Comparison of Visual Evoked Potential and Electro-oculogram Tests in Early Detection of Hydroxychloroquine Retinal Toxicity

Purpose: To compare the sensitivity of visual evoked potential (VEP) and electro-oculogram (EOG) tests in early detection of hydroxychloroquine (HCQ) retinal toxicity.Patients and Methods: In this prospective cross-sectional study, 100 consecutive patients (age range: 18 to 30) with juvenile rheumatoid arteritis (JRA) and a cumulative hydroxychloroquine dosage of at least 200gr were included.  In addition 100 healthy individuals with matched age and sex were included as controls. Ocular examinations including visual acuity testing, refractive errors measurement, applanation tonometry, slit lamp biomicroscopy fundus ophthalmoscopy and electrophysiological examinations (EOG and VEP) were performed in both groups. Scores of less than 1.8 for the Arden Index in EOG (AI), as well as less than 4mv of P100 amplitude and more than 110ms of P100 latency in VEP were considered abnormal.Results: The mean cumulative dosage of HCQ among participants was 262.4±31.9g (95% CI: 256.1 to 268.8g). The mean measurement of AI (EOG), P100 latency and amplitude of VEP were 1.8±0.4, 112.7±10.1ms and 3.7±2.1mv, respectively. There was a significant difference between case and control groups in all parameters (p<0.001 for all). There was not any significant difference between AI (EOG), P100 latency and amplitude of VEP in detecting the ocular toxicity due to HCQ.Conclusion: We conclude that AI (EOG), P100 amplitude and latency of VEP can all be useful parameters to detect HCQ retinal toxicity, and we did not detect any difference between these two methods.

Quantity and Quality of Vision Using Tinted Filters in Patients with Low Vision Due to Diabetic Retinopathy.

[en] PURPOSE: To investigate the effect of tinted filters on visual acuity (VA), contrast sensitivity and patient satisfaction in diabetic retinopathy associated with low vision. METHODS: In a prospective study, 51 patients with diabetic retinopathy and low vision were assessed. We chose a simple random sampling method and used the patient's files for data collection. LogMAR notations were applied for assessing VA and a contrast sensitivity chart (CSV-1000) was employed for measuring contrast sensitivity. First, measurements were performed without tinted filters and then using them. Appropriate lenses were given to the patients for 2 days, and they were questioned about their satisfaction using them in different places. RESULTS: A total of 20 male and 31 female patients with mean age of 57.3 years participated in the study. With a 527 ± 10 nm filter, mean VA improved significantly (P ≤ 0.05). Using the 527 ± 10 nm and 511 ± 10 nm filters, mean contrast sensitivity was improved significantly at 3 and 6 cycles/degree frequencies (P < 0.05). The effect of other filters on VA and contrast sensitivity was not significant. Patient satisfaction rate was generally high. CONCLUSION: Tinted filters are able to rehabilitate low-vision patients due to diabetic retinopathy. The 527 ± 10 and 511 ± 10 nm wavelength filters improved contrast sensitivity and the 527 ± 10 nm filter improved VA to some extent. Further investigations are recommended to assess the effect of these filters in patients with other causes of low-vision

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Refractive Errors in School-age Children in Qazvin, Iran

Background: Refractive error remains one of the primary causes of visual impairment among school children all over the world, and its prevalence varies widely. Objectives: The present study was aimed to determine the prevalence of refractive errors in school children aged 7 to 18 years in Qazvin, Iran. Patients and Methods: In this cross-sectional study, 11821 students (aged 7 to 18 years) were recruited from different schools. Emmetropia was defined as refractive status between +0.25 and -0.25 D sphere. A -0.50 D or greater spherical considered as myopia, -6.00 D or more as high myopia, and +0.50 D or more as hyperopia, and a cylinder refraction greater than 0.75 D was defined as astigmatism. Visual acuity and refraction of all students were tested. Anterior and posterior segment examination and ocular motility evaluation were also performed to rule out the pathological causes of visual impairments. Results: The study was performed on 5641 (47.72%) male and 6180 (52.28%) female students. The prevalence of myopia (from 32.96% at the age of 7 to 79.02% at the age of 18 years) significantly increased (P < 0.001), and hyperopia significantly decreased (from 47.07% in 7-year- old individuals to 8.32% in 18-year- old subjects) with age (P < 0.001). There were significant differences in refractive errors between males and females. Hyperopia and myopia was more common among female in comparison to males (P < 0.001). Astigmatism greater than 0.75 D in one or both eyes was found in 990 children (8.37%). Astigmatism increased from 6.04% in 7-year-old students to 9.86% in 15-year-oldstudents e and then no more difference was found in age group ranged from 15 to 18 years. Conclusions: Based on our study, the prevalence of myopia is more than other types of refractive error, which is similar to that reported in previous studies on other school-age populations in some Asian countries. The high prevalence of refractive error among school-age children indicated that untreated refractive error is one of the most common public health problems. Keywords: Refractive Error; Myopia, Hyperopia; School children; Age; Se

Prevalence of strabismic binocular anomalies, amblyopia and anisometropia. Rehabilitation Faculty of Shahid Beheshti Medical University

Purpose: Manifest strabismus such as constant and alternative esotropia and exotropia, not only cause cosmetic problem in patients but also induce disorders such as amblyopia. These anomalies can lead to academic failure in students and reduce efficiency in other jobs. Therefore, determining the prevalence of binocular anomalies is important. The purpose of this study is to determine the prevalence of strabismic binocular anomalies, amblyopia and anisometropia in patients examined in optometry clinic of the rehabilitation faculty of Shahid Beheshti Medical University in 2008/2009. Methods: In this study, files of 600 patients were evaluated. Cycloplegic refraction was performed in infants, elementary and middle school children and other patients had noncylcoplegic refraction. Anisometropia was defined as a difference of 1.00D or more between two eyes. Amblyopia was diagnosed as a reduction of best corrected visual acuity (BCVA) to 20/30 or less in one eye or 2-line difference in the absence of pathological causes. Cover test was performed to investigate of strabismus. Results: The prevalence of strabismic binocular anomalies, amblyopia and anisometropia were respectively: anisometropia in 64 patients (10.67%), anisometropic amblyopia in 9 patients (1.5%), anisometropic amblyopia with exotropia in 1 patient (0.17%), anisometropic amblyopia with esotropia in 1 patient (0.17%), bilateral amblyopia in 5 patients (0.83%), esotropia in 2 patients (0.33%), exotropia in 1 patients (0.17%) and convergence insufficiency in 2 patients (0.33%). Discussion: The results show that the prevalence of anisometropia was higher than shown in previous studies but prevalence of convergence insufficiency, esotropia and exotropia was lower than previous studies

A Study On The Frequency Of Different Types Of Optical Low Vision Aids Prescribed For Low Vision Patients Examined In The Clinic Of Optometry, Faculty Of Rehabilitation Sciences Shahid Beheshti University Of Medical Sciences, Tehran, 1387

Background and Aim: Different diseases can be the cause of low vision. In the case of low vision, visual acuity with conventional optical devices such as glasses and contact lenses is between” 20/70 to 20/200”. To improve the visual performance in these patients, low vision aids are prescribed.The types of prescribed low vision aids vary in different diseases. The purpose of this study is to determine the type and frequency of optical aids prescribed for low vision patients examined in optometry clinic of Rehabilitation faculty of shahid Beheshti University in 1387. Materials and Methods: In this retrospective cross-sectional study, 204 low vision patients went under investigation. In the present study variables including type and rate of refractive error, visual acuity with the best correction, type of diseases and type of prescribed optical low vision aids were investigated.Results: The frequency of prescribed distance glasses in diabetic retinopathy was 97%, age related macular degeneration 86.2%, Stargarts 92%, retinitis pigmentosa 86.4% and albinism 88.2%, Also the frequency of prescribed microscope in diabetic retinopathy was 81.82% , age related macular degeneration 48.27%, Stargarts 40% , retinitis pigmentosa 35.3% , albinism 35.3% and the frequency of prescribed magnifier in diabetic retinopathy was18.18%, age related macular degeneration 24.12% , Stargarts 52%, retinitis pigmentosa18.18% and albinism 29.4%.Conclusion: In many low vision conditions, it is more suitable to prescribe distance glasses rather than telescope. In this study the distance glass with the frequency of 84.8% is seen more acceptable in comparison with the telescope with the frequency of 41.7%. Among near optical low vision aids, microscope with the frequency of 50.5% is more accepted by the patients compared to magnifier with the frequency of 26% and CCTV with the frequency of 0.50%

Characteristics of posterior corneal astigmatism in different stages of keratoconus

Purpose: To evaluate the magnitudes and axis orientation of anterior corneal astigmatism (ACA) and posterior corneal astigmatism (PCA), the ratio of ACA to PCA, and the correlation between ACA and PCA in the different stages of keratoconus (KCN). Methods: This retrospective case series comprised 161 eyes of 161 patients with KCN (104 men, 57 women; mean age, 22.35 ± 6.10 years). The participants were divided into four subgroups according to the Amsler-Krumeich classification. A Scheimpflug imaging system was used to measure the magnitude and axis orientation of ACA and PCA. The posterior-anterior corneal astigmatism ratio was also calculated. The results were compared among different subgroups. Results: The average amounts of anterior, posterior, and total corneal astigmatism were 4.08 ± 2.21 diopters (D), 0.86 ± 0.46 D, and 3.50 ± 1.94 D, respectively. With-the-rule, against-the-rule, and oblique astigmatisms of the posterior surface of the cornea were found in 61 eyes (37.9%), 67 eyes (41.6%), and 33 eyes (20.5%), respectively; corresponding figures in the anterior corneal surface were 55 eyes (32.4%), 56 eyes (34.8%), and 50 eyes (31.1%), respectively. A strong correlation (P ≤ 0.001, r = 0.839) was found between ACA and PCA in the different stages of KCN; the correlation was weaker in eyes with grade 3 (P ≤ 0.001, r = 0.711) and grade 4 (P ≤ 0.001, r = 0.717) KCN. The maximum posterior-anterior corneal astigmatism ratio (PCA/ACA, 0.246) was found in patients with stage 1 KCN. Conclusion: Corneal astigmatism in anterior surface was more affected than posterior surface by increasing in the KCN severity, although PCA was more affected than ACA in an early stage of KCN