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Background: The American Optometric Association defines computer vision syndrome (CVS), also known as digital eye strain, as "a group of eye- and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use". We aimed to create a well-structured, valid, and reliable questionnaire to determine the prevalence of CVS, and to analyze the visual, ocular surface, and extraocular sequelae of CVS using a novel and smart self-assessment questionnaire. Methods: This multicenter, observational, cross-sectional, descriptive, survey-based, online study included 6853 complete online responses of medical students from 15 universities. All participants responded to the updated, online, fourth version of the CVS questionnaire (CVS-F4), which has high validity and reliability. CVS was diagnosed according to five basic diagnostic criteria (5DC) derived from the CVS-F4. Respondents who fulfilled the 5DC were considered CVS cases. The 5DC were then converted into a novel five-question self-assessment questionnaire designated as the CVS-Smart. Results: Of 10 000 invited medical students, 8006 responded to the CVS-F4 survey (80% response rate), while 6853 of the 8006 respondents provided complete online responses (85.6% completion rate). The overall CVS prevalence was 58.78% (n = 4028) among the study respondents; CVS prevalence was higher among women (65.87%) than among men (48.06%). Within the CVS group, the most common visual, ocular surface, and extraocular complaints were eye strain, dry eye, and neck/shoulder/back pain in 74.50% (n = 3001), 58.27% (n = 2347), and 80.52% (n = 3244) of CVS cases, respectively. Notably, 75.92% (3058/4028) of CVS cases were involved in the Mandated Computer System Use Program. Multivariate logistic regression analysis revealed that the two most statistically significant diagnostic criteria of the 5DC were ≥2 symptoms/attacks per month over the last 12 months (odds ratio [OR] = 204177.2; P <0.0001) and symptoms/attacks associated with screen use (OR = 16047.34; P <0.0001). The CVS-Smart demonstrated a Cronbach's alpha reliability coefficient of 0.860, Guttman split-half coefficient of 0.805, with perfect content and construct validity. A CVS-Smart score of 7-10 points indicated the presence of CVS. Conclusions: The visual, ocular surface, and extraocular diagnostic criteria for CVS constituted the basic components of CVS-Smart. CVS-Smart is a novel, valid, reliable, subjective instrument for determining CVS diagnosis and prevalence and may provide a tool for rapid periodic assessment and prognostication. Individuals with positive CVS-Smart results should consider modifying their lifestyles and screen styles and seeking the help of ophthalmologists and/or optometrists. Higher institutional authorities should consider revising the Mandated Computer System Use Program to avoid the long-term consequences of CVS among university students. Further research must compare CVS-Smart with other available metrics for CVS, such as the CVS questionnaire, to determine its test-retest reliability and to justify its widespread use.

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Background and purpose: Increasing people's knowledge and then changing their attitude and practice with the aim of taking care of their eye health are very important. Considering the importance of the mentioned topic, the main goal of this study was to evaluate the knowledge, attitude, and practice about eye diseases in the general population of the world in the form of a systematic literature review. Materials and Methods: This study was a systematic literature review study, and to do it, a systematic search was conducted in internationally available databases including Web of Science, ScienceDirect, Scopus, PubMed, and Google Scholar in the time range of 1998 to 2023. Finally, considering the inclusion and exclusion criteria of the study, the results of 18 articles were extracted. Results: The findings showed that in general, people's level of knowledge about glaucoma was lower compared to other eye diseases, and the level of knowledge of men and women about eye diseases was different. In addition, the results showed that there was significant relationship between age and knowledge of various eye diseases. The results of all evaluated studies showed that people with higher education have more knowledge about eye diseases. Conclusion: Based on this, it can be concluded that as glaucoma is one of the most important causes of blindness worldwide, it is necessary to plan to increase the level of public knowledge to recognize the symptoms and complications of this disease. In addition to that, it is necessary to increase people's advertisement by ophthalmology centers and eye specialists about the use of glasses and also to encourage people to visit the eye physician regularly.

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Background: Keratoconus (KCN) is an ectatic disorder of the cornea characterized by stromal weakness and apical protrusion of the cornea, and is associated with a gradual and painless reduction in visual acuity. KCN in pediatric patients has certain important characteristics, such as a progressive and aggressive nature. We aimed to analyze the visual, refractive, and topographic outcomes of implanting a single 210° arc-length Keraring segment according to a novel, objective, Q value-based nomogram (Q-N) for the treatment of pediatric versus adult KCN. Methods: This prospective, multicenter, non-randomized, open-label trial included 47 eyes of 47 patients who were allocated to one of two groups. The adult group included 33 eyes of patients ≥ 18 years of age, whereas the pediatric group included 14 eyes of patients aged 14 - 17 years. All patients underwent femtosecond laser-assisted implantation of a single 210° arc-length Keraring segment according to the Q-N and were followed up for 6 months. All eyes underwent visual acuity measurement, cycloplegic refraction, and corneal topography at baseline and 6 months after surgery. Results: The study groups were comparable in terms of sex proportions and KCN grades (both P > 0.05). The adult group exhibited significant postoperative improvements in mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere, cylinder, spherical equivalent (SE), and Kmax (all P < 0.001) with a mean change of -0.56 logarithm of the minimal angle of resolution (logMAR), - 0.40 logMAR, 3.07 diopters (D), 0.70 D, 3.42 D, and - 5.26 D, respectively. The pediatric group exhibited significant postoperative improvements in mean UDVA, CDVA, sphere, SE, and Kmax (all P < 0.05) with a mean change of - 0.62 logMAR, - 0.34 logMAR, 3.18 D, 3.67 D, and - 5.37 D, respectively. There were no significant differences between the groups in terms of the mean change in visual, refractive, and topographic variables (all P > 0.05). No postoperative complications were observed in either group. Conclusions: Use of the objective Q-N was efficient in the treatment of pediatric KCN, with postoperative improvements in the mean visual, refractive, and topographic parameters, comparable to outcomes in adult keratoconus. Q-N achieved good corneal remodeling with subsequent improvements in visual, refractive, and topographic outcomes in both adult and pediatric patients with keratoconus. To verify our preliminary findings, we recommend further multicenter randomized clinical trials using the Q-N nomogram in a larger sample of pediatric patients with KCN as an adjunct treatment before or after CXL.

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OBJECTIVE: The increasing prevalence of type 2 diabetes mellitus (T2DM) calls for evolving a concomitant screening strategies for early disease detection and prediction of the complications. Progranulin (PRGN) was recently introduced as a biomarker of inflammation in T2DM. However, little data have been published as regarding progranulin in relation to diabetic micro angiopathy among Egyptian patients with T2DM. The aim of this study was therefore to investigate and evaluate serum progranulin as a biomarker for the presence and severity of micro vascular complications among Egyptian patients with T2DM. METHODS: A total of 90 age and sex matched participants were included in this cross sectional study. They were divided into group 1 included 30 non diabetic healthy controls and group 2 included 60 patients with type 2 diabetes mellitus. Furthermore, diabetic patients were categorized into two subgroups depending on the presence or absence of microvascular complications. Evaluation for diabetic nephropathy, neuropathy and retinopathy were determined. Furthermore, laboratory investigations were performed and serum progranulin levels were measured by a quantitative sandwich enzyme linked immune sorbent assay. RESULTS: The mean serum PRGN levels were significantly elevated in type 2 diabetic patients (20.90 ± 6.38 ng/ml) compared to control group (9.20 ± 1.41 ng/ml) (p < 0.001). Moreover,the serum PRGN levels were increased parallel to the severity of diabetic nephropathy (DN) and diabetic retinopathy (DR) with significantly highest detectable values were in macro albuminuric group of diabetic nephropathy as well as proliferative diabetic retinopathy (PDR) groups (P < 0.001). Besides, it worth mentioning that, the level of Serum progranulin started to increase significantly in stage 2 DN in spite of normal level of albuminuria. There were highly significant positive correlation between serum PRGN and disease duration, body mass index (BMI),fasting blood sugar (FBS), HbA1c, Total cholesterol (TC),triglyceride (TG), serum creatinine, ACR (r = 0.918, 0.623, 0.430, 0.539,0.910,0.842,0.759, 0.903, resp., P < 0.001) and a significant positive correlation with low density lipoprotein (LDL) (r = 0.344),but there was a highly significant negative correlation between serum PRGN and eGFR (r = -0.866, P < 0.001) in the studied diabetic patients. CONCLUSION: Progranulin might be considered as a biomarker for diabetic micro angiopathy and its severity. In addition, there is a group of diabetic patients with decreased eGFR but without albuminuria in which serum PRGN level was indicated to be used as an early biomarker of diabetic nephropathy.

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by alternating periods of activity and remission. Evaluation of the clinical activity of SLE is important for choosing the correct treat¬ment. Current blood biomarkers for assessing SLE activity are not highly sensitive or specific to changes in disease activity. Therefore, the search for clinically useful markers of its activity is ongoing. This study aimed to evaluate serum beta-2 microglobulin (ß2-MG) level in SLE patients and its relation to different clinical manifestations, laboratory parameters and disease activity using systemic lupus disease activity index (SLEDAI). The study included 40 SLE patients, divided according to SLEDAI into two groups: 20 active SLE patients with SLEDAI ≥4 and 20 inactive SLE patients with SLEDAI < 4. Also, 20 ages and sex matched apparently healthy individuals formed a control group. Serum ß2-MG levels (mg/L) were measured by MININEPHPLUS. Furthermore, laboratory investigations and fundus examinations were performed. The study revealed a significant increase in serum ß2-MG level in SLE patient groups (mean 6.77 ± 1.83 and 2.59 ± 0.43 mg/L), compared with the controls (0.82 ± 0.20mg/L, P=0.000), and its level increased in the active SLE group (mean 6.77 ± 1.83 mg/L) than in the inactive group of patients (mean 2.59 ± 0.43 mg/L). Serum ß2-MG levels were significantly higher in SLE patients with arthritis, cutaneous and/or mucosal manifestations, Lupus nephritis, and cardiac manifestations but not in patients suffering from hematological, neurological or ocular manifestations. In active SLE patients, serum ß2-MG levels correlated positively with SLEDAI, and ESR and correlated negatively with C3 and C4 complement. In conclusion, determination of ß2-MG concentration in SLE patients may be helpful in assessing the disease activity as its serum level was higher in SLE patients especially those with active lupus and correlated with certain clinical and laboratory parameters.

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