Alarm Thresholds for Pertussis Outbreaks in Iran: National Data Analysis

Objectives@#The purpose of the current study was to determine the upper threshold number of cases for which pertussis infection would reach an outbreak level nationally in Iran. @*Methods@#Data on suspected cases of pertussis from the 25th February 2012 to the 23rd March 2018 from the Center for Disease Control and Prevention in Iran was used. The national upper threshold level was estimated using the exponentially weighted moving average (EWMA) method and the Poisson regression method. @*Results@#In total, 2,577 (33.6%) and 1,714 (22.3%) cases were reported in the Spring and Summer respectively. There were 1,417 (18.5%) and 1,971 (25.6%) cases reported in the Autumn and Winter, respectively. The overall upper threshold using the EWMA and the Poisson regression methods, was estimated as a daily occurrence of 8 (7.55) and 7.50 (4.48-11.06) suspected cases per 10,000,000 people, respectively. The daily seasonal thresholds estimated by the EWMA and the Poisson regression methods were 10, 7, 6, 8 cases and 10, 7, 7, 9 cases for the Spring, Summer, Autumn, and Winter, respectively. @*Conclusion@#The overall and seasonal estimated thresholds by the 2 methods were similar. Therefore, the estimated thresholds of 6-10 cases in a day, per 10,000,000 people could be used to detect pertussis outbreaks and epidemics by health policymakers.

Impact of simulated cigarette excise tax increase on its consumption in Iran / 한국역학회지

OBJECTIVES@#To assess the impact of a simulated tax-induced cigarette price increase on its consumption by different expenditure clusters in Iran. @*METHODS@#Employing consecutive cross sections for cigarette consumption, a two-part model was applied for different expenditure groups. @*RESULTS@#A 75% price increase in cigarettes noticeably— as is common in some countries with strong tobacco control policies—reduces current consumption in all five social classes, causing nearly 8% of current male smokers to quit or not to start. @*CONCLUSIONS@#Findings of the current study suggest that Iranian policy makers go through to implement tobacco taxation policies to control smoking prevalence, which in turn might lead to a reduction in national healthcare expenditures as well as enhance the global community’s capacity to meet Sustainable Development Goals.

Impact of simulated cigarette excise tax increase on its consumption in Iran / 한국역학회지

OBJECTIVES@#To assess the impact of a simulated tax-induced cigarette price increase on its consumption by different expenditure clusters in Iran. @*METHODS@#Employing consecutive cross sections for cigarette consumption, a two-part model was applied for different expenditure groups. @*RESULTS@#A 75% price increase in cigarettes noticeably— as is common in some countries with strong tobacco control policies—reduces current consumption in all five social classes, causing nearly 8% of current male smokers to quit or not to start. @*CONCLUSIONS@#Findings of the current study suggest that Iranian policy makers go through to implement tobacco taxation policies to control smoking prevalence, which in turn might lead to a reduction in national healthcare expenditures as well as enhance the global community’s capacity to meet Sustainable Development Goals.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES: The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. METHODS: This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. RESULTS: The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. CONCLUSIONS: A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES@#The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions.@*METHODS@#This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework.@*RESULTS@#The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage.@*CONCLUSIONS@#A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

Risk factors of fatal occupational accidents in Iran

BACKGROUND: Occupational accidents are of most important consequences of globalization in developing countries. Therefore, investigating the causes of occupational accidents for improving the job situation and making operational policy is necessary. So the aim of this study was to investigate factors affecting the fatal occupational accidents and also calculate the years of life lost for dead workers. METHODS: This cross-sectional study was conducted on data related to the 6052 injured workers that was registered in the 2013 registry system of the Ministry of Health and Medical Education of Iran. Variables including sex, education, age, job tenure, injury cause, referred location of injured workers, occupation, shift work, season, accident day, damaged part of the body were chosen as independent variables. The Chi-squared and Fisher exact tests were used for univariate analysis and then exact multiple logistic regression was carried out to identify independent risk factors of fatal occupational accidents. Finally, for dead workers, years of life lost, according to the injury causes was calculated. RESULTS: Among the 6052 accidents reported, 33 deaths were recorded. Chi-square and Fisher exact tests showed that factors including: current job tenure (p = 0.01), damaged parts of the body (p < 0.001) and injury cause (p < 0.001) are associated with the fatal accidents. Also exact multiple logistic regression analysis showed a significant association between electric shocks as a cause of injury (OR = 7.04; 95% CI: 1.01–43.74; p = 0.02) and current job tenure more than 1 year (OR = 0.21; 95% CI: 0.05–0.70; p = 0.005) with the fatal accidents. The total amount of years of life lost based on causes of injuries was estimated 1289.12 years. CONCLUSIONS: In Iran, fatal accident odds in workers with job tenure more than 1 year was less in comparing to the workers with job tenure less and equal to 1 year. Also odd of death for electrical shock was more than other causes of injuries. So it seems that employing of workers who have more than one-year work experience in a specific job and using of appropriate safeguards will be useful for the reducing of fatal occupational accidents.

Macular Thickness in Moderate to Severe Amblyopia

PURPOSE: To compare the macular retinal thickness of moderately to severely amblyopic eyes with non-amblyopic eyes as controls. METHODS: This case control study was conducted on 56 children aged 4 to 10 years old (64.3% female subjects). Twenty-eight children had unilateral amblyopia (28 amblyopic eyes as cases and 28 normal fellow eyes as internal controls) and 28 children had normal visual acuity in both eyes and were considered as external controls (n = 56 eyes). Among our cases, 14 had strabismic amblyopia and 14 had anisometropic amblyopia. Macular retinal thickness was measured using optical coherence tomography at the center and in 1-, 3-, and 6-mm rings. RESULTS: Best-corrected visual acuity of the amblyopic eyes was less than that of the internal and external controls, and the best-corrected visual acuity of their fellow eyes was also less than that of the external controls. Thickness of the central macula and a 1-mm ring area in the amblyopic eyes was higher than that of both internal and external controls. Difference of central macular thickness ≥20 µm between two eyes of the amblyopic children was significantly more than non-amblyopic subjects. CONCLUSIONS: Based on the results of this study, the macular retinal thickness was significantly higher in moderate to severe amblyopic eyes compared to their fellow eyes and external controls. This might be due to macular developmental disorders in amblyopic eyes. Therefore, optical coherence tomography imaging is recommended if subtle macular abnormalities are suspected in moderate to severe amblyopic eyes.

Depression, Anxiety, and Perceived Social Support among Adults with Beta-Thalassemia Major: Cross-Sectional Study / 가정의학회지

BACKGROUND: Considering the high prevalence of depression and anxiety among thalassemia patients and the role of social support in preventing mental disorders, this study aimed to determine prevalence of depression, anxiety, and perceived social support (PSS) among adults with beta-thalassemia major. METHODS: This cross-sectional study was performed with 389 adults with beta-thalassemia major. Data were collected via a questionnaire consisting of three parts: demographic and medical information, the Persian version of the hospital anxiety and depression scale, and the Persian version of the Multidimensional Scale of Perceived Social Support. Data were analyzed using IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA) through analytical statistics (independent-samples t-test, one-way analysis of variance, Pearson correlation coefficient, and multilevel linear regression), and the results less than 0.05 were considered to be significant. RESULTS: The mean scores of depression, anxiety, and PSS of patients were 7.42±3.17, 7.47±4.35, and 41.8±8.64, respectively. Of 389 patients, 19.8% had depression and 23.7% had an anxiety disorder. Relationships of depression and anxiety with age, the level of education, job, and family income were statistically significant, as were those of PSS with age, thalassemia center, family income, job, and the level of education. PSS from family, friends, and significant others were the significant predictive factors of depression and anxiety among adult patients with beta-thalassemia major. CONCLUSION: Considering the PSS as a factor influencing the reduction in depression and anxiety in thalassemia patients, social support from the social networks (spouse, family members, friends, and healthcare workers) should be integrated with interventions that are designed to improve the mental and physical health of thalassemia patients.

Sperm retrieval in patients with klinefelter syndrome: a skewed regression model analysis

Background: The most common chromosomal abnormality due to non-obstructive azoospermia [NOA] is Klinefelter syndrome [KS] which occurs in 1-1.72 out of 500-1000 male infants. The probability of retrieving sperm as the outcome could be asymmetrically different between patients with and without KS, therefore logistic regression analysis is not a well-qualified test for this type of data. This study has been designed to evaluate skewed regression model analysis for data collected from microsurgical testicular sperm extraction [micro-TESE] among azoospermic patients with and without non-mosaic KS syndrome

Materials and Methods: This cohort study compared the micro-TESE outcome between 134 men with classic KS and 537 men with NOA and normal karyotype who were referred to Royan Institute between 2009 and 2011. In addition to our main outcome, which was sperm retrieval, we also used logistic and skewed regression analyses to compare the following demographic and hormonal factors: age, level of follicle stimulating hormone [FSH], luteinizing hormone [LH], and testosterone between the two groups

Results: A comparison of the micro-TESE between the KS and control groups showed a success rate of 28.4% [38/134] for the KS group and 22.2% [119/537] for the control group. In the KS group, a significantly difference [P<0.001] existed between testosterone levels for the successful sperm retrieval group [3.4 +/- 0.48 mg/mL] compared to the unsuccessful sperm retrieval group [2.33 +/- 0.23 mg/mL]. The index for quasi Akaike information criterion [QAIC] had a goodness of fit of 74 for the skewed model which was lower than logistic regression [QAIC=85]

Conclusion: According to the results, skewed regression is more efficient in estimating sperm retrieval success when the data from patients with KS are analyzed. This finding should be investigated by conducting additional studies with different data structures

Altered miR-223 expression in sputum for diagnosis of non-small cell lung cancer

Background: Diagnosis of Non-small Cell Lung Cancer [NSCLC] at an early stage is a daunting challenge due to the deficiency of specific noninvasive markers. MicroRNAs [miRNAs] play important roles in the initiation and progression of NSCLC. Measuring miRNA expression levels could provide a potential approach for the diagnosis of NSCLC. Our goals were to examine miR-223, miR-212, miR-192, miR-3074, SNORD33 and SNORD37 expression levels in tissue and sputum of NSCLC patients and cancer free subjects for molecular diagnosis of NSCLC

Methods: Relative expressions of miR-223, miR-212, miR-192, miR-3074, SNORD33 and SNORD37 were examined with quantitative real-time RT-PCR assay in tissue and sputum obtained from 17 NSCLC patients and 17 controls

Results: miR-3074 was upregulated in tissue samples of NSCLC patients compared with control group. miR-223 was upregulated, miR-212 and SNORD37 were downergulated in sputum samples of patients compared with controls. miR-223 quantification produced 82% sensitivity and 95% specificity with areas under the ROC curve at 0.90 in detection of NSCLC

Conclusion: miR-223 clearly discriminated cancer patients from cancer-free subjects and our results suggest that miR-223 could be a diagnostic useful biomarker. The measurement of altered miRNA expression in sputum samples manifested the potential noninvasive approach for detection of lung cancer

Analgesic Effect of Topical Sodium Diclofenac before Retinal Photocoagulation for Diabetic Retinopathy: A Randomized Double-masked Placebo-controlled Intraindividual Crossover Clinical Trial

PURPOSE: To evaluate the analgesic effect of topical sodium diclofenac 0.1% before retinal laser photocoagulation for diabetic retinopathy. METHODS: Diabetic patients who were candidates for peripheral laser photocoagulation were included in a randomized, placebo-controlled, intraindividual, two-period, and crossover clinical trial. At the first session and based on randomization, one eye received topical sodium diclofenac 0.1% and the other eye received an artificial tear drop (as placebo) three times before laser treatment. At the second session, eyes were given the alternate drug. Patients scored their pain using visual analogue scale (max, 10 cm) at both sessions. Patients and the surgeon were blinded to the drops given. Difference of pain level was the main outcome measure. RESULTS: A total of 200 eyes of 100 patients were enrolled. Both treatments were matched regarding the applied laser. Pain sensation based on visual analogue scale was 5.6 ± 3.0 in the treated group and 5.5 ± 3.0 in the control group. The calculated treatment effect was 0.15 (95% confidence interval, −0.27 to 0.58; p = 0.486). The estimated period effect was 0.24 (p = 0.530) and the carryover effect was not significant (p = 0.283). CONCLUSIONS: Pretreatment with topical sodium diclofenac 0.1% does not have any analgesic effect during peripheral retinal laser photocoagulation in diabetic patients.

Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy

PURPOSE: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.

Associations between a health-promoting lifestyle and quality of life among adults with beta-thalassemia major / 한국역학회지

OBJECTIVES: A health-promoting lifestyle (HPL) is a factor that affects the quality of life (QoL) in patients with beta-thalassemia (β-thalassemia). Due to the lack of studies of this issue, this study aimed to determine the association between HPL and QoL among adults with β-thalassemia. METHODS: This cross-sectional (descriptive-analytic) study was conducted among 389 adult patients with β-thalassemia in Tehran, Iran. The research instrument included a questionnaire consisting of three parts: demographic items, the Short-Form Health Survey and the Health-Promoting Lifestyle Profile. The data were analyzed using SPSS version 23.0. The results were considered significant at the conventional p<0.05 level. RESULTS: The mean age of the participants was 30.2±8.3 years. The mean score of the HPL dimensions was 127.28±21.53, and the mean score of the QoL domains was 61.44±23.38. The highest and the lowest mean scores of the HPL dimensions were found for spiritual growth (23.96±5.74) and physical activity (11.32±3.95), respectively. The QoL scores in all three domains (total, physical component summary score, and mental component summary score) were moderate. Health responsibility, physical activity, spiritual growth, and interpersonal relations were significant predictive factors of QoL in adults with β-thalassemia; these four dimensions explained 37.9% of the variance in QoL. CONCLUSIONS: QoL and HPL were not at acceptable levels among patients with thalassemia. Therefore, educational interventions emphasizing spiritual growth, physical activity, and interpersonal relations are necessary for patients with thalassemia.

Economic burden of thalassemia major in Iran, 2015

Background: Major Thalassemia is an autosomal recessive disease with complications, mortality and serious pathology. Today, the life expectancy of patients with major thalassemia has increased along with therapeutic advances. Therefore, they need lifelong care, and caring for them would incur many costs. Being aware of the patients' costs can be effective for controlling and managing the costs and providing efficient treatments for the care of patients. Hence, this study was conducted to estimate the economic burden of the patients with major thalassemia

Methods: Totally, 198 patients with major thalassemia were randomly selected from among the patients with major thalassemia in Tehran, Iran in 2015. The economic burden of the patients was estimated from a social perspective and through a bottom-up, prevalence-based approach

Results: The average annual cost per patient was estimated $ 8321.8 regardless of the cost of lost welfare. Of this amount, $ 7286.8 was related to direct medical costs, $ 461.4 to direct non-medical costs, and $ 573.5 to indirect costs. In addition, the annual cost per patient was estimated $ 1360.5 due to the distress caused by the disease

Conclusions: Considering the high costs of the treatment of patients with major thalassemia, adopting new policies to reduce the costs that patients have to pay seems necessary. In addition, making new decisions regarding thalassemia screening, even with higher costs than the usual screening costs, can be useful since the costs of treatment are high

Vision therapy/orthoptics among three to seven year old children

Vision Therapy/Orthoptics [VT/O] is a package of treatments that enables patients to achieve the maximum level of visual performance. The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity [BCVA], fusion, stereopsis and ocular alignment in 3-7 year old children. In this randomized clinical trial study, 80 children with amblyopia and/or nonparalytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent [BCVA >/= 20/30, deviation /= 20/30, deviation 10pd and no stereopsis]. A total of 80 cases [56 girls and 24 boys] with the mean age of 5.6 +/- 1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group [P<0.001 for both groups], there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group [P<0.001, for both groups]. Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted

New scoring system for intra-abdominal injury diagnosis after blunt trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma.</p><p><b>METHODS</b>This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor.</p><p><b>RESULTS</b>Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%).</p><p><b>CONCLUSION</b>The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.</p>

Adherence and attrition in a web-based lifestyle intervention for people with metabolic syndrome

The aim of this study was to determine adherence and attrition rates in a lifestyle intervention for people with metabolic syndrome. Adherence and attrition data from a randomized controlled trial were collected. Participants were classified as adherence group if they completed assessments at 3 and 6 months follow-up and as attrition group if they did not. Physical activity and quality of life was measured using the International Physical Activity Questionnaire [IPAQ] and the Short Form Health Survey [SF-36]. Generalized Estimating Equations [GEE] was used to explore predictors of attrition. The mean age of participants [n=160] was 44.1 years. Attrition rate in the intervention and control groups at first follow-up were the same [20%]. However, the control group had significantly higher attrition rate [%33.7] compared to the intervention group [%20] at 6 months follow up. Results showed that low educated participants were more likely to not stay in the study than better educated participants [OR=2.95,CI:1.39-6.33,P=0.05]. According with length of the study, attrition was decreased at six month [OR=0.66,CI:0.52-0.83,P<0.001]. Also, some aspects of health-related quality of life contributed to the attrition rate. Those who had higher scores on general health [OR=0.66,CI:0.54-0.97,P=0.023], social functioning [OR=0.44,CI:0.40-0.76,P=0.032], role emotional [OR=0.74,CI:0.54-0.98,P=0.18], vitality [OR=0.55,CI:0.38-0.90,P=0.015] and mental health [OR=0.63,CI:0.45-0.85,P=0.033] were more likely to stay in the study. It remains a concern that Web-based lifestyle programs may fail to reach those who need it most. Participant in the study generally had better quality of life than those who were lost to follow up

Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: a clinic-based study

To determine the prevalence of second-eye senile cataract surgery [SECS] as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years [2006-2009] was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected [1, 585 out of 10, 517 records]. First- and second-eye operations were performed in 1, 139 [71.9%; 95% confidence interval [CI], 69.5-74.1] and 446 eyes [28.1%; 95% CI, 25.9-30.35], respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 [P- 0.017]. The median [interquartile range] interval between the two operations was 9 [4-24] months, which remained stable during the study period. The SECS rate was 10.4% higher [P - 0.0l] and the time interval was 13 months shorter [P- 0.007] in patients who underwent phacoemulsification than extracapsular cataract extraction. The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time

Vision related quality of life in myopia; photorefractive keratectomy versus nonsurgical optical correction

To compare quality of life [QOL] in myopic patients who underwent photorefractive keratectomy [PRK] with that of myopic spectacle or contact lens users. This observational comparative study was performed on 102 low to moderate myopic patients who had undergone PRK at least 6 months ago and 106 myopic spectacle or contact lens wearers. Vision related QOL and its correlation with demographic variables, visual acuity and refractive status were compared between the two groups. QOL was measured using a validated translated version of the Visual Function Questionnaire [VFQ-25] which contains 25 questions in 12 subscales with a total score of zero to 100. Mean total QOL score was 97.0 +/- 4.4 and 86.1 +/- 10.7 in PRK and nonsurgical groups respectively [mean difference [d]=11, P<0.001]. The difference was independent of age, sex, education or marital status [P>0.05]. Overall, 10 out of 12 QOL subscales were significantly higher in the PRK group [P<0.001] especially general vision [d=23.8], general health [d=22.2], driving [d=19.3], role difficulties [d=14.6], distance activities [d=13.8] and mental health [d=13.7]. Only color vision [d=1.6, P>0.9] and ocular pain [d=3.1, P=0.3] were not significantly different between the study groups. Correction of myopia using PRK is associated with higher QOL scores in most subscales as compared to spectacle or contact lens wear.

Is noncycloplegic photorefraction applicable for screening refractive amblyopia risk factors?

Purpose: To compare the accuracy of noncycloplegic photorefraction [NCP] with that of cycloplegic refraction [CR] for detecting refractive amblyopia risk factors [RARFs] and to determine cutoff points

Methods: In this diagnostic test study, right eyes of 185 children [aged 1 to 14 years] first underwent NCP using the Plusopti Chi SO4 photoscreener followed by CR. Based on CR results, hyperopia [>/=+3.5 D], myopia [>/=-3 D], astigmatism [>/=1.5 D], and anisometropia [>/=1.5 D] were set as diagnostic criteria based on AAPOS guidelines. The difference in the detection of RARFs by the two methods was the main outcome measure

Results: RARFs were present in 57 [30.8%] and 52 [28.1%] of cases by CR and NCP, respectively, with an 89.7% agreement. In contrast to myopia and astigmatism, mean spherical power in hyperopic eyes was significantly different based on the two methods [P<0.001], being higher with CR [+5.96 +/- 2.13 D] as compared to NCP [+2.37 +/- 1.36 D]. Considering CR as the gold standard, specificities for NCP exceeded 93% and sensitivities were also acceptable [>/=83%] for myopia and astigmatism. Nevertheless, sensitivity of NCP for detecting hyperopia was only 45.4%. Using a cutoff point of+1.87 D, instead of+3.5 D, for hyperopia, sensitivity of NCP was increased to 81.8% with specificity of 84%

Conclusion: NCP is a relatively accurate method for detecting RARFs in myopia and astigmatism. Using an alternative cutoff point in this study, NCP may be considered an acceptable device for detecting hyperopia as well