I was told by Miss Kawamura in 1962 whether she should work forever without qualification. I conveyed the message to the committee of Japanese Oththalmological Society. That message triggered the creation of nationally qualified orthoptists in Japan. Ophthalmic service in Japan is given by 8500 ophthalmologists, 1500 orthoptists, 9000 ophthalmic medical assistants, 20000 opticians and nurses working with ophthalmologists. Eye diseases may be curable, as cataract, or preventable, as infectious diseases or ocular trauma, or cure or prevention still not possible as most genetic eye diseases. Rehabilitation of the patients is the only remaining mean of relieving the patients. The method of surgery of cataract is rapidly changing. Still, cataract is most important cause of blindness in developing countries, half of blind people by cataract. Blindness by diabetic retinopathy is preventable by prevention and strict control of diabetes, and photocoagulation and vitrectomy. Onchocerciasis, river blindness, is preventable by control of black flies and a new drug, ivermectin given once a year to the patients. The number of visually impaired in Japan is in 1987 10% less than the figure in 1980, whereras the number of other physically handicapped increased 20% at the same time.

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The interest for adult diseases with the high aged society, the chance of a group medical examination and physical check are increasing in recent years. So that, we reported the results of persons entered Kumamoto central hospital for physical check and mainly statistical analysis of grown-up visual acuity.
The persons entered the hospital for physical check were examined 512 cases 1024 eyes during from april 1985 to september 1986. We observed subjective visual acuity by sight-testing of Landolt ring, intraocular pressure by schiötz tonometer, frontal and middle transparent eye body by slit lamp microscope, and funds by ophthalmoscope at the ophthalmic department of the hospital. The physicians examined blood pressure, blood sugar, urine sugar and obesity grade at the internal department of the hospital.
The results were as follows:
1. The persons were aged 30-77 years, including aged 40-59 years in 80% of all cases.
2. Neked eye visual acuity of 1.0 or more were 421 eyes (41%) and final corrected visual acuity of 1.0 or more were 897 eyes (88%) in 1024 eyes.
3. Regular visual acuity increased from 30 years old, peaked at 40-49 years old, and gradually dicreased to 50-69 years old. Myopia and myopic astigmatism decreased from 30 years old to high decade of ages. Hyperopia and hyperopic astigmatism increased from 30 years old to high decade of ages. Those curved-lines were analysed dominantly between each decade of ages by x² test.
4. We found mostly cataract in 47 eyes (4.6%) among eye diseases without retinal angiosclerose.
5. Retinal angiosclerose with I grade or more of Keith-Wagener classification were 170 eyes (17%) in all cases. The retinal angiosclerose had dominantly relation to hypertention and diabetes millitus.

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Orthoptists have participated in vision screening for 1.5 year old children in Tachikawa city since April 1982. Pediatric, dental and eye examinations are carried out all in the same day, twice a month and on 60 children per day. Three orthoptists and six practicing ophthalmologists take turns in making up an eye examination staff, and such a staff consists of an opthalmologist, an orthoptist and three public health nurses.
A child is first examined by a nurse who records retinal reflexes by video retinoscope. Then, an orthoptist examines a child using a streak retinoscope for refractive errors and strabismus. Retinoscopic examinations are carried out under normal pupil, estimating refraction by brightiness of the reflex, movement and width of the band. One year and six months old children are very cooperative and 100% of children were possible to examine.
Of the 916 notified, 849 children received checkups. 23 out of 849 (2.7%) were found to have refractive errors of more than two dioptors. 5 cases of strabismus were found (0.5%), 3 intermittent exotropia and 2 esotropia. Other abnormalities found are 4 entropium, one ptosis, one nystagmus and 7 apparent esotropia.
The screening of this age group is only possible by retinoscope. Retinoscopic examinations require training but once accustomed to, it is effective and efficient. Vision screening will be included in 1.5 or 3 year old health checkup at the public health office and orthoptist' social and medical role will expand in this field. Then, we stress the need for orthoptists to become proficient in various examinations in cooperation with opthalmologists.

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Two thirds of the visually impaired in Japan are believed to have residual vision ability. Usually impaired person are forced to give up their jobs or leave school. However if given proper support, including optical aids, proper training and social support services, the majority can return to their privious occupations. In 1985 in order to help provide this kind of treatment we at the National Rehabilitation Center for the Disabled have created the Low Vsion Clinic.
The work at the Low Vision Clinic requires the carefully coordinated services of many specialists. Our staff includes ophthalmologists, orthoptists, social workers and rehabilitation instructors.
Orthoptists at the clinic are responsible for selecting the proper optical aids for partially sighted patients. They must also help train them in the use those devices for reading and writing purposes.

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History taking is important for ocular evaluation especially in infant or child.
In our clinic, the history taking questionnaire has been used to improve the efficiency in diagnosis and also allow patients arranging complaints themselves before the interview by the opthalmological staff.
We investigated the data of the questionnaire in use. The results revealed some problems as follow: not all the patients necessarilly comprehended the intention of the questions, some of the patients did not answer the truth especially about family history or past illness and so on.

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Dynamic stereopsis in 94 patients with amblyopia or esotropia was studied with the Synopto-five, a new major amblyoscope employing computer graphics. The findings for dynamic stereopsis were compared with those for other binocular functions.
The results were as follows:
1) Dynamic stereopsis could not be found in approximately half of the subjects.
2) Patients with accommodative esotropia displayed better dynamic stereopsis than patients with partial accomodative esotropia.
3) In cases of amblyopia, patients with anisometropic amblypia showed better dynamic stereopsis than patients with strabismic amblyopia.
4) Patients with micro-abnormal retinal correspondence showed poorer dynamic stereopsis than patients with N. R. C.
5) Evidence of a correlation between dynamic stereopsis and static stereopsis was found.

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Using a field-sequential stereoscopic TV system (Sharp X-1 turbo) and a pair of eye glasses with build in liquid crystal shutters, we studied stereopsis from far distance in patients with strabismus and normal subjects.
The odd fields of the TV were designed to be seen by the left eye and the even fields by the right eye through the liquid crystal shutters. The fields were displayed on the TV with 60Hz. The stereoscopic patterns were drawn with a microcomputer and displayed on the TV screen.
Stereopsis was detected in some cases of very young or low intelligent children in whom ordinary stereoscopic tests can not be properly performed.
It was found that the stereoscopic TV system was quite useful for examining stereopsis in young patients with strabismus.

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A case of the manifest esotropia after viewing a stereoscopic movie was reported.
This case was 4-years-old boy at that time.
When he got home after viewing a stereoscopic movie, his mother recognized a manifest esotropia on his right eye.
Glasses were prescribed and continued to wear, however, esotropia was unchanged.
An operation of the deviating eye was performed, and binocular function following surgery was almost normal.

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We preliminarily studied time-dependent components of the cycloplegic action of atropine by use of a quasi-static mesurement of accommodation.
Seven eyes of seven children aged 5 to 12 years were measured; five eyes of five esotropes without amblyopia and two sound eyes of two unilateral amblyopes.
An infrared optometer with computerized control which could continuously measure the accommodation was adopted.
Before and 3, 5, 7 and 10 days after the initial medication of 1% solution of atropine sulfate which was instilled twice daily for ten days, measurements were performed. Furthermore 0, 2, 4, 6 and 8 weeks following the final adminstraction, the children were also examined. From each quasi-static measurement, an objective accommodation amplitude was obtained. Accommodation was completely paralyzed at the seventh and tenth days from the begining of the medication, and fully recovered from cycloplegia at the fourth or the eighth week following the final instillation.
We conclude that, in order to obtain complete cyclolegia, seven days medication of atropine is necessary when it is instilled twice a day and that four to eight weeks are needed to wash it out entirely.

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It is important to hold orthoptic prisms correctly for the proper assessment of the ocular deviation. It is well known that small errors in holding prisms may produce large errors in the amount of deviation neutralized. Therefore, we have investigated the errors induced by various states of the holding positions of the orthoptic prisms such as the block and bar prisms. Accurate measurements at various holding positions of the prisms were performed using a He-Ne laser as a light source. The induced errors become larger as to the prism deviates from the calibrated positions. Tolerable limits of the errors in holding prisms were estimated for each prism.

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We observed pseudoaccommodation in the eyes corrected with IOL after unilateral or bilateral cataract surgery and its mean power was 2.29±0.67 D. After implantation of IOL, they got better vision by wearing multifocal glasses.
In order to evaluate the effects of wearing multifocal glasses in these eyes, we compaired the visual functions in them after one month wearing 3 kinds of glasses.
As the results, the older were fond of weaker lens to get the clear vision at near. And almost cases (91%) were satisfied with wearing the multifocal glasses.
We concluded that it is useful for the IOL implanted eyes to wear those glasses to get better visual functions.

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As a measure to confirm the accuracy of astigmatic correction, using a fan-dial chart, there is a technique of shifting the cylinder axis back and forth purposely.
Expanding this technique, a table was completed which enables to read off possible errors in both power and axis simultaneously, from the directions of darker lines noticed in shifting the axis +10 and -10 degrees respectively.
This method, tentatively called “the Double-shift Method”, is described in detail, explaining the use of the table and its application in determining astigmatism.

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1.正常な若年成人の正視101眼について,眼屈折要素を計測しその拡がりと組み合わせを検討した.
2.眼軸長に対する他の屈折要の素関係において角膜曲率半径,前房深度,硝子体長は正の相関を,水晶体厚は弱い負の相関を示した.
3.眼軸長別に平均的眼軸群,長眼軸群,短眼軸群の3群に分けて,他の屈折要素を検討したところ,すべての要素において群間に有意差を認めた.
4.長眼軸群では角膜はflatで前房は深く水晶体は薄かったのに対し,短眼軸群では角膜はsteepで前房は浅く,水晶体は厚くて,いずれも正視化に向けて相補的関係にあることが判った.

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The studies were carried out on the difference of degrees and axis between total astigmatism (TA) and corneal astigmatism (CA) in 7353 eyes, from 3 to 73 years old, and revealed as follows,
1) In 75.5% of all subjects, the difference was less than 1 dptr., and 40% of the 3750 eyes had no difference in the axis within 10 degrees, between total and corneal astigmatism.
2) In both total and corneal astigmatism, the astigmatism with the rule was the largest in number: Total astigmatism 61.9%, Corneal astigmatism 66.9%.
3) In 57% of the 7353 eyes, the CA was larger than TA and in 5% the TA was larger. This ratio was as same as in the different spherical refractive status.
4) Eyes with larger CA than TA appeared to have astigmatism with the rule, the others and those TA was larger than CA appeared to have against the rule; however myopic eyes in the latter group seemed to have a direct astigmatism.

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The purpose of this paper is to report that a six years child with axial hyperopic anisometropic amblyopia could use the glasses successfully by Knapp's law.
The patient, a healthy boy, was first examined at the age of five in our clinic, complaining of poor visual acuity in his right eye.
His visual acuity without correction was 0.04 with the right eye and 1.0 with the left eye.
Cycloplegic refraction and visual acuity were +9.00D with 0.06 visual acuity in the right eye and +0.75D with 1.2 visual acuity in the left eye.
Axial length of the right eye was 20.82mm and the left eye was 22.61mm.
The full cycloplegic refraction was prescribed, the aniseikonia was 2 or 3% with the glasses. After four months of wearing the glasses, patching of left eye and pleoptics therapy were instituted.
After sixteen months of these treatments, he had a visual acuity of 1.0 in the right eye and 100 seconds of arc stereo acuity.

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Ten cases of anisometropic amblyopia with poor therapeutic effects were analysed by means of spatial frequency sensitivity VEP using a control of favorable cases. Pattern reversal targets (8Hz) consisted of vertical gradients of 0.47, 0.94, 1.94, 3.88 and 7.76 cycles per degree (96% contrast). Two types of response were obtained: 1) that in which low VEP amplitudes corresponding to high and low spatial frequency stimuli were recognized and 2) that in which only high spatial frequency responses were impaired. The former was observed in older patients (over 16 years) and the latter in cases of anisometropic amblyopia with microtropia. Cases demonstrating good visual recovery had normal spatial frequency sensitivity curves, the highest sensitivity at 3.88c/deg.

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Seventeen amblyopic patients with eccentric fixation were treated with intensive pleoptics, who had been treated previously with various home-trainings such as sound eye occlusion non-effectively. Out of these 17 patients, 8 had strabismic amblyopia with visual acuity between 0.01 and 0.1, and 9 had microstrabismic amblyopia between 0.1 and 0.2. 15 of these 17 patients were treated with pharmacological pleoptics with Amobarbital.
Results were as follows:
1) Out of these 17 patients, 7 achieved crowded visual acuity more than 0.8, and 4 patients between 0.4 and 0.7, and 6 patients less than 0.3.
2) Out of these 17 patients, 13 had been treated from less than 8 years old, and 4 from more than 8 years. 6 patients were in the strabismic group, and 7 were in the microstrabismic group in the former 13 patients. 4 of the 6 strabismic patients and 7 of 7 microstrabismic patients achieved more than 0.3 crowded visual acuity. And in 4 patients whose start of the treatment was more than 8 years, nobody didn't achieve more than 0.3.
3) Improvement of fixation to “foveal” was observed in 3 patients of 8 strabismic group and in 7 of 9 microstrabismic group.
4) Improvement of amblyopia with Amobarbital was due to improvement of fixation. Fixation was improved in 4 of 7 strabismic patients and 8 of 8 microstrabismic patients. 3 patients with no improvement of fixation had no improvement of visual acuity.
5) cases with no improvement of visual acuity had various factors such as exotropia, late start of treatment more than 8 years old, peripheral fixation before treatment.

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In the conventional cover test, examiner cannot observe the eye position or its movements while it is under an occluder. Spielman, A. developed a translucent occluder for observing the static eye position, but for being able to see the covered eye condition more clearly and exactly, there is much room for further improvement.
So we searched for a more useful translucent occluder and examined various materials with patients with intermittent exotropia or dissociated vertical deviation (D. V. D).
In conclusion, a vinyl chloride sheet used inwood working was the best translucent occluder for having both the covering effect and for being able to observe the covered eye condition.

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A controversy still exists concerning whther or not there is a constant relationship between the amount of hypermetropia in cases with accommodative esotropia and the size of the angle of squint. In order to evaluate the effect of hyperopic correction on the reduction rate of esodeviation a statistical analysis was done in 26 cases with refractive partially accmmodative esotropia. All children were treated with fully corrected plus lenses for 36 months in the average. Cycloplegic refraction with aids of atropine was performed at the interval of 6 months to one year. The results were as follows. 1) A significant correlation was found between the degree of hypermetropia and the size of the angle of squint without spectacles in cases where the hypermetropia had been fully corrected at least more than one year. 2) The degree of hypermetropia was significantly correlated to the reduction rate of angles of squint. 3) There was a significant correlation between the reduction rate of esodeviation and the length of hyperopic correction. These results suggest that the degree of hypermetropia has an important predictive value in the clinical course for treating the refractive partially accommodative esotropia, and that the long-lasting treatment is recommended as long an increasing manifest as well as latent hypermetropia may be disclosed with cycloplegic refraction and spectacles.

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We studied the effects of orthoptic training on binocular vision and aligment after surgery retrospectively in 8 patients of acquired partially accommodative esotropia. Normal retinal correspondence (NRC) was found in 2 cases and anomalous retinal correspondence (ARC) in 6 cases.
A kinetic bi-retinal stimulation and chasing training for NRC cases, and a keinetic bi-retinal stimulation and proprioceptive re-orientation training was performed on ARC cases. These trainings were continued for 15 days on an average.
Binocular vision improved in 5 cases of ARC and in all cases of NRC. Among those who underwent surgery before orthoptic training, there were some cases whose eye position did not improve to the parallel alignment. However, intended surgical correction was obtained in one patient who underwent surgery during the course of orthoptic training.
The present results seem to demonstrate that orthoptic training is effective for the improvement of binocular vision in NRC patients. They also seem to suggest that presurgical orthoptic training for ARC cases may improve the surgical results.

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The visual recovery in traumatic cataract have much improved, because of introduction of microsurgery and of progress in postoperetive manegement or pleoptics. Only a few reports are available on the prognosis for the binocular function. Eight patients after unilateral traumatic cataract operation, who complained diplopia just after the contact lens wearing, were reviewed in postoperative course of visual acuity, binocular vision, eye position, and the relation to the duration of visual recovery.
The length of the duration of visual recovery was well correlated with the degree of abnormal eye position, not with deterioration of binocular vision. Binocular vision was deteriorated in fusion and stereopsis, while simultaneous perception was maintained. This suggests the normal retinal correspondence. After the surgical correction of abnormal eye position, the range of fusion was improved.
At the point of prognosis of visual function, there was a separation between visual acuity and binocular vision.
We considered after unilateral traumatic cataract operation not only visual acuity but also binocular function should be followed-up.

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To determine the usefulness of preoperative prism treatment of Fresnel press-on prisms in esotropia, 12 esotropia patients, in whom the esodeviations were neutralized with Fresnel prisms, were analysed retrospectively.
After the postoperative follow-up periods of 1 to 7 years, according to our criteria, i. e., orthophoria, esophoria or esophoria-tropia less than 8 PD was evaluated as a good result and esotropia more than 9 PD as poor, nine cases were judged to show good results and no cases showed exo-deviation.
In the remaining 3 cases of poor results, immaturity of binocularity, dissociated vertical deviation or blind spot mechanism including the potential abnormal retinal correspondence, was suspected as the cause of poor postoperative results.

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We made a retrospective study on the long-term (over 10 years) results of squint surgeries on 44 cases of infantile esotoropia and 14 cases of partially accomodative esotropia.
We had 20 consecutive exotropias out of 58 patients. Those who had amblyopia or hypertropia had more chance of being exotropic. Exotropia took place between 3 to 4, or 7 to 9 years after surgery.
We found that 15 out of 44 infantile esotropia had developed accomodative factors after the surgeries. They had not only a better condition of squint angle but also better binocular functions than the remaining 29 cases.

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A case of “Phoria-Myopia” was presented in this report.
He was 29 years old who had astenopie complaints for 2 years.
Visual acuity was decreased in binocular vision compared with in monocular vision.
Excessive accomodative convergence (2.5D) in compensation for intermitted extropia (40^Δ-46^Δ) was revealed.
Prism therapy was not effective, while surgical therapy was successful.
Excessive accomodation and astenopia were disappeared after the correction of exodeviation.
The condition of pre-and post surgery was compared regarding the following items: in accomodation, pupil size, binocular vision and binocular function.
The relation between the accomodation and the angle of deviation in cases of Phoria-Myopia presented recentry was discussed.

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