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Significance: Epidemiological information about the epiretinal membrane is important for better clinical management and understanding of the nature and burden of this disease. There are some gaps in our understanding of the epidemiology of epiretinal membranes, particularly in Africa and the Middle East., Purpose: This study aimed to determine the prevalence and risk factors of epiretinal membrane using spectral-domain optical coherence tomography (OCT) in an Iranian elderly population., Methods: This report is a part of a population-based study conducted on the elderly population 60 years and older from Tehran, the capital of Iran, using multistage stratified random cluster sampling. Study participants underwent measurement of visual acuity, autorefraction, subjective refraction, and slit-lamp biomicroscopy. The epiretinal membranes were diagnosed by a retinal specialist from OCT images (Spectralis OCT)., Results: A total of 1298 individuals were analyzed for this report. Of these, 58.9% were female, and the mean age of the participants was 67.4 ± 6.4 years. The prevalence rates of all epiretinal membranes, primary epiretinal membrane, and secondary epiretinal membrane were 6.0% (95% confidence interval [CI], 4.6 to 7.5%), 4.7% (95% CI, 3.0 to 6.3%), and 10.1% (95% CI, 6.6 to 13.6%), respectively. According to the multiple logistic regression model, the interaction between age and diabetes (odds ratio [OR], 1.09; 95% CI, 1.01 to 1.18, p=0.048) and the presence of posterior vitreous detachment (OR, 2.89; 95% CI, 1.45 to 5.78, p=0.003) were significantly linked to a higher prevalence of primary epiretinal membrane. Additionally, a significant inverse relationship was found between the prevalence of primary epiretinal membrane and the number of years of education (OR, 0.91; 95% CI, 0.85 to 0.97; p=0.002)., Conclusions: The prevalence of primary epiretinal membrane in Tehran, Iran, was found to be lower than that reported in the majority of earlier studies. Posterior vitreous detachment, interaction between age and diabetes, and lower education level were risk factors of primary epiretinal membrane in this study., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2025 American Academy of Optometry.)

To determine the distribution of keratometry and corneal astigmatism (CA) and their association with demographic factors, systemic parameters, anthropometric measures, ocular biometric indices, and refractive errors in people aged 60 years and above. In this cross-sectional study, 160 clusters were randomly selected from Tehran city (Iran) using the multi-stage cluster sampling method. All participants underwent optometric examinations including testing uncorrected and best-corrected distance visual acuity, non-cycloplegic autorefraction, and subjective refraction. Pentacam imaging for all participants was carried out using Pentacam AXL. Keratometry and CA were reported based on Pentacam's data. The average, standard deviation (SD) and 95% confidence interval (CI) of flat keratometry (Kf), steep keratometry (Ks), mean keratometry (mean K), and CA were 44.02 ± 1.58 D (95% CI 43.94-44.1), 44.86 ± 1.67 D (95% CI 44.78-44.94), 44.44 ± 1.58 D (95% CI 44.36-44.52), and 0.84 ± 0.74 D (95% CI 0.81-0.87), respectively. The 95% and 99% percentiles of mean K were 47.1 and 48.6 D, respectively. According to the multiple generalized estimating equation model, the mean K was significantly higher in males, in myopes, and in those with higher systolic blood pressure. Moreover, the mean K was inversely related to the axial length, height, anterior chamber depth (ACD), corneal diameter, and central corneal thickness (CCT). The prevalence of various types of CA based on a cut-off > 0.50 D was as follows; with-the-rule: 32.5% (95% CI 30.6-34.4), against-the-rule: 18.2% (95% CI 16.7-19.7), and oblique: 10.0% (95% CI 9.1-11.0). The present study investigated the normal distribution of keratometry and CA in individuals ≥ 60 years, and results can be used in clinical matters, especially in intraocular lens power calculation. Sex, systolic blood pressure, height, and some biometric components such as ACD, corneal diameter, and CCT were significantly related to keratometry and should be considered., (© 2024. The Author(s).)

Background: Corneal abnormalities are one of the important reasons for visual impairment. There is little evidence of the prevalence of different types of corneal abnormalities. The aim of this study was to assess the prevalence of various corneal abnormalities and identify the key risk factors associated with these abnormalities in an elderly population residing in Tehran., Methods: The Tehran Geriatric Eye Study (TGES) was conducted as a cross-sectional study, utilizing a population-based approach and employing stratified cluster random sampling. The study focused on individuals aged 60 years and above residing in Tehran. An ophthalmologist performed a slit lamp examination to evaluate the eyelid, cornea, and crystalline lens., Results: The prevalence of posterior embryotoxon (PE), punctate epithelial defect (PED), pigment on endothelium (POE), corneal dystrophy (CDys), corneal vascularization (CV), and corneal degeneration (CDeg) were estimated to be 0.08% (95% confidence interval [CI]: 0.02 to 0.40), 8.77% (95% CI: 6.64 to 11.51), 0.57% (95% CI: 0.33 to 0.98), 0.53% (95% CI: 0.33 to 0.82), 0.95% (95% CI: 0.60 to 1.52), and 44.87% (95% CI: 41.80 to 47.98), respectively. Overall, approximately 49.08% of the participants exhibited some form of corneal abnormality in at least one eye. The multiple logistic regression model revealed that increasing age was significantly associated with PED, CV, and CD. Furthermore, illiterate participants had a significantly higher prevalence of PE., Conclusion: The findings of this study indicate that approximately half of the elderly population aged 60 years and above in Tehran have at least one corneal abnormality, with corneal degeneration being the most prevalent. Age was identified as the primary determinant of corneal abnormalities., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Purpose: The aim of this study was to determine the distribution of corneal volume (CV) using Pentacam and its relationship with demographic and ocular factors in an elderly population older than 60 years., Methods: The present report is a part of the Tehran Geriatric Eye Study. The sampling was performed using the multistage stratified random cluster sampling method. The preliminary ocular examinations were performed for all individuals including visual acuity measurement, objective and subjective refraction, and slit-lamp biomicroscopy. Finally, study participants underwent anterior segment imaging and ocular biometry using Pentacam AXL., Results: The mean CV was 57.92 mm 3 [95% confidence interval (CI): 57.76-58.08] in the whole sample. The mean CV was 57.69 mm 3 (95% CI: 57.52-57.87) after excluding diabetic patients. The mean CV was 57.79 mm 3 (95% CI: 57.57-58.01) and 58.04 mm 3 (95% CI: 57.83-58.26) in men and women, respectively. The mean CV was 57.96 mm 3 (95% CI: 57.71-58.21), 57.84 mm 3 (95% CI: 57.49-58.19), and 57.92 mm 3 (95% CI: 57.7-58.13) in individuals with emmetropia, myopia, and hyperopia, respectively. The CV decreased significantly with advancing age. Moreover, the anterior chamber depth, central corneal thickness, mean keratometry, anterior corneal asphericity (Q value), and posterior corneal astigmatism were significantly directly related to CV, whereas axial length and white-to-white distance had a statistically significant inverse association with the CV., Conclusions: Aging is one of the important factors in reducing CV that should be considered. Some other topographic and biometric indices also have a significant relationship with CV., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

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., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

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

Purpose: To determine the prevalence of astigmatism and its associated factors and examine astigmatism symmetry patterns in an elderly population., Study Design: Population based cross-sectional study., Methods: The present population-based cross-sectional study was conducted on an elderly population above 60 years of age in Tehran, Iran in 2019. The sampling was done using the stratified multistage random cluster sampling method. All study participants underwent a complete optometric examination and slit-lamp biomicroscopy., Results: The prevalence of astigmatism higher than -0.50, -1.00, and -2.00 D was 83% (95% CI: 81 -84), 52 % (95% CI: 50 -54), and 19% (95% CI: 17-20), respectively. These prevalence was 79%(95% CI: 77-81), 46(95% CI: 44-49) and 14(95% CI: 13-16) in subjects without a history of ocular surgery, respectively. Based on cylinder power worse than -1.00 D, 10% (95% CI: 9-12), 20% (95% CI: 18-22), and 21% (95% CI:19-23) of study participants had with the rule, against the rule, and oblique astigmatism, respectively. According to the results of the multiple regression model, male gender, older age, low education level, pure posterior subcapsular cataract, pseudophakia, and myopia were independent factors associated with astigmatism. The prevalence of anisorule astigmatism was 57 % (95% CI: 56-59), the most common anisorule astigmatism was against the rule-oblique type with a prevalence of 36% (95% CI: 34-38)., Conclusion: The prevalence of astigmatism was high in the elderly population of Tehran. More than half of the participants in this study had anisorule astigmatism, and against the rule-oblique combination was more prevalent than other types. A posterior subcapsular cataract, a history of cataract surgery, and myopia were the associated factors of astigmatism in this study., (© 2022. Japanese Ophthalmological Society.)

Purpose: To determine the age and sex-standardized prevalence of corneal arcus and its associated factors in a geriatric population., Methods: This population-based cross-sectional study was conducted in 2019 in Tehran; the capital of Iran, using a multi-stage stratified random cluster sampling method. All participants underwent a detailed interview, blood pressure measurement, laboratory blood tests, and a complete ocular examination., Results: Three thousand three hundred ten of 3791 invitees participated in the study (response rate: 87.31%). The mean age of the participants was 69.35 ± 7.62 years (60-97 years) and 1912 (57.76%) were female. Overall, the age and sex-standardized prevalence (95% CI) of corneal arcus was 44.28% (41.21-47.39). Based on the multiple logistic regression, the odds of corneal arcus were higher in men than in women (OR: 1.51; 95% CI: 1.14-2.00); in the age group ≥ 80 years compared to the age group 60-64 years (OR: 2.44; 95% CI: 1.68-3.53), and in retired people compared to employed individuals (OR: 2.05; 95% CI: 1.31-3.21)., Conclusion: The present study showed a high prevalence of corneal arcus in the geriatric population. Although various studies have reported a significant relationship between corneal arcus with blood lipid and glucose levels as well as blood pressure, these relationships were not found in the present study., (© 2022. The Author(s).)

Purpose: The purpose of this study was to evaluate the efficacy and safety of implantation of a new continuous corneal ring in keratoconic corneas of an Iranian population., Methods: This study was conducted on 95 contact lens-intolerant keratoconic eyes with clear central corneas. A continuous corneal ring, annular intrastromal corneal inlay (AICI), was inserted using femtosecond laser in all cases. Patients were followed up for 1, 3, and 12 months postsurgery. Visual and subjective refractive outcomes were evaluated in each examination. Besides, keratometry and aberrometric values were recorded before and 12 months after surgery. Finally, vector analysis of refractive astigmatism was performed using the Alpins method., Results: The uncorrected and corrected distance visual acuities improved significantly 12 months after surgery from 0.91 ± 0.39 to 0.38 ± 0.22 (P < 0 0.001) and 0.33 ± 0.21 to 0.13 ± 0.11 logMAR (P < 0.001), respectively. Moreover, spherical and cylindrical refractive components reduced from -2.52 ± 2.62 to -0.76 ± 1.78 D (P < 0.001) and -4.14 ± 1.64 to -1.91 ± 1.18 D (P < 0.001), respectively. The mean anterior keratometry had a significant reduction 12 months after AICI insertion (P< 0.001). Primary coma and spherical aberration values showed a significant increase (both, P < 0.05). Our results showed 100% safety (safety index: 1.8) and 45% efficacy (efficacy index: 1)., Conclusions: AICI implantation seemed to be a safe and effective procedure for improving visual acuity and refractive outcomes in subjects with keratoconus., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To determine the age-sex-standardized prevalence of uncorrected refractive error and its determinants., Methods: This population-based cross-sectional study was conducted on 3310 people aged≥ 60 years in Tehran, Iran in 2019. Need for spectacles was defined as uncorrected visual acuity worse than 20/40 in better eye that could be corrected to more than 20/40 with suitable spectacles. Met need was defined as proportion of individuals with need for spectacles whose visual acuity was 20/40 or better with current spectacles. Unmet need was defined as proportion of individuals with need for spectacles who needed but did not have spectacles or their visual acuity was worse than 20/40 with current spectacles while suitable spectacles improved their visual acuity to 20/40 or better., Results: The age-sex-standardized prevalence of need for spectacles, met need, and unmet need was 16.67% (95% CI: 15.33-18.09), 7.81% (95% CI: 6.95-8.78), and 8.85% (95% CI: 7.77-10.07), respectively. Myopic subjects had the highest prevalence of need for spectacles (24.06%, 95% CI: 21.47-26.87). The odds ratio of met and unmet need in subjects≥ 80 years versus those aged 60-65 years was 0.36 ( p -value: 0.009) and 2.34 ( p -value: <0.001), respectively. The odds ratio of met and unmet need in subjects with a university education versus illiterate subjects was 1.72 ( p -value: 0.045) and 0.42 ( p -value: 0.007), respectively., Conclusion: The prevalence of uncorrected refractive error was lower in this study compared to previous studies. The met need rate was lower in subjects with older age and lower education levels.

Background: To determine the distribution of the near point of convergence (NPC) and its related factors in an elderly population in Tehran, Iran., Methods: This population-based cross-sectional study was conducted on the elderly population (60 years of age and over) of Tehran, Iran in 2019. The samples were selected using stratified random cluster sampling. The examinations included the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, unilateral and alternate cover test, ocular health examination, and NPC measurement., Results: The mean age of the participants was 65.90 ± 4.56 years and 59.6% of them were females. The mean (95% CI) NPC in the total sample was 7.84 cm (95% CI: 7.65-8.03). The mean (95% CI) NPC in males and females was 7.92 cm (7.63-8.21) and 7.75 cm (7.54-7.97) (P = 0.338), respectively. The mean NPC increased from 7.8 cm (95% CI: 7.55-8.05) in the age group 60-64 years to 8.83 cm (95% CI: 7.47-10.2) in the age group ≥ 80 years (P > 0.05). The mean (95% CI) NPC in emmetropic, myopic, and hyperopic individuals was 7.67 cm (95% CI: 7.33-8.02), 7.96 cm (7.56-8.37), and 7.87 cm (7.63-8.11), respectively (P = 0.378). There was no statistically significant relationship between NPC with education level, smoking, diabetes mellitus (DM), and hypertension (HT)., Conclusions: The NPC values found in this study were significantly lower (less remote) than the values reported in previous studies in similar age groups. The NPC had no significant relationship with age, sex, education level, smoking, DM, and HT., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To determine the age and sex-standardized prevalence and risk factors of anterior blepharitis in a geriatric population in "…"., Methods: This population-based study was conducted on the elderly population (over 60 years of age) of Tehran, the capital of "…" in 2019. Examinations included visual acuity assessment, refraction, and complete slit lamp examination. After the diagnosis of anterior blepharitis, its type (staphylococcal vs. seborrheic) was also determined. Multiple logistic regression was used to determine the risk factors of the disease., Results: 3310 individuals participated in this study. The data of 3284 participants were available for this report. The mean age of the participants was 68.6 ± 24.5 years, and (57.8 %) were female. Age and sex-standardized prevalence of anterior blepharitis was 33.5 % (95 % CI: 30.6-36.5%) of which 96.5 % were bilateral. The prevalence of seborrheic and staphylococcal types was 22.4 % (95 % CI: 19.9-25.2%) and 11.3 % (95 % CI: 9.2-13.5%), respectively. According to the multiple logistic regression, the prevalence of anterior blepharitis was positively related to age over 80 years (P < 0.001) and male gender (P < 0.001), and inversely related to education level (P = 0.033). No significant relationship was found between anterior blepharitis and other variables including systemic hypertension, diabetes mellitus, hyperlipidemia, smoking, socioeconomic status, and history of the previous eye examination. Sex had the greatest effect on developing anterior blepharitis (standardized coefficient: 0.325)., Conclusion: The results of this study showed a relatively high prevalence of anterior blepharitis in the elderly population which requires special attention of the health system to inform and control this disease through continuous training of the media and regional health centers., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: This study was conducted to determine economic inequality in Eye Care Services Utilization (ECSU) and its determinants in the underserved rural population of Iran., Methods: In this population-based study, two underserved regions in the north and southwest of Iran were randomly selected and 3850 individuals living in these regions were invited to participate in the study. ESCU was defined as a history of at least one optometric or ophthalmologic visit during the lifetime. Concentration index (C) was used to evaluate economic inequality and the Oaxaca- Blinder decomposition was applied to decompose the gap between the rich and poor., Results: Of 3851 individuals, 3314 participated in the study (response rate: 86%). The data of 3094 participants were analyzed. The concentration index was 0.139 (95% CI: 0.218 - 0.590), indicating a pro-rich inequality in the ECSU. The ECSU was 12.38% (10.46 to 14.31) in the poor and 21.15% (18.38 to 23.92) in the rich, and the gap between them was about 90% in favor of the rich ( p < 00.001). A marked percentage of the gap was due to the explained portion (b: -11.49; p < .001). The unexplained portion coefficient was b: 2.72 (p: 0.020). In the explained portion, economic status (b: -12.37; p < .001) and age (b: 0.90; p: 0.021) caused inequality in favor of the rich and poor respectively while only economic status (b:-21.1; p < .001) had a significant effect on inequality in favor of the rich in the unexplained portion., Conclusion: There is a significant pro-rich inequality in ECSU in the rural areas of Iran. A major portion of this inequality is related to differences in age and economic status between the two groups. Economic status has direct and indirect effects on inequality in ECSU; therefore, health policymakers should focus on economic improvement to remove the gap.

Purpose: To determine the distribution of the corneal asphericity coefficient (Q value) and related factors in an Iranian geriatric population., Methods: This population-based study was conducted in 2019 in Tehran, using stratified multistage random cluster sampling. The study population was ≥60 years of age. Participants underwent corneal imaging using a Pentacam HR. Mean keratometry, corneal astigmatism, central corneal thickness, anterior chamber depth and the overall anterior and posterior Q values (for 8 mm chord diameter) were recorded. Axial length measurements were performed using the IOL Master 500., Results: 2457 eyes of 2457 individuals were analysed. The mean age was 67.3 ± 5.82 years and 1479 (60.2%) were female. The mean Q value for the anterior corneal surface was -0.35 ± 0.17 (95% CI: -0.35 to -0.34). The anterior Q value showed a statistically significant inverse relationship with axial length and mean keratometry, and a significant direct association with anterior chamber depth and corneal astigmatism. The mean posterior Q value was -0.41 ± 0.15 (95% CI: -0.42 to -0.40). The posterior Q value had a significant direct relationship with age, anterior chamber depth, mean keratometry and corneal astigmatism., Conclusion: The corneal Q values in this geriatric Iranian population were more negative than the values reported in most previous studies. Corneal asphericity was greater affected by ocular biometry and corneal curvature than demographic factors and refractive status., (© 2021 The Authors Ophthalmic and Physiological Optics © 2021 The College of Optometrists.)

Purpose: To determine the prevalence of Meibomian gland dysfunction (MGD) and its risk factors in an elderly Iranian population METHODS: This cross-sectional study was conducted in 2019. The target population was the subjects aged 60 and over living in Tehran. Multistage cluster sampling was done to select the subjects from all Tehran districts. After an initial interview, all subjects underwent complete ophthalmic examinations including the measurement of visual acuity and refraction as well as slit lamp biomicroscopy to evaluate Meibomian glands., Results: Of 3791 selected subjects, 3310 participated in the study. The data of 3284 participants were analyzed. The mean age of the subjects was 68.24 ± 6.53 years (range: 60-97 years) and 57.8% of them were female. The total prevalence of MGD was 71.2% (68.3-74.1), and 38.1% (8.35-40.4), 30.3% (27.4-33.2), and 2.8% (2-3.6) of the subjects had MGD stage 2, 3, and 4, respectively. The prevalence of MGD was significantly higher in men (p < 0.001) and increased with age from 64.4% in the age group 60-64 years to 82.4% in subjects aged 80 years and over. There was no significant difference in the prevalence of MGD between smokers and nonsmokers; however, severe MGD was more common in smokers. The prevalence of MGD was 76.3% and 68.52% in subjects with and without a history of ocular surgery, respectively. The prevalence of MGD stage 3 and 4 was higher in subjects with a history of ocular surgery., Conclusions: In line with the results of other studies in Asian countries, this study found a high prevalence of MGD in an elderly population of Iran. It was found that male gender and advanced age were risk factors of MGD and smoking and history of ocular surgery might worsen this disease in MGD patients.

Significance: The present study is the first population-based study to examine the prevalence of convergence insufficiency and its associations specifically in the geriatric population. Knowledge of the population-based determination of prevalence of this disorder in the elderly is necessary to support proper clinical diagnosis and management., Purpose: This study aimed to determine the prevalence of convergence insufficiency and its associated factors in a geriatric population., Methods: In this study, all residents older than 60 years in Tehran city were selected through random stratified cluster sampling. All participants underwent a complete ocular examination including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, binocular vision assessments including unilateral and alternating cover tests, measurement of the near point of convergence, the positive fusional vergence, and finally ocular health examination., Results: In this population-based sample of 1793 participants, the overall prevalences of two-sign and three-sign convergence insufficiency were 29.6% (95% confidence interval, 27.2 to 32.0%) and 21.5% (95% confidence interval, 19.5 to 23.6%), respectively. There were no statistically significant differences in the prevalence of both two-sign (P = .19) and three-sign (P = .41) convergence insufficiency between men and women. The highest and lowest prevalences of two-sign and three-sign convergence insufficiency were in the age groups 70 to 74 and 75 to 79 years, respectively. The prevalence showed no significant trend with age (P = .26 for two-sign convergence insufficiency, P = .33 for three-sign convergence insufficiency). In the multiple logistic regression model, none of the variables, including age, sex, and refractive errors, showed a significant relationship with convergence insufficiency (all, P > .05)., Conclusions: The results of the present study showed a high prevalence of convergence insufficiency in the geriatric population. Clinicians should give special attention to this binocular vision disorder in this age group., Competing Interests: Conflict of Interest Disclosure: No conflicting relationship exists for any author., (Copyright © 2021 American Academy of Optometry.)

Background: To assess the epicanthal fold (EF), eyelid, eyebrow, scar, and patients' satisfaction after anchor epicanthoplasty and upper blepharoplasty and histopathologically compare Asian epicanthal fold skin with non-Asian counterpart., Methods: Asian Iranians with grade 2 and 3 EF were included. Photographs were taken before and at least 12 months after the surgery. Photoanalysis included EF grade, inter-canthal distance (ICD), margin reflex distance 1 (MRD1), tarsal plate show (TPS), brow fat span (BFS), and eyebrow height. Manchester scar scale score (5-28) and patients' satisfaction score (0-100) were documented. The most medial skin of 5 Asian and 5 non-Asian subjects was histologically compared for the thickness and elastic fiber density and morphology., Results: Included were 89 patients (178 eyelids) with a mean age of 31.6 years and follow-up of 13.1 months. Mean ICD significantly decreased by 3.5 mm (shortening ratio of 9.7%). All grade 2 and almost half of the grade 3 EF disappeared. Significant postoperative increase in mean MRD1 (0.3 mm) and TPS (1.1-1.4 mm) and decrease in BFS (3.3-3.6 mm) and eyebrow height (1.7-3.4 mm) were observed. Revision rate of epicanthoplasty was 7.3%. Mean satisfaction and scar scores were 97.1 and 5.4, respectively. Histopathologically, Asian and non-Asian medial upper eyelid skin was not significantly different., Conclusion: Anchor epicanthoplasty eliminated grade 2 and improved grade 3 EF with a high satisfaction and negligible scar. Simultaneous upper blepharoplasty significantly increased MRD1 and TPS and decreased eyebrow height. EF skin was not histologically different from non-Asians., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose : The aim of this study is to determine the prevalence of tropia, phoria, and their types in Islamic Azad University students in Shahrekord, Iran. Methods : Of 826 students that were invited, 752 participated in this cross-sectional study (response rate = 91.04%). After applying exclusion criteria, statistical analyses were performed on the data of 726 individuals. All participants underwent optometric tests including measurement of visual acuity, objective and subjective refraction, as well as binocular vision and ocular health examinations. The unilateral and alternate cover tests were done to detect the tropia and phoria at 6 m and 40 cm, respectively. Results : The overall prevalence and 95% confidence interval (CI) of tropia, exotropia, and esotropia were 1.5% (0.8 to 2.7), 1.2% (0.6 to 2.4), and 0.3% (0.1 to 1.1), respectively. The prevalence of esotropia was significantly higher in older age groups (24 years old) ( p = .040) . The prevalence of exotropia was significantly higher in females (0.039) and in myopic individuals ( p = .001). The overall prevalence and 95% CI of phoria, exophoria, and esophoria were 12.9% (10.7 to 15.6), 11.7% (9.6 to 14.3), and 1.2% (0.6 to 2.3), respectively. There was a significant difference in the overall prevalence of exophoria according to the age (0.021). The prevalence of esophoria was significantly higher in females ( p = .039). The prevalence of exophoria was significantly higher in myopic participants ( p = .003). Exophoria and exotropia were the most common types of phoria and tropia, respectively. Conclusion : The prevalence of strabismus in university students was similar to the Iranian general population but lower than other countries. One in every 10 students had phoria, which was much lower than similar reports on Iranian populations; however, due to near-work activity, these students are prone to asthenopia, early visual fatigue, and decreased productivity. Therefore, it is suggested that university students also undergo screening programs to detect the cases of tropia and phoria.

Objective: This study was conducted to evaluate the level of agreement in keratometry measurements between a rotating Scheimpflug imaging-based system (Pentacam) and a handheld auto-refractokeratometer (handheld NIDEK ARK-30)., Method: This analytical cross-sectional study was conducted in the right eyes of 579 subjects. Keratometry measurements were conducted with the Pentacam and the handheld NIDEK ARK-30 systems. The SPSS Software version 22 and MedCalc V3 were applied to estimate descriptive statistics using paired t-test, Pearson correlation coefficient, 95% limits of agreement (LoA), and Bland-Altman plot., Results: In the total sample, the inter-device difference in the mean flat and steep keratometry values was -0.266 diopter (D) (P-value<0.001) and 0.052D (P-value=0.093), respectively. There was a significant difference in mean flat keratometry between the two devices in all groups of refractive errors (paired difference <0.5D and P-value<0.001). The difference in mean steep keratometry was significant only in myopic subjects (P-value=0.046). The 95% LoA between the two devices measurements was 2.51D, 3.98D, and 6.37D for flat keratometry and 2.6D, 3.2D, and 3.9D for steep keratometry in emmetropic, myopic, and hyperopic subjects, respectively., Conclusion: Our study showed relatively wide limits of agreement between handheld NIDEK ARK-30 and Pentacam; therefore, these devices cannot be used interchangeably for measuring corneal curvature., (Copyright © 2019 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To determine the distribution of anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) values in a rural population over 5 years of age using the Pentacam., Methods: In this cross-sectional study, samples were selected from over 1-year-old inhabitants of two villages in Iran using a multistage cluster sampling approach. All participants underwent the measurement of uncorrected and corrected visual acuity and auto-refraction, retinoscopy, subjective refraction, and slit lamp examination. Finally, corneal imaging was done for all subjects over 5 years of age using the Pentacam., Results: Of 3851 selected individuals, 3314 participated in the study, of whom 2681 met the inclusion criteria. The mean age of the sample was 36.03 ± 18.5 years (range 6-90 years). The mean ACD, ACA, and ACV values were 3.37 mm (95% CI: 3.37-3.39), 34.82° (95% CI: 34.45-35.2), and 159.17 µL (95% CI: 156-161.36), respectively. The results of multiple linear regression models showed that ACD, ACA, and ACV values reduced with age, and ACD and ACV values were significantly higher in males. ACA and ACV values correlated inversely with central corneal thickness, while the ACA value correlated directly with keratometry and inversely with the ACV value., Conclusion: This study is one of the few studies in the world showing changes in ACD values in different age groups using the Pentacam. According to the results, aging was associated with a decline in the mean ACD, ACA, and ACV values. These parameters were the largest in patients with emmetropia and smallest in hyperopic subjects.

Purpose: To determine the prevalence of accommodative insufficiency (AI) and its relation with age, gender, and refractive errors in a college-age student population in Iran., Methods: The present study was conducted cross-sectionally in 2017. All students had optometric tests including measurement of visual acuity, objective and subjective refraction, as well as binocular vision and accommodative examinations. Amplitude of accommodation was measured with the Donders' push-up method using the Royal Air Force (RAF) rule. Monocular accommodative facility was measured with ±2.00diopter flipper lenses. The accommodative response was tested using dynamic retinoscopy with the monocular estimation method (MEM)., Results: The prevalence of AI in the studied population was 4.07% (95% CI: 2.61-5.52). The rate was 6.04% (95% CI: 3.58-8.50) in females and 2.01% (95% CI: 0.53-3.48) in males, and logistic regression showed a significantly higher odds of AI in females (OR=3.14, 95% CI: 1.33-7.45, p-value=0.009). The prevalence of AI was 2.59% (95% CI: 0.55-7.56) in the 18-19-year-old age group and 4.08% (95% CI: 0.09-8.07) in the 24-25-year-old group (p-value=0.848). The prevalence of AI among emmetropic, myopic, and hyperopic individuals was 3.74% (95% CI: 1.88-5.61), 4.44% (95% CI: 2.07-6.81), and 5.26% (95% CI: 4.79-16.32), respectively (p-value=0.869). In the multiple regression model, only gender showed significant relationship with AI (Odds ratio=3.14, 95% CI: 1.33-7.45; p-values=0.009)., Conclusion: The prevalence of AI in the present study is lower than the most prevalence rates reported in previous studies. In the present study, gender and AI showed a strong association, such that AI prevalence was significantly higher in females than males., (Copyright © 2018 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate the relationship patterns between astigmatism axes of fellow eyes (rule similarity and symmetry) and to determine the prevalence of each pattern in the studied population., Methods: This population-based study was conducted in 2015 in Iran. All participants had tests for visual acuity, objective refraction, subjective refraction (if cooperative), and assessment of eye health at the slit-lamp. Axis symmetry was based on two different patterns: direct (equal axes) and mirror (mirror image symmetry) or enantiomorphism. Bilateral astigmatism was classified as isorule if fellow eyes had the same orientation (e.g. both eyes were with-the-rule) and as anisorule if otherwise., Results: Of the total cases of bilateral astigmatism, 80% were isorule, and in the studied population, the prevalence of isorule and anisorule astigmatism was 14.89% and 3.53%, respectively. The prevalence of isorule increased with age (p<0.001). The prevalence of both isorule and anisorule increased at higher degrees of spherical ametropia (p<0.001). Median inter-ocular axis difference was 10° in mirror symmetry and 20° in direct symmetry with no significant difference between two genders (p>0.288). Both symmetry patterns reduced with age (p<0.001). Among cases of bilateral astigmatism, 15.5% and 19.8% had exact direct and mirror symmetry, respectively., Conclusion: Bilateral astigmatism is mainly isorule in the population and anisorule astigmatism is rare. The enantiomorphism is the most common pattern in the population of bilateral astigmatism., (Copyright © 2018 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To examine the heritability of the anterior chamber depth, angle, and volume as well as the corneal volume and diameter using Pentacam in households living in underserved rural areas of Iran., Materials and Methods: This cross-sectional population-based study was conducted in randomly selected households living in 2 rural districts in the south and north. The data of subjects above 5 years and households in which at least 2 members (father or mother and a child) had Pentacam data were analyzed. Each subject underwent a comprehensive ophthalmic examination, with emphasis on the measurement of visual acuity and refraction, biomicroscopy, and Pentacam imaging. Heritability was estimated to investigate familial aggregation of anterior chamber indices, and the effects of age, sex, and living area were controlled for as confounding factors., Results: Of the 3851 selected individuals, 3314 participated in the study. After applying the exclusion criteria, the data of 1383 subjects from 382 households were included in the analysis. The mean age of the participants was 37.23±19.35 years (range, 6 to 93 y). The highest and lowest heritability estimates were related to the anterior chamber angle (72%) and corneal diameter (28%), respectively. The heritability percentages of the anterior chamber depth, anterior chamber volume, and corneal volume were 47%, 39%, and 57%, respectively., Conclusions: The high heritability of the anterior chamber angle points to a high correlation between this phenotype and genetic factors. Further genetic and molecular investigations are suggested to find the related genes and understand the etiology of glaucoma.

Purpose: The objective of this study was to determine the prevalence of keratoconus and the potential effect of genetic and environmental factors on its prevalence in households living in rural areas of Iran in a large population-based study., Methods: The present cross-sectional study was performed in two Iranian rural populations. Two rural areas were randomly selected in the southwest and north of Iran. All individuals over one year of age were invited to participate in the study. The study population underwent a thorough eye examination, including visual acuity measurement, refraction, slit lamp biomicroscopy, and Scheimpflug imaging. The diagnosis of keratoconus was made based on Pentacam-specific criteria, tomographic maps, and clinical findings. After detecting keratoconus cases, its prevalence in the study population was reported as a percentage with a 95% confidence interval (CI). For familial aggregation analysis, the odds ratios of keratoconus and its more severe types were calculated in different family relationships (siblings, parents-offspring, spouses) using second order generalised estimating equation., Results: Of the 3851 eligible individuals, 3314 subjects participated in the study. After applying the exclusion criteria, data from 2667 subjects was used in the analysis. The prevalence of keratoconus in the present population was 4% (95% CI: 3-4). The odds of keratoconus were significantly higher in males (OR = 2.30, p = 0.032). To investigate the familial aggregation of keratoconus, we only evaluated families from which at least two members participated in the study. So, 403 families (1452 participants) were evaluated. Our results showed a higher odds ratio for the sibling pairs compare to parent-offspring pairs and as reported, the odds ratio of the spouses was less than 1.0., Conclusion: Our findings showed a relatively high prevalence and familial aggregation of keratoconus in rural areas of Iran, independent of age, sex, and place of residence. This aggregation may be due to heredity or the effect of undetermined shared environmental factors., (© 2018 The Authors Ophthalmic & Physiological Optics © 2018 The College of Optometrists.)

Objective: To evaluate the rate of acute endophthalmitis after resident-performed intravitreal bevacizumab (IVB) injections and to compare the results with those performed by attending retina surgeons., Design: Retrospective comparative case series., Participants: Eight thousand thirty-seven patients treated with intravitreal injection of bevacizumab., Methods: A retrospective chart review of the resident-performed IVB injections at Rassoul Akram Hospital and attending-performed IVB injections at a private eye clinic between 2011 and 2014 was undertaken. Cases of clinical endophthalmitis were identified., Results: During the study interval, the overall incidence rate of postinjection endophthalmitis was 0.01% (1/8037). Antibiotic eye drops were prescribed after IVB injection for 2771 eyes (34.5%). The single case of acute endophthalmitis occurred after a resident-performed injection, and vitreous culture showed growth of Staphylococcus epidermidis. The incidence rate of acute endophthalmitis after resident-performed IVB injection was 0.02% (1/4921). No statistically significant difference was found in the rates of endophthalmitis between resident-performed and attending-performed injections (p = 1). Also, the difference in the rates of endophthalmitis between those receiving postinjection antibiotics and those who did not was not statistically significant (p = 0.3)., Conclusions: The risk for endophthalmitis after resident-performed IVB injection is low and similar to that of the supervising surgeons performing the procedure., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background: Osteoporosis has been described as a progressive skeletal disorder until a patient experiences a fragility fracture. The number of patients with osteoporotic fractures is increasing at an exponential rate. Orthopaedic surgeons, most of the time, first clinicians seen by patients at the time of fracture, do not routinely consider osteoporosis management. Therefore, we compared the knowledge of orthopaedic surgeons and internists regarding medical treatment required: which group would have more abilities to keep patients with osteoporotic fractures under management?, Hypothesis: We hypothesize that internists may have more abilities to assess and treat osteoporosis for patients with osteoporotic fractures; therefore, referring these patients to this specialized team for post-fracture medical consultation is required., Methods: A questionnaire composed of seven closed questions was administered to 4700 orthopaedic surgeons and internists. This question list addressed the orthopaedic surgeons' and internists' knowledge in managing patients with osteoporotic fractures. The questions were designed in a way to cover the topics of diagnosis, treatment, and approach to an osteoporotic patient with osteoporotic fractures., Results: In this survey, 3431 respondents were included. Only 118 (fewer than 10%) orthopaedic surgeons would order bone mineral densitometry (BMD) in osteoporotic fractures in contrast to 1544 (79%) internists. Approximately 1485 (76%) internists against 487 (33%) orthopaedic surgeons prescribe proper dosage of calcium and vitamin D., Conclusion: Typical orthopaedic surgeon is not naturally inclined to manage patients with osteoporotic fractures. The existing management gap between the occurrence of an osteoporotic fracture and the identification and treatment of osteoporosis requires multifaceted intervention. Improved communication between orthopaedic surgeons and internists may reduce this gap between fracture occurrence and osteoporosis management., Level of Evidence: Level III prospective diagnostic study., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)