The aim of the present study was to evaluate sleep quality in myopic children and adults. This cross sectional study surveyed 486 participants aged from 10 to 59 years with refractive errors using a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). Children (< 20 years) in the high myopia group exhibited the poorest PSQI scores (P < 0.01), while the adults showed no such correlations. Subscales of PSQI and HADS in children disclosed that the high myopia groups had the shortest sleep duration (P < 0.01), worst subjective sleep scores (P < 0.001), and latest bedtime (P < 0.05). Regression analyses in children significantly correlated myopic errors with PSQI (P < 0.05), sleep duration (P < 0.01), and bedtime (P < 0.01). Sleep efficacy (P < 0.05) and daytime dysfunction (P < 0.05) were significantly better in contact-lens users compared to the respective non-user groups across all participants. In conclusion, sleep quality in children was significantly correlated with myopic error, with the high myopia group worst affected.

PurposeWe aimed to explore the prevalence of probable sleep and mood disorders in eye clinic visitors.MethodsThis was a cross-sectional study. The participants were outpatients at six eye clinics from January through March, 2014. Outpatients were invited to complete a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). A final diagnosis was made, and patients were classified into six diagnostic groups. The main outcome measures were the scores of the PSQI and HADS among the diagnostic groups.ResultsA total 1,000 outpatients participated, and 730 patients (mean age 59.5±19.0 years; 487 females) were analyzed after exclusion of children and patients diagnosed with healthy eyes, acute injury, or unilateral pseudophakia. The mean PSQI and HADS scores across all patients were 5.3±3.1 and 9.2±6.2, respectively. For the diagnostic groups, the mean PSQI and HADS scores, respectively, were 5.7±3.3 and 10.2±6.0 for dry eye (n=247), 5.4±3.2 and 9.2±5.7 for bilateral cataracts (n=159), 5.3±3.3 and 8.0±5.3 for bilateral pseudophakia (n=99), and, 5.0±3.1 and 9.8±6.6 for glaucoma (n=109). Overall, 37.3% of patients were poor sleepers (PSQI ≥6), and 45.5% had possible mood disorders (HADS ≥10). Stepwise regression analysis revealed that the PSQI and HADS scores were significantly correlated with both age (P<0.05) and the presence of dry eye (P<0.05).ConclusionThe prevalence of sleep and mood disorders was significantly higher in patients with dry eye. The present results suggest consultation-liaison psychiatry services may be beneficial among eye disease patients.

Age-related cataracts are a leading cause of blindness. Previously, we have demonstrated the association of unfolded protein response with various cataractogenic stressors. However, DNA methylation alterations leading to suppression of lenticular antioxidant protection remains unclear. Here, we report the methylglyoxal-mediated sequential events responsible for Keap1 promoter DNA demethylation in human lens epithelial cells, because Keap1 is a negative regulatory protein that regulates the Nrf2 antioxidant protein. Methylglyoxal induces the ER stress and activates the unfolded protein response leading to overproduction of ROS prior to human lens epithelial cells death. Methylglyoxal also suppresses the Nrf2 and DNA methyltransferases but activates the DNA demethylation pathway enzyme, TET1. Bisulfite genomic DNA sequencing confirms the methylglyoxal-mediated Keap1 promoter DNA demethylation leading to over-expression of Keap1 mRNA and protein. Similarly, bisulfite genomic DNA sequencing of human clear lenses (n=15) slowly lose 5-methylcytosine in the Keap1 promoter throughout life, at a rate of 1% per year. By contrast, diabetic cataractous lenses (n=21) lose an average of 90% of the 5-methylcytosine regardless of the age. Over-expressed Keap1 protein is responsible for decreasing the Nrf2 by proteasomal degradation, thereby suppressing the Nrf2 dependent stress protection. This study demonstrates for the first time about the associations of unfolded protein response activation, Nrf2 dependent antioxidant system failure and loss of Keap1 promoter methylation because of altered active and passive DNA demethylation pathway enzymes in human lens epithelial cells by methylglyoxal. As an outcome, cellular redox balance is altered towards lens oxidation and cataract formation.

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The aim of the present study was to evaluate sleep and mood disorders in patients with irritating ocular diseases. The study design was a cross-sectional/case-control study conducted in six eye clinics. Out of 715 outpatients diagnosed with irritating ocular surface diseases and initially enrolled, 301 patients with dry eye disease (DED) and 202 age-matched control participants with other ocular surface diseases were analyzed. The mean Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) scores were 6.4 ± 3.2 and 11.1 ± 5.7 for severe DED (n = 146), 5.5 ± 3.3 and 9.8 ± 4.0 for mild DED (n = 155), 5.5 ± 3.1 and 9.5 ± 6.6 for chronic conjunctivitis (n = 124), and 5.0 ± 3.3 and 8.9 ± 5.3 for allergic conjunctivitis (n = 78). There were significant differences among these diagnostic groups for PSQI (P < 0.05). Regression analysis of patients with DED revealed the PSQI and HADS scores were significantly correlated with the severity of DED (P < 0.05). Our results demonstrate that sleep quality in patients with DED is significantly worse than in patients with other irritating ocular surface diseases and it is correlated with the severity of DED.

We investigated sleep quality and melatonin in 12 adults who wore blue-light shield or control eyewear 2 hours before sleep while using a self-luminous portable device, and assessed visual quality for the two eyewear types. Overnight melatonin secretion was significantly higher after using the blue-light shield (P < 0.05) than with the control eyewear. Sleep efficacy and sleep latency were significantly superior for wearers of the blue-light shield (P < 0.05 for both), and this group reported greater sleepiness during portable device use compared to those using the control eyewear. Participants rated the blue-light shield as providing acceptable visual quality.

The cytotoxicity of ophthalmic solutions to HCEC, corneal epithelia and conjunctival epithelia decreased in the absence of preservative.

Aim-To evaluate outcome of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens material. Methods-Clinical records associated with consecutive 8536 phacoemulsification procedures were reviewed retrospectively. Results-17 (0.20%) eyes had a posterior capsule rupture with retained lens material in the vitreous cavity that required vitrectomy. Final visual acuity was 0.5 or better in 14 eyes (82%) and 0.4 to 0.1 in three eyes (18%). Retinal detachment occurred in one eye during vitrectomy and two after the surgery. Cystoid macular oedema was observed in two eyes and none developed glaucoma. The corneal endothelial cell loss was 5.7% (SD 6.8 %) (n=15) at 3-6 months postoperatively. Conclusions-Combined vitrectomy and intraocular lens implantation at the time of phacoemulsification complicated by intravitreal lens material is an option to be considered to reduce the risk of postoperative complications including secondary glaucoma and corneal endothelial cell damage. (Br J Ophthalmol 2001;85:1038-1040 Dislocation of crystalline lens fragments into the vitreous cavity is an uncommon but potentially serious complication of cataract surgery. It can lead to marked intraocular inflammation resulting in cystoid macular oedema, vitreous opacification, glaucoma, and retinal detachment. [1][2][3][4][5][6] For the purpose of reducing the further ocular damage, since 1992 we have routinely converted to three port vitrectomy in such case.The first purpose of present study was to estimate the incidence of complicated phacoemulsification and aspiration (PEA) which needed vitrectomy to remove lens fragments in the vitreous; secondly, to evaluate intraoperative and postoperative complications and visual outcome after the procedure. Patients and methodsWe retrospectively reviewed the operative records of consecutive patients who underwent PEA from 1 June 1992 to 31 December 1999 at University of Showa, Fujigaoka Hospital, using computerised electronic databases. A total of 8536 PEA procedures were performed during the study period and 17 (0.20%) were combined with vitrectomy for removal of lens material. All eyes had a large fragment of lens material in the vitreous cavity at least one third the size of the nucleus. A total of 7295 surgeries were performed by 11 senior surgeons who were very experienced in vitrectomy. Others were by 21 ophthalmological trainees. Surgical procedures of vitrectomy included three port pars plana vitrectomy, three port pars plana vitrectomy with phacofragmentation, or three port limbal based vitrectomy. In the case of trainee operators, vitrectomy was performed by the senior surgeon who was to be available any time in the operating theatre.The imaging of the corneal endothelium was used for detailed evaluation of surgical intervention. The images were recorded with a specular microscope (SP-8000, Konan Co, Hyogo, Japan), and the density of endothelial cells was analysed both before and 3-6 months after the operation. We compared the results of the study group wi...