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1.
BMC Public Health ; 24(1): 2797, 2024 Oct 12.
Article in English | MEDLINE | ID: mdl-39395938

ABSTRACT

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) in the population covered by the Tehran University of Medical Sciences is unclear but crucial for healthcare programs. This study aims to validate four non-laboratory risk-score models, the American Diabetes Association (ADA) Risk Score, Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), Finnish Diabetes Risk Score (FINDRISC), and TOPICS Diabetes Screening Score, for identifying undiagnosed diabetes and indirectly estimate the prevalence of T2DM in a subset of the Tehranian population using the selected model. METHODS: This research consisted of two main parts. In the first part, non-laboratory risk-score models to identify undiagnosed T2DM were validated using Iranian data from STEPs 2016 survey. The model performance was evaluated through the Area Under the Curve (AUC) and calibration via the observed-to-expected (O/E) ratio. Additional independent data from STEPs 2011 survey in Iran were utilized to test the model results by comparing indirect prevalence estimates with observed estimates. In the second part, the prevalence of T2DM was estimated indirectly by applying the selected model to a representative random sample from a Tehranian population telephone survey conducted in 2023. RESULTS: Among the different models used, AUSDRISK showed the best performance in both discrimination (AUC (95% confidence interval (CI)): 0.80 (0.78, 0.81)) and calibration (O/E ratio = 1.01). After updating the original model, there was no change in the AUC value or calibration. Additionally, our findings indicate that the indirect estimates are nearly identical to the observed values in STEPs 2011 survey. In the second part of the study, by applying the recalibrated model to a subsample, the indirect prevalence of undiagnosed diabetes and T2DM (95% CI) were estimated at 4.18% (3.87, 4.49) and 11.1% (9.34, 13.1), respectively. CONCLUSION: Given the strong performance of the model, it appears that indirect method can provide a cost-effective and simple approach to assess disease prevalence and intervention effectiveness.


Subject(s)
Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/epidemiology , Iran/epidemiology , Middle Aged , Male , Female , Prevalence , Adult , Risk Assessment/methods , Aged , Young Adult
2.
Clin Exp Optom ; : 1-9, 2024 Oct 07.
Article in English | MEDLINE | ID: mdl-39374949

ABSTRACT

CLINICAL RELEVANCE: Distinguishing between the pathological thinning of the retinal nerve fibre layer (RNFL) and age-related reduction requires a comprehensive understanding of the longitudinal changes in RNFL thickness within a healthy population. BACKGROUND: To determine five-year changes in RNFL thickness and associated factors in people aged 45-69 years. METHODS: This report pertains to the second and third phases of the Shahroud Eye Cohort Study. Participants were recruited by a multi-stage cluster sampling in Shahroud, Iran. Data on demographic details, visual acuity, non-cycloplegic refraction, and slit-lamp biomicroscopy were collected. High-definition optical coherence tomography was employed for retinal imaging. RESULTS: A total of 1,524 eyes from 908 participants were examined. The average RNFL thickness was 92.2 ± 8.5 (95% CI: 91.6 to 92.8) and 93.1 ± 8.7 µm (95% CI: 92.5 to 93.7) in the first and second phases with a five-year mean change of 0.95 ± 4.15 µm (95% CI: 0.70 to 1.20). The RNFL thickness mean changes in the superior, inferior, nasal, and temporal quadrants were 2.51 ± 7.86 (95% CI: 2.01 to 3.02), 2.93 ± 7.39 (95% CI: 2.56 to 3.29), -0.53 ± 6.15 (95% CI: -0.84 to -0.21), and -1.01 ± 4.67 µm (95% CI: -1.27 to -0.75), respectively. The five-year changes in average RNFL thickness were inversely correlated with axial length (ß = -0.69, p < 0.001), mean keratometry (ß = -0.37, p = 0.017), and baseline RNFL thickness (ß = -0.617, p < 0.001). In hyperopic individuals, the increase in average RNFL thickness (ß = 0.65, p = 0.012) was significantly greater than in those with emmetropia. Macular volume (ß = 1.65, p < 0.001) showed a direct association with five-year changes in average RNFL thickness. CONCLUSION: Over 5 years, RNFL thickness changes were clinically insignificant in the normal population. The mean RNFL thickness seems to remain stable unless there is ocular disease. However, increased axial length and steeper keratometric readings were linked to RNFL thinning. Those with thicker RNFL measurements were at higher risk of thinning over time.

3.
Sci Rep ; 14(1): 22304, 2024 09 27.
Article in English | MEDLINE | ID: mdl-39333250

ABSTRACT

Smartphone addiction is a public health problem and is increasing globally. It is important to know the latest status of this phenomenon in different region of the world. This study aimed to investigate smartphone addiction in an Iranian student population. The participants were a random sample of Shahroud Schoolchildren Eye Cohort study in 2018. Smartphone addiction was measured by the Smartphone Addiction Scale Short Version (SAS-sv) questionnaire. The prevalence and mean estimates were reported with 95% confidence intervals. The analysis of variance, t-test and multiple logistic regression were used for analysis of data. The mean age of 2682 participating students was 13.5 year with an age range of 10 to 15 year, and 1197 (44.6%) of them were girls. The mean SAS-sv score was 27.96 (95% CI: 27.36-28.58) for boys and 26.10 (95% CI: 25.34-26.80) for girls. This score follows a U-shaped pattern with a lower mean score observed at age 8. The Prevalence of smartphone addiction was 29.8% (95% CI: 28.1-31.5) in studied population. Compared to 10 year old students, smartphone addiction was higher in 14 (Odds Ratio (OR) = 1.7, 95% CI: 1.1-2.7) and 15 (OR = 2.4, 95% CI: 1.5-3.8) years old students. Smartphone addiction was higher in boys (OR = 1.9; 95% CI, 1.5-3.0; P value < 0.001). Smartphone addiction was not different in urban and rural students after adjusting for age and gender (P = 0.089). Compared to European countries the prevalence of smartphone addiction in Iranian students is relatively high and need prompt intervention especially in boys and older adolescents.


Subject(s)
Smartphone , Students , Humans , Female , Male , Iran/epidemiology , Adolescent , Child , Smartphone/statistics & numerical data , Prevalence , Surveys and Questionnaires , Internet Addiction Disorder/epidemiology , Behavior, Addictive/epidemiology
4.
J Optom ; 17(4): 100523, 2024 Sep 21.
Article in English | MEDLINE | ID: mdl-39306986

ABSTRACT

PURPOSE: To determine the mean value and normative distribution of intraocular pressure (IOP) in children and their association with demographic and ocular biometrics. METHODS: Cluster sampling was done to select the students in urban areas of Shahroud, northeast Iran, while all students living in rural areas were selected. IOP was measured in mmHg using a non-contact tonometer, along with corneal and retinal imaging and ocular biometric measurement. RESULTS: After applying the exclusion criteria, 9154 eyes of 4580 students were analyzed, of whom 2377 (51.9 %) were boys. The mean age of the participants was 12.35±1.73 years (range: 9-15 years). The mean IOP was 15.58±2.83 (15.47-15.69) in total, 15.31±2.77 (15.17-15.46) in boys, and 15.88±2.86 (15.73-16.03) in girls (p < 0.001). The mean IOP was 15.07 and 15.49 in students aged 9 and 15 years, respectively. The mean IOP was 15.7 ± 2.64 (15.58-15.81) in urban and 14.52±4.05 (14.27-14.77) in rural students (p < 0.001). In the multiple generalized estimating equation model, IOP had a positive association with female sex (ß=0.84, P < 0.001), systolic blood pressure (ß=0.02, P < 0.001), cup volume (ß=0.99, P < 0.001), corneal thickness (ß=0.04, P < 0.001) and anterior chamber volume (ß=0.007, P < 0.001) and a negative association with living in the rural area (ß=-0.65, P < 0.001), rim area (ß=-0.39, P < 0.001), and corneal diameter (ß=-0.18, P = 0.045). Furthermore, individuals with myopia exhibited a significantly higher IOP (ß=0.35, P < 0.001) compared to those with emmetropia. CONCLUSION: This study showed the normative distribution of IOP and its associated factors in children. The results can be used in diagnosis and management of glaucoma.

5.
BMJ Open Ophthalmol ; 9(1)2024 Sep 20.
Article in English | MEDLINE | ID: mdl-39306331

ABSTRACT

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.


Subject(s)
Accommodation, Ocular , Refraction, Ocular , Visual Acuity , Humans , Accommodation, Ocular/physiology , Child , Male , Female , Adolescent , Visual Acuity/physiology , Refraction, Ocular/physiology , Vision Tests/methods , Refractive Errors/diagnosis , Refractive Errors/physiopathology , Optometry/methods , Reproducibility of Results
6.
PLoS One ; 19(8): e0306778, 2024.
Article in English | MEDLINE | ID: mdl-39172976

ABSTRACT

INTRODUCTION: Monitoring social inequalities in dental caries is crucial for establishing priorities in oral health systems. This study aimed to assess economic inequalities in dental caries and its contributing factors among Iranian schoolchildren. METHODS: Data were obtained from the first phase of the Shahroud Schoolchildren Eye Cohort Study in 2015. A total of 4992 children aged 6-12 years old were included in the analysis. Dental examinations were conducted following the diagnostic methods and standards of the Oral Health Examination Survey, as recommended by the World Health Organization. The concentration index (C) was utilized to assess economic inequalities in dental caries. Additionally, the decomposition of C was employed to explain the determinants of the measured inequalities. RESULTS: In total, 71.4% of the schoolchildren had dental caries in primary dentition (dft≥1), and 41.6% of the schoolchildren had dental caries in permanent dentition (DMFT≥1). The Cs of dft≥1, primary decayed teeth (pdt≥1), and permanent missing teeth (PMT≥1) were -0.136 (95% CI: -0.167, -0.104), -0.164 (95% CI: -0.194, -0.134), and -0.208 (95% CI: -0.262, -0.153), respectively, which indicates their more concentration among low-economic children. Conversely, pft≥1 and PFT≥1 had Cs of 0.327 (95% CI: 0.292, 0.361) and 0.218 (95% CI: 0.179, 0.256), showing more concentration among high-economic children. Basic health insurance coverage and age were the main contributors that explained 28.6% and 19.2% of the economic inequality in dft≥1, and 25.7% and 16.6% of the pdt≥1 inequality, respectively. Economic status, residence in rural areas, mother education, father education, and age were the main contributors to the measured inequality in pft≥1 by 80.5% and 26.5%, 21.9%, 22%, and -18.3%, respectively. Economic status, having a housekeeper mother, residence in rural areas, having basic health insurance coverage, mother education, and father education positively contributed to the measured inequality in PMT≥1 by 45.4%, 42.4%, 37.8%, 35.1%, 21.3%, and 15.2%, respectively, while age had a negative contribution of -19.3%. For PFT≥1, economic status, age, and father education accounted for 76%, 25.4%, and 20.3% of the measured inequality, respectively. CONCLUSION: Pro-rich economic inequalities were observed in children's primary and permanent teeth caries. Thus, government interventions to reduce these inequalities should aim to expand the coverage of basic and supplementary health insurance in line with increasing the coverage of dental health costs in these plans, training and providing access to required dental health services for low-socioeconomic children, including the poor, rural, and those who have low-educated parents and a housekeeper mother, especially at younger ages.


Subject(s)
Dental Caries , Socioeconomic Factors , Humans , Dental Caries/epidemiology , Dental Caries/economics , Child , Iran/epidemiology , Male , Female , DMF Index
7.
Sci Rep ; 14(1): 9390, 2024 04 24.
Article in English | MEDLINE | ID: mdl-38658745

ABSTRACT

There is limited information about the relationship between diabetes mellitus (DM) and ALT to HDL-C ratio. This study aims to investigate this relationship for the first time in Iran. The data of this study were taken from the third phase of the Shahroud Eye Cohort Study, which was conducted in 2019 with the participation of 4394 people aged 50-74. ALT and HDL-C levels were measured using a BT-1500 autoanalyzer. The mean ALT/HDL-C ratio was reported along with 95% confidence intervals (CI). The multiple logistic regression was used to examine the association between this ratio and DM, while controlling for the effects of other independent variables. The mean and standard deviation of the ALT/HDL-C ratio in all participants were 16.62 ± 11.22 (95% CI 16.28-16.96). The prevalence of DM was 34.7% and individuals with DM had a mean ALT/HDL-C ratio that was 1.80 units higher than those without diabetes (P < 0.001). Also, in individuals with DM, the HDL-C was found to be 0.035 (mmol/L) lower (P < 0.001), while ALT was 1.13 (IU/L) higher (P < 0.001) compared to those without diabetes. Additionally, after controlling for confounding factors, the odds of developing DM increased in a non-linear manner with an increase in the ALT/HDL-C ratio. Abdominal obesity, advanced age, female gender, and hypertension were also found to be associated with increased odds of DM. In conclusion, an increase in the ALT/ HDL-C ratiowas associated with higher odds of DM. This ratio can serve as an important predictor for diabetes mellitus.


Subject(s)
Alanine Transaminase , Cholesterol, HDL , Diabetes Mellitus, Type 2 , Humans , Male , Female , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/epidemiology , Middle Aged , Cholesterol, HDL/blood , Aged , Iran/epidemiology , Alanine Transaminase/blood , Risk Factors , Prevalence
8.
Sci Rep ; 14(1): 5076, 2024 03 01.
Article in English | MEDLINE | ID: mdl-38429283

ABSTRACT

Sleep plays an essential role in improving the quality of life of people living with HIV (PLWH); however, sleep traits in this population are not well studied. This study aims to evaluate the sleep traits and related associated factors among PLWH in Iran. A nationwide cross-sectional study was conducted with 1185 PLWH who attended Voluntary Counseling and Testing centers in 15 provinces in Iran between April 2021 and March 2022. The Berlin Obstructive Sleep Apnea questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index were used. A two-step clustering method was employed to identify the number of sleep clusters in PLWH. Prevalence of poor sleep quality, sleepiness and insomnia were 49.6%, 21.15% and 42.7% respectively. Three sleep trait clusters were identified: I. minor sleep problems (45.6%); II. Snoring & sleep apnea (27.8%), and III. poor sleep quality and insomnia (26.7%). Age (Odds Ratio (OR) 1.033, 95% Confidence Interval (CI) 1.017-1.050), academic education (OR 0.542, 95% CI 0.294-0.998) and HIV duration were associated with being in Snoring & sleep apnea cluster, while age (OR = 1.027, 95% CI 1.009-1.040) was associated with being in Poor sleep quality and insomnia cluster. PLWH with depression had higher odds of being in Poor sleep quality and insomnia cluster, and those with anxiety had higher odds of being in Snoring & sleep apnea cluster and Poor sleep quality and insomnia cluster. A significant proportion of PLWH have poor sleep quality, sleepiness, and insomnia. The identification of three distinct sleep trait clusters underscores the need for increased attention and tailored interventions to address the specific sleep issues experienced by PLWH.


Subject(s)
Acquired Immunodeficiency Syndrome , HIV Infections , Sleep Apnea Syndromes , Sleep Initiation and Maintenance Disorders , Humans , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/complications , Snoring/complications , Sleepiness , Iran/epidemiology , Cross-Sectional Studies , Quality of Life , Acquired Immunodeficiency Syndrome/complications , Sleep , Sleep Apnea Syndromes/complications , HIV Infections/complications , HIV Infections/epidemiology
9.
Clin Exp Ophthalmol ; 52(5): 545-557, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38403409

ABSTRACT

BACKGROUND: The aim of this study is to determine the 5-year changes in macular thickness and related factors. METHODS: Data were from the second (2014) and third (2019) phases of the Shahroud Eye Cohort Study. Examinations included measurement of uncorrected and best-corrected visual acuity, non-cycloplegic autorefraction, slit-lamp biomicroscopy, and funduscopy. Participants underwent Cirrus HD-OCT 4000 (Carl Zeiss Meditec, Dublin, CA). RESULTS: The 5-year changes (95% confidence interval) of central and overall macular thicknesses were - 3.48 ± 8.16 µ (-3.92, -3.03) and - 0.79 ± 4.06 µ (-1.03, -0.54), respectively. The median and IQR of 5-year changes in the central subfield thickness were -3 and 10, although they were 0 and 5 in the overall macular thickness, respectively. Multiple regression model showed the central macular thickness (CMT) decreased with a U-shape pattern with increasing age. The 5-year changes in CMT were significantly lower in females compared to males ß = -1.55; (-2.78, -0.32) and in smokers compared to non-smokers ß = -1.92; (-3.55, -0.28). Moreover, higher body mass index ß = -0.12; (-0.22, -0.02) and CMT at baseline ß = -0.08; (-0.10, -0.06) were significantly associated with lower CMT changes. The average 5-year changes in overall macular thickness showed a non-linear decrease with age and was significantly higher in females ß = 0.93; (0.4, 1.43). These changes were directly related to the anterior chamber depth ß = 0.87; (0.10, 1.64) in the baseline. CONCLUSIONS: The macular thickness decreased slightly after 5 years; however, this change is not clinically significant. Demographic factors such as age and sex and refractive errors were significantly related to macular thickness changes.


Subject(s)
Macula Lutea , Tomography, Optical Coherence , Visual Acuity , Humans , Male , Female , Macula Lutea/diagnostic imaging , Macula Lutea/pathology , Tomography, Optical Coherence/methods , Aged , Visual Acuity/physiology , Middle Aged , Follow-Up Studies , Aged, 80 and over , Cohort Studies , Refraction, Ocular/physiology , Organ Size , Aging/physiology , Slit Lamp Microscopy
10.
Sci Rep ; 14(1): 2192, 2024 01 25.
Article in English | MEDLINE | ID: mdl-38272946

ABSTRACT

This study aimed to evaluate the association between iris color and refractive errors in children aged 6-12 years. This cross-sectional study was based on data obtained from the first phase of the Shahroud Schoolchildren Eye Cohort Study. The target population was 6 to12 year-old students living in urban and rural areas. Iris colors were classified by comparing eye colors with close-up images of iris colors. Myopia was defined as a spherical equivalent (SE) ≤ - 0.5 diopter and hyperopia was defined as SE ≥ 2 diopter in cycloplegic refraction. The association of iris color with hyperopia and myopia was investigated by fitting two separate multiple logistic regression models adjusted for place of residence, age, sex, and times for outdoor activity and near work. Among the 5394 participates with the mean age of 9.7 year, the prevalence of myopia and hyperopia was 4.8% and 4.7% respectively. The number and proportion (in parentheses) of amber, light blue, light brown, dark brown, gray, green and hazel iris colors were 19(0.4%), 26(0.5%), 645(12.0%), 4517(83.7%), 4(0.1%), 59(1.1%), and 124(2.3%) respectively. Compared to dark brown, the odds ratios and 95% confidence intervals (in parentheses) of myopia were 4.8(1.2-18.7), 0.8(0.1-5.8), 1.0(0.7-1.5), 0.4(0.1-2.7) and 0.6(0.2-1.8) for amber, light blue, light brown, green and hazel iris colors in multiple logistic regression model. No significant association was observed between iris colors and hyperopia. This study shows that amber iris is significantly associated with higher odds of myopia. These children should be further monitored and examined. More studies with higher sample size in all iris colors are recommended.


Subject(s)
Corylus , Hyperopia , Myopia , Refractive Errors , Child , Humans , Hyperopia/epidemiology , Cohort Studies , Cross-Sectional Studies , Amber , Refractive Errors/epidemiology , Myopia/epidemiology , Prevalence , Coloring Agents
11.
J Optom ; 17(3): 100512, 2024.
Article in English | MEDLINE | ID: mdl-38244522

ABSTRACT

PURPOSE: In children under 20 years, refractive development targets a cycloplegic refractive error of +0.5 to +1.5D, while presbyopes over 40 years generally have non-cycloplegic errors of ≥ +1D. Some papers suggest these periods are separated by a period of myopic refractive error (i.e., ≤ -0.50D), but this remains unclear. Hence, this work investigates the mean cycloplegic refractive error in adults aged between 20 - 40 years. METHODS: In 2002 a cross-sectional study with stratified cluster sampling was performed on the population of Tehran, providing cycloplegic and non-cycloplegic refractive error data for the right eyes of 3,576 participants, aged 30.6±18.6 years (range: 1-86 years). After grouping these data into age groups of 5 years, the refractive error histogram of each group was fitted to a Bigaussian function. The mean of the central, emmetropized peak was used to estimate the mean refractive error without the influence of myopia. RESULTS: The mean cycloplegic refractive error at the emmetropized peak decreased from +1.10±0.11D (95 % confidence interval) to +0.50±0.04D before 20 years and remains stable at that value until the age of 50 years. The non-cycloplegic refractive error also sees a stable phase at 0.00±0.04D between 15 - 45 years. After 45 - 50 years both cycloplegic and non-cycloplegic refractive error become more hypermetropic over time, +1.14±0.12D at 75 years. CONCLUSIONS: The cycloplegic refractive error in adults is about +0.50D between 20 - 50 years, disproving the existence of the myopic period at those ages.


Subject(s)
Emmetropia , Mydriatics , Refractive Errors , Humans , Adult , Cross-Sectional Studies , Male , Iran/epidemiology , Female , Middle Aged , Young Adult , Adolescent , Aged , Refractive Errors/physiopathology , Refractive Errors/epidemiology , Emmetropia/physiology , Mydriatics/administration & dosage , Aged, 80 and over , Child , Child, Preschool , Refraction, Ocular/physiology , Infant , Myopia/physiopathology , Myopia/epidemiology
12.
Strabismus ; 32(1): 1-10, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38230509

ABSTRACT

PURPOSE: To determine the prevalence of anisometropia and the associated demographic and biometric risk factors in children. METHODS: This cross-sectional study was conducted on the elementary school children of Shahroud, east of Iran, in 2015. All rural students were recruited, while multistage cluster sampling was used to select the students in urban areas. All children underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, autorefraction, and subjective refraction with cycloplegia. Biometric components were measured using the Allegro Biograph. Myopia and hyperopia were defined as a spherical equivalent ≤-0.5 and ≥ +2.00 diopter, respectively. Students with a history of ocular trauma or lack of cycloplegic refraction at least in one eye were excluded from the study. RESULTS: Of 6624 selected children, 5620 participated in the study. After applying the exclusion criteria, the data of 5357 students (boys: 52.8%, n = 2834) were analyzed. The mean age of the subjects was 9.2 ± 1.7 years (range: 6-12 years). The prevalence of anisometropia ≥ 1 D was 1.1% (95% CI: 0.8 to 1.4) in all children, 1.0% (95% CI: 0.7-1.3) in boys, 1.3% (95% CI: 0.8-1.7) in girls, 1.1% (95% CI: 0.8-1.4) in urban children, and 1.4% (95% CI: 0.5-2.3) in rural children. The prevalence of anisometropia was 8.8% (95% CI: 5.3-12.2) in myopic and 5.7% (95% CI: 2.8-8.5) in hyperopic children. Axial length asymmetry (OR = 40.9; 95%CI: 10.2-164.1), myopia (OR = 17.9; 95% CI: 9.4-33.9), and hyperopia (OR = 10.1; 95% CI: (5.1-19.7) were associated with anisometropia in multiple logistic regression model. More anisometropia was associated with more severe amblyopia. The odds of amblyopia (OR = 82.3: 38.2-177-3) and strabismus (OR = 17.6: 5.5-56.4) were significantly higher in anisometropic children. The prevalence of amblyopia was 21.7% in children with myopic anisometropia ≥ 3D, 66.7% in children with hyperopic anisometropia ≥ 3D, and 100% in cases with antimetropia ≥ 3D. CONCLUSION: The prevalence of anisometropia was low in Iranian school children. However, a high percentage of anisometropic students had amblyopia and strabismus. Axial length was the most important biometric component associated with anisometropia.


Subject(s)
Anisometropia , Refraction, Ocular , Visual Acuity , Humans , Anisometropia/epidemiology , Child , Prevalence , Male , Female , Cross-Sectional Studies , Iran/epidemiology , Risk Factors , Refraction, Ocular/physiology , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Myopia/epidemiology
13.
Clin Exp Optom ; 107(1): 32-39, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37121670

ABSTRACT

CLINICAL RELEVANCE: Accurate thickness measurement of corneal layers using anterior segment OCT can be used to improve visual outcomes. Understanding its applications is essential for optometric practices to enhance eye care procedures. BACKGROUND: To evaluate the thicknesses of different corneal layers for identifying keratoconus (KCN) and subclinical keratoconus (SKCN) using spectral-domain optical coherence tomography (SD-OCT). METHODS: This prospective study analyzed 60 eyes with KCN, 48 eyes with SKCN, and 53 normal eyes. The central corneal thickness (CCT) and thicknesses of the epithelium, Bowman, stroma, and Descemet-endothelium layers were measured using SD-OCT. One way analysis of variance and the area under the curve (AUC) were used to evaluate the parameters. The Delong method was used to compare AUCs. RESULTS: In KCN, CCT and thicknesses of epithelium, Bowman, stroma, and Descemet-endothelium layers were 495.5 ± 41.7, 52.6 ± 6.4,11.5 ± 1.4, 415.5 ± 38.9, and 12.3 ± 1.7 µm, respectively. These thickness values were respectively 524.5 ± 33.3, 56.8 ± 6.8, 11.5 ± 1.6, 439.8 ± 30.6, and 12.4 ± 1.7 µm in SKCN and 563.8 ± 37.9, 57.7 ± 6.9, 12.2 ± 1.6, 469.5 ± 33.7, and 12.8 ± 2.1µm in normal group. Total cornea and stroma in KCN and SKCN, and epithelium in KCN were significantly thinner compared to the normal group (P < 0.001). The highest AUC values were observed for CCT in KCN (AUC 0.90) and SKCN (AUC 0.782). The diagnostic accuracy was significantly higher for stromal thickness in KCN (sensitivity 81.7%, specificity 73.6%, AUC 0.871) and SKCN (sensitivity 80.0%, specificity 56.6%, AUC 0.751) than other individual corneal layers (Delong, P < 0.001) . CONCLUSION: CCT can accurately distinguish keratoconus from normal eyes. However, central corneal stromal thinning was the most sensitive diagnostic index for early detection of SKCN. Developing standardized stromal maps may be helpful for detecting SKCN.


Subject(s)
Keratoconus , Humans , Keratoconus/diagnostic imaging , Tomography, Optical Coherence/methods , Prospective Studies , Cornea/diagnostic imaging , Corneal Topography , Corneal Pachymetry
14.
Eye (Lond) ; 38(7): 1283-1289, 2024 May.
Article in English | MEDLINE | ID: mdl-38102470

ABSTRACT

OBJECTIVES: To determine the three-year changes in crystalline lens power (LP) and thickness (LT) in children and their associated factors. METHODS: Schoolchildren aged 6-12 years living in Shahroud, northeast Iran were examined in 2015 and 2018. The Bennett formula was used to calculate LP. Multiple generalized estimating equations (GEE) analysis was used for data analysis. RESULTS: Among the 8089 examined eyes, the mean LP in Phase 1 and 2, and the three-year change were 21.61 ± 1.47D, 21.00 ± 1.42D, and -0.61 ± 0.52D, respectively. The GEE model showed that negative shifts in LP were less pronounced with increasing age (ß = 0.176; p < 0.001), and were also less noticeable in hyperopes compared to emmetropes (ß = 0.120; p < 0.001). The changes in LP decreased when outdoor activity increased among urban residents (ß = 0.013; p = 0.039), while it increased in rural area (ß = -0.020; p = 0.047). Mean three-year change in LT was 0.002 ± 0.13 mm. Female sex and aging by one year increased the LT by 0.022 mm (P < 0.001). However, LT decreased in 6-8-year-olds, while it increased in 10-12-year-old children, both in a linear fashion. The change in LT was less in myopes than in emmetropes (ß = -0.018, P-value = 0.010). CONCLUSION: LP decreases after three years in 6 to 12-year-old children. LT increases slightly after three years in 6 to 12-year-old children. The changes in LP and LT were associated with the refractive errors, place of residence, age and gender and outdoor activity time.


Subject(s)
Lens, Crystalline , Refraction, Ocular , Humans , Child , Female , Male , Refraction, Ocular/physiology , Iran/epidemiology , Rural Population/statistics & numerical data , Myopia/physiopathology , Emmetropia/physiology
15.
Int J Ophthalmol ; 16(12): 2095-2104, 2023.
Article in English | MEDLINE | ID: mdl-38111949

ABSTRACT

AIM: To determine the agreement of ocular biometric indices including axial length, keratometric readings, anterior chamber depth, and horizontal corneal diameter between the Pentacam AXL and IOL Master 500. METHODS: The study was a large cross-sectional population-based study (Tehran Geriatric Eye Study) conducted from Jan 2019 to Jan 2020. A total of 160 clusters were randomly selected proportional to size (each cluster contained 20 individuals) from 22 strata of Tehran city. All people aged 60y and above were invited to participate in the study. For all participants, preliminary ocular examinations were performed including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, anterior and posterior segment examinations. All participants underwent an ocular biometry using the Pentacam AXL and IOL Master 500. RESULTS: The 95% limits of agreement (LoA) between the two devices were -0.13 to 0.19, -0.15 to 0.17, and -0.13 to 0.19 in normal, pseudophakic, and cataractous eyes, respectively. With increasing the axial length, the difference between the two devices significantly increased in all three groups of normal, pseudophakic, and cataractous eyes (P<0.001). The 95% LoAs between the two devices regarding the mean keratometry shows that the best LoAs were seen in cataractous (-0.33 to 0.81) and followed by normal eyes (-0.36 to 0.86) and the pseudophakic eyes (-0.48 to 0.90) had the widest LoA. The 95% LoAs for horizontal corneal diameter measurements were -0.08 to 0.86, -0.03 to 0.83, and -0.07 to 0.87 in normal, pseudophakic, and cataractous eyes, respectively. The 95% LoAs of anterior chamber depth measurements between the two devices was -0.39 to 0.19 and -0.37 to 0.13 in normal eyes and cataractous, respectively. CONCLUSION: The Pentacam AXL has excellent agreement with the gold standard, IOL Master 500 in measuring axial length. In eyes with cataracts, the difference between the two devices is more scattered. With the increasing of axial length, the difference between the two devices increased, which should be considered when using Pentacam AXL.

16.
BMC Public Health ; 23(1): 2540, 2023 12 19.
Article in English | MEDLINE | ID: mdl-38114954

ABSTRACT

OBJECTIVE: This study aimed to investigate the association between depression and self-care in diabetic patients potentially influenced by biases in depression measurement using weighting the positive and negative predictive values. METHODS: In this cross-sectional study, 1050 patients informedly consented to participate in the study. Using a WHO-5 well-being index, the participants were examined for depressive mood as exposure. The sensitivity and specificity of this index in a systematic review study were 0.86 and 0.81, respectively. Self-care (that is outcome) was assessed using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. To correct the misclassification bias of exposure, the predictive weighting method was used in the multivariable logistic regression model adjusted for covariates. Bootstrap sample with replacement and simulation was used to deal with random error. RESULTS: The mean age of patients was 42.8 ± 7.5 years. In this study, 70.1% of diabetic patients (n = 720) were depressed based on the questionnaire score and only 52.7% (n = 541) of them had appropriate self-care behaviors. Our study revealed a close relationship between self-care and covariates such as gender, depression, having comorbidities, abdominal obesity, economic status and education. The odds ratio of the association between depressive mood and lack of self-care in primary multivariable logistic regression was 2.21 (95% CI: 1.62-3.00, p < 0.001) and after misclassification bias adjusting, it was equal to 3.4 (95% CI: 1.7-6.6, p < 0.001). The OR percentage of bias was - 0.55. CONCLUSION: After adjusting for depression misclassification bias and random error, the observed association between depression and self-care was stronger. According to our findings, psychiatric interventions, and counseling and education along with self-care interventions are necessary for these patients. Special attention should be paid to male, low economic classes, less educated and those having a history of comorbidities along with psychological assessment when improving the care and progress of treatment in diabetic patients is expected. Future studies are needed to clarify the role of other psychological disorders on self-care of diabetics.


Subject(s)
Depression , Diabetes Mellitus , Adult , Humans , Male , Middle Aged , Bias , Cross-Sectional Studies , Depression/epidemiology , Depression/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Diabetes Mellitus/psychology , Self Care
17.
BMC Oral Health ; 23(1): 728, 2023 10 07.
Article in English | MEDLINE | ID: mdl-37805469

ABSTRACT

BACKGROUND: First permanent molars (FPM) play an important role in the masticatory function and oral health. This study aimed to assess the economic inequalities of FPM health indices among schoolchildren in the northeast of Iran. METHODS: A total of 4051 children aged 8-12 years old were included in the analyses of this cross-sectional study in 2015. Economic status was measured using the principal component analysis on home assets. Concentration index (C) was used to measure economic inequality in FPM health indices, and its contributing factors determined by Wagstaff decomposition technique. RESULTS: The prevalence of having decayed, missing, and filled FPMs among children was 40.9% (95% CI: 38.8-43.0), 1.2% (95% CI: 0.8-1.6%), and 7.8% (95% CI: 6.7-8.9%), respectively. Missing FPM was generally more concentrated among low-economic children (C=-0.158), whereas, filled FPM was more concentrated on high-economic children (C = 0.223). Economic status, mother education, having a housekeeper mother, and overweight/obesity, contributed to the measured inequality in missing FPM by 98.7%, 97.5%, 64.4%, and 11.2%, respectively. Furthermore, 88.9%, 24.1%, 14.5%, and 13.2% of filled FPM inequality was attributable to children's economic status, father education, residence in rural areas, and age, respectively. CONCLUSION: There is a significant economic inequality in both missing and filled FPM. This inequality can be attributed to the economic status of individuals. To reduce FPM extraction, it is important to target low-income and rural children and provide them with FPM restoration services. Additionally, it is necessary to provide training to less-educated parents and housekeeper mothers to address the observed inequalities.


Subject(s)
Dental Caries , Child , Female , Humans , Iran/epidemiology , Dental Caries/epidemiology , Cross-Sectional Studies , Oral Health , Molar , Prevalence , DMF Index
18.
J Curr Ophthalmol ; 35(1): 42-49, 2023.
Article in English | MEDLINE | ID: mdl-37680291

ABSTRACT

Purpose: To compare the intraocular lens (IOLs) power calculated with Haigis, Hoffer Q, Holladay 1, and SRK/T formulas between the IOLs Master 500 and Pentacam AXL according to the lens status. Methods: In this cross-sectional study, sampling was done in subjects above 60 years living in Tehran using multi-stage cluster sampling. All participants underwent optometric examinations including the measurement of visual acuity and refraction as well as slit-lamp biomicroscopy to determine the lens status. Biometric measurements and IOLs power calculation were done using the IOL Master 500 and Pentacam AXL. The order of imaging modalities was random in subjects. IOL power calculation was done according to optimized ULIB constants for the Alcon SA60AT lens. The IOL power was calculated according to a target refraction of emmetropia in all subjects. Results: After applying the exclusion criteria, 1865 right eyes were analyzed. The mean IOL difference between the two devices was -0.33 ± 0.35, -0.38 ± 0.39, -0.41 ± 0.43, and -0.51 ± 0.43 according to the SRK/T, Holladay, Hoffer Q, and Haigis formulas, respectively. The Pentacam calculated larger IOL power values in all cases. The 95% limits of agreement (LoA) between the two devices for the above formulas were -1.01 to 0.35, -1.14 to 0.39, -1.25 to 0.43, and -1.35 to 0.33, respectively. The best LoA were observed in normal lenses for all formulas. The difference in the calculated IOL power between the two devices using the four formulas had a significant correlation with axial length, mean keratometry reading, and anterior chamber depth. According to the results of the four formulas, mean keratometry reading had the highest standardized regression coefficient in all formulas. Conclusion: Although the difference in the calculated IOL power between IOL Master 500 and Pentacam AXL is not significant clinically, the results of these two devices are not interchangeable due to the wide LoA, especially for the Haigis formula; therefore, it is necessary to optimize lens constants for the Pentacam.

19.
BMC Cardiovasc Disord ; 23(1): 318, 2023 06 24.
Article in English | MEDLINE | ID: mdl-37355590

ABSTRACT

BACKGROUND: By the lengthening of life span, the incidence of chronic diseases such as hypertension and uncontrolled hypertension has increased. This study aims to determine the prevalence of uncontrolled hypertension and its related factors in the age group of 50-74 years in Shahroud, northeast Iran. METHODS: The data of the third phase of the Shahroud Eye Cohort Study were used in this study. This phase of the cohort study included 4394 participants aged 50 to 74 years from the previous phases. In addition to ophthalmological and optometric examinations, demographic characteristics, blood biochemistry tests, and blood pressure measurements were performed in this phase. Individuals with a blood pressure ≥ 140/90 mm/Hg (being treated or not treated with antihypertensive medicines) were defined as uncontrolled hypertension. In patients with diabetes and chronic kidney disease, blood pressure equal to or higher than 130/80 mm/Hg was considered uncontrolled hypertension. Descriptive statistics and multiple logistic regression were used to analyze the data. FINDINGS: Overall, the prevalence of uncontrolled hypertension out of all the participants was 61.7% (95% CI: 60.3-63.2). Multiple regression results showed that the male gender (OR: 2.1, 95% CI: 1.5-2.9), patients with diabetes (OR:3.2, 95% CI: 2.4-4.3), and patients with chronic kidney disease (CKD) (OR: 3.2, 95% CI: 2.5-4.1) increased the risk of uncontrolled hypertension while in patients with cardiovascular disease (OR: 0.6, 95% CI: 0.4-0.8) and polypharmacy (OR: 0.2, 95% CI: 0.1-0.2) reduced the risk of uncontrolled hypertension. CONCLUSION: The present study showed that uncontrolled hypertension has a high prevalence, and factors such as male gender, diabetes, and CKD are associated with this disorder. So, it is recommended to take the necessary measures to formulate and implement immediate actions to prevent or control hypertension.


Subject(s)
Diabetes Mellitus , Hypertension , Mercury , Renal Insufficiency, Chronic , Humans , Adult , Male , Middle Aged , Aged , Iran/epidemiology , Cohort Studies , Prevalence , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Blood Pressure , Antihypertensive Agents/therapeutic use , Antihypertensive Agents/pharmacology , Diabetes Mellitus/drug therapy , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/complications , Mercury/pharmacology , Risk Factors
20.
Osteoporos Int ; 34(9): 1535-1548, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37286664

ABSTRACT

Poor adherence reduces the effectiveness of osteoporosis treatment, resulting in lower bone mineral density and subsequently higher fracture rates. Reliable and practical tools are needed to measure medication adherence. The aim of this systematic review was to find osteoporosis medication adherence measurement tools and assess their applicability. Osteoporosis adherence measurement tools and all their related keywords in PubMed, Embase, Web of Science, and Scopus databases were searched on 4 December, 2022. After excluding duplicates in the Endnote software, two researchers independently investigated the remaining articles and included all those that used a method for measuring adherence to osteoporosis pharmacotherapy. Articles that did not specify the medications evaluated or if the primary focus was not adherence excluded. Two common measures of adherence, i.e., compliance and persistence were included. Four separate tables were designed, one for direct methods, one for formulas, one for questionnaires, and one for electronic methods of measuring adherence to treatment. Quality assessment was performed for selected articles by the Newcastle-Ottawa Quality Assessment Scale (NOS). A total of 3821 articles were found, of which 178 articles met the inclusion and exclusion criteria. In general, five types of methods were observed to measure medication adherence of osteoporosis, including direct methods (n = 4), pharmacy records (n = 17), questionnaires (n = 13), electronic methods (n = 1), and tablet counting (n = 1). The most commonly used adherence measurement tool, based on pharmacy records, was medication possession ratio (MPR). Among questionnaires, Morisky Medication Adherence Scale was mostly used. Our findings show what tools have been used to measure medication adherence in osteoporosis patients. Among these tools, direct methods and electronic methods are the most accurate methods. However, due to their high cost, they are practically not used in measuring osteoporosis medication adherence. Questionnaires are the most popular among them and are mostly used in osteoporosis.


Subject(s)
Bone Density Conservation Agents , Fractures, Bone , Osteoporosis , Humans , Bone Density Conservation Agents/therapeutic use , Osteoporosis/drug therapy , Medication Adherence , Fractures, Bone/drug therapy , Bone Density
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