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Purpose: To compare biometric and optical coherence tomography parameters as well as refractive status in preterm children aged 4-8 years with or without retinopathy of prematurity (ROP), and evaluate their correlations with age and gender-matched full-term children., Methods: Retrospective comparative cohort study of four groups of children. Children with a history of preterm birth, including ROP who received intravitreal bevacizumab (IVB) treatment, children with a history of ROP that regressed without treatment and those with no history of ROP were compared to age and gender-matched full-term children as a control group. Best corrected visual acuity (BCVA), spherical equivalent of refraction (SE), macular and choroidal thickness, as well as biometric parameters was measured., Results: A total of 120 eyes of 120 children (30 children in each group) were included. There was no significant difference in BCVA, SE, and subjective cylinder between groups ( p =0.05, p =0.3, p =0.6, respectively). Axial length was significantly shorter, and the cornea was steeper in both ROP groups than in other groups ( p =0.001, p < 0.001, respectively). The central macular thickness was significantly thicker in the treated, regressed ROP and preterm groups than in full-term children ( p < 0.001). The gestational age was negatively correlated with macular thickness in both treated and regressed ROP groups ( r  = -0.517; p =0.003, r  = - 0.490; p =0.006, respectively)., Conclusions: Children with a history of ROP had a shorter axial length, steeper cornea, and thicker macula that correlated with lower gestational age., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Marzieh Najjaran et al.)

Objective: To determine the agreement between measurements of accommodative amplitude (AoA) in children using a specialised accommodative rule and measurments without it., Methods: A total of 502 children underwent optometric examinations, including the measurement of visual acuity, objective and subjective refraction. AoA measurements were done with and without the Berens accommodative rule. The measurements of AoA were conducted monocularly using a -4 D lens. A fixation stick containing English letters equivalent to 20/30 visual acuity and a long millimetre ruler was used to measure AoA without the accommodative rule. This measurement was performed by the two trained examiners. The agreement between these methods was reported by 95% limits of agreement (LoA) and interclass correlation coefficient (ICC)., Results: The mean age of the participants was 11.7±1.3 years (range: 9-15 years) and 52.4% were male. The mean AoA with and without the accommodative rule was 20.02±6.02 D and 22.46±6.32 D, respectively. The 95% LoA between the two methods was -12.5 to 7.5 D, and the ICC was 0.67 (95% CI 0.63 to 0.70). The 95% LoA was narrower in higher age groups and males compared with females (18.92 vs 20.87). The 95% LoA was narrower in hyperopes (16.83 D) compared with emmetropes (18.37 D) and myopes (18.27 D). The agreement was not constant and decreased in higher values of AoA., Conclusion: There is a poor and non-constant agreement between the measurements of the AoA with and without the accommodative rule. The mean AoA was 2.5 D lower with using the accommodative rule., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Clinical Relevance: Evaluating factors affecting corneal higher-order aberration component has a very important role in interpreting the characteristics of the formed image on the retina., Background: To determine the relationship between ocular biometric components and corneal higher-order aberrations in an elderly population., Methods: This report is related to a subsample of the Tehran Geriatric Eye study (TGES), a population-based cross-sectional study that was conducted on individuals aged 60 years and above in Tehran city, Iran using multistage stratified random cluster sampling. All study participants underwent ocular examinations including visual acuity measurement, refraction and slit-lamp biomicroscopy. Anterior segment imaging and corneal aberrometry were performed using Pentacam AXL., Results: In the present study, 644 eyes of 415 individuals (56.9% female) with mean age of 66.36 ± 4.70 years were evaluated. According to a multiple generalised estimating equation model, the root mean square of total higher-order aberrations was related to age (β = 0.081, p  = 0.002), crystalline lens thickness (β = 0.08, p  < 0.001), and corneal diameter (β = -0.04, p  = 0.014). The root mean square of total coma aberration was directly related to the female sex (β = 0.02, p  = 0.05), and crystalline lens thickness (β = 0.06, p  < 0.001). There was a direct relationship between the root mean square of third- and fourth-order higher-order aberrations and crystalline lens thickness ( p  < 0.001). Spherical aberration was directly related to the male sex (β = -0.02, p  = 0.004), axial length (β = 0.05, p  < 0.001) and central corneal thickness (β = 0.001, p  = 0.025), and was inversely related to anterior chamber depth (β = -0.07, p  = 0.031) and crystalline lens thickness (β = -0.25, p  < 0.001)., Conclusion: Ocular biometric components are related to corneal aberrations in the elderly. These factors need to be considered in respect of medical and surgical procedures required for the elderly.

Purpose: The present study sets out to investigate the effect of cyclopentolate-induced cycloplegia on distance and near deviation and the accommodative convergence/accommodation (AC/A) ratio., Methods: This prospective study was performed on 30 subjects. The inclusion criteria included a lack of any active ocular pathology and systemic diseases, no history of ocular surgery, and nonuse of various medications. Refraction, near and distance deviation were measured for all subjects, and the same examinations were repeated after the administration of two drops of cyclopentolate 1% to both eyes., Results: The obtained data from 30 subjects, including 19 males, with a mean age of 22.53 ± 1.74 years were analyzed. The mean ± SD of near deviation in dry and cycloplegic conditions were -6.9 ± 8.1 and +6.4 ± 9.1 prism diopters, respectively, which were statistically significant ( P < 0.001). Distance deviation in cycloplegic conditions demonstrated an average difference of 0.8 prism diopters, compared to dry conditions ( P < 0.001). AC/A ratios were 4.7 ± 2.5 and 9.7 ± 3.9 (Δ/D) in non-cycloplegic and cycloplegic conditions, respectively, which was a statistically significant difference ( P < 0.001). The multiple regression indicated that among all under study variables, refraction (B coefficient: -2.4; P < 0.001) and near pre-cycloplegic deviation (B coefficient: 0.56; P < 0.001) were significantly associated with post-cycloplegic near deviation., Conclusion: The results of this study indicated that cycloplegia causes a considerable esophoric shift in near deviation and a negligible esophoric shift in distance deviation. As a result, the AC/A ratio demonstrated a significant increase due to unequal changes in near and distance deviation., Competing Interests: None., (Copyright © 2024 Asharlous et al.)

Purpose: To determine the long-term effects of night shift work on dry eye in hospital nurses., Methods: Each participant was evaluated four times, including at the beginning of the day shift (8 am), at the end of the day shift (2 pm), at the beginning of the night shift (8 pm), and at the end of the night shift (8 am), using the tear break-up time (TBUT) test and ocular surface disease index (OSDI) questionnaire., Results: The results showed significant differences in the TBUT and OSDI between the end of the day shift (2 pm) (10.26, 16.61) and the end of the night shift (8 am) (6.89, 38.59) relative to each other and relative to the beginning of the day and night shifts. As for the correlation between TBUT and OSDI, a significant correlation was found at all measurement times (correlation coefficient: - 0.478, - 0.707, - 0.556, and - 0.365, respectively) ( p < 0.05)., Conclusion: The results showed that the severity of dry eye increased after the night shift with variation over a 24-hr period. Moreover, a significant correlation was observed between TBUT and OSDI results at the beginning and at the end of the day and night shifts., Competing Interests: None., (Copyright © 2023 Bouyeh et al.)

To compare the anterior segment indices between mentally retarded and normal children. The current study was conducted as a cohort. In this study, 73 mentally retarded and 76 normal children were selected from normal school and special schools for mentally retarded children using random cluster sampling method. Mental retardation in children was confirmed by a psychologist. Optometry examinations including visual acuity and refraction were performed for all participants, and ultimately, corneal imaging measurements were taken by Pentacam. The mean age of mentally retarded and normal children was of 13.30 ± 1.83 and 13.05 ± 1.82 years, respectively (P = 0.180). A multiple generalized estimating equations model demonstrated that there is a significant association between central corneal thickness (CCT) (coef = 1.011, P < 0.001), corneal diameter (CD) (coef = 0.444, P = 0.046), anterior chamber depth (ACD) (coef = 0.23), P < 0.001) and index of vertical asymmetry (IVA) (coef = 0.12, P < 0.001) and mental retardation. Cerebral palsy children had higher keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry(IHA), and index of height decentration (IHD) compared to those without cerebral palsy (P < 0.05). Children with moderate mental retardation had higher index of surface variance (ISV), IVA, IHA, and IHD than those with mild mental retardation (P < 0.05). The mean and standard deviation of CCT, CD, ACD and IVA index in mentally retarded children were 535.3 ± 46.68 micron, 11.87 ± 0.42 mm, 3.29 ± 0.24 mm and 0.25 ± 0.18 mm, respectively. These indices in the normal group were 525.53 ± 47.52 micron, 11.84 ± 0.38 mm, 3.15 ± 0.28 mm and 0.17 ± 0.05 mm, respectively. The findings of this study showed that some anterior segment indices were different in mentally retarded compared to normal children. Moreover, some keratoconus indicators were worse in cerebral palsy children and children with higher grade mental retardation. So, it is important to consider keratoconus screening in these children., (© 2023. Springer Nature Limited.)

Purpose: The aim of this study was to determine the distribution of corneal volume (CV) using Pentacam and its relationship with demographic and ocular factors in an elderly population older than 60 years., Methods: The present report is a part of the Tehran Geriatric Eye Study. The sampling was performed using the multistage stratified random cluster sampling method. The preliminary ocular examinations were performed for all individuals including visual acuity measurement, objective and subjective refraction, and slit-lamp biomicroscopy. Finally, study participants underwent anterior segment imaging and ocular biometry using Pentacam AXL., Results: The mean CV was 57.92 mm 3 [95% confidence interval (CI): 57.76-58.08] in the whole sample. The mean CV was 57.69 mm 3 (95% CI: 57.52-57.87) after excluding diabetic patients. The mean CV was 57.79 mm 3 (95% CI: 57.57-58.01) and 58.04 mm 3 (95% CI: 57.83-58.26) in men and women, respectively. The mean CV was 57.96 mm 3 (95% CI: 57.71-58.21), 57.84 mm 3 (95% CI: 57.49-58.19), and 57.92 mm 3 (95% CI: 57.7-58.13) in individuals with emmetropia, myopia, and hyperopia, respectively. The CV decreased significantly with advancing age. Moreover, the anterior chamber depth, central corneal thickness, mean keratometry, anterior corneal asphericity (Q value), and posterior corneal astigmatism were significantly directly related to CV, whereas axial length and white-to-white distance had a statistically significant inverse association with the CV., Conclusions: Aging is one of the important factors in reducing CV that should be considered. Some other topographic and biometric indices also have a significant relationship with CV., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors., Methods: A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications., Results: Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension., Conclusion: A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level., Competing Interests: Competing interestsWe declare no competing interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: To determine the prevalence of different types of ocular trauma and their relationship with some factors in the elderly population., Methods: The present population-based cross-sectional study was conducted on the elderly population aged 60 years and above in Tehran, Iran, using multi-stage stratified random cluster sampling in 2019. After selecting the samples and their participation in the study, demographic information and history of ocular trauma were obtained through an interview. Psychological evaluation was performed using the Goldberg's 28-question General Health Questionnaire. All study participants underwent optometric and ophthalmological examinations., Results: Three thousand three hundred and ten people participated in the study (response rate: 87.3%). Of these, 1912 individuals (57.8%) were female and the mean age of individuals was 68.25 ± 6.55 (from 60 to 97) years. 7.46% (95% confidence interval [CI]: 6.51-8.41) of the study participants reported a history of ocular trauma. Blunt and chemical traumas were the most and the least common types of ocular trauma, respectively (5.72% and 0.16%). 3.93% of cases visited an ophthalmologist for ocular trauma, 1.67% reported a history of hospitalization, and 1.47% underwent surgery. The prevalence of visual impairment in individuals with a history of ocular trauma was 12.53%. Visual impairment was more prevalent in people with a history of ocular trauma than those without a history of ocular trauma ( P < 0.05). History of ocular trauma was only significantly related to low education level (odds ratio = 0.63, 95% CI = 0.40-0.99). Participants with a history of ocular trauma had more anxiety and higher mean psychological distress score than those without a history of ocular trauma ( P = 0.035)., Conclusions: The development of preventive programs against the occurrence of ocular trauma can play an important role in reducing the psychological damage of affected patients while reducing visual disorders. These interventions should be especially considered in groups with a lower education level., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Current Ophthalmology.)

Aim: To collect and present updated evidence about epidemiological aspects of retinoblastoma (Rb) in the world., Methods: A comprehensive search without the time and language restrictions was conducted in international databases, including MEDLINE, Scopus, Web of Science, and PubMed. The search keywords were "retinoblastoma" OR "retinal Neuroblastoma" OR "retinal glioma" OR "retinoblastoma eye cancer" OR "retinal glioblastoma"., Results: The worldwide incidence of Rb is 1 in 16 000-28 000 live births, but was higher in developing compared to developed countries. Several attempts for improving early detection and treatment had increased the Rb survival rate from 5% to 90% in developed countries over the past decade, but its survival was lower in developing countries (about 40% in low-income countries) and the majority of mortalities occurred in developing countries. The etiology of Rb could be viewed as genetics in the heritable form and environmental and lifestyle factors in the sporadic form. Some environmental risk factors such as in vitro fertilization; insect sprays; father's occupational exposure to oil mists in metal working, and poor living conditions might play a role in the occurrence of the disease. Although ethnicity might affect Rb incidence, sex has no documented effect and the best treatment approaches were now ophthalmic artery chemosurgery and intravitreal chemotherapy., Conclusion: Determining the role of genetics and environmental factors helps to accurately predict the prognosis and identify the mechanism of the disease, which can reduce the risk of tumor development., (International Journal of Ophthalmology Press.)

Purpose: To determine the prevalence of vision impairment (VI) and blindness and their determinants in the elderly population of Tehran., Methods: In a cross-sectional study, multi-stage cluster sampling was used to select a sample of over 60 year population of Tehran. Optometric examinations included the measurement of uncorrected visual acuity, objective and subjective refraction, presenting and best corrected visual acuity. Vision impairment is reported according to the WHO definition. Visual acuity worse than 20/60 and 20/400 in the better eye was regarded as low vision and blindness, respectively., Results: According to presenting visual acuity, VI was found in 14.8% (95%CI: 13.1-16.5) of the participants, including low vision in 13.8% (95%CI: 12.2-15.4) and blindness in 1.1% (95%CI: 0.5-1.6). The prevalence of VI ranged between 7.8% (95%CI: 6.0-9.5) in subjects aged 60-64 years and 40.0% (95%CI: 33.0-47.0) in participants over 80 years (p < .001). Multivariable logistic regression analysis showed that older age (OR = 1.07(per year)), lower education level (illiterate versus college: OR = 3.55), and lower economic status (middle versus rich: OR = 1.30 and poor versus rich; OR = 1.72) had a significant relationship with an increase in the prevalence of VI, and older age (OR = 1.14(Per year increase)) and diabetes (OR = 2.62) had a significant relationship with blindness. Refractive errors (63.1%) was the leading cause of VI followed by cataract (22.5%). However, cataract (48.3%) was the leading cause of blindness., Conclusion: Many older adults suffer from VI. Correction of refractive errors and cataract reduces a large percentage of VI. Age, education level, and economic status are other determinants of VI.

Purpose: This study used contrast sensitivity (CS) and optical coherence tomography (OCT) to assess the functional and structural alterations of the macula and the optic nerve head (ONH) in diabetic patients with no retinopathy and those with mild nonproliferative diabetic retinopathy (NPDR)., Materials and Methods: In this study, 40 eyes of 20 diabetic patients with no diabetic retinopathy (DR), 40 eyes of 20 diabetic patients with mild NPDR, and 36 eyes of 18 healthy individuals were examined. Best-corrected visual acuity (VA) and CS were performed using early treatment DR study charts and the Pelli-Robson chart, respectively. The macula and ONH were evaluated using OCT, which provided data on the entire retina, inner retinal layer, outer retinal layer, retinal nerve fiber layer (RNFL), and the macula zone-ellipsoid zone-retinal pigment epithelium layer., Results: VA and CS were significantly different between the three groups ( P < 0.001). The entire thickness of the retina and the internal thickness of the retina in the 3-6 mm subfields of the macular region, as well as the thickness of the ganglion cell layer + inner plexiform layer (GCL + IPL) and GCL + IPL + RNFLs, differed significantly across the groups ( P < 0.013)., Conclusion: In diabetic subjects with no retinopathy, the reduced thickness of the GCL + IPLs is possibly indicative of early neurodegenerative changes in the inner retina. Furthermore, in the diabetic groups, a decrease in CS was observed compared to the control group., Competing Interests: The authors declare that there are no conflicts of interest of this article., (Copyright: © 2023 Taiwan J Ophthalmol.)

Purpose: Assessment of the pattern visual evoked potential (PVEP) responses in different areas of visual fields in individuals with normal vision., Methods: This study was conducted on 80 eyes of normal subjects aged 18-35 years. All participants underwent refraction and visual acuity examination. Visual evoked potential (VEP) responses were recorded in different areas of field. The repeated measure test was used to compare the P100 latency and amplitude of PVEP among different areas., Results: The repeated measures analysis of variance showed a statistically significant difference among different areas in terms of amplitude and latency of P100 ( P = 0.002 and P < 0.001, respectively). According to the results, the highest and lowest amplitude of P100 was observed in inferior-nasal and superior areas, respectively. The highest and lowest latency of P100 was related to the temporal and inferior-nasal areas, respectively., Conclusion: This study partially revealed the details of local PVEP distribution in the visual field and there was a significant difference in the amplitude and latency of PVEP wave in different areas of the visual field., Competing Interests: No conflicting relationship exists for any author., (Copyright © 2023 Mirzaee Saba et al.)

Clinical Relevance: Evaluation of corneal higher-order aberrations can be used clinically to diagnose early cases of keratoconus as well as to classify the severity of keratoconus., Background: To investigate the anterior and posterior corneal higher-order aberrations (HOAs) up to the sixth order and their ability to identify early keratoconus (KCN) as well as differentiate different severities of KCN using cross-validation analysis., Methods: This prospective cross-sectional comparative study was performed at a tertiary eye hospital in Tehran, Iran, in 2019. The study sample consisted of 95 eyes of 95 patients with KCN and 53 eyes of 53 normal individuals. The eyes with KCN were classified into three groups based on the Amsler-Krumeich classification system: group 1 (mild KCN), group 2 (moderate KCN), and group 3 (severe KCN). Corneal wavefront analysis was performed using Pentacam HR., Results: Based on the magnitude of AUC, posterior vertical secondary coma (Z5 -1 ) had an excellent discriminant ability (AUC: 0.91) and anterior vertical coma (Z3 -1 ) and anterior vertical secondary coma (Z5 -1 ) had a good discriminant ability (0.8 < AUC < 0.89) for differentiating eyes with mild KCN from normal eyes. The anterior and posterior primary spherical aberrations (Z4°) had an excellent ability (AUC > 0.9), and anterior secondary spherical aberration (Z6°) had a good ability (AUC: 0.83) for differentiating moderate from mild KCN. In the differentiation of severe from moderate KCN, anterior and posterior primary aspherical aberrations (Z4°) had a good AUC value (AUC > 0.8)., Conclusion: Coma-like aberrations had a good discriminant ability between normal eyes and eyes with mild KCN. Spherical aberrations showed a good ability for differentiating between different stages of KCN. The cut-off values reported in this study can be used for early detection of KCN as well as classification of KCN severity.

Aim: To determine the distribution and associated factors of intraocular pressure (IOP) in an Iranian elderly population 60 years of age and above., Methods: The present report is part of the Tehran Geriatric Eye study (TGES), a population-based cross-sectional study that was conducted on the residents of Tehran 60 years of age and above. The sampling was performed using multistage stratified random cluster sampling methods from 22 districts of Tehran, Iran. Demographic and history information, blood samples, and blood pressure were collected from all participants. Ocular examinations included measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, and slit-lamp biomicroscopy. The IOP was measured using Goldmann applanation tonometry (GAT). Corneal imaging and ocular biometry were performed using Pentacam AXL., Results: The data of 3892 eyes of 2124 individuals were analyzed for this report. The mean age of the study participants was 66.49±5.31y (range: 60 to 95y). The mean IOP was 15.2 mm Hg (95%CI: 15.1 to 15.4), 15.3 mm Hg (95%CI: 15.1 to 15.5) and 15.1 mm Hg (95%CI: 15.0 to 15.3) in all participants, males, and females, respectively. Of the study participants, 1.3% had an IOP of ≥20 mm Hg. The mean IOP increased from 15.1 mm Hg in the age group 60-64y to 16.3 mm Hg in the age group ≥80y. According to the final multiple GEE model, the IOP was statistically significantly higher in men than in women. All the studied age groups, except for the 75-79-year-old age group, had significantly higher IOP compared to the 60-64-year-old age group. The IOP was significantly higher in underweight compared to other body mass index groups. Moreover, the IOP had a statistically significant direct relationship with the mean corneal power (mean CP), central corneal thickness (CCT), and systolic blood pressure., Conclusion: The present study presents the distribution of IOP in an Iranian elderly population. A higher IOP (within the range 14 to 17 mm Hg) is significantly associated with older age, male sex, high systolic blood pressure, increased mean CP, and CCT. These factors should be considered in the clinical interpretation of IOP., (International Journal of Ophthalmology Press.)

Purpose: To determine the distribution of central corneal thickness (CCT) and its determinants in an Iranian geriatric population., Methods: This population-based study was conducted in 2019 in Tehran, the capital of Iran, using stratified multistage random cluster sampling. The study population was all residents ≥60 years of age. First, preliminary optometric and ocular health examinations were performed including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, anterior and posterior segment examination. The study participants then underwent corneal imaging using Pentacam HR., Results: Out of 3791 invitees, 3310 participated in this study (response rate: 87.3%). The mean CCT and apex corneal thicknesses were 528 µ (95% CI: 526-529) and 529 µ (95% CI: 527-530), respectively. The highest and lowest mean corneal thickness was related to the superior (620 µ: 95% CI: 618-622) and the temporal (591 µ: 95% CI: 590-592) paracentral points, respectively. According to the multiple linear regression model, the CCT was significantly inversely related to keratometry readings (K1 and K2) and had a statistically significant direct relationship with intraocular pressure (IOP), corneal eccentricity (ECC), and corneal volume (CV) (all p values <0.05). The CCT was significantly higher in diabetic patients (p = 0.043)., Conclusion: The CCT values in the geriatric Iranian population were lower than the values reported in most previous studies. The CCT is mostly influenced by IOP and corneal parameters (curvature, shape factor, and volume) and is not affected by demographic factors, refractive error, and ocular biometric components., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To determine the prevalence of myopia and hyperopia in Shahroud schoolchildren and their risk factors., Methods: Optometric examinations including the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic and cycloplegic refraction using retinoscopy were done for students. Generalized Structural Equation Modeling (GSEM) was used to determine direct and indirect effects of independent variables on myopia and hyperopia., Results: The data of 5581 students with a mean age of 9.24 ± 1.7 years were used in this study. The prevalence of myopia was 5.0% (95%CI: 4.3-5.7) and the prevalence of hyperopia was 4.8% (95%CI: 4.0 - 5.5) in all schoolchildren. According to the GSEM results, the odds of myopia in rural areas were 0.55 compared to urban areas. A one-unit increase in the ocular AL increased the odds of myopia by 4.91 times. The interaction of sex and age on myopia was significant such that in girls, the odds of myopia increased by 20% for every one-year increase in age while no significant change was seen in boys. A one-unit increase in the ocular AL decreased the odds of hyperopia by 0.49 times. Moreover, the interaction of outdoor activity hours and sex on the prevalence of hyperopia was significant such that increased outdoor activity reduced the odds of hyperopia in girls while no significant correlation was found in boys., Conclusion: Myopia and hyperopia had moderate prevalence. Axial Length had the largest direct association on myopia and hyperopia. Age and outdoor activity had weak associations on refractive errors.

Purpose: To determine the distribution of corneal biomechanical parameters in an elderly population., Methods: This cross-sectional study was conducted in subjects above 60 years living in Tehran. The participants were selected using multi-stage cluster sampling. Corneal biomechanical parameters were measured in a randomly selected subsample of this population using the Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments, Inc., Buffalo, NY, USA)., Results: Of 470 subjects, the data of 420 participants aged over 60 years were analyzed (mean age: 69.3 ± 6.5 years and range: 61-88 years), 363 (86.4%) of whom were male. The mean and standard deviation of corneal hysteresis (CH) and corneal resistance factor (CRF) were 8.37 ± 1.55 mmHg (95% confidence interval [CI]: 8.02-8.72) and 9.06 ± 1.70 mmHg (95% CI: 8.69-9.44), respectively. The mean CH was 8.27 ± 1.54 mmHg in men and 9.25 ± 1.28 mmHg in women, and the mean CRF was 9.00 ± 1.71 mmHg in men and 9.63 ± 1.37 mmHg in women. According to the results of multiple linear logistic regression analysis, CH had a significant association with younger age (β = -0.05, P = 0.032), female sex (β = 1.83, P < 0.001), reduced maximum keratometry (β = -0.22, P = 0.06), and increased anterior chamber volume (β = 0.01, P = 0.007). CRF had a significant correlation with a younger age (β = -0.06, P = 0.02), female sex (β = 1.01, P = 0.05), central corneal thickness (β = 0.02, P < 0.001), and reduced maximum keratometry (β = -0.39, P = 0.010)., Conclusion: The mean CH and CRF values were low in this sample of the Iranian population aged over 60 years indicating the weaker elasticity of the corneal connective tissue., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Current Ophthalmology.)

Purpose: To determine the relationship between road accidents with visual acuity, refractive errors, visual field, and contrast sensitivity., Methods: This population-based case-control study was conducted on roads leading to Tehran Province, Iran. The case group comprised drivers who had met with accidents and were at fault for the accident. The cases were selected in an ongoing manner (incidence cases). The controls were drivers who were the opposing victims in the same. After an initial interview, optometric and ophthalmic examinations including the measurement of visual acuity, refraction, visual field assessment, contrast sensitivity measurement, and slit lamp biomicroscopy were performed for all study participants., Results: In this study, 281 and 204 individuals were selected for the case and control groups. The mean uncorrected visual acuity was 0.05 ± 0.12 and 0.037 ± 0.10 logMAR in the case and control groups, respectively ( P = 0.095). Of the participants in the case and control groups, 32.8% and 23% had a visual field defect in at least one eye, respectively (adjusted odds ratios [aOR] = 1.63, 95% confidence interval [CI]: 1.08-2.48; P = 0.021). Moreover, 16.2% of the cases and 8.3% of the controls had visual field defects in both eyes (aOR = 2.13, 95% CI: 1.17-3.86; P = 0.012). Contrast sensitivity was worse in the case group in all spatial frequencies under non-glare conditions. However, under glare conditions, the contrast sensitivity was significantly worse in the case group only in the spatial frequency of 12 cycles per degree (cpd)., Conclusion: Reduced contrast sensitivity, especially under non-glare conditions, and visual field defects are risk factors that influence the prevalence of road accidents. It is strongly advised that special attention be paid to these visual functions in legal assessments to apply the necessary interventions in individuals with these types of disorders., Competing Interests: No conflicting relationship exists for any author., (Copyright © 2022 Hashemi et al.)

Purpose: To determine the prevalence of cataract and its relationship with some determinants in individuals above 60 years., Methods: Of 3792 subjects that were invited, 3310 participated in the study (response rate = 87.31%). All subjects underwent full optometric, slit lamp, and fundoscopic examinations. Then, their lenses were evaluated according to the World Health Organization cataract grading system after pupil dilation., Results: Age- and sex-standardized prevalence with 95% confidence interval (CI) of nuclear, cortical, posterior subcapsular cataracts (PSC), any type cataract, and all lens change was 53.09% (49.80 to 56.35), 23.02% (20.87 to 25.32), 5.57% (4.62 to 6.70), 58.78% (55.65 to 61.83), and 72.49% (70.14 to 74.71), respectively. Any type, nuclear, cortical, and PSC cataracts, had a positive association with age and an inverse association with education. Moreover, the prevalence of cortical and PSC cataract had an inverse association with economic status. Among all variables, age was the strongest determinant for cataract and its subtype., Conclusion: This study found a higher prevalence of cataract compared to some previous studies such that about two-thirds of the geriatric population had cataract in the past or at the time of the study. Considering the association of cataract with variables such as economic status and education level, it seems that training and increased awareness and knowledge of the elderly population regarding the importance of eye care by physicians plays an important role in reducing the burden of cataract.

Purpose: To determine the prevalence of astigmatism and its associated factors and examine astigmatism symmetry patterns in an elderly population., Study Design: Population based cross-sectional study., Methods: The present population-based cross-sectional study was conducted on an elderly population above 60 years of age in Tehran, Iran in 2019. The sampling was done using the stratified multistage random cluster sampling method. All study participants underwent a complete optometric examination and slit-lamp biomicroscopy., Results: The prevalence of astigmatism higher than -0.50, -1.00, and -2.00 D was 83% (95% CI: 81 -84), 52 % (95% CI: 50 -54), and 19% (95% CI: 17-20), respectively. These prevalence was 79%(95% CI: 77-81), 46(95% CI: 44-49) and 14(95% CI: 13-16) in subjects without a history of ocular surgery, respectively. Based on cylinder power worse than -1.00 D, 10% (95% CI: 9-12), 20% (95% CI: 18-22), and 21% (95% CI:19-23) of study participants had with the rule, against the rule, and oblique astigmatism, respectively. According to the results of the multiple regression model, male gender, older age, low education level, pure posterior subcapsular cataract, pseudophakia, and myopia were independent factors associated with astigmatism. The prevalence of anisorule astigmatism was 57 % (95% CI: 56-59), the most common anisorule astigmatism was against the rule-oblique type with a prevalence of 36% (95% CI: 34-38)., Conclusion: The prevalence of astigmatism was high in the elderly population of Tehran. More than half of the participants in this study had anisorule astigmatism, and against the rule-oblique combination was more prevalent than other types. A posterior subcapsular cataract, a history of cataract surgery, and myopia were the associated factors of astigmatism in this study., (© 2022. Japanese Ophthalmological Society.)

Purpose: To determine the age and sex-standardized prevalence of corneal arcus and its associated factors in a geriatric population., Methods: This population-based cross-sectional study was conducted in 2019 in Tehran; the capital of Iran, using a multi-stage stratified random cluster sampling method. All participants underwent a detailed interview, blood pressure measurement, laboratory blood tests, and a complete ocular examination., Results: Three thousand three hundred ten of 3791 invitees participated in the study (response rate: 87.31%). The mean age of the participants was 69.35 ± 7.62 years (60-97 years) and 1912 (57.76%) were female. Overall, the age and sex-standardized prevalence (95% CI) of corneal arcus was 44.28% (41.21-47.39). Based on the multiple logistic regression, the odds of corneal arcus were higher in men than in women (OR: 1.51; 95% CI: 1.14-2.00); in the age group ≥ 80 years compared to the age group 60-64 years (OR: 2.44; 95% CI: 1.68-3.53), and in retired people compared to employed individuals (OR: 2.05; 95% CI: 1.31-3.21)., Conclusion: The present study showed a high prevalence of corneal arcus in the geriatric population. Although various studies have reported a significant relationship between corneal arcus with blood lipid and glucose levels as well as blood pressure, these relationships were not found in the present study., (© 2022. The Author(s).)

Competing Interests: None.

Purpose: The aim of this study was evaluate the effect of governmental support in the form of Health Transformation Plan (HTP) on increasing the cataract surgical rate., Methods: The number of cataract surgeries was collected from Iranian cataract surgery clinics during 2019. HTP was implemented in 2014. Forty-seven major and forty-five minor surgery centers were selected from all provinces. In each center, sampling was done from 2012, 2013, 2015, and 2016., Results: On average, 6202 and 7134 cataract surgery rate were performed before and after HTP, respectively. The cataract surgical rate rose by 15.03% after the HTP. After HTP, the proportion of cataract surgery increased by 21.32% in governmental centers and decreased by 17.56%, 24.45%, and 14.89% in private, insurance, and charity centers, respectively. The cataract surgical rate was 4093 and 6026 in the first economic quartile (the poorest), 3669 and 4595 in the second quartile, 5884 and 5928 in the third quartile, and 8427 and 9681 in the fourth quartile (the richest) before and after HTP, respectively. The highest growth in the cataract surgical rate was seen in the first quartile (47.24%) followed by the second (25.26%), fourth (14.88%), and third quartiles (0.74%)., Conclusion: The Health Transformation Plan has been successful in increasing the cataract surgical rate in the low-income group and identifying differences in the services as well as the economic groups within the population., (© 2022. The Author(s).)

Clinical Relevance: Accurate measurement of the anterior chamber depth is very important. There is no report regarding the agreement between rotating Scheimpflug imaging (Pentacam HR) and biograph (Lenstar LS 900) in children. This study therefore explores the agreement between Pentacam and Biograph in measuring anterior chamber depth in children., Background: This study aims to determine the agreement between Pentacam and Biograph in measuring anterior chamber depth in children., Methods: The participants were students living in urban and rural areas of Shahroud, Iran, selected through cluster sampling. The students were transported to the examination site to undergo imaging and optometric tests. Pentacam imaging was then conducted, and biograph was used to measure biometric components. In this report, the anterior chamber depth was calculated from the corneal endothelium., Results: Of 6624 students selected randomly, 5620 participated in the study. After applying the exclusion criteria, 4882 eyes were included in the final analysis. The mean anterior chamber depth measured by the Pentacam (3.09 ± 0.26 mm) was higher than that of biograph (3.04 ± 0.24 mm) (p < 0.001). The 95% limit of agreement (LOA) between the two devices was -0.19 to 0.09 mm. The variation of the difference between the two devices decreased, LOA became narrower, and the correlation coefficient of the devices increased with ageing. The highest intraclass correlation coefficient was seen among myopic (0.974) participants. The 95% LOA was -0.20 to 0.12 mm in hyperopic, -0.17 to 0.07 mm in myopic and -0.19 to 0.09 mm in emmetropic participants., Conclusion: The Pentacam and Biograph can be used interchangeably for measuring the anterior chamber depth in children.

Aim: To determine the prevalence of ocular trauma in Iranian children aged 6-12 years., Methods: This population-based cross-sectional study, comprised the first phase of the Shahroud Schoolchildren Eye Cohort Study on primary school children using cluster sampling in urban areas and census in rural areas. The students underwent the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic, cycloplegic, and subjective refraction. The history of trauma, hospitalization, and surgery due to trauma was collected from parents using a questionnaire., Results: The data of the trauma history was recorded for 5267 out of 5620 students. The mean age of the students was 9.7 ± 1.7 years (range: 6-12 years), 53.7% of them were boys, and 79.3% were from urban areas. A positive history of ocular trauma was found in 285 participants, and the lifetime prevalence of ocular injury (95% CI) was 5.2% (4.6-5.9). Blunt trauma was the most common ocular injury with a prevalence of 66.2%. There was a significant positive assocation between ocular trauma and living in rural areas (OR: 1.49, p: 0.012), older age (OR: 1.17, p < 0.001), and male sex (OR: 1.62, p: 0.002). Furthermore, 9.3% and 4.7% of the traumas required hospitalization and surgical intervention, respectively., Conclusion: This study found a marked prevalence of ocular trauma compared to previous studies. Male sex, older age, and living in rural areas were associated with ocular trauma, which could be due to differences in lifestyle preference, outdoor exposure, and dangerous situations. Educational programs and safety instructions should be encouraged., (© 2022. The Author(s).)

Purpose: To determine the distribution of corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated intraocular pressure (IOPg) and their associated factors in a geriatric population., Methods: The present cross-sectional study was performed in individuals above 60 years of age in Tehran, the capital of Iran. The sampling was performed using multi-stage random cluster sampling method. All participants underwent preliminary ocular examinations, and then imaging by Pentacam HR and IOL master 500. Measurement of IOPg, IOPcc, and corneal biomechanical indices including corneal hysteresis (CH) and corneal resistant factor (CRF) was performed in a random sub-sample using ocular response analyzer (ORA)., Results: The mean IOPg and IOPcc were 16.76 ± 4.71 mmHg and 19.05 ± 4.67 mmHg, respectively. There were no statistically significant differences in both IOPg (p = 0.891) and IOPcc (p = 0.248) between males and females. Based on the multiple linear regression models, both IOPg and IOPcc showed a statistically significant direct relationship with CRF (P < 0.001) and a significant inverse relationship with CH (P < 0.001 for IOPg and IOPcc), anterior chamber angle (ACA) (p = 0.006 for IOPg and p = 0.017 for IOPcc), and spherical equivalent refractive error (p = 0.032 for IOPg and p = 0.046 for IOPcc)., Conclusion: Mean IOPg and IOPcc in the present study were higher compared to most previous studies. Corneal biomechanical indices including CH and CRF, refractive error and anterior chamber angle were independent associated factors of IOPg and IOPcc in the present study. There was no significant relationship between ORA-derived IOP values and CCT., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To determine the distribution of blood glucose and prevalence of diabetes in people above 60 years living in Tehran and their relationship with some variables., Methods: In this cross-sectional population-based study, multistage cluster sampling was performed in the over 60-year-old population of Tehran. Blood samples were collected from all participants and the data of the history of diabetes and the use of blood glucose lowering agents or other drugs were collected using interviews., Results: Of 3791 selected subjects, 3310 participated in the study (response rate = 87.3%). The mean blood Sugar (BS) and hemoglobin A1c (HbA1c) of the patients was 118.11(95% CI: 115.34 -120.88) and 6.12(95% CI: 6.05-6.2) respectively. The prevalence of diabetes was 29.03%(95% CI: 27.12-30.94) in all subjects, 26.83%(95% CI: 24.58-29.07) in men, and 31.2%(95% CI: 28.24-34.16) in women. Odds of diabetes was significantly worse in women. systolic blood pressure, diasstolic blood pressure, height, weight, waist circumference, wrist circumference, hip circumference, neck circumference and body mass Index were significantly higher in diabetic after adjusting for the effect of sex and age. The odds of blindness was 2.69 (95% CI: 1.10-6.59) times higher in diabetic than in non-diabetics., Conclusions: On average, one in every three persons above 60 years of age was diabetic. Therefore, attention should be paid to this age group, especially women, due the higher prevalence of diabetes. All anthropometric measurements except height had a strong correlation with diabetes. Blindness was significantly more in diabetics., Competing Interests: Conflicts of interestNone, (© Springer Nature Switzerland AG 2022.)

To determine the repeatability of biometric measurements by dual Scheimpflug Devices with Integrated Optical Biometers and its agreement with partial coherence interferometry according to the axial length (AL), and the presence of cataracts. The present population-based cross-sectional study was conducted on the geriatric population in Tehran. For participants, imaging was performed by dual Scheimpflug Devices with Integrated Optical Biometers (Galilei G6) and partial coherence interferometry (IOL Master 500). All measurements were performed by one person. In both normal and cataractous eyes, the ICC values were above 0.99 for three measurements of AL, intraocular lens (IOL) power target, anterior chamber depth (ACD), central corneal thickness (CCT), flat and steep keratometry readings, and mean total corneal power (MTCP). The repeatability coefficient for the AL measurements was 0.003 and 0.002 in eyes with and without cataracts, respectively. The mean difference of AL between IOL Master 500 and Galilei G6 in normal and cataractous eyes was 0.015 and -0.003 mm, respectively. The 95% limits of agreement (LoA) of AL between these two devices were -0.09 to 0.12 mm in normal and -0.09 to 0.08 mm in cataractous eyes. The 95% LoA of ACD between the two devices was -0.13 to 0.36 mm and -0.10 to 0.31 mm in eyes without and with cataracts, respectively. The 95% LoA of steep K between the two devices was -0.63 to 0.32 and -1.04 to 0.89 diopter in normal and cataractous eyes, respectively. The results of the present study indicate the high repeatability of Galilei G6 in ocular biometric measurements. Galilei biometric measurements, had a very high agreement with the IOL Master 500., (© 2022. The Author(s).)

Clinical Relevance: Considering the significant relationship between opioid abuse and some accommodative and convergence disorders, opioid use should be considered in the differential diagnosis and will directly affect the management plan., Background: To determine the prevalence of accommodative and convergence anomalies and their related factors in a population of male young adults with opioid use disorder (OUD)., Methods: This cross-sectional study was conducted using a convenience sampling method in 2019. The study sample included male young adults with OUD who had been referred to a specialised drug-dependence rehabilitation centre in Mashhad, Iran. The diagnosis of OUD was made by a psychologist based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. All patients underwent complete optometric examinations., Results: Eighty male young adults with OUD were included in this study. The mean age of participants was 30.5 ± 3.9 years (age range 19 to 35 years). The prevalence of accommodative and convergence disorders was 33.75% (95% CI: 23.55-45.19) and 25.00 (95% CI: 15.99-35.94), respectively. Accommodative insufficiency (22.5%, 95% CI: 13.91-33.21) had a higher prevalence than accommodative excess (3.75%, 95% CI: 0.78-10.57) and accommodative infacility (7.50%, 95% CI: 2.80-15.61). Convergence insufficiency (18.75%, 95% CI: 10.89-29.03) had a higher prevalence compared to convergence excess (3.75%, 95% CI: 0.78-10.57) and basic exophoria (2.50%, 95% CI: 0.30-8.74). According to the multiple logistic regression, a significant inverse relationship was observed between pupil size with accommodative insufficiency (OR = 0.45), accommodative infacility (OR = 0.67), and convergence insufficiency (OR = 0.55)., Conclusion: The results of the present study showed a higher prevalence of some accommodative and convergence disorders in OUD patients compared to the prevalence reported in previous studies conducted on the normal populations with a similar age range.

Purpose: To evaluate varied aspects of binocular function in multiple gaze positions., Methods: In 2018, this cross-sectional study was conducted on 21 participants (male = 11) with an age range of 19-25 years. Having emmetropia and 10/10 visual acuity in both eyes were conditions of the inclusion criteria for the cross-sectional study. The following aspects of binocular function including amplitude of accommodation (AA), near point of convergence, near phoria, and monocular accommodative facility were evaluated in five gazes (primary, upward, downward, left, and right) for all subjects., Results: Near point of convergence values showed significant differences in all gaze positions ( P < 0.001). The lowest near point of convergence value was seen in the primary gaze (2.69 cm) and the downward gaze (3.47 cm) and the highest near point of convergence value was seen in the left gaze (7.5 cm). There was also a significant difference in the amplitude of accommodation among the upward, downward, and the primary gaze ( P < 0.001) positions but no difference was observed among the temporal, nasal, and the primary gaze positions. There was a significant difference in near phoria between the upward gaze and the primary gaze ( P = 0.008) while no significant differences were observed among the other gazes. There was no significant variance in the monocular accommodative facility among the different gaze positions ( P = 0.175)., Conclusion: The results of this study indicated variations that exist in the convergence and accommodation reflex functions in multiple gaze positions, which proved to be more prominent in the convergence system. Although the accommodative sufficiency evaluation was inconsistent among the multiple gaze positions, the accommodative facility evaluation was consistent in all gazes., Competing Interests: No conflicting relationship exists for any author., (Copyright © 2022 Asharlous et al.)

Purpose: To determine the global prevalence and common causes of visual impairment (VI) and blindness in children., Methods: In this meta-analysis, a structured search strategy was applied to search electronic databases including PubMed, Scopus, and Web of Science, as well as the list of references in the selected articles to identify all population-based cross-sectional studies that concerned the prevalence of VI and blindness in populations under 20 years of age up to January 2018, regardless of the publication date and language, gender, region of residence, or race. VI was reported based on presenting visual acuity (PVA), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) of equal to 20/60 or worse in the better eye. Blindness was reported as visual acuity worse than 20/400 in the better eye., Results: In the present study, 5711 articles were identified, and the final analyses were done on 80 articles including 769,720 people from twenty-eight different countries. The prevalence of VI based on UCVA was 7.26% (95% confidence interval [CI]: 4.34%-10.19%), PVA was 3.82% (95% CI: 2.06%-5.57%), BCVA was 1.67% (95% CI 0.97%-2.37%), and blindness was 0.17% (95% CI: 0.13%-0.21%). Refractive errors were the most common cause of VI in the subjects of selected articles (77.20% [95% CI: 73.40%-81.00%]). The prevalence of amblyopia was 7.60% (95% CI: 05.60%-09.10%) and congenital cataract was 0.60% (95% CI: 0.3%-0.9%)., Conclusion: Despite differences in the definition of VI and blindness, based on PVA, 3.82%, and based on BCVA, 1.67% of the examined samples suffer from VI., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Current Ophthalmology.)

Purpose: We conducted a systematic search to estimate DR prevalence in different age and gender groups, and to evaluate the determinants of heterogeneity in its prevalence., Methods: A systematic and comprehensive search from inception to August 10, 2020, was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross-sectional studies related to the prevalence of DR., Results: Of 6399 studies, 90 articles with a sample size of 563460 individuals and 204189 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.98 to 30.84); 25.93% (95% CI: 23.54 to 28.31) and 28.95% (95% CI: 26.57 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I 2 was 99% ( p < .001). According to the meta-regression results, the variables of WHO region (Coefficient of AMRO vs SEARO: 15.56; p: 0.002), age (Coefficient of above 60 years vs below 40 year: 18.67; p: 0.001), type of DR (Coefficient: 19.01; p < .001), and publication year (Coefficient: -0.60; p: 0.001) had a significant correlation with heterogeneity., Conclusion: One third of diabetic patients suffered from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR.

Background: We aimed to determine the age and sex standardized prevalence of corneal opacity and its determinants., Methods: The Tehran Geriatric Eye Study (TGES) is a population-based cross-sectional study conducted on 3791 subjects aged above 60 yr in Tehran, Iran (2019) selected using stratified random cluster sampling. After sampling, all subjects underwent complete ophthalmic, optometric, and eye examinations., Results: The 3310 participated in the study, of whom the data of 3284 were analyzed. The age and sex standardized prevalence with 95% confidence interval (CI) of corneal opacity in at least one eye, both eyes, and one eye was 9.58% (95% CI: 8.50 to 10.79), 5.52% (95% CI: 4.71 to 6.45), and 4.07% (95% CI: 3.35 to 4.94), respectively. The mean uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) according to LogMar were worse in subjects with corneal opacity (both P <0.001). According to multiple logistic regression analysis, male sex (OR: 1.98; P : 0.003), age>80 yr (OR: 2.05; P : 0.004), and lack of insurance coverage (OR: 1.87; P : 0.004) increased the odds and high school education (OR: 0.68; P : 0.003) reduced the odds of corneal opacity. Among the study variables, sex was the most important determinant of corneal opacity (standardized beta: 0.126)., Conclusion: This study found a high prevalence of corneal opacity in the geriatric population. Considering the increasing trend of population aging in Iran, attention should be paid to prioritizing public health policies to estimate resources required for providing comprehensive corneal services and improving geriatric eye health., Competing Interests: Conflict of interest No conflicting relationship exists for any author., (Copyright © 2022 Hashemi et al. Published by Tehran University of Medical Sciences.)

Purpose: To simplify the fitting process, this study was designed to predict the initial power of contact lenses using the regression model based on manual Javal keratometry data and refractive errors., Methods: In this retrospective study, 121 eyes of 69 patients with keratoconus (KCN) were fitted with a specific trial set of rigid gas permeable contact lenses based on the standard criterion of "three-point touch" over a 7-year period. Power of the cornea was measured using Javal keratometer. Refractive errors and over refraction of patients were diagnosed using Topcon autorefractometer (RM-A2000) and confirmed by Heine beta 2000 retinoscope., Results: The results of multiple linear regression showed the following equation: power of contact lens = -14.368 (constant of the final multiple regression model), +0.475 (spherical refraction), and +0.275 (flatter corneal power)., Conclusions: The results of this study revealed that lens power has a significant relationship with the power of the flat corneal meridian and spherical refractive error in KCN patients. The obtained regression model can be used to shorten patients' chair time and optometric examination for predicting the power of contact lens., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Current Ophthalmology.)

Purpose: 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., Methods: 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., Results: 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., Conclusion: 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.

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 ( p  < 0.0001), keratometry readings ( p  < 0.0001), and cylinder power ( p  < 0.0001). The central, inferior, and nasal cornea were significantly thinner in the welders than in controls ( p  < 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 ( p  < 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.

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., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

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., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

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.

Purpose: This study was conducted to determine economic inequality in Eye Care Services Utilization (ECSU) and its determinants in the underserved rural population of Iran., Methods: 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., Results: 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 ( p < 00.001). A marked percentage of the gap was due to the explained portion (b: -11.49; p < .001). The unexplained portion coefficient was b: 2.72 (p: 0.020). In the explained portion, economic status (b: -12.37; p < .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; p < .001) had a significant effect on inequality in favor of the rich in the unexplained portion., Conclusion: 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.

Purpose: To determine economic inequality in visual impairment (VI) and its determinants in the rural population of Iran., Methods: In this population-based, cross-sectional study, 3850 individuals, aged 3-93 years were selected from the north and southwest regions of Iran using multi-staged stratified cluster random sampling. The outcome was VI, measured in 20 feet. Economic status was constructed using principal component analysis on home assets. The concentration index ( C ) was used to determine inequality, and the gap between low and high economic groups was decomposed to explained and unexplained portions using the Oaxaca-Blinder decomposition method., Results: Of the 3850 individuals that were invited, 3314 participated in the study. The data of 3095 participants were finally analyzed. The C was -0.248 (95% confidence interval [CI]: -0.347 - -0.148), indicating a pro-poor inequality (concentration of VI in low economic group). The prevalence (95% CI) of VI was 1.72% (0.92-2.52) in the high economic group and 10.66% (8.84-12.48) in the low economic group with a gap of 8.94% (6.95-10.93) between the two groups. The explained and unexplained portions comprised 67.22% and 32.77% of the gap, respectively. Among the study variables, age (13.98%) and economic status (80.70%) were significant determinants of inequality in the explained portion. The variables of education (coefficient: -4.41; P < 0.001), age (coefficient: 14.09; P < 0.001), living place (coefficient: 6.96; P : 0.006), and economic status (coefficient: -7.37; P < 0.001) had significant effects on inequality in the unexplained portion., Conclusions: The result showed that VI had a higher concentration in the low economic group, and the major contributor of this inequality was economic status. Therefore, policymakers should formulate appropriate interventions to improve the economic status and alleviate economic inequality., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Current Ophthalmology.)

Purpose: To determine the prevalence of fusional vergence dysfunction (FVD) and its relationship with age, sex, and refractive errors in a population-based study., Methods: In this cross-sectional study, all residents of Mashhad, northeast of Iran, aged >1 year were subjected to random stratified cluster sampling. After selecting the participants, they all underwent complete optometric examinations including the measurement of visual acuity and refraction, assessment of binocular vision and accommodative status, and slit-lamp biomicroscopy., Results: Of 4453 invited individuals, 3132 participated in the study. After applying the exclusion criteria, statistical analysis was performed on the data of 1683 participants. The prevalence of FVD was 3.2% in all participants, 4.0% in men, and 2.9% in women ( P = 0.234). The prevalence of FVD increased linearly with aging from 2.3% in the age group of 10-19 years to 5.4% in the age group of 40-49 years ( P = 0.034). The prevalence of myopia, hyperopia, and emmetropia was 11.1%, 29.6%, and 59.3% in participants with FVD and 16.7%, 26.4%, and 57% in participants without FVD, respectively ( P = 0.570). Multiple logistic regression analysis only showed a significant association between age and FVD (odds ratio =1.03 95% confidence interval: 1.02-1.05, P = 0.031)., Conclusion: The prevalence of FVD in this study was higher than most previous reports and increased significantly with aging. FVD had no significant association with sex and refractive errors., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Current Ophthalmology.)

Clinical relevance : 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. Background : 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. Methods : 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. Results : 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. Conclusion : 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.

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., (© 2021 The Authors Ophthalmic and Physiological Optics © 2021 The College of Optometrists.)

Clinical relevance : 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. Background : To determine the relationship between the demographic variables and baseline clinical characteristics with the prism effectiveness in young adults with convergence insufficiency. Methods : 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. Results : 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. Conclusion : 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.

Purpose : 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. Methods : 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. Results : 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 ( P < .001). Conclusion : 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.

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.

Purpose: To find an appropriate correlation between the base curve (BC) of rigid gas permeable (RGP) contact lenses and manual keratometry findings in Iranian patients with keratoconus (KCN) in order to simplify the fitting process, reduce the time, and lower the costs., Method: This retrospective study was done in 121 eyes of 69 patients with KCN fitted with a specific trial set of RGP contact lenses over a 7-year period. The specifications of the final lens parameters included power, total diameter (1), and BC, the first two of which were fixed in all of the lenses in the trial set while BC was changed in 0.1-mm steps. Javal keratometer was used to measure keratometric values. The final fit assessment was performed based on the standard criterion of "three-point touch"., Result: Single and multiple linear correlations were done and the result was the following equation: BC = 2.455 (constant of the final multiple regression model) + 0.280 (steep keratometry) + 0.368 (flat keratometry) + 0.047 (corneal astigmatism) CONCLUSION: The advantages of this study include simplifying the RGP fitting process, reducing the examination time, lowering the costs, enhancing the confidence of the examiners and patients, easier lens fitting in remote places where more advanced devices are not accessible., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)