Governmental support for achieving "VISION 2020: the Right to Sight" in Iran: the cataract surgical rates.

PURPOSE: The aim of this study was evaluate the effect of governmental support in the form of Health Transformation Plan (HTP) on increasing the cataract surgical rate. METHODS: The number of cataract surgeries was collected from Iranian cataract surgery clinics during 2019. HTP was implemented in 2014. Forty-seven major and forty-five minor surgery centers were selected from all provinces. In each center, sampling was done from 2012, 2013, 2015, and 2016. RESULTS: On average, 6202 and 7134 cataract surgery rate were performed before and after HTP, respectively. The cataract surgical rate rose by 15.03% after the HTP. After HTP, the proportion of cataract surgery increased by 21.32% in governmental centers and decreased by 17.56%, 24.45%, and 14.89% in private, insurance, and charity centers, respectively. The cataract surgical rate was 4093 and 6026 in the first economic quartile (the poorest), 3669 and 4595 in the second quartile, 5884 and 5928 in the third quartile, and 8427 and 9681 in the fourth quartile (the richest) before and after HTP, respectively. The highest growth in the cataract surgical rate was seen in the first quartile (47.24%) followed by the second (25.26%), fourth (14.88%), and third quartiles (0.74%). CONCLUSION: The Health Transformation Plan has been successful in increasing the cataract surgical rate in the low-income group and identifying differences in the services as well as the economic groups within the population.

Intraoperative Complications of Cataract Surgery in Tehran Province, Iran.

PURPOSE: To determine the prevalence and types of intraoperative complications of cataract surgery and examine potential risk factors. METHODS: Data were obtained from the 2011 Iranian Cataract Surgery Survey in which information about cataract surgeries throughout the nation was collected. In the Province of Tehran, 55 centers and 1 week per season per center were randomly selected for sampling. In each center, the charts of all patients who underwent cataract surgery during the selected weeks (total of 20 weeks per center) were reviewed for data extraction. The prevalence of different types of intraoperative cataract surgery complications were determined, and their relationships with age, sex, surgical method, surgeon, and hospitalization time were examined. RESULTS: The prevalence of intraoperative complications of cataract surgery was 4.15% (95% confidence interval, 0.94 to 7.36). The prevalence of posterior capsular rupture with vitreous loss, posterior capsular rupture without vitreous loss, retrobulbar hemorrhage, suprachoroidal effusion/hemorrhage, intraocular lens drop, and nucleus drop was 2.86, 0.69, 0.06, 0.39, 0.03, and 0.11%, respectively. The prevalence of cataract surgery complications decreased from 6.95% in 2006 to 3.07% in 2010. The results of multiple logistic regression showed that surgery by residents, nonphacoemulsification methods of surgery, and patient age less than 10 years and more than 70 years were the risk factors for complications. CONCLUSIONS: This study evaluated the prevalence of intraoperative complications of cataract surgery for the first time in Tehran Province. The prevalence of complications was high in this study. To achieve the goals of the Vision 2020 Initiative and improve surgical quality, it is necessary to minimize complication rates. Factors to note for decreasing complication rates include type of surgery, surgeon experience, and patient age.

OPD-Scan III: a repeatability and inter-device agreement study of a multifunctional device in emmetropia, ametropia, and keratoconus.

The purpose of this study was to test the measurements of a multifunctional device, the NIDEK OPD-Scan III in terms of repeatability and agreement with retinoscopy and Pentacam in cases with emmetropia, ametropia, and KCN (grade 1-3). We enrolled 170 eyes (40 in each group of emmetropia and ametropia, and 90 in the 3 KCN subgroups). Acquisitions were done twice by a single technician to check the intra class correlation, repeatability index, and precision. To assess agreement, we compared OPD-Scan III with retinoscopy and Pentacam results by two blinded technicians. All device functions had acceptable precision in groups with emmetropia, ametropia, and KCN1, except spherical error in ammetropics (0.97 D). In KCN2, repeatability was acceptable with the refractive function, topography, and ocular aberrations but was more than 1.0 D for corneal aberrations. In KCN3, repeatability was low for the refractive function and corneal spherical aberration. Refractive data were not convertible to those obtained by retinoscopy in any group. OPD-Scan III keratometry data were interchangeable with Pentacam counterparts in emmetropes, ammetropes, and KCN1. In KCN2, the OPD-Scan III-Pentacam agreement for Kmax was 0.71 D, and there was 1.25 D difference in Kmin. No OPD-Scan III-Pentacam agreement was observed in KCN3. OPD- Scan III is a multifunctional device with acceptable repeatability in emmetropic, ammetropic, and KCN cases. Its measurements of corneal curvature and ocular aberrations are better than other functions. In cases with high degrees of refractive error and corneal irregularities, device repeatability and agreement with Pentacam is decreased.

Distribution of cataract surgical rate and its economic inequality in Iran.

PURPOSE: To determine the distribution of the cataract surgical number per million population per year (CSR), the CSR in the population older than 50 years (CSR 50+) in the provinces of Iran, and their economic inequality in 2010. METHODS: As part of the cross-sectional 2011 CSR survey, the provincial CSR and CSR 50+ were calculated as the total number of surgeries in major and minor centers divided by the total population and the population older than 50 years in each province. Economic inequality was determined using the average province income, the average urban and rural household incomes, and the percentage of urban and rural population in each province. RESULTS: Tehran and Ilam provinces had the highest and lowest CSR (12,465 vs. 359), respectively. Fars and Ilam provinces had the highest and lowest CSR 50+ (71,381 vs. 2481), respectively. Low CSR (<3000) was detected in 9 provinces where 2.4 to 735.7% increase is needed to reach the minimum required. High CSR (>5000) was observed in 14 provinces (45.2%) where rates were 0.6 to 59.9% higher than the global target. Cataract surgical rate increased at higher economic quintiles. Differences between the first, second, and fifth (poorest) quintiles were statistically significant. The CSR concentration index was 0.1964 (95% confidence interval, 0.0964 to 0.2964). CONCLUSIONS: In line with the goals of the Vision 2020 initiative to eliminate cataract blindness, more than 70% of geographic areas in Iran have achieved the minimum CSR of 3000 or more. However, a large gap still exists in less than 30% of areas, mainly attributed to the economic status.

Cataract surgical rate in Iran: 2006 to 2010.

PURPOSE: To determine the cataract surgical rate (CSR) between 2006 and 2010 in Iran. METHODS: In this cross-sectional study, sampling was done from surgical centers throughout Iran. Centers throughout all of Iran with more than 3000 surgeries per year were grouped as major centers and the rest were grouped as minor centers. All major centers and a percentage of minor centers were selected from each province. For each center, we determined the number of cataract surgeries in a random week of each season. RESULTS: Of the 237 eligible surgical centers, 124 were selected and 106 were enrolled in the study; 80 were major centers and 26 were minor centers. The number of surgeries has increased from 335,948 in 2006 to 475,526 in 2010. Cataract surgical rate has increased from 4723 (95% confidence interval, 4707 to 4739) per million population in 2006 to 6328 (95% confidence interval, 6309 to 6346) per million population in 2010. In the 50 and older population, CSR was 38,450 per million population in 2010. Average annual number of cataract surgeries per surgeon was 263 in 2006 and 339 in 2010. CONCLUSIONS: Compared with previous studies, the 2006 to 2010 CSR in Iran is on an ascending trend. Also, our numbers are higher than the minimum recommended by the World Health Organization, although lower than that in Western countries. Considering the aging population of the country, the observed rate is not sufficient for all cases of cataract in the future, and there is a need to increase CSR throughout the nation.

ClearKone-Synergeyes or rigid gas-permeable contact lens in keratoconic patients: a clinical decision.

OBJECTIVE: To compare the best-corrected visual acuity (BCVA), vision-related quality of life (VRQoL), comfort, foreign body sensation in the eye, tolerance, and handling of ClearKone-Synergeyes hybrid contact lenses and rigid gas-permeable (RGP) lenses in patients with keratoconus. METHODS: This comparative case series was conducted between 2011 and 2012 on 40 keratoconic patients (20 in each group). The BCVA of each patient was evaluated on the same day when the lens was prescribed. The National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25) questionnaire was assessed in addition to other subjective criteria 2 months after the lens prescription. RESULTS: The BCVA did not show a significant difference between the two lenses. Of the subjective criteria, the scores of the domains of general vision (P=0.008), ocular pain (P<0.001), distance activity (P=0.008), mental health (P<0.001), role difficulty (P<0.001), dependency (P=0.016), driving (P=0.067), total score of the NEI-VFQ 25 questionnaire (P<0.001), and comfort (P<0.001) were significantly higher in the ClearKone-Synergeyes group when compared with the RGP group. Foreign body sensation was statistically higher with RGP lens versus the ClearKone-Synergeyes lens (P=0.013). Regarding tolerance, the preference of the ClearKone-Synergeyes lens over the RGP lens was borderline (P=0.085). CONCLUSION: Although the BCVA did not differ significantly between the two lenses and both corrected vision to the same extent, satisfaction and VRQoL was better in keratoconic patients who used the ClearKone-Synergeyes lens in comparison with the RGP lens.

Analysis of superoxide dismutase 1, dual-specificity phosphatase 1, and transforming growth factor, beta 1 genes expression in keratoconic and non-keratoconic corneas.

PURPOSE: To quantitatively assess the superoxide dismutase 1 (SOD1), transforming growth factor, beta 1 (TGF-ß1), and dual-specificity phosphatase 1 (DUSP1) messenger ribonucleic acid (mRNA) expression levels as the main intracellular reactive oxygen species neutralizers, wound healing mediators, and immunomodulators (respectively) in keratoconic (KCN) and non-KCN corneas. METHODS: Total RNA was extracted from normal and keratoconic cultured corneal stromal fibroblasts. Semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to measure the relative expression levels of mRNAs of the SOD1, TGF-ß1, and DUSP1 genes. RESULTS: The mRNA expression of TGF-ß1 and DUSP1 was augmented in the KCN corneas (three- and fivefold, respectively; both p<0.05). The KCN and non-KCN samples showed no difference in comparative SOD1 mRNA levels. CONCLUSIONS: This study demonstrated a higher level of DUSP1 and TGF-ß1 expression as known molecules in the inflammatory process. These results may provide new insight into the complex molecular pathways underlying KCN for investigating other inflammatory molecules.

High prevalence of refractive errors in a rural population: 'Nooravaran Salamat' Mobile Eye Clinic experience.

BACKGROUND: The prevalence of myopia and hyperopia and determinants were determined in a rural population of Iran. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Using random cluster sampling, 13 of the 83 villages of Khaf County in the north east of Iran were selected. Data from 2001 people over the age of 15 years were analysed. METHODS: Visual acuity measurement, non-cycloplegic refraction and eye examinations were done at the Mobile Eye Clinic. MAIN OUTCOME MEASURES: The prevalence of myopia and hyperopia based on spherical equivalent worse than -0.5 dioptre and +0.5 dioptre, respectively. RESULTS: The prevalence of myopia, hyperopia and anisometropia in the total study sample was 28% (95% confidence interval: 25.9-30.2), 19.2% (95% confidence interval: 17.3-21.1), and 11.5% (95% confidence interval: 10.0-13.1), respectively. In the over 40 population, the prevalence of myopia and hyperopia was 32.5% (95% confidence interval: 28.9-36.1) and 27.9% (95% confidence interval: 24.5-31.3), respectively. In the multiple regression model for this group, myopia strongly correlated with cataract (odds ratio = 1.98 and 95% confidence interval: 1.33-2.93), and hyperopia only correlated with age (P < 0.001). The prevalence of high myopia and high hyperopia was 1.5% and 4.6%. In the multiple regression model, anisometropia significantly correlated with age (odds ratio = 1.04) and cataract (odds ratio = 5.2) (P < 0.001). CONCLUSION: The prevalence of myopia and anisometropia was higher than that in previous studies in urban population of Iran, especially in the elderly. Cataract was the only variable that correlated with myopia and anisometropia.

Prevalence and Causes of Visual Impairment and Blindness in Elderly Population; an Urgent Geriatric Health Issue: Tehran Geriatric Eye Study (TGES).

PURPOSE: To determine the prevalence of vision impairment (VI) and blindness and their determinants in the elderly population of Tehran. METHODS: In a cross-sectional study, multi-stage cluster sampling was used to select a sample of over 60 year population of Tehran. Optometric examinations included the measurement of uncorrected visual acuity, objective and subjective refraction, presenting and best corrected visual acuity. Vision impairment is reported according to the WHO definition. Visual acuity worse than 20/60 and 20/400 in the better eye was regarded as low vision and blindness, respectively. RESULTS: According to presenting visual acuity, VI was found in 14.8% (95%CI: 13.1-16.5) of the participants, including low vision in 13.8% (95%CI: 12.2-15.4) and blindness in 1.1% (95%CI: 0.5-1.6). The prevalence of VI ranged between 7.8% (95%CI: 6.0-9.5) in subjects aged 60-64 years and 40.0% (95%CI: 33.0-47.0) in participants over 80 years (p < .001). Multivariable logistic regression analysis showed that older age (OR = 1.07(per year)), lower education level (illiterate versus college: OR = 3.55), and lower economic status (middle versus rich: OR = 1.30 and poor versus rich; OR = 1.72) had a significant relationship with an increase in the prevalence of VI, and older age (OR = 1.14(Per year increase)) and diabetes (OR = 2.62) had a significant relationship with blindness. Refractive errors (63.1%) was the leading cause of VI followed by cataract (22.5%). However, cataract (48.3%) was the leading cause of blindness. CONCLUSION: Many older adults suffer from VI. Correction of refractive errors and cataract reduces a large percentage of VI. Age, education level, and economic status are other determinants of VI.

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.

Prevalence of refractive errors among school children in Northeastern Iran.

PURPOSE: To determine the prevalence of refractive errors among schoolchildren in Northeastern Iran by age and gender. METHODS: Using multistage random cluster sampling, 2020 schoolchildren 6-17 years of age were selected for this cross-sectional study. The participants totalled 1551 (response rate 76.8%) elementary and junior high school children (41.5% boys and 58.5% girls) from the northeast of Iran. Cycloplegic autorefraction was used to determine refractive error. Myopia was defined as a spherical equivalent (SE) of -0.50 dioptre (D) or worse, hyperopia as a SE of +2.00 D or more, and astigmatism as cylinder equal to or worse than -0.75 D. RESULTS: The prevalence of uncorrected, habitual and optimal visual acuity of 6/12 (0.30 logMAR) or worse in the better eye was 2.2%, 1.0%, and 0.2% respectively. The prevalence rates of myopia, hyperopia and astigmatism were 4.3% (95%CI: 3.3-5.3), 5.4% (95%CI: 4.3-6.5) and 11.5% (95%CI: 9.9-13.1) respectively and were not related to gender. The prevalence of myopia and against-the-rule astigmatism increased significantly with age (p < 0.0001). The prevalence of hyperopia significantly decreased with age (p < 0.0001). CONCLUSIONS: The prevalence of myopia in schoolchildren in Northeastern Iran is considerably lower than that of East Asian populations, but similar to many other populations, including South Africa, Chile and other countries of the Middle East. Whilst comparisons with other studies show that the prevalence of hyperopia and astigmatism in Northeastern Iran is higher than that of some countries, it is lower compared with others.

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.

High prevalence of diabetes in elderly of Iran: an urgent public health issue.

Purpose: To determine the distribution of blood glucose and prevalence of diabetes in people above 60 years living in Tehran and their relationship with some variables. Methods: In this cross-sectional population-based study, multistage cluster sampling was performed in the over 60-year-old population of Tehran. Blood samples were collected from all participants and the data of the history of diabetes and the use of blood glucose lowering agents or other drugs were collected using interviews. Results: Of 3791 selected subjects, 3310 participated in the study (response rate = 87.3%). The mean blood Sugar (BS) and hemoglobin A1c (HbA1c) of the patients was 118.11(95% CI: 115.34 -120.88) and 6.12(95% CI: 6.05-6.2) respectively. The prevalence of diabetes was 29.03%(95% CI: 27.12-30.94) in all subjects, 26.83%(95% CI: 24.58-29.07) in men, and 31.2%(95% CI: 28.24-34.16) in women. Odds of diabetes was significantly worse in women. systolic blood pressure, diasstolic blood pressure, height, weight, waist circumference, wrist circumference, hip circumference, neck circumference and body mass Index were significantly higher in diabetic after adjusting for the effect of sex and age. The odds of blindness was 2.69 (95% CI: 1.10-6.59) times higher in diabetic than in non-diabetics. Conclusions: On average, one in every three persons above 60 years of age was diabetic. Therefore, attention should be paid to this age group, especially women, due the higher prevalence of diabetes. All anthropometric measurements except height had a strong correlation with diabetes. Blindness was significantly more in diabetics.

Global and Regional Prevalence of Diabetic Retinopathy; A Comprehensive Systematic Review and Meta-analysis.

PURPOSE: We conducted a systematic search to estimate DR prevalence in different age and gender groups, and to evaluate the determinants of heterogeneity in its prevalence. METHODS: A systematic and comprehensive search from inception to August 10, 2020, was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross-sectional studies related to the prevalence of DR. RESULTS: Of 6399 studies, 90 articles with a sample size of 563460 individuals and 204189 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.98 to 30.84); 25.93% (95% CI: 23.54 to 28.31) and 28.95% (95% CI: 26.57 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I2 was 99% (p < .001). According to the meta-regression results, the variables of WHO region (Coefficient of AMRO vs SEARO: 15.56; p: 0.002), age (Coefficient of above 60 years vs below 40 year: 18.67; p: 0.001), type of DR (Coefficient: 19.01; p < .001), and publication year (Coefficient: -0.60; p: 0.001) had a significant correlation with heterogeneity. CONCLUSION: One third of diabetic patients suffered from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR.

Mutation analysis of VSX1 and SOD1 in Iranian patients with keratoconus.

PURPOSE: To evaluate mutations in the visual system homeobox gene 1 (VSX1) and superoxide dismutase 1 (SOD1) genes with keratoconus (KTCN), direct sequencing was performed in an Iranian population. METHODS: One hundred and twelve autosomal dominant KTCN patients and fifty-two unaffected individuals from twenty-six Iranian families, as well as one hundred healthy people as controls were enrolled. Genomic DNA was extracted from whole blood sample. Then to study the possible linkage between KTCN and six known loci linkage analysis was performed using 12 short tandem repeat (STR) markers. Also, the entire coding region and intron-exon boundaries of VSX1 and SOD1 were amplified by the PCR technique in each proband. Subsequently, PCR products were subjected to direct sequencing. Co-segregation analysis of the identified mutation was conducted in the family members. An Amplification Refractory Mutation System PCR (ARMS-PCR) was additionally employed for detection of the identified mutation in healthy controls. RESULTS: Linkage analysis of aforementioned loci did not detect evidence for linkage to KTCN. Direct PCR sequencing revealed two single nucleotide polymorphisms (SNPs; g.1502T>G and g.9683C>T), as well as two missense mutations that have been previously reported (R166W and H244R) in VSX1. We also found three undescribed SNPs (g.4886G>A, g.4990C>G, and g.9061T>A) in SOD1. The R166W and H244R mutations were co-segregated in affected family members but not in those that were unaffected. Moreover, the ARMS-PCR strategy did not detect the identified mutations in controls. CONCLUSIONS: Our data suggest a significant association between KTCN patients and VSX1 genetic alterations (p.R166W and p.H244R). Although our findings support VSX1 as a plausible candidate gene responsible for keratoconus, other chromosomal loci and genes could be involved in KTCN development. Taken together, our results suggest that p.R166W and p.H244R could have possible pathogenic influences on KTCN.

Prevalence of the refractive errors by age and gender: the Mashhad eye study of Iran.

BACKGROUND: Refractive errors are a common eye problem. Considering the low number of population-based studies in Iran in this regard, we decided to determine the prevalence rates of myopia and hyperopia in a population in Mashhad, Iran. DESIGN: Cross-sectional population-based study. PARTICIPANTS: Random cluster sampling. Of 4453 selected individuals from the urban population of Mashhad, 70.4% participated. METHODS: Refractive error was determined using manifest (age > 15 years) and cycloplegic refraction (age ≤ 15 years). Myopia was defined as a spherical equivalent of -0.5 diopter or worse. An spherical equivalent of +0.5 diopter or worse for non-cycloplegic refraction and an spherical equivalent of +2 diopter or worse for cycloplegic refraction was used to define hyperopia. MAIN OUTCOME MEASURES: Prevalence of refractive errors. RESULTS: The prevalence of myopia and hyperopia in individuals ≤ 15 years old was 3.64% (95% CI: 2.19-5.09) and 27.4% (95% CI: 23.72-31.09), respectively. The same measurements for subjects > 15 years of age was 22.36% (95% CI: 20.06-24.66) and 34.21% (95% CI: 31.57-36.85), respectively. Myopia was found to increase with age in individuals ≤ 15 years and decrease with age in individuals > 15 years of age. The rate of hyperopia showed a significant increase with age in individuals > 15 years. The prevalence of astigmatism was 25.64% (95% CI: 23.76-27.51). CONCLUSIONS: In children and the elderly, hyperopia is the most prevalent refractive error. After hyperopia, astigmatism is also of importance in older ages. Age is the most important demographic factor associated with different types of refractive errors.

The efficacy of photodynamic therapy in treatment of recurrent squamous cell and basal cell carcinoma.

OBJECTIVES: A number of investigations have already been carried out to assess the effect of photodynamic therapy (PDT) on primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) lesions, but lack of investigations on recurrent lesions or lesions with treatment failure, prompted the authors to carry out this study. The aim of the present study was to evaluate the efficacy of photodynamic therapy on recurrent BCC and SCC lesions on head and neck skin. PATIENTS AND METHODS: A total of 30 patients, including 16 men and 14 women, were selected from patients with recurrent SCC and BCC who referred to Iran university ENT research center Rasool-e-Akram Hospital, Tehran-Iran, met the criteria and entered the study. This is a longitudinal study of 30 patients with 43 histologically verified head and neck skin tumors, candidate for photodynamic therapy. RESULTS: To cite the results obtained in this study, it is worth mention that five cases expressed disagreement with this treatment modality after the first session of illumination; the treatment was stopped because of pain or burning. In a three-month evaluation, complete treatment response rates were obtained in 72% of patients (18 cases); in SCC cases it was 71.4% (10 cases) and in BCC it was 72.7% (eight cases). The final result of complete response rate in three years of follow up, demonstrated that 16 (64%) patients out of 25 were disease-free from recurrent BCC and SCC (Table 1). In BCC cases the final three-year response rate was seven (63.6%) and in SCC cases it was nine (64.2%). Hence, there was no statistical difference between SCC and BCC cases to treatment (P = 0.34). DISCUSSION: The obtained data from the current study is supportive of the recommended treatment method of PDT as an effective, tolerable and less invasive treatment in patients with recurrent BCC and SCC carcinomas, particularly when cosmetic effects are an important consideration. However, more research is needed to establish this.

Five year cataract surgical rate in Iran.

PURPOSE: To determine the number of cataract surgeries per million population per year or the cataract surgical rate (CSR) in Iran for every year from 2000 to 2005 as part of the objectives of the Vision 2020 initiative by the World Health Organization (WHO) to eliminate cataract blindness. METHODS: This study is part of the Iranian Cataract Surgery Survey, which was conducted as a retrospective cross-sectional study. All major cataract surgery centers and 10% of randomly selected minor centers throughout the nation were approached. Excluding the 2-week Iranian New Year holiday, 1 week per season between 2000 and 2005 (a total of 24 weeks) was selected for each center, and data concerning all cataract surgeries performed during these weeks were recorded by reviewing records of patients operated for cataracts. RESULTS: A total of 13,409 surgical records from 2000 to 2005 were evaluated, and CSR was calculated for each year based on the population data obtained from the Statistical Center of Iran. CSR showed an increasing trend in Iran, rising from 526 (95% confidence interval: 352 to 700) in year 2000 to 1331 (95% confidence interval: 1084 to 1577) in 2005. CONCLUSIONS: CSR has significantly increased in Iran in recent years but is still below the target suggested by WHO. Considering the age structure of the young population of Iran, the present CSR may suffice. However, it is necessary to implement plans to increase CSR and obviate obstacles to eliminating cataract blindness.

The histological and clinical effects of 630 nanometer and 860 nanometer low-level laser on rabbits' ear punch holes.

Low-level laser therapy (LLLT) studies on the musculoskeletal and cartilage tissues of rabbits have reported conflicting results. We aimed to investigate the effects of 630 nm and 860 nm low-level laser on injured rabbit cartilage. After punching 5 mm holes in both ears of ten rabbits, we grouped the rabbits randomly. The punched holes of the laser-treated group were irradiated with 630 nm and 860 nm diode laser on days 3-5 and then every other day until day 20. In both laser and control groups, the hole diameters were measured weekly. Histological evaluation was carried out on day 30. The inter-group difference in hole diameters was not significant. Mann-Whitney U tests showed significant inter-group differences in histological variables related to chondrocyte production and organization, growth rate, granulation tissue and pseudocarcinomatosis. LLLT improved cartilage formation and reduced inflammation and formation of granulation tissue. More accurate results on its healing effects warrant studies with larger sample sizes.

Prevalence and risk factors of pterygium: a systematic review and meta-analysis.

The present study was conducted to determine the global prevalence and risk factors for pterygium. Three thousand two hundred fifty-five articles were identified, of which 68 articles with a total of 415,911 participants from 24 countries were included in the final analysis. The prevalence of pterygium in the total population was 12% (95% confidence interval [CI] 11-14%). The lowest and highest prevalence rates were, respectively, 3% (95% CI 0.0-9%) in the 10- to 20-year-age group and 19.5% (95% CI 14.3-24.8%) in those over 80 years. The prevalence was 13% (95% CI 11-15%) in men and 12% (95% CI 9-13%) in women. The odds ratio for men was 1.30 (95% CI 1.14-1.45). The lowest prevalence of pterygium was reported in a clinic-based study in Saudi Arabia (0.07%) and the highest prevalence was in China (53%). The odds were 1.24 (95% CI 1.11-1.36) for sunlight exposure over 5 hours, 0.84 (95% CI 0.74-0.94) for smoking, 1.45 (95% CI 1.33-1.57) for living in rural areas, 1.17 (95% CI 1.03-1.32) for alcohol consumption, 1.46 (95% CI 1.36-1.55) for outdoor occupations, and 0.47 (95% CI 0.19-0.57) for use of sunglasses. This is the second meta-analysis arriving at an estimate of 12% for the prevalence of pterygium. According to our results, pterygium risk factors fall in 3 categories: demographic, environmental, and lifestyle factors. Older age, male gender, outdoors occupation, and living in rural environments are the leading demographic risk factors for the development of pterygium. Exposure to sunlight is the most common environmental risk factor, and the results of this study provide a more exact and reliable value of the effect of sunlight exposure. The use of sunglasses and cigarette smoking are protective factors, and the significant effect of alcohol consumption is related to lifestyle factors.