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Purpose: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. Methods: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling "E" chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. Results: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). Conclusion: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diabetes is one of the major health challenges in world. Herbal medicines are widely used for the treatment of diabetes. The current study assessed the effects of oral administration of essential oils from Myrtus communis, Trachyspermum copticum and Ferula gummosa on blood glucose and lipid profiles in streptozotocininduced diabetic rats and inhibitory effects of these oils on α-glucosidase activity in vitro. Materials and Methods: Forty-eight male Wistar rats were divided into six groups of healthy control, diabetic control, healthy control received corn oil and three experimental diabetic groups treated by the essential oils. Four weeks after intraperitoneal injections of 45-mg/kg streptozotocin doses, experimental groups were gavaged with 200 mg/kg/day of the oils for thirty days, then serum glucose and lipid profiles of the rats were assessed. Data were analyzed using one-way ANOVA and Tukey test. Study was carried out in Animal Laboratory of the Translational Ophthalmology Research Center, Tehran, Iran, 2016. Results: Compared to healthy control group, serum glucose, triglyceride (TG) total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) increased in diabetic control group significantly (P < 0.001). No significant differences were observed in high-density lipoprotein cholesterol (HDL-C) between the healthy and diabetic control groups. The M. Communis oil showed the most significant inhibitory effects on α-glucosidase than those two other oils did. Furthermore, M. communis significantly decreased glucose (478±24 vs. 355±48; p<0.001), TG (167±13 vs. 118±13; p<0.001), TC (107±11 vs. 83±13; p<0.01), and LDL-C (70±8 vs. 47±4; p<0.001) while increased HDL-C (37±5 vs. 53±9; p<0.01). F. gummosa and T. copticum had no effect on glucose levels in diabetic rats. T. copticum lowered TC (107±11 vs. 89±12; p<0.05) and (LDL-C (70±8 vs. 43±10; p<0.001) while increased HDL-C (37±5 vs. 49±8; p<0.05). F. gummosa just decreased TG (167±13 vs. 105±12; p<0.001) and LDL-C (70±8 vs. 30±4; p<0.001) levels in diabetic rats. Conclusions: In general, lipid profile improvement was demonstrated using the three essential oils in diabetic rats; of these essential oils, only M. Communis oil included hypoglycemic effects possibly due to its α-glucosidase inhibitory activity. [ABSTRACT FROM AUTHOR]

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PURPOSE: The purpose of this study is to provide a pooled estimate of moderate-to-severe visual impairment (MSVI) and blindness in Iran for people 50 years and over and to identify the major causes through systematic review. MATERIALS AND METHODS: International (PubMed, ISI Web of Science, and Scopus) and national databases (Scientific Information Database, Barakat Knowledge Network System, Iran Databank of Ophthalmology Research, and Magiran) databases were searched. Following relevance assessment and critical appraisal, eight studies were included. A funnel plot was drawn to explore the stability for estimation. Single-variable meta-regression analysis was applied for heterogeneity assessment, and a random effect model was used (but no significant source for the observed heterogeneity was found). RESULTS: Age-standardized pooled estimate of MSVI was 4.24% (95% confidence interval [CI]: 2.92-5.56); 3.98% (95% CI: 2.37-5.59) for men, and 4.08% (95% CI: 2.95-5.21) for women. Blindness (visual acuity <3/60) prevalence was 1.31% (95% CI: 1.23-1.39); 0.96% (95% CI: 0.89-1.03) for men, and 1.13% (95% CI: 1.06-1.20) for women. Causes of visual impairment (VI) were cataract (40.23%), amblyopia (12.03%), corneal opacity (9.63%), age-related macular degeneration (9.31%), diabetic retinopathy (4.94%), and glaucoma (3.67%). CONCLUSION: VI prevalence in the 50 years and older population in Iran seems significantly better than the corresponding global estimates. A rough 60% rate of treatable VI was estimated, mostly attributable to unoperated cataract. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety and outcome of single-piece posterior chamber intraocular lens (PC-IOL) implantation in the ciliary sulcus following posterior capsular rupture during cataract surgery. Methods: Patients with posterior capsular rupture during cataract surgery with a single-piece acrylic IOL implanted into the ciliary sulcus were studied. Complete ocular examinations were performed after 6 months postoperatively. Results: Twenty-four eyes were included. Mean follow-up duration was 8.33 ± 2.33 months. There was no significant difference between preoperative and postoperative keratometric cylinder or intraocular pressure. Visual acuity of 87.50% of patients was ≥20/40 after surgery. Complications included foveopathy (10 eyes), iris transillumination defect (4 eyes), iris chafing (2 eyes), pigmented keratic precipitate (KP) (4 eyes), clinical IOL tilt (6 eyes), endothelial pigment dusting (14 eyes), IOL pigment dusting (17 eyes), iris bowing (6 eyes), IOL decentration (4 eyes), and IOL tilt detected with ultrasonography biomicroscopy (UBM) (4 eyes). IOL pigment dusting was significantly higher in eyes with short axial lengths, high IOL power, small sulcus-to-sulcus (STS) diameter, large STS IOL diameter mismatch, and small anterior chamber depth and angle. Significant relationships were observed between pigmented KP with small STS diameter and large STS IOL diameter mismatch, UBM and clinical IOL tilt with large anterior chamber depth and between iris transillumination defect and STS IOL diameter mismatch. Conclusion: This implantation is associated with higher incidence of complications. Single-piece acrylic IOLs are not designed for sulcus implantation. However, they may be used in eyes with longer axial length if the 3-piece IOL is not available. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although Visual impairment (VI) and its prevention is a public health issue, sub-optimal information about its magnitude in national level and its distribution is one of the impediments for visual health advocacy. In this article, we are detailing the approaches which will be taken to estimate the magnitude (prevalence, incidence, and burden), distribution, and trend (1990 to 2013) of low vision and blindness in Iran. Besides that, an attempt will be made to describe inequalities and their determinants. METHODS: After finalizing the list of diseases, a systematic search will be started using confirmed search terms and all published and unpublished data will be extracted. Other data sources, including data from hospital records, schoolchildren amblyopia and refractive error screening data, registries such as Iran Eye Bank keratoplasty will be added to the data extraction sheet. Using distinct statistical models including spatio-temporal model and multilevel autoregressive model, we will estimate rate of burden measures of eye disease and their uncertainty interval by sex, age, year, and province as well as social determinants of visual impairment inequality. Conclusion: The results are to be reported in separated analyses of meta-analysis, trend, risk factors and diseases burden, inequality, Bayesian prediction modeling, and map for visualizing the results. CONCLUSION: The results of the current study will address gaps in different regions and have implication for evidence-based policy making in Iran. [ABSTRACT FROM AUTHOR]

The letter to the editor discusses how tactile feedback is revolutionizing simulation-based medical education by providing realistic touch sensations, enhancing skill transfer to clinical practice. Tactile feedback aligns with educational theories, improves experiential learning, and bridges the gap between theory and practice. Recent technological advancements have made tactile feedback more realistic and accessible, enriching medical training and producing more competent healthcare professionals. [Extracted from the article]

Objective: To assess the national health system for management of diabetes mellitus (DM) in Iran, with particular focus on diabetic retinopathy (DR). Materials and Methods: In this qualitative study, the national stakeholders related to DR and DM management system were invited to participate. Two researchers performed interview using a semi-structured questionnaire recommended by the World Health Organization titled "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire contains seven different sections, each consisting of closed and open-ended questions, and a final Likert-type score, ranging from 1 indicating the worst to 4 indicating the best status. Inconsistencies were resolved through a collective decision of the research team, followed by a focus group discussion with stakeholders at the Ministry of Health. Results: Fourteen stakeholders out of 15 total invitees were interviewed (response rate: 93.3%). There were national priorities, defined policies, and running programs (score = 3), but the care system should be strengthened in terms of implementation of clinical guidelines, with specific reference to the availability of regular screenings for DR (score = 2). The network of care providers, health information systems, and promotional programs were insufficient (score = 2). The health workforce and technology for DR and DM were acceptable (scores 4 and 3, respectively); however, there were concerns about the appropriate distribution and utilization of resources and out-of-pocket costs paid by patients. Conclusion: The existence of national policies, programs, a qualified workforce, and modern technology is promising. Nevertheless, other aspects of the health system need to be improved to ensure access to health and eye care for people with DM and achieve Universal Health Coverage. [ABSTRACT FROM AUTHOR]

Competing Interests: There are no conflicts of interest.

Purpose: This study aimed to evaluate the corneal epithelial thickness changes after photorefractive keratectomy (PRK) and the impact of long-term artificial tear usage on epithelial thickness changes in these patients., Methods: This study was performed on 71 patients (142 eyes) without dry eye disease who received PRK for myopic refractive correction. The corneal epithelial thickness profile was obtained before, one, three, and six months after surgery using anterior segment optical coherence tomography. Patients were randomly divided into two groups: group A, who received preservative-free artificial tears post-surgery, and group B, who did not receive artificial tears., Results: The epithelial thickness decreased universally in the first month and then increased in the 3- and 6-month follow-ups. Group A had a significantly thicker epithelium in central, paracentral, and midperipheral zones compared with group B in the 3-month follow-up. In the 6-month follow-up, no significant differences were detected between groups. At the last follow-up, the central, paracentral, and midperipheral zone epithelial thicknesses in all patients were significantly higher than preoperative values, but peripheral zone thickness only increased to preoperative values., Conclusions: Patients using artificial tears showed a faster thickening, especially in the central and paracentral zones, but there were no significant differences between the two groups in the final follow-up. Artificial tear usage may increase the rate of the epithelial remodeling process in post-PRK patients without significantly altering the final epithelial thickness profile. Further studies are warranted to evaluate the influence of different factors on epithelial remodeling., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Competing Interests: There are no conflicts of interest.

Purpose: To compare intraocular pressure (IOP) values measured by ocular response analyzer (ORA) in contact lens-induced corneal warpage, normal, and keratoconic eyes., Methods: In a prospective, observational case-control study, 94 eyes of 47 warpage-suspected cases and 46 eyes of 23 keratoconic patients were enrolled. Warpage-suspected cases were followed until a definite diagnosis was made (warpage, nonwarpage normal, or keratoconus). ORA tonometry and corneal biomechanics testing were performed for all cases in each visit. We had 2-3 measured corneal-compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) for each patient (based on group) with at least 2-week interval., Results: After following up of warpage-suspected patients, finally 44 eyes of 22 patients had confirmed soft contact lens-related corneal warpage. Forty-six eyes of 23 people were finally diagnosed as nonwarpage normal eyes. Forty-six eyes of 23 known keratoconus patients were also included for comparison. The demographic and refractive data were not different between the warpage and nonwarpage normal groups but were different in the keratoconus group. Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups; the same trend was observed in central corneal thickness (CCT). The mean of IOPg was 14.94 ± 2.65, 13.7 ± 2.33, and 10.86 ± 3 and IOPcc was 15.73 ± 2.4, 15.28 ± 2.43, and 14.08 ± 2.55 in the warpage, normal, and keratoconus groups, respectively. IOPg and IOPcc in the warpage group (based on baseline diagnosis) did not regress to become closer to IOP of normal eyes after discontinuation of contact lens in their follow-up visits ( P value for IOPg and IOPcc trends in the warpage group was 0.07 and 0.09 controlling for CCT, respectively). Both IOPcc and IOPg were significantly lower in keratoconic eyes in comparison with normal eyes. After correction for the confounding effect of CCT, a lower IOPcc in keratoconus versus warpage remained significant ( P = 0.02)., Conclusion: Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups, just like their CCT. After correction for the confounding effect of CCT, there was no statistically significant difference between the three groups in their measured IOPcc and IOPg except for IOPcc in keratoconus versus warpage ( P = 0.02)., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Current Ophthalmology.)

Aim: To conduct a cost-utility analysis of the tele-retinopathy of prematurity (ROP) screening program against no screening., Methods: A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective. We used the quality adjusted life years (QALY) index to measure the scenarios' effectiveness, which was discounted for the future years by 0.058. One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information. We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach. The figures of the model's inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data, and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties., Results: The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD, respectively. The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD, respectively, and their lifetime discounted QALY gained were calculated as 15.39 and 15.11, respectively. Therefore, incremental cost-effectiveness ratio (ICER) of tele-screening strategy against the competitive strategy was achieved as 161.43 USD., Conclusion: Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation., (International Journal of Ophthalmology Press.)

Background: Due to lack of information about ophthalmic economics in Iran, health policy makers unable to distribute resources optimally in terms of efficiency and equity. Therefore, we estimated the total and eye care utilization, out-of-pocket expenditures, and its association with social determinants of health in Iran in 2015., Methods: A multi-stage population-based, cross-sectional study in a random sample aged 50 yr or older in Kurdistan Province, Northwest Iran was used. The utilization rate of eye and general health care and related out-of-pocket expenditures was estimated during the recent last six months. To find the association between social factors and care out-of-pocket expenditures, we used a Heckman two-step regression model., Results: About 81% and 37% of participants were utilized the health and ophthalmic services, respectively. Statistically significant lower ophthalmic utilization rates were observed among men, middle-aged population, illiterate participants, rural residents, daily-paid workers, and the poorest participants. The average of vision and total health-related out-of-pocket expenditures among those used these services have estimated as US$43.7 (SE: 2.6) and US$439.9 (SE: 22.8), respectively. The highest (US$ 396.6) and lowest (US$ 10.4) ophthalmic out-of-pocket costs were related to patients with Glaucoma and Central Nervous System abnormalities, respectively. Multivariate analyses confirmed an unequal probability of having the ophthalmic out-of-pocket expenditures among different subgroups especially in favor of females, older, and those with more severe visual impairment., Conclusion: Ophthalmic disorders reconstituted about 10% of all health services OOP expenditures on average among individuals older than 50 yr., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Aim: To compare the lifetime and annual economic burden of spectacles, contact lenses, and refractive surgery in correction of refractive errors., Methods: This is a cross-sectional study with convenience sampling which 120 patients were interviewed in a tertiary referral hospital in the Iranian health care system. The bottom-up based cost of illness approach was estimated using a face-to-face interview to assess the direct and indirect cost of different refractive errors correction of any correction technologies., Results: Correction with spectacle imposes a total direct cost of US dollar (US$) 342.5 (±8.41) per year and US$9373.5 (±230.1) per lifetime to each patient. These figures for the contact lenses were obtained US$198.3 (±0.12) and US$5203.1 (±256.3) and for refractive surgery were obtained US$19.1 (±1.2) and US$568.1 (±64.6), respectively. Overall, based on age-adjusted prevalence rates, astigmatism had the highest share of refractive errors economic burden with a lifetime direct cost of slightly less than US$5.49 billion, while hyperopia and myopia imposed less than US$5.24 and 4.2 billion on patients, respectively. The annually imposed cost on each individual Iranian patient with refractive errors is US$308.5., Conclusion: Based on 18mo post refractive surgery course observation, which is generalized to whole life, refractive surgery significantly imposed much less cost compared with spectacles and contact lenses. Refractive errors among Iranians result in considerable economic burden. Using the refractive surgery instead of other two correction methods has the ability to reduce this economic loss in the future.

Background: To extract utility values of diabetic retinopathy on a perfect health and perfect vision scales for Iranians with both types diabetes., Methods: In this investigation, 150 untreated patients with diabetic retinopathy consecutively were examined and interviewed in Farabi Eye Hospital, Tehran, Iran, a tertiary referral center in the Iranian health care system. Utility values based on patients-reported outcome measures, standard gamble, time trade off and visual analogue scale approaches, were estimated., Results: Considering all three utility elicitation methods were valid, diabetic retinopathy patients, on average reported the 0.95 (±0.03), 0.85 (±0.15) and 0.80 (±0.30) standard policy scale utility according to standard gamble, TTO and VAT respectively. In all three-studied approach, diabetic retinopathy had more disutility in higher levels of disease and had more disutility in the presence of both maculopathy and vasculopathy compared with one of them. Evidence show that share of macular edema in imposing disutility was maximum in early stage and exponentially decreased with advancing the severity of diabetic retinopathy., Conclusion: Study indicated utility scores in DR-experienced Iranian patients were highest with the SG and lowest with the VAT method. The proffered utility-elicitation method in Iranian patient populations could be the TTO approach. The novel model we employed for DR takes the effects of diabetic macular edema and vascularization into account separately, and can provide a better estimate of the QoL for these patients.

Aim: To determine risk factors of regression and undercorrection following photorefractive keratectomy (PRK) in myopia or myopic astigmatism., Methods: A case-control study was designed in which eyes with an indication for re-treatment (RT) were defined as cases; primary criteria for RT indication, as assessed at least 9mo postoperatively, included an uncorrected distance visual acuity (UDVA) of 20/30 or worse and a stable refraction for more than 3mo. Additional considerations included optical quality symptoms and significant higher order aberrations (HOAs). Controls were chosen from the same cohort of operated eyes which had complete post-operative follow up data beyond 9mo and did not need RT. The cohort included patients who had undergone PRK by the Tissue-Saving (TS) ablation profile of Technolas 217z100 excimer laser (Bausch & Lomb, Rochester, NY, USA). Mitomycin C had been used in all of the primary procedures., Results: We had 70 case eyes and 158 control eyes, and they were comparable in terms of age, sex and follow-up time (P values: 0.58, 1.00 and 0.89, respectively). Pre-operative spherical equivalent of more than -5.00 diopter (D), intended optical zone (OZ) diameter of less than 6.00 mm and ocular fixation instability during laser ablation were associated with RT indications (all P values <0.001). These factors maintained their significance in the multiple logistic regression model with odd ratios of 6.12, 6.71 and 7.89, respectively., Conclusion: Higher refractive correction (>-5.00 D), smaller OZ (<6.00 mm) and unstable fixation during laser ablation of PRK for myopia and myopic astigmatism were found to be strong predictors of undercorrection and regression.

We aimed to present herein the case of a potentially preventable death involving traumatic aortic rupture and to develop a critical pathway for the management of isthmic aortic ruptures consistent with the available resources. A retrospective record review by a multidisciplinary panel of experts was done, and the probability of survival was estimated based on the Revised Trauma Score and Injury Severity Scale score. Literature review and expert consensus were used in a quality and safety analysis to develop a critical care pathway for future cases. A 32-year-old man, injured in a motorcycle accident, was referred to a trauma center in a state of shock. Thoracic aortic rupture was highly suspected. For educational purposes, the classic signs of a widened mediastinum, right tracheal deviation, and left-sided hemothorax (in a context of significant deceleration injury) are incorporated into an acute care triad for traumatic aortic rupture. In such cases, in the absence of poor access to aortography, we suggest (serial - if needed) contrast-enhanced chest computed tomography scanning for diagnosis confirmation and operative planning. Assumption of hemodynamic stability can be catastrophic, and transferring the patient to a second facility may endanger survival, when operative capacity exists at the initial trauma facility.

Background: Ophthalmology is unique in that its practitioners are exposed to a host of ergonomic (eg, indirect ophthalmoscopy), ergo-ophthalmologic (laser), infectious (adenovirus), and allergic (topical anesthetics) hazards. The purpose of this study is to provide a preliminary occupational health profile of Iranian ophthalmologists., Methods: A comprehensive list of occupation-related entities was incorporated into a questionnaire, which was distributed among 350 ophthalmologist participants of the Annual Iranian Congress of Ophthalmology (November 2000, Tehran) and was mailed twice to the 1050 nation's registered ophthalmologists. Independent Samples t and chi-square tests were used to assess the relationships., Results: One hundred sixty-two questionnaires were returned. The mean career time was 15.7 (range, 1-40) years. Twenty (12.3%) of the participants were women. The reported prevalences were as follows: history of infectious conjunctivitis, 49.4%; contact dermatitis, 43.2%; back pain, 80%; chronic headache, 54.9%; and laser or operating microscope-related visual disturbances, 15%. Psychological indispositions were reported by two thirds. Age and career time were inversely related to contact dermatitis, chronic headache, and stress-related problems (P < .05). Visual complaints were more prevalent in vitreoretina surgeons (P < .004). Psychosocial disorders were significantly more reported by women (P = .026; odds ratio = 4.4). Only 3% of participants reported to have none of the listed problems., Conclusion: Our preliminary survey disclosed a high prevalence of diverse complaints from back and neck pain, contact dermatitis, visual disturbances, and infectious conjunctivitis to stress-related and psychosocial disorders among the participants. Younger age, being a woman, and vitreoretina practice were the complaints correlates. Due to the low response rate, uncertainty over the representativeness and coverage of the sample, and lack of control groups, the findings have to be interpreted conservatively.