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 PlusoptiX 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

Long-term visual outcome of congenital cataract at a Tertiary Referral Center from 2004 to 2014

AbstractPurposeTo assess the long-term visual acuity (VA) outcome after congenital cataract surgery at Imam Hossein Medical Center (Tertiary Referral Center) (2004–2014).MethodsIn this descriptive study, records of 120 patients with a history of congenital cataract surgery were studied. Those with traumatic, metabolic cataract, aged <5 years at the last visit who were not able to respond VA testing accurately and follow-up < 6 months were excluded. Cases with incomplete files were recalled and reexamined. Finally, the records of 42 patients (71 eyes) were included.ResultsIn this study, 20 males and 22 females with a mean age of 11.80 ± 6 years at their last visit were studied. Bilateral and unilateral cataract was seen in 69% and 31% of cases, respectively. Posterior and anterior subcapsular opacity was the most common (53.70%) and rarest (1.90%) type of congenital cataract, respectively. The mean age at the time of operation and surgical interval was 65 ± 66.6 (range: 1–200) and 12.9 ± 23.5 (range: 0–96) months, respectively. The most common method of refractive error correction was pseudophakia plus glasses (56.3%) with the mean best corrected visual acuity (BCVA) of 0.29 ± 0.28 LogMAR., The mean BCVA was 0.7 ± 0.53 LogMAR for aphakic patients correcting by glasses. In our study, amblyopia (56%), glaucoma (23.90%), and posterior capsular opacity (16.40%) were observed during their follow-ups on an average of 76 ± 65 months (median: 60, range: 6–240). Unilateral cataract, aphakia, nystagmus, female gender, and strabismus were risk factors of VA loss.ConclusionBased on our results, 56% of cases showed amblyopia. It could be due to late operation (especially in unilateral cases), longer surgical interval between two eyes, and no compliance of amblyopia therapy. Early detection through screening may reduce the rate of amblyopia. Refractive errors, visual acuity, amblyopia, glaucoma, posterior capsular opacity, and compliance of amblyopia therapy should be checked regularly at follow-up visits

Intervention to Improve Menstrual Health Among Adolescent Girls Based on the Theory of Planned Behavior in Iran: A Cluster-randomized Controlled Trial

Objectives: Poor menstrual health may lead to school absenteeism and adverse health outcomes for adolescents. The purpose of this study was to determine the effect of pubertal and menstrual health education on health and preventive behaviors among Iranian secondary school girls. Methods: A quasi-experimental study was conducted to evaluate the effectiveness of a health intervention program. A total of 578 students (including intervention and control participants) in 12 schools in Tehran Province, Iran were included by multistage random sampling. The program comprised seven 2-hour educational sessions. After confirming the reliability and validity of a researcher-made questionnaire, that questionnaire was used to collect the required data, and the groups were followed up with after 6 months. Results: After the educational intervention, the mean scores of menstrual health-related knowledge and constructs of the theory of planned behavior were significantly higher in the intervention group than in the control group (p<0.001 for all dimensions). Conclusions: The results of this study emphasize the effectiveness of menstrual health interventions in schools. These findings should also encourage health policy-makers to take committed action to improve performance in schools

Major Dietary Patterns Relationship with Severity of Coronary Artery Disease in Gaza-Strip, Palestine: A Cross-Sectional Study

BACKGROUND፡ The association of dietary patterns (DPs) linked to the severity of coronary artery disease (CAD) is little known. Therefore, this study aims to explore the relationship between major DPs and the severity of CAD.METHODS: This cross-sectional study was conducted among423 newly discovered CAD patients (both genders, aged 35-65 years), who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested using a semi-quantitative food frequency questionnaire and other related data through face-to-face interviews. Factor analysis and logistic regression were applied by using SPSS version-24.RESULTS: By principal component analysis, two major DPs were identified: “Unhealthy” DP that characterized mainly by high intakes of sugar and sweets, soft drinks, salts, cooking oils, and processed meats, and “Healthy” DP that consisting high intakes of fruits, fish, poultry, vegetables, whole grains. After adjustment for confounding variables, the odds of severe CAD was significantly higher in the third (T3) and second (T2) tertile of the unhealthy pattern by 4.79 and 2.48 times more compared to the first tertile (T1) (OR 4.79; 95%CI 2.60, 8.83; P&lt;0.001) and (OR 2.48; 95%CI 1.40, 4.39; P=0.002), respectively. However, the odds of CAD severity in the T3 and T2 of the healthy pattern was lowered by 0.24 and 0.38 times less compared to the T1 (OR 0.24; 95%CI 0.12, 0.47; P=0.002) and (OR 0.38; 95%CI 0.20, 0.73;P=0.006), respectively.CONCLUSION: The severity of CAD was significantly increased by the unhealthy dietary pattern, while decreased by adherence to the healthy pattern

Intravitreal Medications for Retinal Vein Occlusion: Systematic Review and Meta-analysis

Purpose: To evaluate the outcomes of different intravitreal injections for the treatment of retinal vein occlusion including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Methods: PubMed, Cochrane, the metaRegister of ControlledTrials, and ClinicalTrials were searched for intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and steroids with relevant keywords and date limitation of 2009-2018. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were visual acuity (VA) and central macular thickness (CMT). Results: Out of 681 studies, 36 articles (including 21 reporting CRVO and 15 dealing with BRVO) were selected for systematic review. All five intravitreal drugs including triamcinolone, dexamethasone, ranibizumab, bevacizumab, and aflibercept showed improvement of CMT and VA as compared to placebo or laser treatment. Six randomized controlled trials were selected for meta-analysis in RVO patients. The pooled mean difference of visual improvement between sham and ranibizumab was 12.7 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (95%CI: 11.00 to 13.2), and the pooled mean difference in CMT reduction was 221 μm (95%CI: 153 to 284); both changes were significantly in favor of ranibizumab. The pooled mean difference of visual improvement between bevacizumab and triamcinolone was 5.3 ETDRS letters in favor of bevacizumab (95%CI: 16 μm to 17.5 μm). Triamcinolone led to 68.1 μm greater CMT reduction than bevacizumab (95%CI: 58 μm to 76 μm). However, none of these differences were statistically significant. Conclusion: Treatment with anti-VEGF agents in RVO is superior to observation. No significant difference was seen between the eyes treated with bevacizumab or triamcinolone based on these results

Factors related to reduction in the consumption of fast food: application of the theory-based approaches

Background. The Trans-Theoretical model (TTM) and Theory of Planned Behaviour (TPB) may be promising models for understanding and predicting reduction in the consumption of fast food. The aim of this study was to examine the applicability of the Trans-Theoretical model (TTM) and the additional predictive role of the subjective norms and perceived behavioural control in predicting reduction consumption of fast food in obese Iranian adolescent girls. Materials and methods. A cross sectional study design was conducted among twelve randomly selected schools in Sabzevar, Iran from 2015 to 2017. Four hundred eighty five randomly selected students consented to participate in the study. Hierarchical regression models used to predict the role of important variables that can influence the reduction in the consumption of fast food among students. using SPSS version 22. Results. Variables Perceived behavioural control (r=0.58, P&lt;0.001), Subjective norms (r=0.51, P&lt;0.001), self-efficacy (r=0.49, P&lt;0.001), decisional balance (pros) (r=0.29, P&lt;0.001), decisional balance (cons) (r=0.25, P&lt;0.001), stage of change (r=0.38, P&lt;0.001), were significantly and positively correlated while experiential processes of change (r=0.08, P=0.135) and behavioural processes of change (r=0.09, P=0.145), were not significant.Conclusions. The study demonstrated that the TTM (except the experiential and behavioural processes of change) focusing on the perceived behavioural control and subjective norms are useful models for reduction in the consumption of fast food

Orthoptic Changes following Photorefractive Keratectomy

Purpose: To report orthoptic changes after photorefractive keratectomy (PRK). Methods: This interventional case series included 297 eyes of 150 patients scheduled for PRK. Complete ophthalmologic evaluations focusing on orthoptic examinations were performed before and 3 months after PRK. Results: Before PRK, 2 (1.3%) patients had esotropia which remained unchanged; 3 (2%) patients had far exotropia which improved after the procedure. Of 12 cases (8%) with initial exotropia at near, 3 (2%) cases became orthophoric, however 6 patients (4%) developed new near exotropia. A significant reduction in convergence and divergence amplitudes (P < 0.001) and a significant increase in near point of convergence (NPC) (P < 0.006) were noticed after PRK. A reduction ≥ 10 PD in convergence amplitude and ≥ 5 PD in divergence amplitude occurred in 10 and 5 patients, respectively. Four patients had initial NPC > 10 cm which remained unchanged after surgery. Out of 9 (6%) patients with baseline stereopsis > 60 seconds of arc, 2 (1.33%) showed an improvement in stereopsis following PRK. No patient developed diplopia postoperatively. Conclusion: Preexisting strabismus may improve or remain unchanged after PRK, and new deviations can develop following the procedure. A decrease in fusional amplitudes, an increase in NPC, and an improvement in stereopsis may also occur after PRK. Preoperative evaluation of orthoptic status for detection of baseline abnormalities and identification of susceptible patients seem advisable

Topical Mitomycin-C versus Subconjunctival 5-Fluorouracil for Management of Bleb Failure

Purpose: To compare the efficacy and safety of topical mitomycin‑C (MMC) drops with that of subconjunctival 5‑fluorouracil (5‑FU) injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation (PT+PCIOL). Methods: In a randomized comparative study, 37 eyes of 37 patients with impending early bleb failure received MMC 0.02% eye drops for 2 or 4 weeks (19 eyes) or subconjunctival 5‑FU injections, 5 mg per dose (18 eyes). Complete success was defined as 5 < IOP ≤ 18 mmHg without medications. Results: Baseline characteristics were comparable between the study groups. However, there were more cases of combined PT+PCIOL in the MMC group [11 (57.9%) eyes versus 3 (16.7%) eyes, P = 0.017]. Mean preoperative IOP was 20.5΁8.85 mmHg in the MMC group and 25.82΁11.35 mmHg in the 5‑FU group (P = 0.129), which was decreased to 13.2΁6.1 and 10.6΁4.8 mmHg respectively after 12 months (P = 0.159). There was no significant difference between the study groups in terms of bleb extent (P = 0.170), height (P = 0.178) or vascularity (P = 0.366). At the end of the study, complete success was achieved in 13 eyes (68.4%) in the MMC group and 14 eyes (77.8%) in the 5‑FU group (P = 0.714). The survival of success at 8 months (median follow-up) was 89.5% and 86.5% in the MMC and 5‑FU groups respectively; the number of glaucoma medications (P = 0.707) and best-corrected visual acuity (P = 0.550) were also comparable. Complication rates were similar in the study groups (P = 0.140). Conclusion: Topical MMC 0.02% has comparable safety and efficacy to subconjunctival 5‑FU injections for management of early bleb failure. Topical MMC 0.02% drops are more convenient and can be initiated first, while 5‑FU injections may be reserved for eyes with an insufficient response to topical MMC