Identifying the content, functionalities, and features of a mobile application for contact lens wearers.

BACKGROUND: Lack of attention to end-users' requirements and preferences may lead to the failure of health information technology (IT) interventions. Identifying users' needs for designing a mobile application can lead to the development of an acceptable intervention. This study aimed to determine the requirements for designing a mobile application to educate and provide needed information to contact lens (CL) wearers. METHODS: A qualitative study was conducted on 24 CL wearers and nine eye care practitioners from the three CL clinics in Iran. Data were collected through semi-structured interviews and analyzed using the conventional content analysis proposed by Lundman and Graneheim. Lincoln and Guba's criteria were used to ensure the trustworthiness of the data. RESULTS: The three main categories that emerged from the interviews were mobile application content, mobile application functionalities, and mobile application features. Ten subcategories and 57 sub-subcategories were also identified. It was determined that mobile content should focus on advice and information for optimizing the CL wearing experience and training regarding the use of CLs. Entering information required for self-care, computational capability, interactivity, updates, and reminders were determined as needed functionalities. The participants recommended features for the structure and user interface of the mobile application and information presentation methods. CONCLUSION: This study identified the information needed to develop a mobile application for CL wearers. This also provides insights regarding required functionalities when applying IT interventions. These findings can be used by CL clinics, developers of health information systems, policymakers, and health planners to design better CL-related care and compliance interventions.

Experiences of Treatment With Contact Lenses in Aphakic Children With Unilateral Congenital Cataract: A Retrospective Study.

BACKGROUND AND OBJECTIVES: Congenital cataract is a condition compromising the eye's crystalline lens in infants and is usually diagnosed at birth. It can lead to irreversible vision loss if not promptly detected and treated, especially in unilateral cases. Nowadays, children with congenital cataracts can undergo surgical removal of their opacified crystalline lenses, and visual rehabilitation is mandatory to prevent deep amblyopia. Contact lenses, predominantly of rigid gas-permeable (GP) type, are gaining more popularity for this matter. METHOD: In this retrospective cohort study, unilateral aphakic children younger than 6 years referred to the Contact Lens Clinic at Farabi Eye Hospital from November 2011 to September 2019 were included. RESULTS: Seventy-six unilateral aphakic children with congenital cataracts (57.9% boys and 42.1% girls) rehabilitated with GP were studied. The mean age of diagnosis and referral to the contact lens clinic were 20.0±19.8 and 32.0±24.4 weeks, respectively, while the mean follow-up time was 12.44±26.28 months. The mean visual acuity for children capable of cooperating at the last follow-up was 0.98±0.62 log MAR. Among the participants, eight children (9.7%) were diagnosed as glaucoma suspects. The mean initial base curve and power of GP lenses were 7.86±0.39 mm and 23.29±5.52 diopters, respectively. Only 21 parents (27.6%) reported nonadherence to the scheduled part-time patch program. CONCLUSION: The results of this study showed GP-based optical treatment after early diagnosis, surgical removal of congenital cataracts, and a long-term close follow-up to be well tolerated by children and their parents, with acceptable parents' compliance and can thus be introduced as a safe and effective method to achieve desirable visual outcomes.

Role of Different Types of Contact Lenses in Epithelial Thickness.

OBJECTIVE: To evaluate the potential role of different types of contact lenses, such as soft (SCL), hard (HCL), and mini scleral (SCCL), in corneal epithelial thickness with anterior segment optical coherence tomography (AS-OCT). METHODS: In this cross-sectional study, patients who used contact lens at recent 6 months were recruited consecutively from September 2019 to October 2019, and the epithelial thicknesses of the cornea were obtained by AS-OCT and compared with control subjects who did not use contact lens. RESULTS: In total, 184 eyes (115 subjects) were included; of them, 75 eyes were keratoconic (KCN) and 109 eyes were nonkeratoconic (non-KCN). Twenty eyes in KCN and 79 eyes of non-KCN group had no history of contact lens use and were included for comparison with KCN and non-KCN contact lens users, respectively. Mean duration of contact lens wearing was 75.63±50.42 months. The epithelial thickness of non-KCN SCL group was thinner than that of non-KCN control subjects all over the cornea, whereas the epithelium of non-KCN HCL was thinner at central site as well as nasal and temporal paracentral and midperipheral areas. Epithelial thickness of the KCN HCL group was not different from the KCN control subjects in all sectors. The KCN SCCL group had thinner epithelium at nearly all peripheral sectors as well as inferior, inferotemporal, inferonasal, and nasal midperipheral sectors compared with KCN control subjects. CONCLUSION: The corneal epithelium was thinner at the peripheral zones in KCN SCCL users; at both peripheral and central zones in non-KCN SCL users and in central zones in non-KCN HCL users.

Determining the information needs of contact lens wearers for better education and more support: a qualitative study.

BACKGROUND: Designing educational interventions tailored to the needs of Contact Lens Wearers (CLWs) are important and necessary. The present study aimed to determine the information needs of CLWs to educate and provide information to them to increase their knowledge and reduce complications and non-compliance behaviors. METHODS: A qualitative approach was applied and semi-structured interviews were conducted in three contact lenses (CL) clinics in Iran among all their practitioners and 24 purposively selected patients. Data were analyzed using the Lundman and Graneheim conventional content analysis. RESULTS: The qualitative analysis revealed knowledge and skill themes as two main categories. The knowledge category includes five subcategories of basic information for the CLWs, acquaintance with the CL, caring for CL, hygiene and vigilance of CL, and challenges of using CL. The skill category consists of two subcategories, including handling/insertion and removal of the CL, and stabilization of learned information. Moreover, 36 sub-subcategories emerged from these seven subcategories that reflected the information needs of CLWs. CONCLUSIONS: A clear understanding of CLWs' information needs can help to design and develop appropriate educational approaches to overcome training barriers such as physicians' time constraints and high workload. Moreover, it can help deal with CLWs' insufficient knowledge and provide the required information simply and practically with the possibility of enough repetition.

Miniscleral Contact Lens in Pediatric Age Group: Indications, Safety, and Efficacy.

OBJECTIVE: To report indications, fitting feasibility, and safety of miniscleral design (MSD) lenses in children. METHODS: Medical records of patients aged <18 years at the time of referral to Contact Lens Clinic of Farabi Eye Hospital, because of inadequate spectacle-corrected visual acuity, rigid gas-permeable or soft contact lens intolerance, and ocular surface disease were reviewed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), best-corrected vision with the lens (CCVA), lens parameters, and comfortable daily wearing time (CDWT) were documented. RESULTS: Seventy-two eyes of 52 pediatric patients were fitted with MSD lens over a 9-year period. The indications for MSD lens fitting were keratoconus (29 eyes), corneal scarring from ocular trauma (16 eyes), ocular surface diseases (25 eyes), and postkeratitis corneal scar (2 eyes). The average UCVA and the mean difference between CCVA and BSCVA were 1.20 and 0.55 logarithm of the minimal angle of resolution, respectively, which shows statistically significant improvement. This significant increase in vision was even seen in those who were referred for the management of ocular surface diseases. The mean CDWT for most patients was 10 hr/day. CONCLUSION: Miniscleral design lens can be used as a safe and helpful modality to provide good vision and comfort in children experiencing ectatic disorders, traumatic corneal scars, and ocular surface diseases.

Effects of Soft Toric, Rigid Gas-Permeable, and Mini-Scleral Lenses on Corneal Microstructure Using Confocal Microscopy.

OBJECTIVE: To determine effects of wearing soft toric silicone hydrogel, rigid gas-permeable (RGP), and mini-scleral lenses on corneal microstructure using confocal microscopy. METHOD: A prospective cohort study was conducted on 33 neophyte patients fitted with contact lenses (avg. age: 26±7 years) in the tertiary eye center. Patients were instructed to wear soft toric silicone hydrogel, RGP, or mini-scleral lenses based on clinical diagnoses. Inclusion criteria were age greater than 18 years and best-corrected visual acuity ≥3/10. Patients with a history of eye-involving systemic diseases were excluded. Baseline examinations included log of minimal angle of resolution visual acuity (Early Treatment Diabetic Retinopathy Study chart), refraction, slit-lamp, and fundoscopy. Confocal microscopy was used to measure subbasal nerve (SBN) density (mm/mm), keratocyte cell density (cells/mm), basal epithelial cell density (cells/mm), and endothelial cell density (cells/mm). Data were gathered on the first and follow-up visits. The follow-up visit happened after 6 months when the subjects had stopped wearing contact lenses for 12 hr. Comparative analysis was conducted within each group using the paired t test. RESULTS: The changes in visual acuity, SBN, and keratocyte cell density were insignificant after 6 months of wearing lenses in all three groups. The basal epithelial cell density significantly decreased (P<0.05) in RGP and mini-scleral groups. In addition, the endothelial cell density decreased significantly (P<0.05) in the RGP group. No significant changes were detected in soft toric silicone hydrogel lens wearers. CONCLUSIONS: Soft toric silicone hydrogel lenses seemed to have the least impact on the corneal cellular microstructure for a wear period of 6 months, controlling confounding factors of prior cross-sectional investigations. The coarse (three layers) versus fine (five layers) division of stroma, the repeatability and reproducibility of stromal layers' demarcation, and the cohort size and its diversity in terms of initial corneal diagnoses (particularly in the mini-scleral wearing group) can potentially influence the outcomes, and their impact remains to be further investigated.

Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014.

Background: Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middleaged population in 2009 and 2014. Methods: Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05. Results: The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821- 0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods. Conclusion: The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.

Comparison of Refractive Error Changes in Retinopathy of Prematurity Patients Treated with Diode and Red Lasers.

AIM: To compare refractive error changes in retinopathy of prematurity (ROP) patients treated with diode and red lasers. METHODS: A randomized double-masked clinical trial was performed, and infants with threshold or prethreshold type 1 ROP were assigned to red or diode laser groups. Gestational age, birth weight, pretreatment cycloplegic refraction, time of treatment, disease stage, zone and disease severity were recorded. Patients received either red or diode laser treatment and were regularly followed up for retina assessment and refraction. The information at month 12 of corrected age was considered for comparison. RESULTS: One hundred and fifty eyes of 75 infants were enrolled in the study. Seventy-four eyes received diode and 76 red laser therapy. The mean gestational age and birth weight of the infants were 28.6 ± 3.2 weeks and 1,441 ± 491 g, respectively. The mean baseline refractive error was +2.3 ± 1.7 dpt. Posttreatment refraction showed a significant myopic shift (mean 2.6 ± 2.0 dpt) with significant difference between the two groups (p < 0.001). There was a greater myopic shift among children with zone I and diode laser treatment (mean 6.00 dpt) and a lesser shift among children with zone II and red laser treatment (mean 1.12 dpt). The linear regression model, using the generalized estimating equation method, showed that the type of laser used has a significant effect on myopic shift even after adjustment for other variables. CONCLUSION: Myopic shift in laser-treated ROP patients is related to the type of laser used and the involved zone. Red laser seems to cause less myopic shift than diode laser, and those with zone I involvement have a greater myopic shift than those with ROP in zone II.

Distribution and prevalence of refractive error in Iranian adult population results of the PERSIAN eye cohort study PECS.

The Persian Eye Cohort Study, a population-based cross-sectional study from 2015 to 2020, examined refractive error prevalence among 48,618 Iranian adults aged 31 to 70. The study encompassed six centers in Iran, employing random cluster sampling for demographic, medical, and socioeconomic data collection through interviews. Ophthalmic exams included visual acuity, automated and manual objective refraction, subjective refraction, slit lamp, and fundus examinations. Using the spherical equivalent definition, the sample population was categorized into groups. Results indicated a mean age of 49.52 ± 9.31 and a mean refractive error of 0.26 diopters (D) ± 1.6 SD (95% CI - 0.27 to -0.24), ranging from -26.1 to + 18.5 SD. Prevalence of myopia (< -0.5D) and hyperopia (> + 0.5D) was 22.6% (95% CI 22.2-23%) and 12.5% (95% CI 12.1-12.8%), respectively. Regarding different age groups, the prevalence of hyperopia and astigmatism exhibited a steady and significant rise with increasing age (p-value < 0.001 for both). The prevalence of Myopia, however, showed a distinctive pattern, initially increasing in adults under 45, declining in those aged 55-64, and rising again among individuals aged 60 and older. Female gender, older age, urban residency, higher education, higher income, and Fars ethnicity were significantly related to a higher prevalence of myopia (p-value < 0.001 for all). Female gender (p-value < 0.001), aging (p-value < 0.001), urban residency (p-value = 0.029), and lower-income (p-value = 0.005) were significantly related to higher prevalence of hyperopia. Astigmatism (> 1D) was prevalent in 25.5% of participants (95% CI 25.1-25.9%) and correlated with male gender, aging, urban residency, illiteracy, and higher income (p-value < 0.001, < 0.001, < 0.001, < 0.001, 0.014, respectively). The study's comparison with regional and international surveys highlighted the increase in myopia among those over 65 due to higher nuclear cataract rates in older adults. Myopia positively related to education, income, and urban residency, while hyperopia did not exhibit such associations.

Nerve fiber layer thickness in eyes treated with red versus green laser in proliferative diabetic retinopathy: short-term results.

PURPOSE: To evaluate changes of retinal nerve fiber layer (RNFL) thickness after panretinal photocoagulation (PRP) in red versus green laser-treated eyes. PROCEDURE: This is a prospective, randomized, fellow-eye controlled clinical trial conducted on 60 eyes of 30 patients (mean age 52.3 ± 7.8 years; 57% male) with early- to high-risk proliferative diabetic retinopathy type II diabetes who received standard red or green laser treatment. Scanning laser polarimetry (GDx) was performed to evaluate RNFL thickness at baseline and at week 6. RESULTS: Only 22 patients (44 eyes) could perform reliable GDx tests. At week 6 after PRP, the RNFL thickness increased by an average of 3.35 ± 9.18 µm (p = 0.02) and 2.08 ± 4.75 µm (p = 0.04) in the red and green laser groups, respectively. There was no significant correlation between changes in RNFL thickness and the number of laser burns, age, HbA1c or blood pressure. The difference in the change of the RNFL thickness between the red and green laser groups was not significant (p = 0.8). CONCLUSION: Though RNFL thickness was increased significantly 6 weeks after PRP with red and green laser in comparison to baseline, there was no significant difference in RNFL thickness between red and green laser groups.

An innovative optics lab design for residency training in ophthalmology.

Proper understanding of the optical function of the eye is the foundation of clinical understanding of ophthalmologists. Although teaching principals of optics has always been a part of ophthalmology residency curriculum, it seems that successful strategies other than lecture-based methods are needed to engage students and facilitate the understanding of optical principals. A collaborative team of physicists (optics Ph.D.), ophthalmologists and medical education experts designed an optics lab for ophthalmology residents to help them practically simulate different optical phenomena. The educational course consisted of 4 sessions of 90 min to practice the optical tests using the lab instruments. Each class consisted of 6-9 residents, divided into 3 groups with a fully equipped unit, and two mentors (an optics Ph.D. professor and an ophthalmology professor). A quasi-experimental design with pre-post test was used to evaluate the effectiveness of the training workshop in changing the ophthalmology residents' optical knowledge and attitude. Thirty-five residents participated in the study. The average score of residents' performance before the workshop was 5.21 (out of 100), which increased significantly to 66.1 after the workshop. Also, the average knowledge of residents, which was measured as self-reported, increased significantly from 28.85 to 71.09. The average score of students' attitudes and interest was increased from 40.49 to 74.81. It seems that training workshops and labs are effective to bring about change in knowledge and attitude of ophthalmology residents toward optics as a new teaching strategy that would be implemented in their curriculum.

Utility of In Vivo Confocal Microscopy in Diagnosis of Acanthamoeba Keratitis: A Comparison of Patient Outcomes.

PURPOSE: The aim of this study was to compare outcomes between cases of Acanthamoeba keratitis (AK) diagnosed and treated with or without the use of in vivo confocal microscopy (IVCM). METHODS: We performed a retrospective comparative case series of 26 eyes of 23 patients diagnosed with AK at the Massachusetts Eye and Ear Infirmary over a 5-year period. The characteristics of all identified cases were summarized. We compared the time from presentation to diagnosis of AK (primary outcome), visual acuity, and rates of therapeutic penetrating keratoplasty between eyes diagnosed by culture-only group (n = 8) and by IVCM to diagnose AK (n = 9) and later confirmed by culture (IVCM/C group). RESULTS: The diagnostic delay was significantly longer in the culture only group (25 ± 29 days) compared with the IVCM/C group (3 ± 3 days, P < 0.01). At 6 months, there was a significant difference in best-corrected visual acuity between the culture-only group (1.46 ± 1.07, n = 7) and the IVCM/C group (0.22 ± 0.22, n = 8), after adjusting for initial baseline visual acuity (P = 0.02). Therapeutic penetrating keratoplasty was performed in 50% of culture-only (n = 7) and 11% of IVCM/C group eyes (n = 9), but this was not statistically significant (P = 0.13). CONCLUSIONS: IVCM can expedite the diagnosis of AK, and its use as an adjunct tool in the diagnosis of AK may result in better patient outcomes compared with basing treatment decisions on corneal cultures alone.

Prevalence of uncorrected distance refractive errors and associated risk factors in employees of an academic centre.

BACKGROUND: Uncorrected refractive error (RE) may affect the work performance of adults in the workplace. The aim of current study was to determine the prevalence of corrected and uncorrected RE, and the determinants of uncorrected RE in adult employees of a university. METHODS: This was a cross-sectional study of Tehran University Medical Sciences' staff. Besides demographic and some specific questionnaires, ophthalmic examinations including the measurement of uncorrected visual acuity (UCVA), best spectacles corrected visual acuity (BCVA), and presenting visual acuity were performed for all participants. The need for spectacles was defined as UCVA worse than 6/12 in the better eye that could be corrected to better than 6/12 with spectacles based on subjective refraction. RESULTS: In total, 4460 individuals with mean age of 42.32 ± 8.80 were included in the study. The VA of the better eye was 0.01 ± 0.05 logMAR for BCVA, 0.13 ± 0.26 for UCVA, and 0.05 ± 0.12 for presenting VA. Prevalence of RE was 15.7%, including uncorrected RE of 5% and spectacles coverage (corrected RE) of 10.7%. The proportion of individuals with elementary education and poor-fair status of general health were 1.62 times higher in the uncorrected group. In the univariate analysis, type of occupation (office versus non-office workers), socioeconomic status, and insurance of employees were not related to uncorrected RE (all P > 0.4). Myopia was the only factor associated with uncorrected RE in logistic regression analysis (odds ratio = 2.73, 95%CI = 1.02-7.31, P = 0.04). CONCLUSION: The prevalence of uncorrected RE and spectacle coverage were 5% and 10.7%, respectively. Myopia was almost three times more likely to be associated among employees with uncorrected RE.

Single-Field Fundus Photography for Screening of Diabetic Retinopathy: The Prevalence and Associated Factors in a Population-Based Study.

INTRODUCTION: We aimed to determine the prevalence and risk factors for diabetic retinopathy (DR) in a multi-primary healthcare facilities-based DR screening project by analyzing single-field fundus photographs among patients with diabetes in Rafsanjan City, Iran, based on the Rafsanjan Cohort Study, as a part of the prospective epidemiological research studies in IrAN (PERSIAN). METHODS: Of all participants in the Rafsanjan Cohort Study (performed in four primary healthcare facilities across Rafsanjan City from August 2015 to December 2017), patients with diabetes were recruited in this study. All participants underwent a standardized interview and clinical and paraclinical examinations for demographic characteristics, and medical conditions according to the PERSIAN's protocols. In addition, digital fovea-centered and single-field fundus photography was performed for DR identification and grading. For assessment of agreement, a subgroup of participants underwent fundus examination, randomly. DR was graded as nonproliferative (NPDR) or proliferative (PDR). RESULTS: Of 8414 screened participants, 1889 had diabetes. The total prevalence of DR was 6.93% [131 individuals including 110 (5.82%) with NPDR, and 21 (1.11%) with PDR] based on single-field fundus photographs, with almost perfect agreement with fundus examinations (κ = 0.82). On adjusted multivariate analysis, duration of diabetes (OR 1.16, 95% CI 1.13-1.19), positive family history for diabetes (OR 1.73, 95% CI 1.09-2.75), fasting plasma glucose (FPG) ≥ 126 mg/dL (OR 1.98, 95% CI 1.16-3.39), and serum creatinine level (OR 1.79, 95% CI 1.08-2.98) were associated with DR. Factors including age, education level, physical activity, body mass index, hypertension, and cardiovascular and renal diseases did not have association with DR on adjusted multivariate analysis. CONCLUSIONS: Single-field fundus photography can be used for screening of DR in primary healthcare facilities. In individuals with diabetes, duration of diabetes, positive family history for diabetes, FPG ≥ 126 mg/dL, and serum creatinine level may be associated with DR.

AZAR eye and vision cohort study.

According to World Health Organization (WHO), currently, 2.2 billion people are living with visual impairment worldwide, of which almost half could have been prevented. There are both modifiable and unmodifiable factors leading to visual disability and, ultimately, blindness. Several population-based studies in different parts of Iran have tried to determine these factors concerning their specific population and environment-related characteristics. AZAR Eye and Vision cohort is the second-largest cohort study in the whole country. AZAR Eye and Vision cohort is the ophthalmologic branch of AZAR cohort which is the largest eye cohort study in the country, which is trying to determine the prevalence and incidence of visual impairment, blindness, and other major ophthalmologic conditions and their associated risk factors in East Azerbaijan province located in Iran, a middle eastern country. A recently emerging phenomenon is the drying of the ultra-salty lake of Urmia located in the West Azerbaijan province which is a direct neighbor of our studied population and has caused recurrent salt storms in the immediate near areas. This phenomenon could adversely affect visual health via different conditions which our study will elucidate. The enrollment phase took place between 2014 and 2017 and 11,208 participants were enrolled out of 15,000 participants in the primary cohort. The resurvey phase will begin five years after the enrollment phase. In this phase, 30% of the participants are randomly selected to be reexamined and complete questionnaires. The participants showing any issues such as diabetes and being a glaucoma suspect will be included in the resurvey phase, too. Data categories gathered include demographics, lifestyle factors, past medical and drug histories, and a diet quality and quantity questionnaire including 130 edible items. Urine, hair, nail, and 25-ml blood samples, were collected from the participants. Then they were referred to an optometrist to complete an ophthalmologic questionnaire and undergo eye examination and lensometry. Then they underwent slit-lamp examinations and pictures were taken of the lens and fundus. People with suspected visual impairment were referred to an ophthalmology clinic. The data are processed and a four-level quality check is performed on each block. The most common visual impairment is cataracts. This study's most important aim is to evaluate the effect of local environmental and ethnic factors on eye diseases in this specific population.

PERSIAN Eye Cohort Study (PECS): Design, Methodology.

BACKGROUND: To report the study protocol, methodology and latest enrollment data of a large epidemiological multi-central eye cohort named PERSIAN Eye Cohort Study (PECS), originating from the ongoing PERSIAN Cohort Study, to investigate the distribution of ophthalmic disorders in different regions and ethnicities of Iran, and determine their associations with various exposures of ophthalmic and non-ophthalmic nature. METHODS: A central committee designed the study and equipped six chosen centers (Khameneh, Some'e Sara, Hoveizeh, Yazd, Rafsanjan and Zahedan). A focal point in each center conducted the study under close supervision of the central committee. RESULTS: This ongoing study was launched in 2014. Out of 65,580 eligible participants of the PERSIAN Cohort, 48,618 individuals aged 35-70 have been enrolled in the PECS (response rate: 74.13%) until June 2021. Slit lamp and fundus photography were performed for 28,702 (59.03%) and 27,437 (56.43%) individuals, respectively. CONCLUSION: This large epidemiological multi-central eye cohort can improve our epidemiological knowledge of the prevalent ophthalmic disorders in different regions and ethnicities of Iran, and determine their associations with various exposures of ophthalmic and non-ophthalmic nature. This will be very useful for future planned nationwide and global interventions.

Risk Factors for Uncorrected Refractive Error: Persian Cohort Eye Study - Rafsanjan Center.

Purpose: To determine the prevalence of visually significant uncorrected refractive error (URE) in Rafsanjan and investigate the related factors. URE is the leading cause of visual impairment (VI) which causes the second-highest number of years lived with disability. The URE is a preventable health problem. Methods: In this cross-sectional study participants from Rafsanjan who were 35-70 years were enrolled between 2014 and 2020. Demographic and clinical characteristics data were gathered, and eye examination was performed. Visually significant URE was defined as present if habitual visual acuity was (HVA; visual acuity with present optical correction) >0.3 logMAR in the best eye and the visual acuity of that eye showed >0.2 logMAR improvement after the best correction. Logistic regression was used to determine the association between predicting variables (age, sex, wealth, education, employment, diabetes, cataract, and refractive error characteristics) and outcome (URE). Results: Among the 6991 participants of Rafsanjan subcohort of the Persian Eye Cohort, 311 (4.4%) had a visually significant URE. Diabetes was significantly more prevalent in the participants with visually significant URE, at 18.7% versus 13.1% in patients without significant URE (P = 0.004). In the final model, each year of increase in age was associated with 3% higher URE (95% confidence interval [CI]: 1.01-1.05). In comparison to low hyperopia, participants with low myopia had 5.17 times more odds of visually significant URE (95% CI: 3.38-7.93). However, antimetropia decreased the risk of visually significant URE (95% CI: 0.02-0.37). Conclusion: Policymakers should pay special attention to elderly patients with myopia to effectively reduce the prevalence of visually significant URE.

Sharp-object-induced open-globe injuries in Iranian children admitted to a major tertiary center: a prospective review of 125 cases.

UNLABELLED: Ocular trauma in children can result in catastrophic visual and psychological outcomes both for the child and his/her family. According to the WHO, childhood blindness is one of the major causes of avoidable blindness and so target of the Vision 2020 program. To achieve this program's goals, it is necessary to explore the epidemiological patterns of ocular trauma in different countries which in its turn could be a valuable means to guide us in developing preventive measures. Our study is a hospital-based prospective study which was conducted to reveal detailed information about children who were admitted to a large tertiary care hospital with the diagnosis of lacerating globe injury due to a sharp object. PATIENTS AND METHODS: During a 6-month period (December 2006 to June 2007), 125 eyes of 125 children (age ≤16 years) with the diagnosis of open-globe injury were enrolled. Clinical data were documented. Demographic data and details of the event were explored and documented based on the study questionnaire (adopting the Birmingham Eye Trauma Terminology and the United States Eye Injury Registry model as basis) by interviewing the parents and the child. RESULTS: The mean age was 8.5 years (SD = 4.36 years, range: 1-16). The boys:girls ratio was 2.5:1; this ratio was age dependent, showing a significant increase with age. The home was the most frequent place (61.7%) for the trauma to occur in. Most traumas (50%) occurred in the afternoon (12 midday to 6 p.m.). Almost half of the traumas were unintentional self-injuries and occurred when the child was alone. A knife and fireworks were the two most frequent causes of injury. CONCLUSION: As the home is the most common place of ocular trauma in this age group and as lack of proper supervision and accessibility of sharp objects such as knives are the background of the event in most cases, it is strongly recommended to educate parents about providing a safe environment at home for their children. Work-related eye injuries in this age group should also be reduced by regulations for prohibiting children's work or at least providing the necessary education and safety goggles.

Accelerated Corneal Collagen Cross-Linking in Pediatric Keratoconus.

PURPOSE: To evaluate the visual, refractive, and topographic outcomes of accelerated corneal collagen cross-linking (CXL) in the pediatric age group. METHODS: In this retrospective case series study, 89 eyes of 56 patients with progressive keratoconus (KCN) who were under or equal to 18 years old at the time of surgery were included. All patients underwent accelerated corneal CXL. A thorough baseline and follow-up ophthalmic examination including uncorrected distance visual acuity, best corrected visual acuity (BCVA), slit-lamp and fundus examination, and corneal tomography by Scheimpflg camera Pentacam (Oculus, Wetzlar, Germany) were performed. RESULTS: The mean age of patients was 16.2 ± 1.8 years. Mean follow-up was 16.46 ± 11.6 months (range, 6-40 months). The mean BCVA improved significantly from 0.26 ± 0.26 to 0.16 ± 0.19 (logMAR) after accelerated CXL (P < 0.001). The mean corneal astigmatism based on refraction decreased from 3.69 ± 2.12 to 3.15 ± 1.86 after the intervention (P = 0.016). The mean maximum keratometry (Kmax) reduced significantly from 53.23 ± 6.07 diopter (D) to 52.23 ± 6.33 D (P = 0.047). The mean flat keratometry (K1) reduced from 46.37 ± 3.69 to 45.95 ± 3.65 after the intervention (P = 0.119). CONCLUSION: Our study shows that accelerated CXL increases visual acuity and stabilizes or improves keratometric indices in pediatric patients with progressive KCN without any serious complication for a mean follow-up time of 16 months.

Developing and validating an instrument to measure: the medical professionalism climate in clinical settings.

This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of "personal behavior", "collegiality" and "respect for patient autonomy" in a 25-item questionnaire for service providers and a single factor of "professional behavior" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.