Subfoveal choroidal thickness in a general elderly population; Tehran geriatric eye study.

PURPOSE: To determine the distribution of subfoveal choroidal thickness (SFCT) and its associated demographic, ocular, and systemic factors in an elderly population. METHODS: This report is part of the Tehran Geriatric Eye Study (TGES); a population-based cross-sectional study that was conducted on the urban elderly population of Tehran, aged 60 years and above using multi-stage stratified random cluster sampling. Choroidal imaging was performed using Spectralis SD-OCT with enhanced depth imaging mode. RESULTS: The average SFCT was 265.3 ± 25.9 µm (95% CI: 262.8-267.7) in the whole sample. According to the multiple generalized estimating equation (GEE) model, pseudophakia had a statistically significant direct relationship with SFCT (coefficient = 5.69), and history of cerebrovascular accident (CVA) was significantly inversely related to SFCT (coefficient=-4.77). Moreover, there was a significant interaction between age and sex in the average SFCT so that with increasing age, the SFCT increased in men and decreased in women. CONCLUSION: The normal values of SFCT in the present study can be used as a reference database for clinical and research purposes. Age-sex interaction, pseudophakia, and history of CVA were significantly associated with SFCT in the elderly population. It is recommended that these factors be taken into account when interpreting SFCT data.

Prevalence and Associated Factors of Pseudoexfoliation Syndrome in an Iranian Elderly Population: The Tehran Geriatric Eye Study.

PURPOSE: To investigate the prevalence and associated factors of pseudoexfoliation syndrome (PEX) in an Iranian elderly population. METHODS: This study, a population-based cross-sectional study conducted on individuals ≥60 years in Tehran, the capital of Iran in 2019 using a multi-stage stratified random cluster sampling. All study participants underwent complete ocular examination (including measurement of uncorrected and best-corrected visual acuity, refraction, slit-lamp biomicroscopy). The PEX was diagnosed based on the presence of white fluffy dandruff-like pseudoexfoliative material on the pupillary margin, on the anterior lens capsule, and/or the trabecular meshwork. RESULTS: Of the 3791 invitees, 3310 participated in the TGES (response rate: 87.3%). After applying exclusion criteria, the data of 3274 individuals were analyzed for this report. The overall prevalence of PEX was 3.63% (95% CI:2.67-4.58) in this study. 81.1% of PEX cases were bilateral. The prevalence of PEX increased significantly with advancing age in a linear trend from 2.38% (95%: 1.27-3.48) in the age group 60-64 years to 6.48% (95%: 2.02-10.95) in the age group ≥80 years (OR = 1.05, p = 0.008). According to the multiple logistic regression model, advancing age (OR: 1.06, p = 0.002) and the presence of cataract (OR: 5.02, p < 0.001) were significantly associated with increased odds of PEX. CONCLUSION: The results showed a lower prevalence of PEX in the Iranian elderly compared to previous studies on the elderly population. Advancing age and cataracts were the only associated factors of PEX in the present study.

Corneal densitometry and associated factors in an elderly population.

CLINICAL RELEVANCE: Knowing normative corneal optical density (COD) values is important for identifying pathologic corneal changes. BACKGROUND: The aim of this work is to determine the distribution and associated factors of COD in the elderly population. METHODS: This report is a part of a cross-sectional population-based study conducted on the elderly population (≥60 years) of Tehran, Iran from Jan 2019 to Jan 2020. Using a multi-stage stratified random cluster sampling method, a total of 160 clusters were randomly selected from 22 districts of Tehran city. Study participants underwent a complete ocular examination including measurement of visual acuity, refraction, and slit-lamp biomicroscopy. Corneal densitometry was evaluated using the Pentacam HR. Generalized estimating equation (GEE) models were used to investigate associations of COD with study variables. RESULTS: A total of 3633 eyes from 2068 individuals were analysed. Of these, 1256 (60.7%) were female, and the mean age of the individuals was 66.42 ± 5.28 (60 to 95) years. The mean entire COD was 21.96 ± 4.45 greyscale unit (GSU) (95% CI: 21.57-22.34). There was a statistically significant difference in the mean COD between the anterior, central, and posterior layers (p < 0.001); the highest and lowest average COD was related to the anterior and posterior corneal layers, respectively. The lowest and highest mean COD were observed in the 0-2 mm [17.21GSU (95% CI:16.87-17.55)], and 10-12 mm annular zones [31.4 GSU (95% CI: 30.89-31.91)], respectively (p < 0.001). According to the multiple GEE model, the COD had a statistically significant direct relationship with age, central corneal thickness, and mean keratometry, while it was significantly inversely associated with female sex, anterior chamber depth, white-to-white distance, and corneal volume. CONCLUSION: These normal values of COD in the present study could be used as reference data in older adults. The associated factors of COD should be taken into account to avoid misinterpretation of physiologic changes as pathologic processes.

P100 Wave Latency and Amplitude in Visual Evoked Potential Records in Different Visual Quadrants of Normal Individuals.

Purpose: Assessment of the pattern visual evoked potential (PVEP) responses in different areas of visual fields in individuals with normal vision. Methods: This study was conducted on 80 eyes of normal subjects aged 18-35 years. All participants underwent refraction and visual acuity examination. Visual evoked potential (VEP) responses were recorded in different areas of field. The repeated measure test was used to compare the P100 latency and amplitude of PVEP among different areas. Results: The repeated measures analysis of variance showed a statistically significant difference among different areas in terms of amplitude and latency of P100 (P = 0.002 and P < 0.001, respectively). According to the results, the highest and lowest amplitude of P100 was observed in inferior-nasal and superior areas, respectively. The highest and lowest latency of P100 was related to the temporal and inferior-nasal areas, respectively. Conclusion: This study partially revealed the details of local PVEP distribution in the visual field and there was a significant difference in the amplitude and latency of PVEP wave in different areas of the visual field.

Receded near point of convergence as a predictor of mild cognitive impairment in the general geriatric population: results from a population-based study.

AIM: To investigate the relationship between near point of convergence (NPC) and mild cognitive impairment (MCI) in the general elderly population. METHODS: The present report is a part of the Tehran Geriatric Eye Study (TGES): a population-based cross-sectional study conducted on individuals 60 years of age and above living in Tehran, Iran using the multi-stage stratified random cluster sampling method. Cognitive status was assessed using the Persian version of the Mini-Mental State Examination (MMSE). All study participants underwent complete ocular examination including measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, cover testing, NPC measurement, and slit-lamp biomicroscopy. RESULTS: The data of 1190 individuals were analyzed for this report. The mean age of the participants analyzed was 66.82±5.42 (60-92y) and 728 (61.2%) of them were female. Patients with MCI had a significantly more receded NPC compared to subjects with normal cognitive status (10.89±3.58 vs 7.76±2.71 cm, P<0.001). In the multivariable logistic regression model and in the presence of confounding variables, a receded NPC was statistically significantly associated with an increased risk of MCI (odds ratio: 1.334, 95% confidence interval: 1.263 to 1.410, P<0.001). According to receiver operating characteristic (ROC) analysis, a cut point NPC> 8.5 cm (area under the curve: 0.764, P<0.001) could predict the presence of MCI with a sensitivity and specificity of 70.9% and 69.5%, respectively. CONCLUSION: A receded NPC can be clinically proposed as a predictor of MCI in older adults. It is recommended that elderly with a receded NPC>8.50 cm undergo detailed cognitive screening for a definite diagnosis of MCI. In this case, the necessary interventions can be carried out to slow down MCI progression to dementia.

Distribution of Corneal Volume and Its Associated Factors in an Elderly Population: Tehran Geriatric Eye Study.

PURPOSE: The aim of this study was to determine the distribution of corneal volume (CV) using Pentacam and its relationship with demographic and ocular factors in an elderly population older than 60 years. METHODS: The present report is a part of the Tehran Geriatric Eye Study. The sampling was performed using the multistage stratified random cluster sampling method. The preliminary ocular examinations were performed for all individuals including visual acuity measurement, objective and subjective refraction, and slit-lamp biomicroscopy. Finally, study participants underwent anterior segment imaging and ocular biometry using Pentacam AXL. RESULTS: The mean CV was 57.92 mm 3 [95% confidence interval (CI): 57.76-58.08] in the whole sample. The mean CV was 57.69 mm 3 (95% CI: 57.52-57.87) after excluding diabetic patients. The mean CV was 57.79 mm 3 (95% CI: 57.57-58.01) and 58.04 mm 3 (95% CI: 57.83-58.26) in men and women, respectively. The mean CV was 57.96 mm 3 (95% CI: 57.71-58.21), 57.84 mm 3 (95% CI: 57.49-58.19), and 57.92 mm 3 (95% CI: 57.7-58.13) in individuals with emmetropia, myopia, and hyperopia, respectively. The CV decreased significantly with advancing age. Moreover, the anterior chamber depth, central corneal thickness, mean keratometry, anterior corneal asphericity (Q value), and posterior corneal astigmatism were significantly directly related to CV, whereas axial length and white-to-white distance had a statistically significant inverse association with the CV. CONCLUSIONS: Aging is one of the important factors in reducing CV that should be considered. Some other topographic and biometric indices also have a significant relationship with CV.

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.

Central corneal thickness and its determinants in a geriatric population: a population-based study.

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

Anterior and posterior corneal higher-order aberrations in early diagnosis and grading of keratoconus.

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

Astigmatism profile in the elderly population: Tehran Geriatric Eye Study.

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

Anisometropia Profile in Elderly Population: Tehran Geriatric Eye Study.

PURPOSE: To investigate the distribution and prevalence of anisometropia according to age, gender and ocular biometry in a geriatric population in Tehran, Iran. METHODS: The present study was conducted on the geriatric population aged above 60 years. The study participants were selected using stratified random cluster sampling. The uncorrected and best-corrected visual acuity, dry objective (ARK510A, Nidek Co. 42 LTD, Aichi, Japan) and subjective refraction and ocular biometry (IOL Master 500; Carl Zeiss Meditec, Jena, Germany) were recorded for each patient. The magnitude and prevalence of anisometropia were evaluated in association with influential factors in cut-points of 0.50, 1.00, 1.50 and 2.00 diopter (D). RESULTS: The mean age of participants (3237 individuals, 54% were female) was 68.19 ± 6.48 (range: 60-97) years. The mean anisometropia in the whole sample was 0.82 D (95% CI: 0.76 - 0.88 D), which increased from 0.62 D (in those aged 60-64 years old) to 1.36 D (in those above 80 years). The prevalence of anisometropia >1 D in total population, males, and females were 23.81%, 24.9%, and 22.76%, respectively. The odds ratio of anisometropia was higher in cases with cataracts, myopia compared to emmetropia, keratometry asymmetry, axial length asymmetry (P = .001), and corneal diameter asymmetry (all others, P < .001). CONCLUSION: The results of the present study show a high prevalence of anisometropia in elderly population, which was related to refractive error, cataract, age, gender, and ocular biometry asymmetry.

Vision-related symptoms, accommodative and binocular vision performance in young diabetics vs. normal controls.

PURPOSE: To compare accommodative and binocular vision performance between young diabetic subjects and normal controls, and to investigate the correlation of accommodative/binocular indices with the severity of diabetes. METHODS: Thirty young subjects with diabetes mellitus (DM) and 30 age-matched normal controls were recruited in this hospital-based cross-sectional study. DM was diagnosed by a haemoglobin A1c (HbA1c) higher than 6.5%. The status of vision-related symptoms was examined by the convergence insufficiency symptoms survey (CISS). All participants underwent a complete optometric examination including visual acuity measurement, objective and subjective refraction, accommodative and binocular vision assessments. RESULTS: All study participants were between 18 and 40 years of age. There were no statistically significant differences in best-corrected visual acuity (BCVA), sphere, cylinder and spherical equivalent refraction (SE) between the diabetes and control groups. The median near point of convergence (NPC) was significantly more remote in diabetics compared with the control group. Mean accommodative amplitude (AA) and vergence facility (VF) and the median monocular accommodative facility (AF) were significantly lower in diabetic subjects compared with normal controls. In addition, the median accommodative lag in the diabetic group was significantly higher than the control group. A significantly higher percentage of the diabetic group were symptomatic (26.6%), compared with the controls (6.6%). The NPC and accommodative lag showed a significant positive correlation with the HbA1c level, while VF, AA and AF exhibited a significant negative correlation with HbA1c. CONCLUSION: Aspects of accommodative and binocular vision performance are strongly affected by DM. There is also a significant correlation between accommodative and binocular disorders with the severity of DM. A significant percentage of young subjects with DM have severe vision-related symptoms.

Abnormal Visual Function: An Under-recognized Risk Factor of Road Traffic Injuries.

Purpose: To determine the relationship between road accidents with visual acuity, refractive errors, visual field, and contrast sensitivity. Methods: This population-based case-control study was conducted on roads leading to Tehran Province, Iran. The case group comprised drivers who had met with accidents and were at fault for the accident. The cases were selected in an ongoing manner (incidence cases). The controls were drivers who were the opposing victims in the same. After an initial interview, optometric and ophthalmic examinations including the measurement of visual acuity, refraction, visual field assessment, contrast sensitivity measurement, and slit lamp biomicroscopy were performed for all study participants. Results: In this study, 281 and 204 individuals were selected for the case and control groups. The mean uncorrected visual acuity was 0.05 ± 0.12 and 0.037 ± 0.10 logMAR in the case and control groups, respectively (P = 0.095). Of the participants in the case and control groups, 32.8% and 23% had a visual field defect in at least one eye, respectively (adjusted odds ratios [aOR] = 1.63, 95% confidence interval [CI]: 1.08-2.48; P = 0.021). Moreover, 16.2% of the cases and 8.3% of the controls had visual field defects in both eyes (aOR = 2.13, 95% CI: 1.17-3.86; P = 0.012). Contrast sensitivity was worse in the case group in all spatial frequencies under non-glare conditions. However, under glare conditions, the contrast sensitivity was significantly worse in the case group only in the spatial frequency of 12 cycles per degree (cpd). Conclusion: Reduced contrast sensitivity, especially under non-glare conditions, and visual field defects are risk factors that influence the prevalence of road accidents. It is strongly advised that special attention be paid to these visual functions in legal assessments to apply the necessary interventions in individuals with these types of disorders.

Binocular vision disorders in a geriatric population.

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

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

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

Accommodative and convergence anomalies in patients with opioid use disorder.

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

Age- and Sex-Standardized Prevalence of Age-Related Cataract and Its Determinants; Tehran Geriatric Eye Study (TGES).

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

The Prevalence of Fusional Vergence Dysfunction in a Population in Iran.

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

Convergence Insufficiency in the Geriatric Population.

SIGNIFICANCE: The present study is the first population-based study to examine the prevalence of convergence insufficiency and its associations specifically in the geriatric population. Knowledge of the population-based determination of prevalence of this disorder in the elderly is necessary to support proper clinical diagnosis and management. PURPOSE: This study aimed to determine the prevalence of convergence insufficiency and its associated factors in a geriatric population. METHODS: In this study, all residents older than 60 years in Tehran city were selected through random stratified cluster sampling. All participants underwent a complete ocular examination including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, binocular vision assessments including unilateral and alternating cover tests, measurement of the near point of convergence, the positive fusional vergence, and finally ocular health examination. RESULTS: In this population-based sample of 1793 participants, the overall prevalences of two-sign and three-sign convergence insufficiency were 29.6% (95% confidence interval, 27.2 to 32.0%) and 21.5% (95% confidence interval, 19.5 to 23.6%), respectively. There were no statistically significant differences in the prevalence of both two-sign (P = .19) and three-sign (P = .41) convergence insufficiency between men and women. The highest and lowest prevalences of two-sign and three-sign convergence insufficiency were in the age groups 70 to 74 and 75 to 79 years, respectively. The prevalence showed no significant trend with age (P = .26 for two-sign convergence insufficiency, P = .33 for three-sign convergence insufficiency). In the multiple logistic regression model, none of the variables, including age, sex, and refractive errors, showed a significant relationship with convergence insufficiency (all, P > .05). CONCLUSIONS: The results of the present study showed a high prevalence of convergence insufficiency in the geriatric population. Clinicians should give special attention to this binocular vision disorder in this age group.