Five-year changes in retinal nerve fibre layer thickness in the adult population: a population-based cohort study.

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.

Smartphone addiction in Iranian schoolchildren: a population-based study.

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.

Intraocular pressure and its association with ocular biometrics in Iranian children.

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.

Comparison of the accommodative amplitude measured with and without the use of a specialised accommodative rule in children.

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.

Decomposition of economic inequalities in dental caries among Iranian schoolchildren.

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.

Effect of Transcranial Direct Current Stimulation on Craving, Cognitive Functions, and Serum Brain-Derived Neurotrophic Factor Level in Individuals on Maintenance Treatment for Opioid Use Disorder, A Randomized Sham-Controlled Trial.

OBJECTIVES: To investigate the effects of transcranial direct current stimulation (tDCS) on brain-derived neurotrophic factor (BDNF) levels, craving, and executive functions in individuals on maintenance treatment for opioid use. METHODS: We randomized 70 right-handed men aged 18-55 years into 2 groups: the intervention group and the sham group. The intervention was 10 sessions of 2 mA stimulation over 5 days. Each session in the sham group ended after 30 seconds. Craving was measured using the Desire for Drug Questionnaire (DDQ), Obsessive Compulsive Drug Use Scale (OCDUS), and visual analog scale (VAS). The measurements were taken before and after the intervention, as well as 2 months later. BDNF was measured before and after the intervention. Repeated-measures analysis of variance, the generalized estimating equation model, and independent t test were used for data analysis. RESULTS: The mean differences (95% confidence intervals) in pre and post craving scores in the intervention group were (12.71 [9.10 to 16.32], P = 0.167) for VAS, (1.54 [1.12 to 1.96], P = 0.012) for OCDUS, and (1.71 [1.27 to 2.15], P = 0.125) for DDQ. These measures in the control group were -0.44 (-1.19 to 0.30), 0.01 (-0.21 to 0.23), and 0.126 (-0.11 to 0.36), respectively. BDNF serum levels significantly increased after the intervention (difference, 0.84 [0.69 to 0.99], P < 0.001); however, this change was not significant in the generalized estimating equation model. The effect of tDCS on craving was significant in OCDUS, but not significant in VAS and DDQ. CONCLUSIONS: The tDCS reduces craving and improves executive functions in the short term. BDNF serum level was not associated with tDCS.

The association of ALT to HDL-C ratio with type 2 diabetes in 50-74 years old adults: a population-based study.

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.

Five-year changes in macular thickness in the elderly population: A cohort study.

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.

Artificial intelligence and the scientific method: How to cope with a complete oxymoron.

Artificial intelligence (AI) can be a powerful tool for data analysis, but it can also mislead investigators, due in part to a fundamental difference between classic data analysis and data analysis using AI. A more or less limited data set is analyzed in classic data analysis, and a hypothesis is generated. That hypothesis is then tested using a separate data set, and the data are examined again. The premise is either accepted or rejected with a value p, indicating that any difference observed is due merely to chance. By contrast, a new hypothesis is generated in AI as each datum is added to the data set. We explore this discrepancy and suggest means to overcome it.

Prevalence of anisometropia and its associated factors in school-age children.

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.

The association between iris color and refractive errors in children.

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.

Longitudinal changes in crystalline lens thickness and power in children aged 6-12 years old.

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.

Economic inequalities in decayed, missing, and filled first permanent molars among 8-12 years old Iranian schoolchildren.

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.

A prospective cohort study protocol: monitoring and surveillance of adverse events following heterologous booster doses of Oxford AstraZeneca COVID-19 vaccine in previous recipients of two doses of Sinopharm or Sputnik V vaccines in Iran.

BACKGROUND: Regarding the paucity of evidence on the side effects of the booster dose of Oxford AstraZeneca vaccine in vaccinated people with Sinopharm or Sputnik V, we aimed to set up a cohort event monitoring (CEM) study to capture adverse events occurring in individuals who will receive the booster doses of AstraZeneca (either the first or second booster dose) following being vaccinated with Sinopharm or sputnik V vaccines in Iran. METHODS: The present study is an active COVID-19 vaccine safety surveillance through an observational prospective cohort study that will be conducted in vaccination centers in Iran. The study will be conducted in twelve provinces of Iran. Study sites are vaccination centers where the AstraZeneca vaccine is administered to the cohort population. The study population includes all individuals who have received two doses of Sinopharm or Sputnik V vaccines and either the first or second booster dose of AstraZeneca according to the national guidelines for immunization in Iran in 2023. We are planning to include 30,000 eligible people in this study. Each individual will be followed up for 13 weeks after either the first or second booster dose of the AstraZeneca vaccine. Furthermore, convenience sampling is used to include participants in the present study. Participation in the study will be strictly voluntary. DISCUSSION: With the planned study we will provide a valid epidemiological evidence to improve the understanding of the safety of the booster dose of the AstraZeneca and to better evaluate the effectiveness of public health interventions. This could help policy makers in managing the COVID-19 pandemic according to scientific evidence.

Prevalence of uncontrolled hypertension and its associated factors in 50-74 years old Iranian adults: a population-based study.

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.

Optic Disc Measurements in Children by Optical Coherence Tomography.

PRCIS: This study showed the distribution of optic disc indices in a population-based sample of Iranian children in detail. Refractive errors and biometric components are among the ocular factors that are related to these indices. PURPOSE: To determine the normative value of optic nerve indices in children and their association with ocular and demographic factors. METHODS: A cross-sectional study was conducted in 2018. Biometry was done using the Allegro Biograph, and macular indices were measured by OCT imaging. RESULTS: After applying the exclusion criteria, 9051 eyes of 4784 children were analyzed. The mean±SD and 95% confidence intervals (in parentheses) of vertical cup-to-disc ratio, average cup-to-disc ratio, rim area, disc area, and cup volume were 0.45±0.15(0.45-0.46) mm, 0.43±0.14 (0.42-0.43) mm, 1.46±0.25 (1.45-1.47) mm 2 , 1.92±0.35 (1.91-1.93) mm 2 , and 0.14±0.14 (0.14-0.15) mm 3 , respectively. Vertical cup-to-disc ratio and average cup-to-disc ratio had a positive association with intraocular pressure (IOP) (both ßs=0.003), and a negative association with retinal nerve fiber layer thickness (both ßs=-0.001), central corneal thickness (CCT) (both ßs=-0.001), anterior chamber depth (ß=-0.025 and ß=-0.027, respectively), lens thickness (ß=-0.034 and ß=-0.032, respectively), and mean keratometry (MK) (both ßs=-0.015). The average cup-to-disc ratio had a positive association with height (ß=0.001). Rim area had a negative association with increased age (ß=-0.008), axial length (ß=-0.065), IOP (ß=-0.009), and MK (ß=-0.014) and a positive association with macular volume (ß=0.021), retinal nerve fiber layer thickness (ß=0.004), and CCT (ß=0.001). Disc area had a positive association with macular volume (ß=0.031) and a negative association with female sex (ß=-0.037), axial length (ß=-0.087), anterior chamber depth (ß=-0.112), lens thickness (ß=-0.059), and MK (ß=-0.048). The results of generalized estimating equations showed that cup volume was smaller in girls (ß=-0.009), and had a positive association with height (ß=0.001), IOP (ß=0.003) and negative association with CCT (ß=-0.0001) and MK (ß=-0.012). CONCLUSION: The results provided the normative values of optic disc indices in children. Demographic factors, biometric components, IOP, SBP, and retinal parameters had a significant association with optic disc indices.

Reactogenicity within the first week after Sinopharm, Sputnik V, AZD1222, and COVIran Barekat vaccines: findings from the Iranian active vaccine surveillance system.

BACKGROUND: This study aimed to evaluate the reactogenicity effects of COVID-19 vaccines, used in Iran. METHODS: At least 1000 people were followed up with phone calls or self-report in a mobile application within 7 days after vaccination. Local and systemic reactogenicities were reported overall and by subgroups. RESULTS: The presence of one or more local and systemic adverse effects after the first dose of vaccines was 58.9% [(95% Confidence Intervals): 57.5-60.3)] and 60.5% (59.1-61.9), respectively. These rates were reduced to 53.8% (51.2-55.0) and 50.8% (48.8-52.7) for the second dose. The most common local adverse effect reported for all vaccines was pain in the injection site. During the first week after the first dose of vaccines, the frequency of the pain for Sinopharm, AZD1222, Sputnik V, and Barekat was 35.5%, 86.0%, 77.6%, and 30.9%, respectively. The same rates after the second dose were 27.3%, 66.5%, 63.9%, and 49.0%. The most common systemic adverse effect was fatigue. In the first dose, it was 30.3% for Sinopharm, 67.4% for AZD1222, 47.6% for Sputnik V, and 17.1% for Barekat. These rates were reduced to 24.6%, 37.1%, 36.5%, and 19.5%, in the second dose of vaccines. AZD1222 had the highest local and systemic adverse effects rates. The odds ratio of local adverse effects of the AZD1222 vaccine compared to the Sinopharm vaccine were 8.73 (95% CI 6.93-10.99) in the first dose and 4.14 (95% CI 3.32-5.17) in the second dose. Barekat and Sinopharm had the lowest frequency of local and systemic adverse effects. Compared to Sinopharm, systemic adverse effects were lower after the first dose of Barekat (OR = 0.56; 95% CI 0.46-0.67). Reactogenicity events were higher in women and younger people. Prior COVID-19 infection increased the odds of adverse effects only after the first dose of vaccines. CONCLUSIONS: Pain and fatigue were the most common reactogenicities of COVID-19 vaccination. Reactogenicities were less common after the second dose of the vaccines. The adverse effects of AZD1222 were greater than those of other vaccines.

A longitudinal study of local stereoacuity and associated factors in schoolchildren: The Shahroud Schoolchildren Eye Cohort Study.

CLINICAL RELEVANCE: Impaired stereoacuity is seen in some children without amblyopia, strabismus, and clinically significant refractive errors. Therefore, there are probably other factors affecting stereoacuity. BACKGROUND: The aim of this work was to investigate the longitudinal changes of local stereoacuity and associated factors in schoolchildren. METHODS: The present report is a part of the Shahroud Schoolchildren Eye Cohort Study. The target population was children aged 6 to 12 years in Shahroud, Iran. The second phase of the study was conducted in 2018 by re-inviting all participants in the first phase (2015). After an initial interview, study participants underwent optometric examination and ocular biometry. Stereoacuity was evaluated using Stereo Fly Test. Exclusion criteria were functional amblyopia, strabismus, significant refractive errors, probable ocular pathology/organic amblyopia in either of the two study phases, a history of intraocular surgery or ocular trauma, and incomplete data. RESULTS: The data of 4666 children were analysed for this report, of which 53.7% were male. The mean age of the studied participants in the second phase was 12.37 ± 1.71 years. The mean stereoacuity was 42.31 (95% CI: 42.05 - 42.57) seconds of arc in the first phase, which reduced to 51.72 (95% CI: 50.79-52.65) seconds of arc in the second phase (P < 0.001). The prevalence of poor stereoacuity was 0.17% (95% CI: 0.06-0.29) in the first phase, which increased to 3.94% (95% CI: 3.34-4.54) in the second phase (P < 0.001). According to the multiple linear regression, older age in the first study phase (ß = 0.011, P < 0.001), urban residence (ß = -0.019, P = 0.006), increased spherical anisometropia (0.038, P = 0.013), and increased axial length (ß = 0.062, P = 0.003) were significantly associated with reduction of stereoacuity (in log scale) after three years. CONCLUSION: In addition to the known risk factors of amblyopia, strabismus, and significant refractive errors, other factors are also associated with stereoacuity changes in children.

Refractive Errors and Their Associated Factors in Schoolchildren: A Structural Equation Modeling.

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.

Three-year change in refractive error and its risk factors: results from the Shahroud School Children Eye Cohort Study.

OBJECTIVES: To determine spherical equivalent (SE) progression among children in the Shahroud School Children Eye Cohort Study. METHODS: A prospective cohort study recruited children aged 6 to 12 years in 2015 (baseline) with a follow-up in 2018. Cycloplegic autorefraction and axial length (AL) measurements were included. SE progression over 3 years was analysed in non-myopic (SE ≥ + 0.76 D), pre-myopic (PM; SE between +0.75 D and -0.49 D), low myopic (LM; SE between -0.5 D and -5.99 D), and high myopic (HM; SE ≤ - 6 D) eyes. Age, sex, near work, outdoor time, living place, parental myopia, mother's education, and baseline SE were evaluated as risk factors for SE progression (≤ -0.50 D). RESULTS: Data were available for 3989 children (7945 eyes). At baseline, 40.3% (n = 3205), 3.4% (n = 274) and 0.1% (n = 7) eyes had PM, LM and HM, respectively. At the 3-year follow-up, 40.5% (n = 3216), 7.5% (n = 599) and 0.2% (n = 15) eyes had PM, LM, and HM, respectively. SE progression in eyes with LM and HM was -1.08 ± 0.76 D and -1.60 ± 1.19 D, respectively. SE progression was associated with age at baseline (Odds Ratio [OR] = 1.14; 95% confidence interval [CI], 1.08-1.21), female sex (OR = 1.80; 95% CI: 1.48-2.18), near work (OR = 1.08; 95% CI: 1.02-1.14), parental myopia (OR = 1.20; 95% CI: 1.01-1.42) and baseline SE (OR = 2.28; 95% CI: 1.88-2.78). CONCLUSION: A myopic shift was associated with older age, female sex, near work, parental myopia and greater myopic baseline SE. These results help identifying children at risk of progression that may benefit from treatment and lifestyle counselling.