Diabetic retinopathy clinical practice guidelines: Customized for Iranian population

Purpose: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. Methods: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology Preferred Practice Pattern 2012, and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefts, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. Results: Agreed recommendations were accepted as the fnal recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. Conclusion: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy. © 2016 Journal of Ophthalmic and Vision Research

Prevalence of refractive errors; The yazd eye study

Purpose: To determine the prevalence of refractive errors in Yazd, central Iran. Methods: This population-based study was performed in 2010-2011 and targeted adults aged 40 to 80 years. Multi-stage random cluster sampling was applied to select samples from urban and rural residents of Yazd. Manifest refraction, visual acuity measurement, retinoscopy and funduscopy were performed for all subjects. Myopia, hyperopia, astigmatism and anisometropia were defined as spherical equivalent (SE) +0.50 D, cylindrical error >0.5 D and SE difference �1 D between fellow eyes, respectively. Results: From a total of 2,320 selected individuals, 2,098 subjects (90.4) participated out of which 198 subjects were excluded due to previous eye surgery. The prevalence (95 confidence interval) for myopia, hyperopia, astigmatism, anisometropia, -6 D myopia or worse, and 4 D hyperopia or worse was 36.5 (33.6-39.4), 20.6 (17.9-23.3), 53.8 (51.3-56.3), 11.9 (10.4-13.4), 2.3 (1.6-2.9) and 1.2 (0.6-1.8), respectively. The prevalence of hyperopia, astigmatism and anisometropia increased with age. The prevalence of myopia was significantly higher in female subjects. The prevalence of with-the-rule, against-the-rule and oblique astigmatism was 35.7, 13.4 and 4.6, respectively. The prevalence of against-the-rule astigmatism increased with age (P<0.001); with-the-rule astigmatism was more common in women (P=0.038). Conclusion: More than half of the study population had refractive errors; the prevalence of myopia and astigmatism was higher than earlier studies in Iran. Since refractive errors are a major cause of avoidable visual impairment, their high prevalence in this survey is important from a public health perspective