Publications by authors named "Mehdi Khabazkhoob"

246 Publications

Evaluating Reading Performance in Different Preferred Retinal Loci in Persian-Speaking Patients with Age-Related Macular Degeneration.

J Curr Ophthalmol 2021 Jan-Mar;33(1):48-55. Epub 2021 Mar 26.

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate reading performance in different preferred retinal loci (PRLs) using a Persian version of a Minnesota Low Vision Reading (MNREAD) chart in Persian-speaking patients with age-related macular degeneration (AMD).

Methods: In this cross-sectional study, 35 patients with AMD were assessed. The reading performance was investigated by the MNREAD chart without using low vision aids. The location of PRL was determined monocularly using an MP1 microperimeter (Nidek Technologies, Padua, Italy). The anatomical location of the fovea was determined using optical coherence tomography (OCT). Images were taken with the MP1 microperimeter, and Spectralis HRA-OCT device was processed using graphic software to determine the location of the PRL on the retina.

Results: Thirty-five patients (51 eyes) with a mean age of 73.8 ± 7.7 years (range, 54-88 years) were assessed. Mean best corrected distance visual acuity (logMAR) was 0.65 ± 0.35 (range, 0.2-1.3). Mean levels of reading acuity (RA) ( = 0.009) and critical print size (CPS) ( = 0.015) were significantly different in different locations of PRL. Average scores of maximum reading speed (MRS) ( = 0.058) and reading accessibility index (ACC) ( = 0.058) were not statistically significant in different locations of PRL. There was a positive correlation between PRL-fovea distance and RA ( < 0.001, = 0.591) and CPS ( < 0.001, = 0.614). Significant negative correlations were observed between PRL-fovea distance and MRS ( < 0.001, = -0.519) and ACC ( < 0.001, = -0.545).

Conclusions: This study provides evidence for differences in the reading performance of Persian-speaking patients with AMD in different PRL locations. The average scores of all reading indices obtained in the right-field PRL are lower than those in other areas and are highly correlated with the PRL-fovea distance.
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http://dx.doi.org/10.4103/JOCO.JOCO_192_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102939PMC
March 2021

The Distribution of Keratometry in a Population Based Study.

J Curr Ophthalmol 2021 Jan-Mar;33(1):17-22. Epub 2021 Mar 26.

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To determine the distribution of keratometry values in a wide age range of 6-90 years.

Methods: In this cross-sectional study, samples were selected from two villages in Iran using multi-stage random cluster sampling. After completing optometry and ophthalmic examinations for all cases, corneal imaging was done using Pentacam, and keratometry values were determined.

Results: Of the 3851 selected people, 3314 people participated in the study, and after applying the exclusion criteria, analyses were done on data from 2672 people. Mean age of the participants was 36.30 ± 18.51 years (from 6 to 90 years). Mean keratometry (mean-K) in flat and steep meridians was 42.98 (42.9-43.06) diopters (D) and 43.98 (43.91-44.07) D, respectively. Average of mean-K was 43.48 (43.41-43.56) D. Mean-K increased linearly up to the age of 70 years, and the cornea became slightly flat afterwards (coefficient = 0.01; < 0.001). Mean-K was significantly higher in females ( < 0.001). Myopic cases had the highest mean-K ( < 0.001). The correlation of mean-K with age, gender, central corneal thickness, anterior chamber depth, pupil diameter, and spherical equivalent was investigated in a multiple regression model. Only older age and female gender showed a statistically significant association with mean-K. Overall, 31.62% (29.14-34.09) of the sample in this study had at least 1.0 D of corneal astigmatism.

Conclusions: This is one of the few studies worldwide that demonstrates changes in keratometry in a wide age range from childhood to old age. Results indicated that age and gender are variables associated with keratometry.
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http://dx.doi.org/10.1016/j.joco.2019.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102948PMC
March 2021

Agreement of Fixation Disparity Curve between Two Different Instruments.

Optom Vis Sci 2021 Jun;98(6):629-635

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Significance: Fixation disparity tests with various characteristics of fusional stimulus are very important for assessment of decompensated heterophoria. The results suggest that there was no reasonable agreement between the fixation disparity curve's parameters of the modified near Mallett unit and the Sheedy disparometer.

Purpose: The purpose of this study was to determine the agreement of the fixation disparity curve parameters between the modified near Mallett unit and the Sheedy disparometer in patients with decompensated near heterophoria.

Methods: A total of 147 young adults (mean age, 22.7 ± 4.8 years) participated in this cross-sectional study. After applying the exclusion criteria, the statistical analysis was done on the data of 134 individuals. All participants underwent preliminary optometric examinations including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, and unilateral and alternating cover tests. The fixation disparity was evaluated using the modified near Mallett unit and the Sheedy disparometer at 40 cm, and forced-vergence fixation disparity curves were generated.

Results: There were statistically significant differences in the fixation disparity curve parameters (except the center of symmetry) between the two devices. The median fixation disparity measured by the Sheedy disparometer was more positive compared with the modified near Mallett unit (toward more esodisparity or less exodisparity). The median associated phoria measured by the Sheedy disparometer was more positive compared with the Mallett unit. Also, the slope of the curve obtained by the Mallett unit was steeper. The wide limits of agreement indicated the poor agreement of all fixation disparity curve parameters between the two instruments.
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http://dx.doi.org/10.1097/OPX.0000000000001708DOI Listing
June 2021

Convergence Insufficiency in the Geriatric Population.

Optom Vis Sci 2021 Jun;98(6):613-619

Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Significance: The present study is the first population-based study to examine the prevalence of convergence insufficiency and its associations specifically in the geriatric population. Knowledge of the population-based determination of prevalence of this disorder in the elderly is necessary to support proper clinical diagnosis and management.

Purpose: This study aimed to determine the prevalence of convergence insufficiency and its associated factors in a geriatric population.

Methods: In this study, all residents older than 60 years in Tehran city were selected through random stratified cluster sampling. All participants underwent a complete ocular examination including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, binocular vision assessments including unilateral and alternating cover tests, measurement of the near point of convergence, the positive fusional vergence, and finally ocular health examination.

Results: In this population-based sample of 1793 participants, the overall prevalences of two-sign and three-sign convergence insufficiency were 29.6% (95% confidence interval, 27.2 to 32.0%) and 21.5% (95% confidence interval, 19.5 to 23.6%), respectively. There were no statistically significant differences in the prevalence of both two-sign (P = .19) and three-sign (P = .41) convergence insufficiency between men and women. The highest and lowest prevalences of two-sign and three-sign convergence insufficiency were in the age groups 70 to 74 and 75 to 79 years, respectively. The prevalence showed no significant trend with age (P = .26 for two-sign convergence insufficiency, P = .33 for three-sign convergence insufficiency). In the multiple logistic regression model, none of the variables, including age, sex, and refractive errors, showed a significant relationship with convergence insufficiency (all, P > .05).

Conclusions: The results of the present study showed a high prevalence of convergence insufficiency in the geriatric population. Clinicians should give special attention to this binocular vision disorder in this age group.
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http://dx.doi.org/10.1097/OPX.0000000000001709DOI Listing
June 2021

Distribution of near Point of Convergence, near Point of Accommodation, Accommodative Facility and Refractive Errors in a Rural Population Living in Northern Iran.

J Binocul Vis Ocul Motil 2021 May 25:1-6. Epub 2021 May 25.

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: To evaluate near point of convergence (NPC), near point of accommodation (NPA), and accommodative facility (AF) in order to determine their normative data in a rural population.: The target population for this population-based, cross-sectional study was people living in rural areas. Each subject underwent extensive optometric and ophthalmic examinations, including the measurement of visual acuity, refraction, NPA, NPC, and AF.: The data of 1113 individuals was analyzed of whom 58.8% (n = 576) were women. The mean age of the participants was 15.26 ± 7.38 years (range: 6-30 years). The mean spherical equivalent of the subjects was 0.16 ± 0.63 D. The prevalence of myopia, hyperopia and astigmatism was 16.28% (13.97-18.58), 5.97% (4.49-7.44), 11.93% (9.91-13.95) in this study, respectively The mean and 95% confidence interval of NPC, NPA, and binocular accommodative facility (BAF) was 6.99 cm (6.84-7.15), 9.91 cm (9.71-10.11), and 9.84 cpm (9.63-10.06), respectively. A significant correlation was found between age and the parameters such that all evaluated parameters worsened significantly with age ( < .001).: The results of the present study showed the normal ranges of NPA, NPC, and BAF in a 6-30 year-old population living in rural areas of northern Iran. These parameters changed significantly with age.
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http://dx.doi.org/10.1080/2576117X.2021.1927291DOI Listing
May 2021

Binocular vision disorders in a geriatric population.

Clin Exp Optom 2021 May 20:1-7. Epub 2021 May 20.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

A population-based epidemiological survey is important to help establish the frequency of binocular vision disorders in a geriatric population. Such data will be useful to clinicians and help guide diagnostic testing for this age group. To determine the prevalence of binocular vision disorders and their associations with age and sex in the geriatric population. This report is a part of the Tehran Geriatric Eye study (TGES); a population-based cross-sectional study conducted on residents over 60 years of age in Tehran, Iran, using random stratified cluster sampling. A total of 165 clusters were selected (proportionally to size) from 22 strata of Tehran city. All participants underwent a complete ocular examination including the measurement of visual acuity, refraction, unilateral and alternating cover tests, and the Worth 4-dot suppression test. Strabismus was defined as the presence of constant unilateral or alternating esotropia or exotropia at either near (40 cm) or far (6 m). Distance and near exophoria were defined as more than 3 and 9 of exophoria at 6 m and 40 cm, respectively. Distance and near esophoria were defined as more than 1 and any amount of esophoria at 6 m and 40 cm, respectively. Statistical analysis was performed on the data of 2,227 participants. The mean age of the participants was 66.6 ± 5.4 years and 59.4% were female. The prevalence of distance exophoria, esophoria, and hyperphoria was 8.9%, 0.34%, and 0.29%, respectively. The prevalence of near exophoria, esophoria, and hyperphoria was 32.4%, 0.61%, and 0.37%, respectively. The prevalence of distance exotropia and esotropia was 1.3% and 0.63%, respectively. The prevalence of near exotropia and esotropia was 4.6% and 0.59%, respectively. Non-strabismic binocular vision disorders were prevalent in an elderly population. Exo deviations were more prevalent than eso deviations.
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http://dx.doi.org/10.1080/08164622.2021.1922065DOI Listing
May 2021

Corneal asphericity and related factors in the geriatric population: A population-based study.

Ophthalmic Physiol Opt 2021 Jul 17;41(4):691-701. Epub 2021 May 17.

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To determine the distribution of the corneal asphericity coefficient (Q value) and related factors in an Iranian geriatric population.

Methods: This population-based study was conducted in 2019 in Tehran, using stratified multistage random cluster sampling. The study population was ≥60 years of age. Participants underwent corneal imaging using a Pentacam HR. Mean keratometry, corneal astigmatism, central corneal thickness, anterior chamber depth and the overall anterior and posterior Q values (for 8 mm chord diameter) were recorded. Axial length measurements were performed using the IOL Master 500.

Results: 2457 eyes of 2457 individuals were analysed. The mean age was 67.3 ± 5.82 years and 1479 (60.2%) were female. The mean Q value for the anterior corneal surface was -0.35 ± 0.17 (95% CI: -0.35 to -0.34). The anterior Q value showed a statistically significant inverse relationship with axial length and mean keratometry, and a significant direct association with anterior chamber depth and corneal astigmatism. The mean posterior Q value was -0.41 ± 0.15 (95% CI: -0.42 to -0.40). The posterior Q value had a significant direct relationship with age, anterior chamber depth, mean keratometry and corneal astigmatism.

Conclusion: The corneal Q values in this geriatric Iranian population were more negative than the values reported in most previous studies. Corneal asphericity was greater affected by ocular biometry and corneal curvature than demographic factors and refractive status.
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http://dx.doi.org/10.1111/opo.12831DOI Listing
July 2021

Prevalence of Uncorrected Refractive Error and Its Risk Factors; Tehran Geriatric Eye Study (TGES).

Ophthalmic Epidemiol 2021 Apr 29:1-7. Epub 2021 Apr 29.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: To determine the age-sex-standardized prevalence of uncorrected refractive error and its determinants This population-based cross-sectional study was conducted on 3310 people aged≥ 60 years in Tehran, Iran in 2019. Need for spectacles was defined as uncorrected visual acuity worse than 20/40 in better eye that could be corrected to more than 20/40 with suitable spectacles. Met need was defined as proportion of individuals with need for spectacles whose visual acuity was 20/40 or better with current spectacles. Unmet need was defined as proportion of individuals with need for spectacles who needed but did not have spectacles or their visual acuity was worse than 20/40 with current spectacles while suitable spectacles improved their visual acuity to 20/40 or better. The age-sex-standardized prevalence of need for spectacles, met need, and unmet need was 16.67% (95% CI: 15.33-18.09), 7.81% (95% CI: 6.95-8.78), and 8.85% (95% CI: 7.77-10.07), respectively. Myopic subjects had the highest prevalence of need for spectacles (24.06%, 95% CI: 21.47-26.87). The odds ratio of met and unmet need in subjects≥ 80 years versus those aged 60-65 years was 0.36 (-value: 0.009) and 2.34 (-value: <0.001), respectively. The odds ratio of met and unmet need in subjects with a university education versus illiterate subjects was 1.72 (-value: 0.045) and 0.42 (-value: 0.007), respectively. The prevalence of uncorrected refractive error was lower in this study compared to previous studies. The met need rate was lower in subjects with older age and lower education levels.
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http://dx.doi.org/10.1080/09286586.2021.1919311DOI Listing
April 2021

To compare on-axis measurements of the axial length with off-axis measurements in the paracentral horizontal and vertical positions.

Semin Ophthalmol 2021 Apr 4:1-4. Epub 2021 Apr 4.

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: To compare on-axis measurements of the axial length (AL) with off-axis measurements in the paracentral horizontal and vertical positions using the Lenstar LS 900 biometer.: In this, the samples were selected from patients scheduled for cataract surgery using a systematic randomization method. After applying the exclusion criteria, all subjects underwent optometric examinations and AL measurement using the Lenstar. Five consecutive, non-cycloplegic measurements were done on the right eye centrally, 10° temporally, 10° nasally, 10° superiorly and 10° inferiorly on the retina by the same examiner.: Two hundred and seven eyes were examined in this study, of which 126 (60%) were for female patients. The mean age of the participants was 64.32 ± 10.77 years (range: 34-91 years). The mean central, superior, inferior, temporal, and nasal axial AL was 23.22 ± 1.02, 23.21 ± 1.02, 23.21 ± 1.02, 23.21 ± 1.02, 23.20 ± 1.03, respectively. Comparison of these readings using repeated measures ANOVA showed a statistically significant difference in the AL value among these positions. According to the post-hoc results, superior and nasal AL was statistically significantly lower compared to the central AL.: If on-axis biometry is not available, AL can be measured in an off-axis manner in the paracentral temporal, superior and inferior positions. Considering the marked difference in AL measurement between central and nasal positions, off-axis measurement is not recommended in the nasal part because it may be associated with a marked hyperopic shift after cataract surgery.
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http://dx.doi.org/10.1080/08820538.2021.1910318DOI Listing
April 2021

Meibomian gland dysfunction in geriatric population: tehran geriatric eye study.

Int Ophthalmol 2021 Mar 24. Epub 2021 Mar 24.

Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To determine the prevalence of Meibomian gland dysfunction (MGD) and its risk factors in an elderly Iranian population METHODS: This cross-sectional study was conducted in 2019. The target population was the subjects aged 60 and over living in Tehran. Multistage cluster sampling was done to select the subjects from all Tehran districts. After an initial interview, all subjects underwent complete ophthalmic examinations including the measurement of visual acuity and refraction as well as slit lamp biomicroscopy to evaluate Meibomian glands.

Results: Of 3791 selected subjects, 3310 participated in the study. The data of 3284 participants were analyzed. The mean age of the subjects was 68.24 ± 6.53 years (range: 60-97 years) and 57.8% of them were female. The total prevalence of MGD was 71.2% (68.3-74.1), and 38.1% (8.35-40.4), 30.3% (27.4-33.2), and 2.8% (2-3.6) of the subjects had MGD stage 2, 3, and 4, respectively. The prevalence of MGD was significantly higher in men (p < 0.001) and increased with age from 64.4% in the age group 60-64 years to 82.4% in subjects aged 80 years and over. There was no significant difference in the prevalence of MGD between smokers and nonsmokers; however, severe MGD was more common in smokers. The prevalence of MGD was 76.3% and 68.52% in subjects with and without a history of ocular surgery, respectively. The prevalence of MGD stage 3 and 4 was higher in subjects with a history of ocular surgery.

Conclusions: In line with the results of other studies in Asian countries, this study found a high prevalence of MGD in an elderly population of Iran. It was found that male gender and advanced age were risk factors of MGD and smoking and history of ocular surgery might worsen this disease in MGD patients.
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http://dx.doi.org/10.1007/s10792-021-01812-2DOI Listing
March 2021

Evaluation of the presence of a central fusion lock effect on fixation disparity curve parameters in symptomatic and asymptomatic subjects.

Clin Exp Optom 2021 Mar 22:1-8. Epub 2021 Mar 22.

Department of Medical Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: Several parameters are likely to affect the magnitude of fixation disparity (FD) and FD curve characteristics. Presence of a central fusion lock may have an important effect on clinical testing of FD and interpretation of its results.: The aim of this study was to evaluate FD curve parameters using the modified near Mallett unit (with a central fusion lock) and the Sheedy disparometer (without a central fusion lock) in symptomatic and asymptomatic subjects.: This cross-sectional study was conducted in 147 patients with a mean age of 22.5 years who presented to the optometry clinic of Paramedical College of Mashhad University of Medical Sciences. The symptoms were recorded in a questionnaire for each patient. FD was measured using the modified near Mallett unit and Sheedy disparometer and FD curves were generated using the AutoCAD 2005 software.: There was a significant difference in the FD, associated phoria, and slope measurements between the two devices (all p values < 0.05). Significant difference was found in the mean FD between symptomatic and asymptomatic subjects using the modified near Mallett unit (p < 0.0001) and Sheey disparometer (p = 0.007). In symptomatic subjects, the mean slope was steeper for the modified near Mallett unit compared to the Sheedy disparometer (p = 0.001). Although the mean centre of symmetry was more negative in the modified near Mallett unit versus the Sheedy disparometer, the difference between the instruments was not significant in symptomatic (p = 0.477) and asymptomatic (p = 0.257) participants.: There are differences in the FD curve parameters between the modified near Mallett unit and Sheedy disparometer. Slope is a proper criterion for differentiating asymptomatic subjects from symptomatic individuals. The modified near Mallett unit is a more precise tool for assessment of non-compensated heterophoria compared to the Sheedy disparometer.
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http://dx.doi.org/10.1080/08164622.2021.1878844DOI Listing
March 2021

Predictor factors of prism effectiveness in young adults with convergence insufficiency.

Clin Exp Optom 2021 Feb 27:1-6. Epub 2021 Feb 27.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: The findings of this study can be useful in the process of patient selection as well as in optimising the prescription of the prism in patients with convergence insufficiency.: To determine the relationship between the demographic variables and baseline clinical characteristics with the prism effectiveness in young adults with convergence insufficiency.: Sixty-four young adults with convergence insufficiency entered a randomised clinical trial and were randomly assigned to either treatment or placebo groups. For participants in the treatment group, the near optical correction containing base-in prism was determined based on the Sheard's criterion. Participants in the placebo group received near optical correction. After three months of using the assigned correction, the outcome examinations were performed.: In the univariate analysis, a remote near point of convergence, a higher baseline symptoms score, and a higher prescribed prism power showed a significant relationship with the increase in prism effectiveness. A significant inverse relationship was found between the near positive fusional vergence, vergence facility, and prism adaptation rate with the prism effectiveness. Based on the results of the multiple regression, the prism adaptation rate was the only independent predictor factor of prism effectiveness, so that the prism effectiveness increased by 0.60 for each per cent reduction in prism adaptation rate.: Prism adaptation is the only independent predictive factor of prism effectiveness in young adults with convergence insufficiency. Based on the findings of the present study, it is recommended that careful assessment of prism adaptation be considered before considering prism prescription.
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http://dx.doi.org/10.1080/08164622.2021.1878828DOI Listing
February 2021

Distribution of Eccentricity in Children Aged 6-12 Years.

Semin Ophthalmol 2021 Mar 9:1-5. Epub 2021 Mar 9.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To determine the distribution of eccentricity and its association with some biometric and demographic parameters.

Methods: In this cross-sectional study, the target population was primary school children aged 6 to 12 years from Shahroud, northeast Iran. Scheimpflug imaging was done using the Pentacam. Multiple linear regression analysis was applied to study the association between Eccentricity (ECC) and independent variables like age, sex, living place as well as biometric parameters.

Results: Of the 6624 selected students, 5620 participated in the study of whom 4968 were eligible for analysis in this study. About half (52.4%) of the students were boys. The mean ECC was 0.600 (95% CI: 0.597-0.602) in total, 0.597 (95% CI: 0.594-0.600) in boys and 0.603 (95% CI: 0.599-0.607) in girls. The mean ECC was 0.611 in 6-year-old and 0.588 in 12-year-old children. The mean ECC was 0.590 in rural and 0.601 in urban children. The mean ECC was 0.600, 0.604, and 0.604 in emmetropic, myopic, and hyperopic children, respectively. Multiple linear regression analysis showed that ECC decreased with age (Coefficient: -0.004; 95%CI: -0.006 to -0.003), was higher in urban areas (Coefficient: 0.008; 95%CI: 0.002 to 0.014), had a direct association with axial length, and had an indirect association with lens thickness, central corneal thickness, and anterior chamber depth.

Conclusion: The cornea had a prolate shape in children and eccentricity value decreased with age. The results of this study add to the existing knowledge and can be used in differentiating normal from abnormal corneal shapes in children.
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http://dx.doi.org/10.1080/08820538.2021.1897853DOI Listing
March 2021

The prevalence of anterior blepharitis in an elderly population of Iran; The Tehran geriatric eye study.

Cont Lens Anterior Eye 2021 Feb 23:101429. Epub 2021 Feb 23.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: To determine the age and sex-standardized prevalence and risk factors of anterior blepharitis in a geriatric population in "…".

Methods: This population-based study was conducted on the elderly population (over 60 years of age) of Tehran, the capital of "…" in 2019. Examinations included visual acuity assessment, refraction, and complete slit lamp examination. After the diagnosis of anterior blepharitis, its type (staphylococcal vs. seborrheic) was also determined. Multiple logistic regression was used to determine the risk factors of the disease.

Results: 3310 individuals participated in this study. The data of 3284 participants were available for this report. The mean age of the participants was 68.6 ± 24.5 years, and (57.8 %) were female. Age and sex-standardized prevalence of anterior blepharitis was 33.5 % (95 % CI: 30.6-36.5%) of which 96.5 % were bilateral. The prevalence of seborrheic and staphylococcal types was 22.4 % (95 % CI: 19.9-25.2%) and 11.3 % (95 % CI: 9.2-13.5%), respectively. According to the multiple logistic regression, the prevalence of anterior blepharitis was positively related to age over 80 years (P < 0.001) and male gender (P < 0.001), and inversely related to education level (P = 0.033). No significant relationship was found between anterior blepharitis and other variables including systemic hypertension, diabetes mellitus, hyperlipidemia, smoking, socioeconomic status, and history of the previous eye examination. Sex had the greatest effect on developing anterior blepharitis (standardized coefficient: 0.325).

Conclusion: The results of this study showed a relatively high prevalence of anterior blepharitis in the elderly population which requires special attention of the health system to inform and control this disease through continuous training of the media and regional health centers.
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http://dx.doi.org/10.1016/j.clae.2021.02.015DOI Listing
February 2021

Investigation of Economic Inequality in Eye Care Services Utilization and Its Determinants in Rural Regions Using the Oaxaca- Blinder Decomposition Approach.

Semin Ophthalmol 2021 Feb 21:1-6. Epub 2021 Feb 21.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: This study was conducted to determine economic inequality in Eye Care Services Utilization (ECSU) and its determinants in the underserved rural population of Iran: In this population-based study, two underserved regions in the north and southwest of Iran were randomly selected and 3850 individuals living in these regions were invited to participate in the study. ESCU was defined as a history of at least one optometric or ophthalmologic visit during the lifetime. Concentration index (C) was used to evaluate economic inequality and the Oaxaca- Blinder decomposition was applied to decompose the gap between the rich and poor.: Of 3851 individuals, 3314 participated in the study (response rate: 86%). The data of 3094 participants were analyzed. The concentration index was 0.139 (95% CI: 0.218 - 0.590), indicating a pro-rich inequality in the ECSU. The ECSU was 12.38% (10.46 to 14.31) in the poor and 21.15% (18.38 to 23.92) in the rich, and the gap between them was about 90% in favor of the rich ( < 00.001). A marked percentage of the gap was due to the explained portion (b: -11.49; < .001). The unexplained portion coefficient was b: 2.72 (p: 0.020). In the explained portion, economic status (b: -12.37; < .001) and age (b: 0.90; p: 0.021) caused inequality in favor of the rich and poor respectively while only economic status (b:-21.1; < .001) had a significant effect on inequality in favor of the rich in the unexplained portion.: There is a significant pro-rich inequality in ECSU in the rural areas of Iran. A major portion of this inequality is related to differences in age and economic status between the two groups. Economic status has direct and indirect effects on inequality in ECSU; therefore, health policymakers should focus on economic improvement to remove the gap.
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http://dx.doi.org/10.1080/08820538.2021.1890782DOI Listing
February 2021

The distribution of the near point of convergence and its related factors in an elderly population: the Tehran Geriatric Eye Study (TGES).

Eye (Lond) 2021 Feb 19. Epub 2021 Feb 19.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: To determine the distribution of the near point of convergence (NPC) and its related factors in an elderly population in Tehran, Iran.

Methods: This population-based cross-sectional study was conducted on the elderly population (60 years of age and over) of Tehran, Iran in 2019. The samples were selected using stratified random cluster sampling. The examinations included the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, unilateral and alternate cover test, ocular health examination, and NPC measurement.

Results: The mean age of the participants was 65.90 ± 4.56 years and 59.6% of them were females. The mean (95% CI) NPC in the total sample was 7.84 cm (95% CI: 7.65-8.03). The mean (95% CI) NPC in males and females was 7.92 cm (7.63-8.21) and 7.75 cm (7.54-7.97) (P = 0.338), respectively. The mean NPC increased from 7.8 cm (95% CI: 7.55-8.05) in the age group 60-64 years to 8.83 cm (95% CI: 7.47-10.2) in the age group ≥ 80 years (P > 0.05). The mean (95% CI) NPC in emmetropic, myopic, and hyperopic individuals was 7.67 cm (95% CI: 7.33-8.02), 7.96 cm (7.56-8.37), and 7.87 cm (7.63-8.11), respectively (P = 0.378). There was no statistically significant relationship between NPC with education level, smoking, diabetes mellitus (DM), and hypertension (HT).

Conclusions: The NPC values found in this study were significantly lower (less remote) than the values reported in previous studies in similar age groups. The NPC had no significant relationship with age, sex, education level, smoking, DM, and HT.
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http://dx.doi.org/10.1038/s41433-021-01428-xDOI Listing
February 2021

Psychometric Assessment of the Persian Version of the Revised Convergence Insufficiency Symptom Survey in Young Adults with Convergence Insufficiency.

J Curr Ophthalmol 2020 Oct-Dec;32(4):395-401. Epub 2020 Dec 12.

Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To translate the Convergence Insufficiency Symptom Survey (CISS) to Persian and to assess its validity and reliability in a group of young adult Iranian patients with convergence insufficiency (CI).

Methods: The questionnaire was translated in backward and forward phases. Face validity was measured using a 6-point scale (very weak, weak, moderate, good, very good, best), and a score of ≥4 for each item indicated an acceptable face validity. The content validity was assessed using three indices of relevancy, clarity, and comprehensiveness. Relevancy and clarity were checked for each item and for the whole scale using a 4-point scale (1-undesirable, 2-relatively desirable, 3-desirable, 4-completely desirable), and Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI) were calculated for the above indices. Comprehensiveness was measured at the scale level using a 4-point scale (1-incomprehensive, 2-relatively comprehensive, 3-comprehensive, 4-totally comprehensive), and S-CVI was calculated. The internal consistency and test-retest reliability were assessed using Cronbach's alpha coefficient and interclass correlation coefficient (ICC), respectively. To evaluate discriminant validity, CI was categorized into mild, moderate, and severe stages, and the mean overall CISS score was compared between these groups.

Results: Thirty CI patients aged 18-34 years participated in this study. On face validity assessment, all items finally had a score of ≥4. As for relevancy and clarity, I-CVI was above 80% for all items, and S-CVI was 98.8% and 96.6%, respectively. The S-CVI was 100% for comprehensiveness. The overall Cronbach's coefficient and ICC were 0.77 and 0.95, respectively. There was a significant difference in the overall score between the three severity groups.

Conclusion: The Persian CISS is a valid and reliable tool for clinical and research applications.
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http://dx.doi.org/10.4103/JOCO.JOCO_194_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861096PMC
December 2020

Corneal and Ocular Residual Astigmatism in School-Age Children.

J Curr Ophthalmol 2020 Oct-Dec;32(4):355-360. Epub 2020 Dec 12.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To determine the distribution of residual and corneal astigmatism (CA) in children aged 6-18 years and their relationship with age, sex, spherical equivalent, and biometric parameters.

Methods: In this cross-sectional study, multi-stage stratified cluster sampling was done to select students from Dezful, a city in Southwestern Iran. Examinations included the measurement of visual acuity with and without optical correction, refraction with and without cycloplegia, and biometry using the Biograph (Lenstar, Germany). The main outcomes in this report were corneal and residual astigmatism. The CA was measured by Biograph (difference between k1 and k2), and residual astigmatism was calculated using Alpine method. The power vector method was applied to analyze the data of astigmatism.

Results: Of 864 students that were selected, 683 (79.1%) participated in the study. The mean residual and CA were -0.84 diopter (D) and -0.85 D, respectively. According to the results of J0 and J45 vectors, residual astigmatism was -0.33 D and 0.04 D, and CA was 0.38 D and 0.01 D, respectively. With-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism were seen in 3.4%, 66.8%, and 4.5% of the children with residual astigmatism and 67.94%, 1.3%, and 1.5% of the children with CA. Residual astigmatism decreased with an increase in spherical refractive error, whereas CA increased with an increase in spherical refractive error.

Conclusion: The results of the present study showed a high prevalence and amount of residual astigmatism with ATR pattern among the 6-18-year-old population and the compensatory effect of this type of astigmatism on CA that mostly followed a WTR pattern.
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http://dx.doi.org/10.4103/JOCO.JOCO_8_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861098PMC
December 2020

Keratoconus Indices and their Determinants in Healthy Eyes of a Rural Population.

J Curr Ophthalmol 2020 Oct-Dec;32(4):343-348. Epub 2020 Dec 12.

Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To determine the distribution of keratoconus indices in a 5-93-year-old healthy eyes of a rural population in Iran.

Methods: In this cross-sectional study, multi-stage cluster sampling was applied to select subjects from two villages in the north and southwest of Iran. After obtaining informed consent, all subjects underwent ophthalmologic and optometric examinations. Corneal imaging by the Pentacam was done in subjects above 5 years between 9 a.m. and 2 p.m., at least 3 h after wakeup. All subjects who had abnormal keratoconus indices were excluded. Our main outcome was keratometry-flat (K), keratometry-steep (K), keratoconus index (KI), and central keratoconus index (CKI).

Results: The mean ± standard deviation of K, K, KI, and CKI was 43.12 ± 1.74, 44.25 ± 1.65, 1.02 ± 0.02, and 1.01 ± 0.01, respectively. According to multiple linear regression analysis, the mean index surface variance (ISV) (b: -1.367, < 0.001), index vertical asymmetry (IVA) (b: -0.012, < 0.001), KI (b: -0.011, < 0.001), CKI (b: -0.001, < 0.001), index height asymmetry (IHA) (b: -0.491, P: 0.005), and index height decentration (IHD) (b: -0.001, < 0.001) were lower in men compared to women. Moreover, age had an indirect association with ISV (b: -0.030, < 0.001) and average pachymetric progression index (RPI_avg) (b: -0.001, < 0.001), and a direct association with KI, CKI, and IHA. Spherical equivalence had an indirect association with KI (b: -0.001, < 0.001) and RPI_avg (b: -0.004, < 0.001) and a direct association with CKI (b: 0.001, < 0.001). Among all variables, sex had the greatest impact on ISV, IVA, KI, IHA, IHD, and minimum sagittal curvature.

Conclusions: The Keratoconus indices of our study were similar to other studies. Although age, living place, and type of refractive error were associated with some indices, sex was the strongest determinant of Keratoconus indices in a population of healthy eyes.
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http://dx.doi.org/10.1016/j.joco.2019.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861110PMC
December 2020

Prevalence of amblyopia and its determinants in a rural population: a population-based cross-sectional study.

Strabismus 2021 Mar 16;29(1):10-18. Epub 2021 Jan 16.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran.

To determine the prevalence of amblyopia and its determinants in underserved rural villages of Iran. This population-based cross-sectional study was conducted in 3850 subjects selected from two underserved districts in the north (Kojur District, Nowshahr County, Mazandaran Province) and southwest (Shahyun District, Dezful County, Khuzestan Province) of Iran using multi-stage cluster sampling. The subjects underwent complete ophthalmic examinations including the measurement of uncorrected (UCVA) and best-corrected (BCVA) visual acuity, objective and subjective refraction, unilateral and alternate cover tests and ocular health examination. Amblyopia was defined as a reduction of BCVA to 20/30 or less in one eye or a 2-line interocular optotype acuity difference in the absence of any pathological factors. Of 3850 selected subjects, 3314 participated in the study (response rate = 86.08%). The mean age of the participants was 36.90 ± 20.21 years (range: 3-93 years). The prevalence and 95% confidence interval of total, bilateral, and unilateral amblyopia were 2.73% (2.17 to 3.38), 0.50% (0.28 to 0.83), and 2.23% (1.73 to 2.83), respectively. The most common type of amblyopia was anisometropic followed by strabismic and mixed. The lowest and highest prevalence was seen in the age group 6-20 years (1.36%; 0.65 to 2.49) and above 70 years (5.97%; 3.02 to 10.44), respectively. According to the results of multiple logistic regression analysis, compared to illiterate subjects, the odds ratio of amblyopia was 0.321 ( = .033) in subjects with High school education, 0.181 ( = .030) in subjects with secondary School education, and 0.486 ( = .041) in subjects with primary school education. The odds ratio of amblyopia for north villages residence vs southwest villages residence was 2.105 ( = .012). The odds ratio of amblyopia was 2.765 for age group>70 years vs. 6-20 years ( = .033). The prevalence of amblyopia was higher in north region, in participants with lower education level and older individuals. The high prevalence of amblyopia in older people may be due to the lack of screening programs in previous generations and consequently the lack of timely diagnosis and treatment.
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http://dx.doi.org/10.1080/09273972.2020.1871375DOI Listing
March 2021

Comparison of ocular aberrations in three types of rigid gas permeable lenses in keratoconus patients.

Rom J Ophthalmol 2020 Jul-Sep;64(3):280-284

Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.

To determine the effect of different types of Rigid Gas Permeable (RGP) contact lenses on ocular aberrations in patients with keratoconus. Eighteen eyes of young patients with mild to moderate keratoconus were selected. General ocular examinations such as refraction, visual acuity, and ocular aberrations were performed. Three types of RGP contact lenses, i.e., Boston, Senso Select and Wohlk, were fitted using the cross over method. Repeated measures analysis of variance and Mauchly's test of sphericity were used to compare the average of residual high order aberrations and visual acuity after fitting each type of lens. Vertical coma was -0.271 ± 0.37 µm before fitting and decreased to 0.081 ± 0.08 µm with Boston, 0.098 ± 0.08 µm with Senso Select and 0.124 ± 0.08 µm with Wohlk contact lens (P-value < 0.0001). The mean RMS (root mean square) for high order aberrations decreased from 0.526 ± 0.43 µm before fitting to 0.256 ± 0.09 µm with Boston, 0.263 ± 0.12 µm with Senso Select, and 0.304 ± 0.10 µm with Wohlk contact lens (P-value= 0.001). The mean RMS for low order aberrations decreased from 1.480 ± 0.78 µm before fitting to 0.703 ± 0.43 µm with Boston, 0.802 ± 0.39 µm with Senso Select, and 0.760 ± 0.45µm with Wohlk (P-value < 0.0001). Despite achieving optimal fit and good visual acuity with these different RGP lenses, in keratoconus patients, their performance is different in reducing ocular aberrations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739550PMC
December 2020

Topographic properties of the cornea in welders.

Eur J Ophthalmol 2020 Dec 6:1120672120974293. Epub 2020 Dec 6.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The aim of the present study was to evaluate the topographic status of the welders' corneas.

Methods: In this historical cohort, a group of welders (with at least 5 years' experience in welding) and a control group were assessed and compared. Lack of exposure to welding for 3 months or more was considered an exclusion criterion. In all participants, after taking a complete history of visual and ocular problems, both eyes underwent Pentacam imaging. Then, all subjects received slit lamp biomicroscopy for evaluation of ocular surface diseases.

Results: The data of 140 welders (mean age: 46.66 ± 13.01 years) and 172 controls (mean age: 45.05 ± 12.61 years) were analyzed. The welders' corneas had significantly higher eccentricity ( < 0.0001), keratometry readings ( < 0.0001), and cylinder power ( < 0.0001). The central, inferior, and nasal cornea were significantly thinner in the welders than in controls ( < 0.0001) while the difference was not significant in the superior and temporal cornea. All indices of corneal irregularity except for the central keratoconus index (CKI) and index of height asymmetry (IHA) were higher in welders compared to the control group ( < 0.0001).

Conclusion: According to the results of this study, the welders' corneas are topographically irregular. Welders exhibit characteristics like steeper keratometry readings; higher eccentricity indexes; thinner central, inferior, and nasal corneas; and higher indices of corneal irregularity, especially the CK index. Long-term ultraviolet exposure may be a possible reason for these corneal changes.
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http://dx.doi.org/10.1177/1120672120974293DOI Listing
December 2020

Visual Acuity Improvement in Adult Anisometropic Amblyopes After Active Vision Therapy.

Clin Optom (Auckl) 2020 15;12:183-187. Epub 2020 Oct 15.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The aim of this study is to evaluate the effect of active vision therapy in adults with anisometropic amblyopia.

Methods: In this study, 20 adults with anisometropic amblyopia aged from 17-35 years old were treated for five sessions (one session per week) with vision therapy techniques which include accommodative rock, vergence rock, and saccadic training. Moreover, computerized vision therapy was performed by Optosys software. Also, patients had been given a daily program for home training, including accommodative and vergence rock, and Optosys software. Best corrected visual acuity (BCVA) was measured before and after treatment.

Results: Comparison of data using -test showed that BCVA significantly improved after the vision therapy period. Initial BCVA (Log MAR) was 0.37±0.04 (mean±standard deviation) which improved to 0.14±0.03 after treatment. The correlation between initial BCVA and the amount of improvement showed that the worse the pre-treatment visual acuity was, the greater improvement that occurred.

Conclusion: The improvement of visual acuity in adult anisometropic amblyopes showed that there are some degrees of plasticity in the visual system of amblyopic patients even in adulthood. Thus, therapists should give the chance of treatment to adult amblyopes.
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http://dx.doi.org/10.2147/OPTO.S250813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571576PMC
October 2020

Corneal Scheimpflug Densitometry in Photorefractive Keratectomy Candidates.

Cornea 2020 Nov;39(11):1381-1388

Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.

Purpose: To describe the normative data of corneal densitometry in photorefractive Keratectomy (PRK) candidates by using a Scheimpflug camera.

Methods: Five hundred twenty-two eyes of 261 PRK candidates that underwent comprehensive optometric and ophthalmic examinations were enrolled in this study. Corneal densitometry values were obtained using a Scheimpflug camera (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) and displayed in grayscale units (GSU).

Results: Of 261 participants, 187 (71.6%) were women. The mean age of the participants was 28.79 ± 5.02 years (range: 21-40 years). The mean entire corneal densitometry was 14.86 ± 2.37 GSU. According to corneal depth, maximum and minimum densitometry values were seen in the anterior (30.28 ± 7.42 GSU) and posterior (9.86 ± 2.08 GSU) layers, respectively (P < 0.001). Based on the annulus over the cornea, the highest and lowest densitometry values were seen in the 10- to 12-mm (21.31 ± 4.26 GSU) and 2- to 6-mm zones (13.26 ± 2.34 GSU), respectively. However, this difference was not seen after 35 years of age. Individuals aged 30 to 35 years showed higher corneal densitometry values compared with subjects aged 20 to 25 years old (P < 0.001). In generalized linear models, the corneal thickness was associated with the densitometry value in the central and posterior corneal layers. There were no significant differences in sex and refractive errors among participants.

Conclusions: This study provided normal corneal densitometry data in PRK candidates. Corneal densitometry increased with age until 35 years of age and then decreased thereafter. This finding should be considered in patient selection for PRK and their postoperative examinations.
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http://dx.doi.org/10.1097/ICO.0000000000002468DOI Listing
November 2020

Comparison of Corneal Higher-order Aberrations between Miniscleral and Hybrid Lenses in Keratoconus.

Optom Vis Sci 2020 09;97(9):749-753

Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Significance: Fitting specialty contact lenses (hybrid and miniscleral) can be a useful option in keratoconus patients to decrease higher-order aberrations (HOAs) and increase the quality of vision.

Purpose: The aim of the present study was to compare corneal HOAs between miniscleral and hybrid lenses in keratoconus patients.

Methods: The target population of this study was 37 patients with bilateral keratoconus aged 20 to 35 years who were referred to a specialized contact lens clinic by a corneal specialist. Pre-fitting examinations included objective and subjective refraction, measurement of uncorrected and best spectacle-corrected visual acuity, and measurement of corneal HOAs. Lens fitting was performed in the next step. Finally, post-fitting measurements including contact lens-corrected visual acuity and corneal HOAs were performed.

Results: The root mean square of the total HOAs significantly decreased after fitting both miniscleral and hybrid lens designs. There was a significant change in the third-order vertical coma and spherical aberration after fitting the miniscleral lens. In the hybrid lens group, a significant change was found only in vertical coma after fitting. There was no significant difference in the post-fitting HOA change between the two groups.

Conclusions: The results of this study showed the effectiveness of both miniscleral and hybrid lenses in decreasing HOAs in keratoconus patients. No significant difference was observed between these two lenses in this regard.
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http://dx.doi.org/10.1097/OPX.0000000000001560DOI Listing
September 2020

Location and stability of the preferred retinal locus in native Persian-speaking patients with age-related macular degeneration.

Clin Exp Optom 2021 Mar;104(2):194-200

Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Clinical Relevance: The findings of this study can be used in the selection of the preferred retinal locus to establish better rehabilitation services such as eccentric viewing training for patients with age-related macular degeneration.

Background: The aim of this study was to determine the characteristics of the preferred retinal locus in native Persian-speaking patients with age-related macular degeneration.

Methods: In this non-interventional case series, all patients with a diagnosis of age-related macular degeneration referred to the Retina Clinic of the Rassoul Akram Hospital, Tehran, Iran, were evaluated. The fixation characteristics were evaluated monocularly using the MP1 microperimeter (Nidek Technologies, Padua, Italy). Optical coherence tomography was used to determine the location of the central fovea. The images were overlaid and the preferred retinal locus-fovea distance was measured using Image J software.

Results: Fifty-one eyes of 35 patients with a mean age of 73.8 ± 7.7-years were evaluated in this study. Inferior-field, left-field, central-field, right-field, and superior-field preferred retinal locus were detected in 49 per cent, 33.3 per cent, 7.8 per cent, 5.9 per cent, and 3.9 per cent of the subjects, respectively. Fixation was stable in 70.6 per cent, relatively unstable in 15.7 per cent, and unstable in 13.7 per cent of the participants. Significant differences were not found in the mean values of logMAR visual acuity between different fields of the preferred retinal locus after Bonferroni correction (p = 0.031). Analysis of co-variance showed no significant difference in mean sensitivity values between different locations of the preferred retinal locus (p = 0.07). The mean preferred retinal locus-fovea distance was not significantly different between different fields of the preferred retinal locus (p = 0.063).

Conclusions: Native Persian-speaking patients with central scotoma secondary to age-related macular degeneration place their self-selected preferred retinal locus most frequently in the inferior and left visual field, which would result in scotoma displacement to the superior and right visual field. Fixation stability was statistically similar in different locations of preferred retinal locus, but it improved with decreasing the preferred retinal locus-fovea distance.
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http://dx.doi.org/10.1111/cxo.13132DOI Listing
March 2021

Agreement of Central Corneal Thickness Measurements between Scheimpflug Photography and Optical Low-Coherence Reflectometry in Children.

Semin Ophthalmol 2020 May 26;35(4):252-256. Epub 2020 Aug 26.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran.

Purpose: Central corneal thickness (CCT) is a key indicator of the corneal health status and is therefore of clinical importance. The aim of the present study was to determine the agreement between Scheimpflug photography (SP) and optical low-coherence reflectometry (OLCR) systems in measuring the CCT in children.

Methods: In this cross-sectional study, the samples were selected from Shahroud schoolchildren using cluster sampling. The samples then underwent optometric examinations, including the measurement of visual acuity and refraction. CCT measurements were done by the SP and OLCR systems between 8 am and 4 pm. To evaluate the agreement between these devices, 95% limits of agreement (LoA) and interclass correlation coefficient (ICC) were reported.

Results: After applying the exclusion criteria, 4890 right eyes (53.2% male) were analyzed. The mean age of the students was 9.22 ± 1.72 years (range: 6-12 years). The mean CCT by the SP and OLCR systems was 555.30 ± 34.15 and 550.23 ± 35.11 µm, respectively. The 95% LoA between the two devices was -19.81 to 9.66 µm, and the ICC was 0.983. The CCT difference between the SP and OLCR systems was 5.61 µm in boys and 3.36 µm in girls. The CCT difference between the two devices was 6.41 µm in 6-year-old and 3.54 µm in 12-year-old children. The 95% LoA was -17.96 to 9.58 µm and -18.89 to 8.47 µm and the ICC was 0.987 and 0.984 in myopic and hyperopic subjects, respectively.

Conclusion: The results of this study showed a high agreement between OLCR and SP measurements of CCT in children.
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http://dx.doi.org/10.1080/08820538.2020.1810288DOI Listing
May 2020

Evaluation of Changes in Refractive Errors Before and After Trabeculectomy and Shunt Surgery.

Clin Optom (Auckl) 2020 29;12:107-112. Epub 2020 Jul 29.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The aim of the present study was to investigate the change rate of astigmatism and axial, myopia, and hypermetropia in trabeculectomy and shunt surgery.

Patients And Methods: In this comparative study, two groups of 16 patients with an average age of 52.4±8.9 and 94.6±6.7 respectively underwent trabeculectomy and shunt surgery. The changes of reactive error were compared before the surgery and 1 week, 1 month, and 3 months after the surgery. Data from the two groups were analyzed via Friedman and Mann-Whitney tests.

Results: Average of intraocular pressure (IOP) before, and 1 week, 1 month, and 3 months after trabeculectomy is 31.31±7.6, 9.8±2.8, 10.5±1.29, 10.9±1.26 (<0.05) and shunt is 36.06±10.32, 13.5±3.3, 11.68±2.21, 11.18±1.27 (<0.05). Average astigmatism in trabeculectomy is -1.00±0.59, -6.00±1.9, -2.21±1.18, -1.37±0.62 (<0.05) and in shunt it is -0.89±0.46, -1.56±1.62, -1.51±1.46, -1.07±0.85 (>0.05). Percent WRT astigmatism in trabeculectomy is 37.5, 100, 37.5, 31.25 and in shunt it is 43.75, 50, 50, 56.25 and average of spherical equivalence (SE) in trabeculectomy is -0.31±1.49, 1.43±1.94, 0.27±1.74, 0.04±1.46 (<0.05) and in shunt it is 0.65±1.5, 1.03±2.03, -0.70±1.64, 0.62±1.54 (<0.05). Astigmatism and axial comparisons between trabeculectomy and shunt with Mann-Whitney test were significant (<0.05), but SE was not significant (>0.05).

Conclusion: The surgeries induced hypermetropia and reduction with the passing of time but astigmatism amount and percent of with-the-rule astigmatism in trabeculectomy were more than in shunt surgery.
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http://dx.doi.org/10.2147/OPTO.S241659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398678PMC
July 2020

The Distribution of Vertical Cup-to-Disc Ratio and its Determinants in the Iranian Adult Population.

J Curr Ophthalmol 2020 Jul-Sep;32(3):226-231. Epub 2020 Jul 4.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To determine the distribution of vertical cup-to-disc ratio (VCDR) and its relationship with ocular biometric indices.

Methods: This study was conducted in 4737 individuals aged 45-69 years living in Shahroud who participated in the second phase of Shahroud Eye Cohort Study in 2014. All participants underwent eye examinations including the measurement of visual acuity and refraction, slit-lamp biomicroscopy, retinal examination, and fundoscopy. Normality index was used to describe data distribution, and a multiple beta regression, with adjustment for the effect of cluster sampling, was applied to explore the relationship between VCDR and the study variables.

Results: The mean [95% confidence interval (CI)] VCDR was 0.297 (0.293-0.301) in all participants; 0.296 (0.291-0.302) in men and 0.297 (0.292-0.302) in women. The highest mean VCDR was seen in the age group 55-59 years (0.299, 95% CI: 0.292-0.307). The 97.5 percentile was 0.600. According to multiple beta regression analysis, VCDR had a positive association with the female sex ( = 0.028), spherical equivalent ( < 0.001), cigarette smoking ( = 0.020), and axial length ( < 0.001), and had a negative association with hypertension ( = 0.001), best corrected visual acuity ( < 0.001), hyperlipidemia ( = 0.029) and anterior chamber depth ( = 0.001).

Conclusions: The mean VCDR and the 97.5 percentile were lower than most other studies. Although ethnicity and race may play a role in this difference, this difference should be considered in clinical decisions in the current population.
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http://dx.doi.org/10.1016/j.joco.2019.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382515PMC
July 2020

Non-surgical Management Options of Intermittent Exotropia: A Literature Review.

J Curr Ophthalmol 2020 Jul-Sep;32(3):217-225. Epub 2020 Jul 4.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To review current non-surgical management methods of intermittent exotropia (IXT) which is one of the most common types of childhood-onset exotropia.

Methods: A search strategy was developed using a combination of the words IXT, divergence excess, non-surgical management, observation, overcorrecting minus lens therapy, patch/occlusion therapy, orthoptics/binocular vision therapy, and prism therapy to identify all articles in four electronic databases (PubMed, Web of Science, Google Scholar, and Scopus). To find more articles and to ensure that the databases were thoroughly searched, the reference lists of the selected articles were also reviewed from inception to June 2018 with no restrictions and filters.

Results: IXT is treated when binocular vision is impaired, or the patient is symptomatic. There are different surgical and non-surgical management strategies. Non-surgical treatment of IXT includes patch therapy, prism therapy, orthoptic sessions, and overcorrecting minus lens therapy. The objective of these treatments is to reduce the symptoms and the frequency of manifest deviation by decreasing the angle of deviation or enhancing the ability to control it.

Conclusions: Evidence of the efficacy of non-surgical management options for IXT is not compelling. More comprehensive randomized controlled trial studies are required to evaluate the effectiveness of these procedures and detect the most effective strategy.
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http://dx.doi.org/10.4103/JOCO.JOCO_81_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382517PMC
July 2020