Effect of Angiography Room Orientation Tour on Anxiety of Patients Awaiting Cerebrovascular Angiography

Abstract Introduction: Cerebrovascular angiography is a method of diagnosing cerebrovascular disorders. Invasive procedures induce anxiety in patients. Poor management of anxiety may be life-threatening for patients. It is the duty of nurses to reduce anxiety. Given the prevalence of anxiety in patients awaiting cerebrovascular angiography and its detrimental complications and also the critical role of nurses in the psychosomatic support of patients and their struggle to reduce anxiety, the use of different methods of patient education such as familiarizing them with diagnostic and therapeutic processes is of utmost significance. This study investigated the effect of orientation tour on anxiety in candidates of cerebrovascular angiography. Methods: In this experimental study, 114 patients awaiting cerebrovascular angiography presenting to Imam Hussein Hospital and Shohadaye Tajrish Hospital in Tehran, capital of Iran, were selected with a convenient sampling method and assigned randomly to either case or control groups. The control group just received routine education in the ward. In contrast, the case group received routine education in the ward and instructions on performing angiography and its pre-, peri-, and post-operative care. Demographics questionnaire and the Depression Anxiety Stress Scale (DASS-21) were used to collect data. Patients' anxiety was measured twice with this instrument at hospitalization and after the intervention. The gleaned data were analyzed with SPSS21 using independent t-test, Chi-square test, and ANOVA. Results: Distribution of age was the same in both groups (P < 0.11). Independent t-test showed a significant difference in the mean score of anxiety before intervention in the control group (9.2) and case group (7.2) (P = 0.02). This test also indicated a significant difference in the mean score of patients' anxiety after intervention in both the control group (9.7) and case group (6.7) (P = 0.001). However, using data collected before the orientation tour as the covariate, repeated measures ANOVA showed a significantly more significant reduction of anxiety in the case group. Conclusions: According to our findings, participation in the angiography room orientation tour leads to reduced anxiety in patients awaiting cerebrovascular angiography. The use of this method is advisable for patients before diagnostic and therapeutic processes

The Repeatability of Axial Length Measurements Using a Scheimpflug-based System

Purpose: To assess the repeatability of Pentacam AXL as a Scheimpflug-based system or measuring axial length according to the age, sex, lens type, axial length value, and type of cataract. Methods: The present study was conducted using multistage cluster sampling in Tehran, Iran. Ocular biometry was performed, using the Pentacam AXL, by an experienced optometrist on all the participants. The axial length (AL) measurements were taken thrice, with a gap of 10 minutes. To evaluate the repeatability, the intraclass correlation coefficient (ICC) and the repeatability coefficient (RC) were calculated. To determine the significant difference in the repeatability index among study variables, the tolerance index (TI) was calculated. Results: In this report, 897 eyes of 677 individuals aged between 20 and 91 years (mean ± SD: 64.90 ± 13.62 years) were reported. The ICC of the axial length measurements was 0.981 for all cases. Based on the within-subject standard deviation, the RC was 0.401. The ICC was 0.976 and 0.985 in men and women, respectively. The TI showed better RC of measurements among females. The ICC decreased from 0.999 in participants under 40 years to 0.973 in individuals over 60 years of age. The TI showed a decrease in RC with advancing age. The RC was worse in eyes with nuclear cataracts; the RC was also worse in the first quartile of the signal-to-noise ratio (SNR) compared to the other SNR quartiles. Conclusion: The Scheimpflug-based system Pentacam AXL had high repeatability in measuring axial length. Some variables such as male gender, older age, and nuclear cataract were associated with reduced repeatability of the measurements. A higher SNR was associated with better repeatability of the axial length measurements

Epidemiology of Dry Eye and Its Determinants Among University Students

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Agreements’ profile of Scheimpflug-based optical biometer with gold standard partial coherence interferometry

AIM: To determine the agreement of ocular biometric indices including axial length, keratometric readings, anterior chamber depth, and horizontal corneal diameter between the Pentacam AXL and IOL Master 500. METHODS: The study was a large cross-sectional population-based study (Tehran Geriatric Eye Study) conducted from Jan 2019 to Jan 2020. A total of 160 clusters were randomly selected proportional to size (each cluster contained 20 individuals) from 22 strata of Tehran city. All people aged 60y and above were invited to participate in the study. For all participants, preliminary ocular examinations were performed including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, anterior and posterior segment examinations. All participants underwent an ocular biometry using the Pentacam AXL and IOL Master 500. RESULTS: The 95% limits of agreement (LoA) between the two devices were -0.13 to 0.19, -0.15 to 0.17, and -0.13 to 0.19 in normal, pseudophakic, and cataractous eyes, respectively. With increasing the axial length, the difference between the two devices significantly increased in all three groups of normal, pseudophakic, and cataractous eyes (P<0.001). The 95% LoAs between the two devices regarding the mean keratometry shows that the best LoAs were seen in cataractous (-0.33 to 0.81) and followed by normal eyes (-0.36 to 0.86) and the pseudophakic eyes (-0.48 to 0.90) had the widest LoA. The 95% LoAs for horizontal corneal diameter measurements were -0.08 to 0.86, -0.03 to 0.83, and -0.07 to 0.87 in normal, pseudophakic, and cataractous eyes, respectively. The 95% LoAs of anterior chamber depth measurements between the two devices was -0.39 to 0.19 and -0.37 to 0.13 in normal eyes and cataractous, respectively. CONCLUSION: The Pentacam AXL has excellent agreement with the gold standard, IOL Master 500 in measuring axial length. In eyes with cataracts, the difference between the two devices is more scattered. With the increasing of axial length, the difference between the two devices increased, which should be considered when using Pentacam AXL

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

The prevalence of ptosis in an Iranian adult population

AbstractPurposeTo determine upper eyelid ptosis prevalence and some related factors in 44- to 69-year-olds of Shahroud in the north of Iran.MethodsIn 2009, using multi-stage cluster sampling, 300 clusters of 40–64-year-olds were selected in Shahroud city, and all 5190 participants were invited to be re-examined in 5 years (2014). The current report is the second phase of the study in which 4737 (91.3%) people participated and underwent vision tests, slit lamp examination, biometry, and ophthalmoscopy in 2014. Upper eyelid ptosis was determined by an ophthalmologist.ResultsThe prevalence of upper eyelid ptosis was 4.7% [95% confidence interval (CI): 4.1–5.4]; 5.2% in women and in 4.0% in men. The prevalence of bilateral and unilateral ptosis was 1.3% (95% CI: 1.0–1.7) and 3.4% (95% CI: 2.8–4.0), respectively. The observed prevalence of ptosis was 3.1% in the 45- to 49-year age group and 5.8% in 65- to 69-year-olds. The prevalence of ptosis increased with age. In the multiple logistic regression model, ptosis prevalence correlated with older age, diabetes (odds ratio = 1.53, 95% CI: 1.16–2.02) and hypertension (odds ratio = 1.41, 95% CI: 1.03–2.92). Mean corneal astigmatism was 1.02 (95%C]: 0.87–1.18) diopter in ptotic eyes and 0.87 (95% CI: 0.84–0.89) diopter in non-ptotic eyes (p = 0.013).ConclusionsThe present report provides valuable information on the prevalence of ptosis in a population of 45-to 69-year-olds. The prevalence of ptosis in this study was considerably high and significantly increased with age

High Prevalence of Asthenopia among a Population of University Students

Purpose: To determine the prevalence of asthenopia and its associated factors in a sample of university students in Iran. Methods: In this cross-sectional study, participants were selected using multistage cluster sampling. Presence of at least one of the 10 symptoms—foreign body sensation, diplopia, blurred vision, eye swelling, dry eye, eye pain, difficulty in sustaining visual operations, decreased visual acuity, tearing, and photophobia—was considered as asthenopia. Ocular examinations, including uncorrected/corrected visual acuity measurement, objective/subjective refraction, cover test, amplitude of accommodation (AA), and near point of convergence (NPC) were performed. Results: Of the 1,462 students (mean age: 22.8 ± 3.1 years), 73% were women. The age- and gender standardized prevalence was 70.9% (95% confidence interval [CI]: 68.3–73.5), 39.8% (95% CI: 36.4–43.1), and 19.7% (95% CI: 16.0–23.3) based on the presence of at least one, two, and three symptoms, respectively. The prevalence was significantly higher in females (P = 0.048), hyperopic students (P &lt; 0.001), and astigmatic participants (P &lt; 0.001). The mean AA and NPC were 9.7 ± 2.6 D and 10.2 ± 4.2 D (P = 0.008) and 7.0 ± 2.1 cm and 7.7 ± 3.9 cm (P &lt; 0.001) in participants with and without asthenopia, respectively. Multiple regression model revealed age (28–29 years), astigmatism, and NPC as independent associated factors (odds ratios: 3.51, 1.61, and 0.91, respectively). Conclusion: This study shows relatively high prevalence of asthenopia in university students. Demographic factors and visual system disorders are important risk factors and timely correction of conditions may lead to decreased asthenopia

Residual refractive errors in pseudophakic eyes and related factors: a population-based study

AIM: To determine residual refractive error after cataract surgery in pseudophakic eyes and its relationship with age, sex, and axial length (AL). METHODS: In this population-based cross-sectional study, the sampling was performed on individuals aged 60y and above in Tehran, Iran using a multi-stage stratified random cluster sampling method. Pseudophakic eyes with a best-corrected visual acuity of 20/32 or better were analyzed and their refractive results were reported. RESULTS: The mean spherical equivalent (SE) refraction was -0.34±0.97 diopters (D) and the mean absolute SE was 0.72±0.74 D with a median of 0.5 D. Moreover, 32.68% (n=546, 95%CI: 30.27%-35.08%), 53.67% (n=900, 95%CI: 51.23%-56.1%), 68.99% (n=1157, 95%CI: 66.96%-71.02%), and 79.73% (n=1337, 95%CI: 77.69%-81.76%) of the eyes had a residual SE within ±0.25, ±0.50, ±0.75, and ±1.00 D of emmetropia, respectively. According to the multiple logistic regression model, increasing age was associated with a statistically significant decrease in predictability for all cut points. Moreover, the predictability based on all cut points was significantly lower in individuals with an AL longer than 24.5 mm than in those with an AL between 22 to 24.5 mm. CONCLUSION: Based on the results, the accuracy of intraocular lens (IOL) power calculation is lower for those who underwent cataract surgery during the last 5y in Tehran, Iran. Among the most important influential factors, the choice of IOL or it's power disproportionate to eye conditions and age can be mentioned

Near Points of Convergence and Accommodation in a Population of University Students in Iran

Purpose: To determine the distribution of the near point of convergence (NPC) and near point of accommodation (NPA) in a young student population in Iran. Methods: The subjects were selected using a cluster sampling method. All students underwent optometry tests, including visual acuity measurement, refraction, and cover test, as well as ophthalmic examinations. The NPC and NPA were measured using an accommodative target (near Snellen chart). Results: Of 1,595 students, the data of 1,357 were analyzed. The mean NPC and NPA in the total sample were 7.25 cm (95% confidence interval [CI], 7.02 to 7.48) and 9.99 cm (95% CI, 9.69 to 10.29), respectively. Older age was associated with an increase in the NPC, which increased from 6.98 cm in 18–20 years olds to 9.51 cm in those over 30 years. The NPA was significantly associated with age and refractive errors in the multiple linear regression model, increasing from 9.92 cm in 18–20 years olds to 11.44 cm in those over 30 years (P = 0.003). Hyperopic eyes had lower NPA than myopic and emmetropic eyes (P = 0.001). In younger age groups, the mean accommodation amplitude was lower than the mean Hofstetter value. Moreover, with age, especially after 30 years, the mean values surpassed those determined using the Hofstetter formula. Conclusion: The NPC values in this study were lower than those previously reported for identical age groups. The Hofstetter formula is not always an accurate predictor of the accommodation amplitude in the Iranian adult population