このグループでは、①角膜・水晶体・眼内レンズ関連の光学機能・視機能研究、②近視進行抑制という２つを大きなテーマとしています。①に関しては、眼光学基礎データの解析結果を踏まえて、眼科治療におけるQuality of Visionの向上をはかり、ヒトが生活する上で理想の光学系を構築することを目標としています。②に関しては、臨床研究と基礎研究の両方を行うことで近視のメカニズムを解明し、近視進行を遅らせることにより将来的に強度近視による失明者数を減少させることを最終目標としています。研究成果をもとに診断検査機器やサージカルデバイスを改良することや、近視進行抑制効果のある機器の開発などもこのグループの重要な仕事です。

The group mainly focuses on two themes: One is on the research related to visual optics and functions of the cornea, lens, intraocular lens, and the other is on the control of progression of myopia. Regarding the first theme of the group, on the basis of the results of the basic optical analysis, we are trying to improve quality of vision, and aim to construct the ideal optical system for the human eye in daily activities. Regarding the second theme, we carry out clinical and basic research about myopia and our ultimate goal is to elucidate the etiology of myopia, retard myopia, and decrease the cases of blindness caused by high myopia in the future. Based on previous and current research results and experience, our focus is on the development of new diagnostic machines and therapeutic instrument for retardation of myopia, and the improvement of the surgical devices, such as intraocular lenses.

有水晶体眼内レンズ(pIOL)挿入術後の角膜・眼内・全眼球高次収差を、異なる解析径でArtisanとArtiflexで後方視的に比較し報告致しました。その結果、解析径4 mmと5 mmでは、眼内・全眼球の球面収差(Z40)はArtisan 群よりもArtiflex群の方が有意に小さい(4 mm, P=0.002, P=0.024; 5 mm, P=0.004, P=0.022)ことがわかりました（図４）。この違いはpIOL自体がもつ球面収差の違いに由来する可能性が高いことを報告しました (Torii H. et al. J Refract Surg. 2013) 。

We retrospectively evaluated surgically induced changes in corneal, internal, and ocular higher order aberrations after phakic intraocular lens (pIOL) implantation and compared them between two pIOLs (Artisan and Artiflex) with different pupillary diameters. With the 4- and 5-mm pupillary diameters, the postoperative internal and ocular spherical aberrations (SAs) (Z40) were significantly lower in the Artiflex group than in the Artisan group (4 mm, P=0.002, P=0.024; 5 mm, P=0.004, P=0.022, respectively) (Figure 4). The postoperative ocular SA was greater in the Artisan group possibly due to differences in the SAs of both pIOLs (Torii H. et al. J Refract Surg. 2013).

図1　ArtisanとArtiflex挿入術後の角膜・眼内・全眼球高次収差の比較。（解析径4 mm：図４A、5 mm：図4B）解析径4 mmと5 mmでは、眼内・全眼球の球面収差(Z40)はArtisan 群よりもArtiflex群の方が有意 (4 mm, P=0.002, P=0.024; 5 mm, P=0.004, P=0.022) に小さいことがわかる。

Figure 1　Evaluation of the corneal, internal, and ocular higher order aberrations after Artisan and Artiflex phakic intraocular lens implantation. (4-mm pupillary diameter; Figure 4A, 5-mm pupillary diameter; Figure 4B)
With the 4- and 5-mm pupillary diameters, the postoperative internal and ocular spherical aberrations (SAs) (Z40) were significantly lower in the Artiflex group than in the Artisan group (4 mm, P=0.002, P=0.024; 5 mm, P=0.004, P=0.022, respectively).

円錐角膜に対する角膜クロスリンキング後に遅発性角膜実質混濁の生じた３例について報告しました。角膜実質混濁は特に問題のなかった症例で、術後数か月で生じており、術後炎症と何らかの関連があることが推測されました（Kato N. et al. Cornea. 2013）。

We reported 3 cases with deep corneal stromal opacity that occurred several months after corneal crosslinking. Deep stromal opacity developed several months after uneventful corneal crosslinking. Postoperative inflammation may play a crucial role in its pathogenesis（Kato N. et al. Cornea. 2013）.

1. －6D以上の強度近視眼で、pIOL 挿入術かLaser in situ keratomileusis (LASIK)をうけて術後3年以上経過観察できた症例のうち、2群間で術前の眼軸長をマッチングさせた計133眼の術後3年間の近視の戻りを2群間で比較しました（図５）。術後3年間の近視の戻りは、pIOL群は-0.12 Dで、LASIK群は -0.82 Dで有意差を認めたことを報告しました(p<0.001) (Torii H. et al. Optom Vis Sci. 2014)。

A retrospective nonrandomized comparison of the rates of myopic regression 3 years after pIOL implantation and laser in situ keratomileusis (LASIK) after matching the preoperative axial length in highly myopic eyes of Japanese patients included 133 eyes with myopia exceeding -6.00 diopters (D) (Figure 5). The mean regression values after 3 years compared with the 1-month postoperative refractions were -0.12 D in the pIOL group and -0.82 D in the LASIK group (p<0.001) (Torii H. et al. Optom Vis Sci. 2014).

図2　等価球面値の経時的変化。LASIK群はpIOL群と比較して、術後3・6か月、術後1・2・3年において有意に(それぞれp = 0.008, p < 0.001, p < 0.001, p < 0.001, p < 0.001) 近視化していることがわかる。

Figure 2　Changes in the SE in all patients over time. The SE values in the LASIK group are significantly (p = 0.008, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively) more myopic than those of the pIOL group at 3 and 6 months and 1, 2, and 3 years after surgery.

2. Artisan挿入術後5年間の眼軸長の伸長程度を評価しました。Artisan挿入術後の屈折値の安定性は報告されているものの、眼軸長が伸び続けていることが確認でき、2013年国際近視学会で発表致しました(Torii H. et al. International Myopia Conference 2013)。

We evaluated the axial elongation for 5 years after implantation of an iris-fixated phakic intraocular lens (Artisan) in Japanese eyes. Axial elongation for 5 years was confirmed after Artisan implantation, although the long-term refractive stability of the Artisan pIOL has been reported (Torii H. et al. International Myopia Conference 2013).

3. 軸外収差抑制眼鏡（近視進行予防メガネ）の多施設共同単焦点レンズ対照二重盲検無作為化並行群試験の前向き多施設共同研究（旭川医科大学、大阪大学、岡山大学、京都府立医科大学、慶應義塾大学、筑波大学、東京医科歯科大学の7施設）が現在進行中です（鳥居ら）。

We conducted a prospective study in normal children to investigate the physiological role of lower- and higher-order aberrations in myopia progression (Yamaguchi T, at Tokyo Dental College). We are now investigating by a prospective multicenter, double blind clinical trial that compares the spectacle lenses to reduce peripheral hyperopic defocus and conventional single-vision spectacle lenses at 7 universities in Japan (Asahikawa, Osaka, Okayama, Kyoto Prefectural, Keio, Tsukuba, and Tokyo Medical and Dental University). (Torii H, et al.)

LASIKを施行した眼に、その後白内障手術を行う際には、挿入する眼内レンズ度数の予測精度が悪くなることが知られています。我々は、LASIK術前後において、角膜周辺部および角膜後面の形状はいずれも変化がないことに着目し、LASIK術後の角膜周辺部および角膜後面の屈折値から、LASIK術前の角膜屈折値を予測する回帰式をそれぞれ導き出し、それを応用した新しい眼内レンズ度数計算式を考案いたしました（Saiki M, et al. Acta Ophthalmol. 2013, Saiki M, et al. J Cataract Refract Surg. 2013）。また、広く臨床応用できるよう、後者の方法のソフトウェアを開発し、前眼部解析装置ペンタカム（Oculus社）に搭載され、現在では世界中で使えるようになっております。

Intraocular lens (IOL) power calculations in eyes that underwent previous corneal refractive surgeries tend to be inaccurate. We a new IOL power calculation formula applying the concept which peripheral and posterior corneal curvature does not change by LASIK, in which we could estimate corneal curvature before LASIK from that after LASIK using regression formula obtained from other patients. (Saiki M, et al. Acta Ophthalmol. 2013, Saiki M, et al. J Cataract Refract Surg. 2013). We develop computer software to use second method using postoperative posterior corneal curvature with a wide clinical application. This software is installed to Pentacam Scheimpflug anterior segment imaging system (Oculus) and widely used around the world.

1day ACUVUE®ソフトコンタクトレンズ (clear type) と1day ACUVUE® Difine™ カラーソフトコンタクトレンズ (tinted type) 装用後の高次収差（φ= 6mm, 4次まで）を比較した結果、瞳孔径6mm の条件下にて、カラーコンタクトレンズ装用群の方が有意に3次と全高次収差が高値を示すことを報告しました。

We investigated the high order aberrations (HOAs) in relation to 1-day ACUVUE®(Vistakon, Jacksonville, FL) clear contact lens and 1-day ACUVUE® Difine ™(Vistakon, Jacksonville, FL) tinted contact lens. We reported that 3rd-order aberrations and total HOAs values of tinted clear contact lens calculated for a 6 mm pupil size showed significantly greater than that of clear contact lens. （Watanabe K, Kaido M, et al. Cont Lens Anterior Eye. 2014）

英文論文 Original Article

1. Ayaki M, Hattori A, Maruyama Y, Nakano M, Yoshimura M, Kitazawa M, Negishi K, Tsubota K. Protective effect of blue-light shield eyewear for adults against light pollution from self-luminous devices used at night. Chronobiol Int. 2016 Jan;33(1):134-9.

2. Negishi K, Masui S, Mimura M, Fujita Y, Tsubota K. Relationship between Functional Visual Acuity and Useful Field of View in Elderly Drivers. PLoS One. 2016 Jan 25;11(1):e0147516.

3. Ayaki M, Toda I, Tachi N, Negishi K, Tsubota K. Preliminary report of improved sleep quality in patients with dry eye disease after initiation of topical therapy. Neuropsychiatr Dis Treat. 2016 Feb;16;12:329-37.

4. Ayaki M, Kawashima M, Kishimoto T, Mimura M, Negishi K, Tsubota K. Sleep and mood disorders in dry eye disease and allied irritating ocular diseases. Sci Rep. 2016 Mar 1;6:22480.

5. Yotsukura E, Torii H, Saiki M, Negishi K, Tsubota K. Effect of neodymium:YAG laser capsulotomy on visual function in patients with posterior capsule opacification and good visual acuity. J Cataract Refract Surg. 2016 Mar;42(3):399-404.

6. Katada Y, Negishi K, Watanabe K, Shigeno Y, Saiki M, Torii H, Kaido M, Tsubota K. Functional visual acuity of early presbyopia. PLoS ONE. 2016 Mar 9; 11(3): e0151094.

7. Yaguchi Y, Yaguchi S, Yaguchi S, Kozawa T, Tanaka Y, Negishi N, Tsubota K. Objective Evaluation of Zonular Weakness: Measurement of Lens Movement at the Start of Capsulorhexis Using Extracted Porcine Eyes.  J Clin Exp Ophthalmol. 2016, 7: 541.

8. Hidaka Y, Yamaguchi T, Saiki M, Dogru M, Tsubota K, Negishi K. Changes in corneal aberrations after cataract surgery. Jpn J Ophthalmol. 2016 May;60(3):135-41.

9. Ayaki M, Shiba D, Negishi K, Tsubota K. Depressed visual field and mood are associated with sleep disorder in glaucoma patients. Sci Rep. 2016 May 11;6:25699.

10. Onishi H, Torii H, Watanabe K, Tsubota K, Negishi K. Comparison of clinical outcomes among 3 marking methods for toric intraocular lens implantation. Jpn J Ophthalmol. 2016 May;60(3):142-9.

11. Yaguchi Y, Negishi K, Saiki M, Torii H, Tsubota K. Comparison of the accuracy of intraocular lens power calculations for cataract surgery in eyes after phototherapeutic keratectomy. Jpn J Ophthalmol. 2016 Sep;60(5):365-72.

12. Tounaka-Fujii K, Yuki K, Negishi K, Toda I, Abe T, Kouyama K, Tsubota K. Effects of laser in situ keratomileusis on mental health-related quality of life. Clin Ophthalmol. 2016 Sep 26;10:1859-1864.

13. Ayaki M, Torii H, Negishi, K, Tsubota K. Decreased sleep quality in high myopia children.　Sci Rep. 2016 Sep;21;6:33902.

14. Yotsukura E, Torii H, Saiki M, Negishi K, Tsubota K. Reply. J Cataract Refract Surg. 2016 Sep;42(9):1392-1393..

15. Ayaki M, Kawashima M, Negishi K, Kishimoto T, Mimura M, Tsubota K. Sleep and mood disorders in women with dry eye disease. Sci Rep. 2016 Oct;12;6:35276.