Investigating the Visual Status Of Preschool Children in Riyadh, Saudi Arabia

Retinoscopes: Past and present

BACKGROUND

Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills.

AIM

To discuss the history of retinoscopes and examine current literature on the subject.

METHODS

A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term "Retinoscopy," with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)].

RESULTS

This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope.

CONCLUSION

The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.

Prescribing patterns for hyperopia: an insight of the optometrist perspective and practice

BACKGROUND

To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current international guidelines. And explore the factors that influence practitioners' prescribing decision.

METHOD

This cross-sectional study employed 30 items online survey that encompass demographic data, current practice and cycloplegia use, numerical response to indicate the minimum level of hyperopia at which optometrists would consider prescribing spectacles to non-strabismic children and determine the diopter value required for prescribing correction for hyperopia if present with other factors.

RESULT

A total of 104 optometrists responded to the survey (52 females and 52 males). They recruited from 35 cities across Saudi Arabia. Out of total, 44% of them considered cycloplegic refraction essential under 12 years and 56% of them extended the range to 18 years. Large variation were found between the optometrists' responses and current guideline recommendations. Several factors influenced the decision-making of the practicing optometrist including signs and symptoms, bilateral hyperopia, average dioptric value, reading difficulty, and accommodative function.

CONCLUSION

There are some matches between the international guidelines and the practice patterns that followed by optometrists in Saudi Arabia, however, the optometrists did not report that they are following them purposefully. These findings highlight the need to improve optometrists' practice about spectacle prescription in pediatric population.

Knowledge, Attitude, and Practice of Parents Regarding Children's Eye Care in Al-Qunfudah Governorate, Saudi Arabia

BACKGROUND

Visual impairment and blindness have a long-term impact on children. Common causes include refractive error, amblyopia, and cataracts, all of which are preventable.

OBJECTIVES

This study aims to evaluate the knowledge, attitude, and practice of parents regarding children's eye care in Al-Qunfudah governorate, Saudi Arabia.

METHODS

A cross-sectional study was carried out on a convenience sample of 403 parents residing in the governorate of Al-Qunfudah. Data were gathered using a validated, self-administered online questionnaire that required participants' consent and ensured data confidentiality. IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States) was used to do the statistical analysis of the data.

RESULTS

This study included 403 participants; 41.2% of them were 36-45 years old, 75.9% were female, and 88.8% were married. Most of the participants had had their children undergo eye examinations (65%). A positive attitude about child eye care among the participants was observed in 48.9% of them, while the level of knowledge about eye care and its regular examinations was poor in 60% of the study sample. A significant positive correlation was detected between participants' attitudes and knowledge scores about the eye care of their children (r = 0.238, p-value = <0.001). Older adults (P = 0.004), those with employment (P = 0.004), and those with a history of children suffering from eye problems (P = 0.018) are associated with a positive attitude, while better knowledge is associated with the parent's age (P = 0.007) and higher education level (P = 0.047).

CONCLUSION

The knowledge and attitude of the parents regarding their children's eye care were suboptimal, and the main reason for conducting eye examinations on their children was the presence of active eye disease and a symptomatic child. Positive attitudes were more prevalent among those aged 36-45 years, employed, and with a higher number of children with eye problems. Those in the age group of 36-45 who had a bachelor's degree were associated with greater knowledge. There is an urgent need to educate parents about routine and recommended eye screening. Family physicians should conduct opportunistic eye screenings for children who attend primary healthcare facilities and provide parents with educational materials about common eye disorders and children's eye care.

Eye Care in Young Children: A Parents' Perspective of Access and Barriers

Purpose

To evaluate parental perspectives of accessing eye care for children aged under seven years.

Methods

The survey was conducted during September 2020 to March 2021 using online applications and distributed to parents whose children were between the ages of three and seven years. The survey included parents' background, their knowledge of the provision of eye-care services, and the possible barriers that existed to access eye-care services. The relationship between parents' knowledge, barrier scores, level of parental education, and demographic or socioeconomic status was assessed using nonparametric tests.

Results

In total, 1037 questionnaires were completed. The respondents were from 50 cities across Saudi regions. The participants' age was 39 ± 7.5 years, and 54% of them had at least one child under the age of seven (n = 564). Further, 47% had not taken their children for vision screening at reception/year one (n = 467). In addition, 65% of them were not aware of the mandatory screening program at reception/year 1; whereas, only 20% (n = 207) knew how to access eye-care services; and only 39% of the children had undergone any kind of eye or vision test. The pathways to eye care and the cost of eye services/glasses were the main limitations. The parents' responses were significantly influenced by their demographic and socioeconomic characteristics (Kruskal Wallis, P < 0.05).

Conclusion

There was a need for enhancing parent information on how to access eye care for young children and the currently available vision screening programs. Finally, a national protocol to cover the cost of the eye exam as well as spectacle prescription shall be proposed as a mean of incentive.

Perspectives and clinical practices of optometrists in Saudi Arabia concerning myopia in children

AIM

To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.

METHODS

An internet-based survey was distributed to all practicing optometrists in Saudi Arabia (n=1886). The survey contained questions related to 1) demographics, 2) knowledge about myopia and its associated complications, 3) current clinical care, 4) type and frequency of myopia treatment prescribed, and 5) potential barriers limiting treatment adoption.

RESULTS

The completed surveys were collected from 171 optometrists (9.06% response rate, 60% male). Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents. Cycloplegic refraction at initial visit was used by 59% of the respondents. The cover test was the most reported binocular vision test (83%), and 38% of optometrists did not perform any ocular biometrics. Two-thirds prescribed single-vision spectacles for children with myopia. Increased time spent outdoors was selected by 80% of the practitioners who prescribed myopia control treatment as the primary approach. Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.

CONCLUSION

The current optometric practices in Saudi Arabia require further investigation. Optometrists appear to be somewhat aware of myopia and the associated risks. However, most evidence-based myopia treatments are not being locally adopted, primarily because of lack of support, lack of experience, and limited availability.

Amblyopia and Routine Eye Exam in Children: Parent's Perspective

Amblyopia is a reduced best-corrected visual acuity of one or both eyes that cannot be attributed to a structural abnormality; it is a functional reduction in the vision of an eye caused by disuse during a critical period of visual development. It is considered the leading cause of visual defects in children. With early diagnosis and treatment, children with amblyopia can significantly improve their vision. However, if it is neglected and not treated during childhood, unfortunately, it permanently decreases vision. Therefore, prevention, detection, and treatment largely depend on parents. This article explores parents' perspectives on amblyopia and routine examination of their children's eyes. A cross-sectional study used an electronic questionnaire consisting of five main sections to assess the level of awareness of amblyopia among parents. As a result, a total of 325 participants were included in our analysis. 209 (64.3%) were mothers, and 116 (35/7%) were fathers. The age groups were 35-50 years of age (61.5%), 20-34 years (23.4%), and older than 50 years (15%). Participants with a history of amblyopia numbered 23 (7.1%), and 39 had an amblyopic child (12%). A good awareness level of amblyopia among parents was found in only 10 (3%) participants, a fair awareness level in 202 (62%), and 113 (35%) participants were classified as having a poor awareness level of amblyopia. Only 13.8% of the parents took their children for yearly routine eye exams, while the majority (72%) took their children only if they had a complaint, and 14.2% took them for eye checkups only before school entry. In conclusion, parents' awareness of amblyopia in Tabuk City, KSA, was low. In addition, a limited proportion of parents reported consistently taking their children for routine eye exams. Therefore, raising awareness should be considered in public education regarding the disease.

Pediatric spectacle prescription: Understanding practice patterns among ophthalmologists and optometrists in Saudi Arabia

PURPOSE

This study aims to understand the approach to prescribing spectacles for children and the interpretation of refractive errors among ophthalmologists/optometrists in Saudi Arabia.

METHODS

A cross-sectional survey was conducted between September and November 2018 using a database of online registrants for ophthalmologists and optometrists practicing in Saudi Arabia. The survey included 10 multiple-choice questions designed to elicit information about how ophthalmologists and optometrists deal with commonly encountered case scenarios covering different practical aspects of pediatric refraction. The responses were compared using the proportion of pediatric clientele received in the respondents' practices (Group A: <25%, Group B: 25%) and drawing upon concepts from the published literature.

RESULTS

One hundred and three participants, including ophthalmologists, specialists/registrars, and optometrists from across Saudi Arabia, participated in this survey. Approximately 25% were classified as Group A. Large discrepancies were observed between the participants' responses and actual practices based on guideline recommendations. Responses varied significantly between Groups A and B on certain issues pertaining to pseudomyopia (P < 0.001), anisometropia (P = 0.033), and high astigmatism (P = 0.023).

CONCLUSION

Practice patterns regarding pediatric spectacle prescription varied among ophthalmologists and optometrists in Saudi Arabia. The approach to managing refractive errors in children was better among ophthalmologists/optometrists servicing a larger pediatric clientele, suggesting the need to increase awareness among all groups of ophthalmologists/optometrists.

Prevalence of Refractive Errors among Children in Saudi Arabia: A Systemic Review

Introduction:

The aim of this review was to estimate the prevalence of refractive errors (RE) and uncorrected refractive error (URE) in school-aged children of 4 to 14 years of age in Saudi Arabia.

Methods:

An extensive search was performed for peer-reviewed studies with data from the Saudi population during the past 20 years. The Cochrane Library, Pubmed, and Embase databases were used. Two independent reviewers evaluated publications and extracted the data. The quality of the studies was evaluated based on a critical appraisal tool designed for systematic reviews. The pooled prevalence of refractive error, uncorrected refractive error and different types of refractive error were estimated by using the random-effects meta-analysis.

Results and Discussion:

Eight school-based studies were included in this review. Among the overall pooled population of 12,247childern, the estimated prevalence of refractive error was 17.5% (95% CI: 11.1- 25). In the five studies that reported uncorrected refractive error (N=10,198), the pooled prevalence was 16.8% (95% CI: 11.4 – 21.3). The overall prevalence of refractive errors was very similar among boys, 16.8 (95% CI: 10.8- 24.1), and girls, 17.7% (95% CI: 10.2 – 25.9). Myopia was the most prevalent refractive error and was present in 40.8% (95% CI: 16.1 – 69.9) followed by astigmatism 29.7% (95% CI: 6.1- 61.7) and hyperopia 28.3% (95% CI: 16.9 – 41.2).

Conclusion:

This review highlights the high prevalence of refractive errors and uncorrected refractive error among children in Saudi Arabia. More studies are required using standardised methods in different regions where there is a lack of information on UREs. It is recommended that vision screening programs of children for RE should be implemented at the community level and integrated into school health programmes in order to detect UREs and prevent amblyopia, which is one of the debilitating consequences of URE.