Journal of Ophthalmic and Optometric Sciences

Purpose: To evaluate the medium-term postsurgical effects of photorefractive keratectomy (PRK) on patients’ subjective perception of dry eye and eyestrain.
Patients and Methods: This prospective comparative pre-post study was performed at Vanak Eye Surgery Center, Tehran, Iran, from May 2020 to September 2021. The inclusion criteria were patients with mild to moderate myopia (less than -6 diopters) undergoing PRK. To evaluate the indirect subjective signs of eyestrain and its severity, we used a questionnaire including six questions regarding itching, foreign body sensation, excessive tearing, eye tiredness, blurring, and photophobia. We administered this questionnaire to each patient in face-to-face interviews pre-surgery as well as 1 and 6 months post-surgery. To evaluate post-surgical dry eye, we asked patients if their dry eye symptoms had increased or decreased compared to the pre-surgical period.

Results: A total of 40 patients were assessed in this study. The mean age of patients was 26 ± 8 years, with 16 (40 %) male patients and 24 (60 %) female patients. There was no statistically significant difference in mean eyestrain scores one month (P = 0.371) and six months (P = 0.939) post-surgery compared to pre-surgery. There was a significant increase in dry eye symptoms at both 1 month (P = 0.010) and 6 months (P = 0.004) post-surgical follow-ups.

Conclusion: Our results indicate that PRK significantly increases dry eye symptoms compared to the pre-surgical period, up to six months post-operatively. There was no statistically significant difference in eyestrain symptoms among patients compared to the pre-surgical period.

Purpose: To investigate the visual and refractive outcomes of topographic-guided customized ablation treatment (T-CAT) photorefractive keratectomy (PRK) combined with iris registration and the use of  mitomycin C among patients who have undergone corneal transplantation.
Patients and Methods: This cross-sectional study was conducted on 18 eyes of 14 patients with keratoconus over a 2-year period at Torfeh Eye Hospital, Tehran, Iran. Of these patients, 11 patients were male and 3 patients were female. All participants had previously undergone penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) and subsequently underwent T- CAT PRK surgery with 0.02 % mitomycin C to correct residual refractive errors due to intolerance or reluctance to wear glasses or contact lenses. Pre- and post- T-CAT PRK surgery assessments included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), cylindrical and spherical lens measurements, spherical equivalent, and corneal opacity in the transplanted cornea.
Results: The mean postoperative spherical equivalent decreased from 4.27 ± 2.28 D to 1.48 ± 1.39 D, a statistically significant reduction (P = 0.001). The improvements in UCVA, BCVA, and spherocylinder levels were also statistically significant during the follow-up periods after PRK.
Conclusion: The present study suggest that T-CAT PRK combined with iris registration and the use of  mitomycin C intraoperatively in keratoconus patients who have undergone corneal transplantation can effectively treat spherical astigmatism. This approach significantly reduced refractive errors and improved visual and refractive parameters.

Purpose: This study aimed to compare the predictability and accuracy of different formulas for calculating the power of Tecnis ZCB00 intraocular lenses (IOLs) in patients undergoing cataract surgery.
Patients and Methods: A retrospective comparative analysis was conducted at Basir Eye Clinic, Tehran, Iran, involving 491 eyes of 491 patients who underwent cataract surgery with Tecnis ZCB00 IOL insertion. Biometry data were entered into calculators for SRK/T, Hill Radial Basis Activation Function-2 (Hill RBF- 2), Barrett Universal II, and Ladas Super Formula. Tecnis ZCB00 IOL was implanted for all patients with the power calculated by SRK/T formula. The mean refractive prediction error was compared between Hill RBF- 2, Barrett Universal II, and Ladas Super Formula.
Results: The mean refractive prediction error when considering the IOL power calculations using the Ladas Super Formula, Hill RBF-2, and Barrett Universal II were 1.07 ± 1.11, 0.97 ± 0.82, 1.21 ± 1.04, respectively (P < 0.01). Also, there was a significant difference between the formulas when accessing patients with short axial length (worst results with Barrett Universal II, P < 0.01), medium axial length (best results with Hill RBF-2, P < 0.01) and long axial length (worst results with Barrett Universal II, P < 0.01).
 Conclusion: For TECNIS^® ZCB00 IOLs, the calculation of IOL power yielded the highest mean refractive prediction error with the Barrett Universal II formula.

Purpose: The aim of the present study was to investigate possible toxic effects of Dienogest treatment on visual pathway among endometriosis patients using visual evoked potential (VEP) measurements.

Patients and Methods: A total of 26 eyes from 13 females aged between 25 and 42 years who received Dienogest for the treatment of endometriosis were included as the case group. VEP measurements were taken from the case group and compared with results from 26 eyes of 13 healthy females with no history of Dienogest use, who served as the control group.

Results: There were no significant differences between the case and control groups in terms of the latency and amplitude of the VEP P100 peak.

Conclusion: Dienogest does not affect the visual pathway in patients, as demonstrated by visual evoked potential measurements.

Purpose: This study aimed to systematically review the validity and reliability of telemedicine methods in evaluating strabismus.
Materials and Methods: Electronic medical databases, including Medline (PubMed), Web of Science, Scopus, and Embase, were systematically reviewed up to April 2021. Two authors independently conducted study selection, data extraction, and quality assessment. Restricted Maximum Likelihood was used to calculate pooled sensitivity, specificity, and reliability. Heterogeneity of the studies was assessed by I-squared statistic (I²) value, and a funnel plot was used to assess publication bias.
Results: A total of 1190 original studies were evaluated. Finally, 8 studies were selected for systematic review and meta-analysis. The pooled estimation of sensitivity was 0.80 (95 % CI: 0.69-0.88, I²: 81.8 %, T²: 0.01, P for heterogeneity < 0.001), the pooled estimation of specificity was 0.91 (95 % CI: 0.77-0.97, I²: 96.9 %, T²: 0.01, P for heterogeneity < 0.001), and the pooled estimation of reliability was 0.91 (95 % CI: 0.83-0.99, I²: 0.00 %, T²: 0.00, P for heterogeneity: 0.94). Additionally, the Diagnostic Odds Ratio (DOR) index for telemedicine strabismus detection was 43.3. In other words, the odds of a positive result in strabismic patients were 43 times higher than in non-strabismic patients.
Conclusion: The results of this review indicate that the sensitivity, specificity, and reliability of telemedicine in strabismus detection are acceptable. Telemedicine emerges as an easy, inexpensive, accurate, and reliable method for diagnosing strabismus.

Purpose: To report a case of positive dysphotopsia (PD) following intraocular lens (IOL) implantation.
Case Report: A 57-year-old male presented with significant PD symptoms, including photophobia and glare, after monofocal IOL implantation. Despite treatment with artificial tears and corticosteroids, the patient continued to experience visual discomfort, requiring sunglasses even indoors. He was prescribed brown-tinted lenses with 40 % tint. After one month of use, the patient reported substantial improvement in PD symptoms, increased contrast sensitivity, and cosmetic satisfaction.
Conclusion: Tinted spectacle lenses provide a non-invasive option for managing persistent PD. In our case, brown-tinted lenses effectively reduced glare and enhanced visual comfort. Further studies are needed to investigate the broader role of tinted lenses in managing visual disturbances associated with IOL implantation.

Triple A syndrome (Allgrove syndrome) is an autosomal recessive disorder characterized by alacrima, achalasia, and Addison's disease. We report an 8-year-old girl diagnosed with Triple A syndrome and abnormal visual evoked potential findings.