimated between 7 and 8 degrees/mm. However, the advanced theoretical and photographic image analyses after 1970 have proved the values between 7 and 8 degrees/mm incorrect and proposed a value of 12 degrees/mm for the Hirschberg ratio.

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Purpose. To provide a historical perspective on the Brückner test.
Methods. Two articles by R. Brückner and related articles concerning the Brückner test were reviewed with reference to its testing principle, clinical method, and diagnostic applicability.
Results. Brückner published in 1962 and 1965 German articles describing a "trans-illumination (Durchleuchtung)" test or red reflex test that proved useful in the detection of small ocular deviation, anisometropia, and amblyopia in uncooperative or nonverbal young children. A bright coaxial light produced with a direct ophthalmoscope is used to simultaneously illuminate both eyes from a distance of about one meter. The first step is to examine the position of the corneal light reflex of the direct ophthalmoscope light and to evaluate its difference between two eyes. In strabismic children, the fixing eye should have a darker reflex than the deviated eye. The second step is to illuminate one eye at a time to evaluate pupil size, pupil reaction, and fixation movement of the eye. This procedure is also useful in the detection of amblyopia. The overall test results may provide a screening for the detection of strabismus, anisometropia, and media opacities in primary eye care personnel young nonverbal children.
Conclusions. In the recent two decades, many articles were published from United States and Europe to report usefulness of the Br_ckner test for the screening of strabismus, refractive error, and amblyopia in young children. Few reports have, however, appeared from Japan or oriental countries. It may be justified to study whether clinical applicability of the Brückner test is limited in highly pigmented eyes.

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[Purpose] To compare the accuracy of the upgraded IOLMaster (Ver.5) and the former IOLMaster (Ver.3).
[Objects and Methods] This study consists of 133 eyes. We compared Ver.5 with Ver.3 about success rate of measuring axial length, rate of manipulation, measured axial length (Ver.5: the composite signal, Ver.3: mean value), measured corneal curvature, signal-to-noise ratio (Ver.5: value of 5 consecutive measurements, Ver.3: maximum in a series of measurements), postoperative refractive error, and the optimized A-constants, respectively. Concerning 80 eyes which implanted SA60AT in the capsular bag and had BCVA 0.7 or better (decimal), we calculated postoperative refractive error and the optimized A-constant using SRK/T formula.
[Results] Although the success rate of measuring axial length was not statistically significant, the rate of manipulation was significantly reduced in Ver.5 (p<0.001). Measured axial length, corneal curvature, postoperative refractive error and the optimized A-constant were not statistically significant, but the composite SNR was quite different from the conventional SNR (p<0.001).
[Conclusion] Ver.5 software independent on a examiner’s skill has improved the measurement success rate, and enables to obtain the measurement accuracy equal with the previous software. However, the SNR of the composite signal which fluctuates according to the measurement frequency is quite different from the conventional SNR. We have to manage the SNR carefully because it is difficult to compare the composite SNR with the conventional SNR. .

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  We compared OA-1000 prototype (Tomey) and IOLMaster^® (Zeiss) with respect to measurement accuracy. The subjects were selected from 169 eyes measured with the following four devices: OA-1000, IOLMaster^®, AL-3000 (for immersion mode A scan, Tomey) and i-SCAN (for contact mode A scan, Ophthalmic Technologies Inc.). The finally selected subjects were the 41 measurable eyes that satisfied the following four conditions: 1. cataract surgery performed by the same surgeon; 2. implanted the intraocular lens SA60AT (Alcon) in the capsular bag; 3. corneal astigmatism <2D; 4. postoperative BCVA≥0.7. In the measurement with OA-1000, SRK/T formula was used for IOL power calculation, and the A-constant 118.4 recommended by the manufacturer was tentatively used because it was unknown. The optimized A-constant 118.9 was used in the case of measurement with IOLMaster^®. OA-1000 showed a higher rate of incapable measurement than IOLMaster^® significantly (p<0.05, x² test). The axial length measured by OA-1000 correlated closely with that of IOLMaster^® (r²=0.9992). There was no significant difference in the mean axial length among the four devices and in the postoperative refractive error between OA-1000 and IOLMaster^®. The optimized A-constant for SA60AT measured by OA-1000 was 118.5.
  The measurement accuracy of OA-1000 was comparable to that of IOLMaster^®. However, the presence of difference in A-constant between the two devices indicated the necessity for optimization of A-constant exclusively for OA-1000. Because of the significant difference in the rate of incapable measurement between OA-1000 prototype and IOLMaster^®, the measurable rate of OA-1000 to be commercialized should be improved.

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[Purpose] To evaluate the influence of cataract on signal strength (SS) by using Cirrus™ HD-OCT (Carl Zeiss Meditec).
[Methods] In this study, we evaluated 53 eyes that had been treated with cataract surgery (Cat-group), and 20 normal eyes were used as control (group-C). The macular thickness (MT) was measured by using Cirrus™ HD-OCT and the axial length was measured using IOLMaster^®Ver.3, pre- and postoperatively. We compared the Cat-group with group-C with respect to the SS and the signal-to-noise ratio (SNR) of axial length which were indices of measurement accuracy. Depending on the SS, the Cat-group was divided into 2 subgroups: group-A (SS<6; 26 eyes) and group-B (SS≥6; 27 eyes). We carried out an inter- and an intragroup comparison for SS, SNR, best-corrected visual acuity (BCVA), and MT for group-A, group-B, and group-C.
[Results] The SS and SNR were decreased significantly in the Cat-group, the main cause being posterior subcapsular cataract rather than nuclear sclerosis. Among the 3 groups, there were significant differences in SS (p<0.0001), SNR (p<0.0001), BCVA (p<0.0001), and MT (p<0.01) preoperatively; however, no other parameter except BCVA showed a significant difference postoperatively.
[Conclusion] Measurement accuracy of Cirrus™ HD-OCT, which is similar to IOLMaster^®, decreased significantly under the influence of cataract.

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Purpose: To evaluate severity of the color vision defect using the Lanthony desaturated panel D-15 test (desaturated test) and the Ichikawa lantern test (lantern test) in anomalous trichromats with congenital red-green color vision defects.
Methods: We examined 159 anomalous trichromats including 53 protanomalous trichromats (PA) and 106 deuteranomalous trichromats (DA), diagnosed by a Nagel model I anomaloscope. All participants had the pass results in the Panel D-15, 1.0 or better of corrected visual acuity and no ocular disease. Lantern pass (good result) was defined as error numbers of 3/9 or less, whereas lantern fail (poor result) was defined as error numbers of 4/9 or more. The desaturated test pass/fail results were compared between lantern good and poor results using a Fisher’s exact test or chi-square test (with significance at p<0.05).
Results: In PA (n=12) with good results of lantern, 11/12 had the pass results and 1/12 had the fail results in the desaturated test. In PA (n=41) with poor results of lantern, 24/41 had the pass results and 17/41 had the fail results in the desaturated test. The good-result ratio in the lantern was significantly (P=0.03) high in PA with pass results in the desaturated test. In DA (n=36) with good results of lantern, 33/36 had the pass results and 3/36 had the fail results in the desaturated test. In DA (n=70) with good results of lantern, 56/70 had the pass results and 14/70 had the fail results in the desaturated test. The good-result ratio in the lantern was high in DA with pass results in the desaturated test.
Conclusion: Anomalous trichromats with good results of lantern may have milder severity of color vision defect than those with pass results of the desaturated test.

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Purpose: The eye with long axial length (AL) tends to have greater refractive error after cataract surgery than the eye with normal AL. We compared the accuracy of SRK / T formula with Haigis, which is third generation formula.
Sublects & Methods: One hundred seventy eyes of 121 patients with AL equal or more than 26.00 mm, best corrected visual acuity equal or more than 1.0, were enrolled in the study. Axial length, keratometry, and anterior chamber depth were measured using IOL MasterTM before cataract surgery. All eyes were followed more than 3 month after surgery. Eyes were divided into two groups according to the AL (Group L; 26.00 mm ≤ AL < 28.00 mm, Group XL; AL ≥28.00 mm). Then the difference between intended and achieved refraction were evaluated using SRK / T or Haigis formula.
Results: The postoperative refractive error in L and XL group were predicted correctly within±1.0D in 95.5 % and 82.8 % respectively using SRK / T, and 92.0 % and 84.5 % respectively using Haigis. There was no statistically significanct difference between SRK/T and Haigis formula(p>0.05, Chi-Square Test). In the eye with AL longer than 30.00 mm, the refractive error when Haigis formula was used was smaller than that of SRK / T (p < 0.05, Wilcoxon signed rank test), however approximately 1.0 D hyperopic shift was observed using either SRK / T or Haigis.
Conclusion: There were no statistical differences regarding postoperative refractive error even if either SRK / T or Haigis formula was used. We need to consider hyperopic shift in the eye with AL longer than 30.00 mm.

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  Psychogenic visual disturbances are often encountered in clinical practice. Usually, the disturbances are bilateral, but they can be unilateral in rare cases. It is important to differentiate visual disturbances caused by psychogenic disorders or malingering from those caused by organic disorders. When various tests including general and specific ocular examinations are performed, inconsistencies in the results from these examinations and discrepancies in ocular findings are often the deciding factors in making such a differentiation.
   We recently experienced two cases of severe unilateral visual disturbances suspected to be psychogenic. we could not obtain any results useful for determining whether they were psychogenic or organic by performing subjective visual acuity examinations that employed lens neutralization or placebo methods. However, we could easily obtain normal vision in these two cases, employing a novel bilateral pinhole method. In this method, in a predetermined sequence, a 1.5-2.0 mm pinhole and an equivalent sphere lens to which about +10.0D is added are inserted into the trial frame over the healthy eye. A 3.0 mm pinhole (and corrective lens) is inserted into the trial frame over the affected eye. The visual acuity of the affected eye is then measured under binocular conditions while the patient is under the illusion that only the healthy eye is being examined. It is important to perform the bilateral pinhole method correctly and smoothly in sequence. The bilateral pinhole method is a useful subjective visual acuity examination tool for differentiating unilateral visual disturbances due to psychogenic disorders or malingering from those due to organic ones.

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Purpose: To investigate the problems which occurred in the Boston Scleral Lens Program, the role of the orthoptists in this program and how deal with the problems.

Methods: Fourteen eyes of ten patients, 5 men and 5 women, were reviewed retrospectively. Keratoconus; 5 eyes of 4 patients, Stevens-Johnson syndrome; 2 eyes of 1 patient, Lagophthalmos; 3 eyes of 2 patients and Keratectasia; 4 eyes of 3 patients. The average age was 40 (27-71). We investigated visiting times of 9 patients who were actually prescribed lenses for training to master wearing and removing lens, including 2 cases we found difficult in the process of the training and 1 case in which great care had to be taken in deciding the lens power.

Results: The minimum visiting time to our clinic was twice and six times was the most frequent for training. In the training of wearing the lens, it was necessary to devise a good way for low vision patients. As a fixation object, we had to change the color of the plunger and also we had to light up the plunger from the opposite side. At the time we decided the lens power, examination of subjective refraction was necessary because objective refraction varied widely.

Conclusion: In the Boston Scleral Lens Program, the role of the orthoptists is important as we need to take flexible action to suit the situation of each patient and his individual disease.

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[Purpose] We introduced refractometry by the orthoptist into health-check program for three-year-old child in Yonago City from 2005. We compared close examination rate and the disease detection rate for 2 years each before and after this introduction.
[Object and Method] GroupI consisted of 2,771 infants who had received checkup by health-check program from May, 2002 to April, 2004. GroupII consisted of 2,843 infants who had received checkup by health-check program from May, 2005 to April, 2007 with participation of orthoptist and introduction of refractometry. The criteria of close examination in groupI was visual acuity less than 0.5 or unmeasurable by a picture index visual acuity test. On the other hand, Morizane dot card visual acuity test and refractometry by portable auto-refractometer was performed to all infants in groupII. The criteria of close examination in groupII was the visual acuity less than 0.6, the hyperopia more than +2.00D, the astigmatism more than 2.00D, the anisometropia more than 2.00D, and the myopia more than 5.00D. We compared 31 infants (groupI) with 86 infants (groupII) who underwent close examination in the Department of Ophthalmology,Tottori University Hospital.
[Result] The false-positive rate in screening of groupI was 62%, however that of groupII was 8%. The following rates in groupII were increased compared with groupI; required close examination rate from 1.59% to 4.68%, the disease detection rate from 0.43% to 2.78%, and the anisometropic amblyopia detection rate from 6% to 17%. In 6 of 7 infants (86%) with good visual acuity and poor refraction value, amblyopia was detected.
[Conclusion] These results indicate orthoptist participation and the refractometry introduction of health-check program for three-year-old child were useful.

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  According to the map created by the Japan Ophthalmologists Association to show the distribution of low-vision care facilities, Nara is the only prefecture in the Kinki district that has no such facilities. To launch a voluntary group for studying low-vision care, we called upon many other relevant facilities and institutions to participate, in recognition that their involvement would be essential. In response, many facilities and institutions took part in the study meetings. First, we conducted a survey to study the present situation regarding low-vision care in Nara Prefecture, the better to promote the establishment of a network among those engaged in medicine, education and social welfare. Although the above-mentioned map indicated that there were no low-vision care institutions in the Prefecture, the survey results showed that two medical institutions (one hospital and one clinic) are in fact providing outpatient low-vision care. In addition, we found that orthoptists, doctors and nurses concerned about low-vision care accounted for 71% of all those surveyed.
  Also, 93% of the respondents were of the opinion that it is necessary to establish cooperation among those engaged in medicine, education and social welfare, showing strong interest in establishing a network for such cooperation.
  The survey results highlighted the fact that low-vision care has tended to remain unaddressed in the Prefecture. Factors contributing to this tendency are the lack of opportunities to begin learning about low-vision care, the lack of knowledge regarding initial approaches to low-vision care, and the shortage of time resulting from involvement with other outpatient-care services.
  In the process of studying the fundamentals of low-vision care, it is important that we establish an effective low-vision care network that enables face-to-face communication between members and involves as many medical professionals as possible, including not only orthoptists, but also doctors and nurses.

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  Children with multiple disabilities frequently have visual impairment. The current study devised vision testing and training for and assessed vision in 21 children with multiple disabilities who had been followed for 10 years or longer.
  All 21 children had visual and linguistic impairments (100%); a proportion also had an intellectual impairment or a physical impairment (90.5%) or a hearing impairment (14.3%). Age upon initial visit was 0-8 years, current age was 10-29 years, and developmental age was 0-6 years. In order to discuss assessment criteria in terms of developmental age and chronological age, developmental age was calculated using developmental tests such as the Infant Mental Development Questionnaire and Kinder Infant Development Scale. In addition, vision tests, refraction, eyeglass wear, and orthoptic exercises were also examined in terms of the chronological age and developmental age of the child in question.
  Orthoptic exercises involved practice having one’s vision measured, practice wearing glasses, and visual recognition exercises in accordance with the patient’s everyday activities; these exercises were individually devised for each child.
  In children with multiple disabilities, vision according to a Landolt C test generally coincided with normal developmental age regardless of the child’s chronological age. That is, children with a developmental age under 3 could not be tested while 66.7% of those with a developmental age of 3-4 were successfully tested and 83.3% of those with a developmental age of 4-5 years were successfully tested. Possibly regardless of developmental age, eyeglass wear was partial or constant in 95.3% of the children. Orthoptics was found to improve vision measurement, eyeglass wear, occlusion therapy, visual recognition exercises, and convergence exercises as the child’s developmental age increased.
  As clearly indicated, developmental age should serve as a criterion for vision assessment in children with multiple disabilities, and particularly vision measurement and refraction. Visual recognition exercises should be devised over time in accordance with the child’s activities, and information on the child’s improvement should be provided to personnel involved in the child’s care. Those exercises should be compatible with the child’s life and should have a synergistic effect.

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Purpose: During a 10-month period between December 2007 to October 2008, 8 domestic violence cases were observed at the outpatient department of Ophthalmology of Asahi General Hospital. An efficient diagnosis and medical management care system were designed based on the examinations of these patients. In order to derive this system, all evaluations were conducted in an objective manner.
Subjects and method: The female victims in those cases ranged from 23.8 to 54.1 years of age (an average age of 41.2±10.4). The first four cases (group A) were carefully examined to create a management flowchart. It was then used as a base for the latter four cases (group B). Two evaluation schemes were conducted. In scheme 1, with using a scoring method for managements against domestic violence victims those were given before and after the use of said flowchart, objectively comparing whether the managements have improved with the aid of a checklist of items in each case. Scheme 2 was assigned to evaluate the ratio of waiting time to the total examination time of those patients in the two groups respectively. Mann-Whitney’s U test was used for the analysis of these evaluations.
Results: The results of scheme 1 were as follow: the four cases from group A scored a 9-point average, while those in group B received a 16-point average. Group B’s score was significantly higher than group A (p <0.05). The results of scheme 2 were as follow: group A’s average time of ratio of waiting time to the total examination time was 69.4 minutes, while group B averaged 27.1 minutes. Group B’s average time was significantly shorter than that of group A (p <0.05).
Conclusion: These findings showed that there is room for improvement in finding an appropriate and efficient way to manage domestic violence victims using our management flowchart developed specifically for this purpose.

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Purpose: An understanding of basic orthoptics is fundamental for orthoptists and should provide the groundwork at an early stage of their education. Among the clinical services provided, visual acuity and refraction tests are considered to be a part of basic orthoptics and involve the use of mathematic formulas. In a previous study, we investigated the relationship between basic scholastic ability for determining trigonometric ratios and academic achievement in regard to visual angle calculation, and reported that a basic course in mathematics was useful as a part of a basic orthoptics curriculum (The 47th Meeting of The Japan Orthoptics Congress). In the present study, for the purpose of clarifying how academic achievement in basic orthoptics is related to clinical performance, we investigated ratings of students in on-site training and their academic achievement in orthoptics, and analyzed their clinical performance during a 2-year on-site training programs.
Materials and Methods: The subjects were 41 students of K University who registered for both the On-site Training I and On-site Training II courses in 2007 and 2008, respectively. Their academic achievement in three subjects related to basic orthoptics, namely ‘Visual acuity evaluation’, ‘Medial axis transformation of a corrective lens’, and ‘Calculation of age-appropriate power of a lens’, as well as their ratings in on-site training were analyzed.
Results: A significant positive correlation was observed between academic achievement in basic orthoptics and the ability to perform in on-site training. Furthermore, the ability to perform in a clinical setting was significantly greater in the 4th-year students.
Discussion: It was considered likely that academic achievement in basic orthoptics would result in the ability to perform basic orthoptics responsibilities in on-site training. We found that the ability to perform in a clinical setting was significantly greater in the 4th year students as compared to the 3rd year students. Thus, it is considered necessary to improve the level of academic achievement in basic orthoptics by providing an introductory curriculum, while it is also important to encourage comprehensive learning of both knowledge and skill through skill practice in clinical settings.

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Purpose: The presence or absence of correlations between self-objective evaluation results by students themselves and those by practical supervisors was investigated.
Subjects and Methods: The subjects were 116 forth-year students (98 females and 18 males) majoring in orthoptics at our university. Evaluations by the supervisors were conducted using a four-step rating scale of excellent, good, fair, and poor. For the self-objective evaluations by the students, a new egogram^®(TEG)(Tokyo University’s type) was used. The evaluations were carried out twice in April before the practice and in July after the practice. Variations in the ego state of the students before and after the practice were investigated from variations in the mean levels of five self-objective evaluation items, which included critical parent (CP), nurturing parent (NP), adult (A), free child (FC), and adapted child (AC). The students were classified according to the scores obtained from the evaluations by the supervisors in both the practices of the first and later terms into a high score group and a low score group. Then, characteristics of the students’ TEG were investigated.
Results: In the evaluations by the supervisors, the score of "excellent" in the later practice increased by about 10 points from the score of the pre-practice and the scores of "good" and "fair" decreased. The TEG scores were high in "NP" and "FC" both before and after the practice, and the score for "A" became significantly higher after the practice (p<0.05). This outcome indicates that the self-objective evaluation enabled an improvement in scientific cool judgments based on facts presented by the students themselves. The high score group showed a high score for "NP" and the low score group showed a high score for "AC" .
Conclusion: It can be expected that the practice effects can be enhanced by students’ objectively understanding the tendency of their personalities before the clinical practice. It will also be possible for the supervisors to use the TEG’s results as a tool by which to understand characteristics of the emotional field.

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[Purpose] To improve the skills of orthoptists, we need to provide training programs tailored to each student’s level of testing and analyzing techniques. The purpose of the study was to assess the level of students’ understanding of kinetic and quantitative perimetry using the Goldmann perimeter and thereby to identify problems in our method for providing technical training and guidance.
[Subjects and method] The study was conducted on 49 students who were receiving training to become orthoptists. The level of students’ understanding of the normal visual fields and the basic operation of the Goldmann perimeter were measured based on the results of visual field examinations recorded on a Goldmann chart. We also identified and analyzed problems in our training method based on the retinal nerve fiber pathway mapped on the chart.
[Results] 1. Normal visual fields and the basic operation of the perimeter: In the study, the number of students who successfully mapped a V-4e target isopter within the normal visual fields on the nasal side was 41 (83.7%) and that on the superior side was 25 (51.0%). However, the areas encompassed by the isopters on the temporal side that were generated by 41 students (83.7%) and those on the inferior side generated by 35 students (71.4%) were smaller than the normal visual fields. In the maps generated by 45 students (91.8%), the intersection of the vertical and horizontal axes was located within the area encompassed by the isopters. There were 21 students (42.9%) who did not present the target outside of the previous target and 28 students (57.1%) who were able to, even partially, select different meridians. 2. Glaucomatous visual field defects: Ten students (20.4%) failed to measure the nasal visual field accurately even after mapping the retinal nerve fiber pathway. Of 28 students who were able to even partially perform the spot-check procedure in the Bjerrum area, 23 students (82.1%) failed to locate the scotoma accurately.
[Conclusion] In providing technical training and guidance on kinetic and quantitative perimetry using the Goldmann perimeter, it is important to ensure that students understand the normal range of visual fields and the basic operation procedures for the device. In mapping the retinal nerve fiber pathway, it is important to take into account the location of the pathway in the visual field. The study has revealed the necessity of improving the method of visual field measurement in such a way as to allow examiners to visualize the actual visual fields.

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Purpose: It is important for students in orthoptics to participate in some voluntary work for supporting visually disabled people. In this study, we evaluated how such experiences could benefit student’s learning.
Subjects and Methods: Subjects were 43 4th-year students in orthoptics who had finished a practical training in 2007. In their 3rd year, these students participated as volunteers in a conference that was held in our university in October of 2006 and sponsored by the Tochigi branch office of the Japanese Retinitis Pigmentosa Society. In the conference, the students had a chance to help and communicate with the members of the Retinitis Pigmentosa Society. A survey among these students was conducted after the practical training regarding how this experience as a volunteer had affected their performance in the practical training.
Results: As many as 87 % of the students indicated that the experience as a volunteer at the conference had been useful for their later practice. The experiences obtained through "Direct communication with people with retinitis pigmentosa" (in 63%) and "Experience of a constricted visual field" (in 56%) were particularly valuable. Other responses included "The members’ talk on their own experiences were helpful later when I (the student) was guiding or assisting patients in a clinical setting." and "This experience had helped me (the student) to communicate better verbally when I performed visual tests on patients."
Conclusion: This study showed that direct contact with visually disabled people could be a very effective learning experience for students in orthoptics. In our department, we are planning to involve the 2nd-year students in practical learning through our affiliated welfare facilities. We considered that student’s participation in voluntary work for visually disabled people in an earlier stage of their education may be even more effective for the later clinical training.

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Purpose: To investigate how amblyopic eyes functioned in the daily life after occlusion therapy, we assessed the reading acuity in children with anisometropic amblyopia and in children with anisometropic amblyopia with microtroia using MNREAD-Jk.
Subjects and Methods: Subjects were 19 patients (age range, 6-11 years), who had completed occlusion therapy. Of them, 10 patients were with anisometropic amblyopia and 9 patients were with anisometropic amblyopia with microtropia. The corrected visual acuity of the amblyopic eyes of the patients with anisometropic amblyopia ranged from 1.0 to 1.5 and that of those with anisometropic amblyopia with microtroia ranged from 0.7 to 1.0. Using MNREAD-Jk, subject’s reading acuity was assessed by three parameters: the reading vision, the critical print size, and the maximum reading speed. We further compared the reading speed of patient’s sound eye with that of amblyopic eyes using a print size smaller than the amblyopic eye’s critical print size. The difference between the near cortical visual acuity and the critical print size of the sound eyes was compared with that of the amblyopic eyes.
Results: The amblyopic eye indicated larger reading vision and critical print size than the sound eye in both patients with anisometropic amblyopia and with anisometropic amblyopia with microtropia. Although the maximum reading speeds of the amblyopic and sound eyes did not differ significantly, the amblyopic eye showed significantly slower reading speed than the sound eye when the print size smaller than the amblyopic eye’s critical print size was used. The amblyopic eye showed larger difference between the critical print size and the near cortical visual acuity than the sound eye in patients with anisometropic amblyopia. But any particular tendency was not seen in patients with anisometropic amblyopia with microtropia.
Conclusion: Even after therapy, the amblyopic eye still showed a difference in reading acuity from the sound eye. This suggests that in the daily life, the sound eye may function dominantly over the amblyopic eye when the print size is smaller than the amblyopic eye’s critical print size.

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