Neuro-Ophthalmology Japan
Online ISSN : 2188-2002
Print ISSN : 0289-7024
ISSN-L : 0289-7024
Volume 34, Issue 1
Displaying 1-16 of 16 articles from this issue
Prefatory Note
Guest Articles
  • [in Japanese]
    2017 Volume 34 Issue 1 Pages 4-
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
    JOURNAL RESTRICTED ACCESS
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  • Hiroyuki Kubo
    2017 Volume 34 Issue 1 Pages 5-11
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
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    In this study, we report a detailed approach to providing care for low-vision patients. First, we evaluated the patient's visual performance using tests for visual acuity, visual field test, reading speed, etc.
    Required documents were prepared for dispatch to the city office, as needed. The patient and/or family member(s) of the patient were questioned in detail using the psycho-ophthalmologic technique. An optical assisting tool such as the white cane was provided to the patients on need basis. We found that the assistance of welfare workers is required to initiate the low-vision care. Moreover, it is important to be aware that low-vision patients need continuous support.
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  • Marie Miwa
    2017 Volume 34 Issue 1 Pages 12-24
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
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    In the ophthalmology clinic, it is important to put into practice“low vision care”for patients with visual difficulties in daily living to promote their“quality of vision”. In low vision care, the orthoptists are in charge of assessing the patients’ visual function and selecting low vision aids required for medical assessment under the instructions of ophthalmologists.
    In low vision care, the assessment of visual function is indispensable for understanding the eye condition of a patient. For correct assessment of visual function, orthoptists must consider the patient’s visual field condition(narrowness, presence of scotoma, etc.)during visual acuity tests, moreover, we should consider the patient’s condition during other assessments. Orthoptists select retinal image enlargement spectacles and magnifiers for patients who have difficulty reading, and optical aids, such as filters, for patients with photophobia. For patients who have difficulty writing, we sometimes find it effective to decrease their visual difficulty by introducing non-optical aids such as writing-guide.
    In this article, I discuss the basic skills required by a neuro-ophthalmologist and an orthoptist for providing low vision care to patients with low vision by introducing various case studies.
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  • Masato Wakakura
    2017 Volume 34 Issue 1 Pages 25-32
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
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    The definitions of terms such as“low vision”and“visually handicapped person”are usually based on the visual acuity and visual field measured using visual function tests. Intractable diplopia and visual confusion are not included in this definition, even though they adversely affect the quality of life of patients and exacerbate their mental disorders. Serious photophobia, ocular pain, and blurred vision without any ocular conditions can be considered visual noise caused by higher brain dysfunction. I propose a hypothesis that visual noise represents defects in the commonly used neural circuit. These symptoms are seen in patients with essential blepharospasm, prolonged and delayed symptoms of head/neck injuries, sarin intoxication, psychotic diseases including panic disorder, and adverse effects of psycholytics.
    I hypothesize the existence of neural filters in the visual information-processing mechanism, similar to the thalamus functioning as a low-pass filter of sensory input, and that various visual noises are caused by the dysfunction of such filters. Neuro-ophthalmologists should aim to clarify the neural mechanism underlying the visual noise. I also emphasize the importance of raising social awareness regarding the visual disturbance caused by higher brain dysfunction, which is currently being ignored by insurance services and social welfare.
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  • Shuhei Yamaguchi
    2017 Volume 34 Issue 1 Pages 33-39
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
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    Visual information is processed in the brain from the primary visual cortex to the posterior association cortex, the latter being responsible for higher level processing. Visual-form and spatial information are separately processed through the ventral and dorsal pathways, respectively, in the posterior association cortex. Visual hemispatial agnosia is a symptom that is observed after injury to the right temporal-parietal cortex. Bilateral parietal lobe damage causes Bálint syndrome, which is characterized by simultanagnosia, psychic paralysis of gaze, and optic ataxia. On the other hand, damage to the ventral pathway results in visual agnosia, which is divided into three types depending on the processing level of visual information. Prosopagnosia is a special type of visual agnosia and appears after bilateral damage to the ventral mesial temporal lobe. Topographical disorientation can be of two types depending on the location of the lesion (on mesial parietal lobe or mesial occipito-temporal lobe). Various strategies including utilization of brain compensatory mechanism, reinforced learning of lost functions, and electrical/magnetic brain stimulation are now available for the treatment of these higher visual dysfunctions.
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  • Akio Tabuchi
    2017 Volume 34 Issue 1 Pages 40-45
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
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    The author was presented with The Outstanding Service in Prevention of Blindness Award at the 31st Asia-Pacific Academy of Ophthalmology annual congress, held in Taipei, Taiwan, in May 2016. The 17 award winners were recommended by their respective ophthalmological organizations.
    The author in this case was one of the key individuals who contributed to the establishment of the Japanese Society for Low-Vision Research and Rehabilitation in 2000 and served as its president for 10 years. He created an important role for the newly established ‘Medical Fee for Low-vision Care' in 2012 during the second presidency of Hiroshi Takahashi. These achievements were among the primary reasons for the recommendation.
    A historical review of low-vision care initiated by ophthalmologists from the Meiji era to 2000 was presented. In addition, the status of the low-vision clinic in the university hospital and the low-vision education in the university after 2000 were discussed. Low-vision care status in other Asian countries and certain overseas collaborations with Japanese ophthalmologists were also highlighted.
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Original Article
  • Noriko Onozato, Naoto Hara, Takahiro Niida, Asako Tagawa
    2017 Volume 34 Issue 1 Pages 46-53
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
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    We examined the retinal nerve fiber, ganglion cell, and inner plexiform layers in the nasal macular inner retinal layer thickness (including the papillomacular nerve fiber bundle) in patients with multiple sclerosis. The subjects included 13 individuals (26 eyes) with multiple sclerosis and 42 individuals (73 eyes) with normal eyes. Using spectral domain optical coherence tomography, we examined their history of optic neuritis, disease duration, age-related changes, and expanded disability status scale. Change in macular ganglion cell layer correlated with disease duration and retinal thinning, despite absence of history of optic neuritis (r = 0.63, p = 0.003). The multiple sclerosis group also demonstrated faster age-related retinal thinning than the normal group. The above results suggest that multiple sclerosis is associated with asymptomatic changes in the inner retina, demonstrating a pathology resembling neurodegeneration. In addition, the use of the immunosuppressant fingolimod, which prevents recurrence, may inhibit retinal thinning.
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Case Report
  • Takahiro Arai, Hiromasa Sawamura, Hirofumi Shoda, Kazuhiko Yamamoto, M ...
    2017 Volume 34 Issue 1 Pages 54-60
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
    JOURNAL RESTRICTED ACCESS
    We report a case of posterior ischemic optic neuropathy (PION) caused by giant cell arteritis (GCA) with concurrent advanced glaucoma in an 81-year-old man with a long-standing history (25 years) of advanced open angle glaucoma. On visual field test, the visual acuity of the left eye was noted to have decreased to light perception, but the patient did not complain of any visual defect. There was pupillary fibrin membrane formation, posterior synechia, and rubeosis iridis in the left eye. Relative afferent pupillary defect (RAPD) was not clearly observed, and the optic disc showed no change except the optic atrophy due to glaucoma. Blood examination revealed elevated inflammatory markers. Contrast-enhanced magnetic resonance imaging showed contrast-enhancement and edema in the wall of aorta, carotid artery and intracranial artery, suggesting GCA, which was definitively diagnosed via temporal artery biopsy. The patient was treated with steroid pulse therapy; there was no improvement in visual acuity of the left eye, while the right eye showed no deterioration. We concluded that ocular ischemia, caused by GCA, led to PION. On the basis of this report, we suggest that when a sudden deterioration of visual acuity is noted on examination, despite the lack of vision related symptoms, GCA-induced PION should be suspected, especially in individuals older than the age of 50.
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Case Report
  • Satoshi Yokota, Akiyasu Kanamori, Masahiro Fujimoto, Yuki Muraoka, Man ...
    2017 Volume 34 Issue 1 Pages 61-64
    Published: March 25, 2017
    Released on J-STAGE: March 31, 2017
    JOURNAL RESTRICTED ACCESS
    Purpose: To examine the acquisition status of the physical disability certificate for patients visiting the neuroophthalmology and strabismus/amblyopia services. Subjects: Patients who visited the neuroophthalmology or strabismus/amblyopia service at Kyoto University between September 2015 and June 2016 or the neuroophthalmology service at Kobe University between November 2016 and December 2016 were enrolled. Their clinical records were retrospectively reviewed for visual disturbances in order to determine whether they met the Japanese physical disability certification criteria. To study the factors associated with the failure to obtain a physical disability certificate, we used multivariate logistic regression models to evaluate factors such as visual acuity, visual field, sex, and age. Results: Among the patients who visited the services during the designated period, 56 had visual disturbance that met the physical disability certification criteria, but 23 (41.1%) of them did not obtain the certificate. The logistic regression analysis revealed that failure to meet the visual acuity criterion was the main risk factor for the failure to obtain the physical disability certificate (odds ratio, 4.59 [95% confidence interval, 1.15-21.44], P = 0.031). Conclusion: Ophthalmologists should pay attention to visual field defects as well as visual acuity when providing information regarding the physical disability certificate to eligible patients for commencing their low vision care.
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