Knowledge, Attitude, and Practice Regarding Vision and Eye Screening of Preschool Children Among Primary Health Center Staff in the Qassim Region, Saudi Arabia

Purpose To study the knowledge, attitude, and practice (KAP) regarding vision and eye screening of preschool children among primary health center (PHC) staff in Qassim, Saudi Arabia.  Methods A survey of PHC staff was conducted in 2023. The questionnaire included knowledge (10), attitude (five), and practice (five)-related questions associated with preschool vision and eye screening. A five-graded Likert scale was used for responses. Cronbach's alpha score of the questionnaire was 0.776. The KAP score was correlated with the demographic variables of participants. The current and desired sources of information were also collected.  Results We surveyed 101 health staff (66 doctors and 35 nurses). The median (interquartile range) knowledge, attitude, and practice scores of participants were 4.1 (3.8; 4.3), 4.2 (4.0; 4.6), and 3.6 (3.0; 4.0), respectively. The doctors had better knowledge (Mann-Whitney U test (MW), P = 0.016) and attitude (MW, P = 0.019) than the nurses. Staff above 40 years had better knowledge (Kruskal-Wallis H test (KW), P = 0.035), attitude (KW, P = 0.017), and practice (KW, P < 0.001). The primary source of information about preschool vision screening was their medical education (51%). Other sources were eye care professionals (11.9%), Google and computers (12.9%), and social media (14.9%). Their preferred sources of information were medical journals (25.7%), eyecare training (22.8%), and eye professionals (33.7%). Conclusions Knowledge and attitude for eye and vision screening of preschool children was high, but practices were less among PHC staff. Providing information through their preferred mode could further strengthen eye care for preschool children.

Spontaneous Recovery of Inferior Oblique Overaction in Three Saudi Children: A Case Report

The inferior oblique muscle overaction (IOOA) results in eye elevation on adduction, head tilt, difficulty in reading/writing, and changing ocular alignments in different gazes. Surgical correction is the management. We present two cases of bilateral and one case of unilateral IOOA that resolved spontaneously, and surgery differed. There was no IOOA six months after diagnosis. A sustained resolution IOOA following correction of hyperopia, improvement of vision, and esotropia correction possibly leading to rebalancing and maturing of extraocular muscles. Ophthalmologists should refer all IOOA cases to strabismologists, should not hurry to operate, counsel parents, and monitor a child's ocular movements.

Parent's Awareness of Preventive Measures for Digital Eye Strain Syndrome among Saudi Students after 1 Year of Online Studies - A Survey

PURPOSE

The digital eye strain (DES) is of public health magnitude in students undertaking online studies during the COVID-19 pandemic. The DES prevention strategies will be effective if all stakeholders, including parents, work together. We present an awareness level of preventive measures among parents of students studying online for 1 year.

METHODS

This web-based survey was held in December 2021. Parents of Saudi students in the Qassim region responded to 15 questions about the preventive measures for DES. The responses were summed up and graded into very poor, poor, good, and excellent. The level of awareness was associated with determinants.

RESULTS

The awareness was excellent in 566 of 704 (80.4%) (95% confidence interval 77.5-83.3) participants. Parents had poor awareness about the importance of the 20-20-20 rule (43.8%), frequent blinking (56.7%), using digital devices beyond studies (57.4%), using eye lubricants while using a digital device (56%), and using devices at night in lying position (69.6%). Excellent awareness was significantly associated with primary-level students (P = 0.0004), those having ophthalmic consultation in the past (P = 0.02), and students with DES (P = 0.0006). Parents with excellent awareness were not satisfied with online studies of their wards (P = 0.001).

CONCLUSION

Awareness of parents about preventive measures to address DES in students is relatively high. However, health promotion is recommended, especially focusing on the weak areas to improve DES and its impact on students.

Infected conjunctival pyogenic granuloma at strabismus surgery site mimicking conjunctival abscess

We present a rare case of infected pyogenic conjunctival granuloma mimicking a conjunctival abscess as complication of strabismus surgery in a Saudi girl with exotropia. Despite administration of local antibiotics following strabismus surgery, a patient presented with localised redness and discharge after three weeks. The patient was afebrile with no signs of pre-septal or orbital cellulitis. After culture (Staphylococcus aureus) sensitivity testing the patient was prescribed oral Amoxicillin and Clavulanate and reviewed under general anaesthesia. A 55 mm² conjunctival pyogenic granuloma was noted. A punch biopsy specimen indicated inflammatory and histiocytic cells. The addition of steroid to the medical therapy resulted in a quiet eye after three weeks.

A Comparison of Rebound to Indentation Tonometry in Supine Sedated Children with Glaucoma

PURPOSE

To compare intraocular pressure (IOP) measurements by rebound tonometry (Icare PRO; Icare Finland Oy, Helsinki, Finland) to measurements by indentation tonometry (Pneumotonometer Model 30 classic and Tono-Pen XL; Reichert, Buffalo, NY, USA) in supine sedated children with glaucoma.

METHODS

Prospective comparative observational study of Saudi Arabian children with glaucoma undergoing chloral hydrate sedation for ophthalmic examination (February 2012 - February 2013). Nonglaucomatous eyes were included as controls. Eyes with corneal scars or prior corneal transplant or lamellar surgery were excluded.

RESULTS

Fifty-two eyes (26 OD, 26 OS) of 28 children were included. Thirty-six eyes had glaucoma (32 primary congenital glaucoma, two Sturge-Weber related, and two aphakia related). Sixteen eyes did not have glaucoma (six with pediatric cataract, five normal eyes, two strabismic eyes, two eyes with simple megalocornea, and one eye had peripheral corneal laceration repair. In the glaucoma group, the mean IOP was 17.55 ± 5.97 mmHg (range, 8-31.5 mmHg) with the Icare PRO and 20 ± 6.4 mmHg (range, 8-35.5 mmHg) with the Pneumotonometer from 20.47 ± 6.81 mmHg (range, 10-43 mmHg) with the Tono-Pen XL. The Icare PRO readings were significantly lower than each of the indentation tonometers. For the control group, there was no statistically significant difference in IOP measured by the Icare PRO and the indentation tonometers.

CONCLUSIONS

In this population of supine sedated children with glaucoma, IOP measurements with the Icare PRO tend to be lower than readings from the Pneumotonometer and Tono-Pen XL.

Vitreous hemorrhage in pediatric age group

Purpose. To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes. Procedure. A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010. Results. A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases. Conclusion. Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases.

False amblyopia prediction in strabismic patients by fixation preference testing correlates with contralateral ocular dominance

BACKGROUND

Binocular fixation preference testing is commonly used to predict strabismic amblyopia in preverbal children. However, false positives can occur and can lead to unnecessary patching treatment. We explored potential causes for this phenomenon.

METHODS

In this prospective cohort study (2013-2014) of consecutive verbal strabismic patients without incomitance or decreased vision other than strabismic amblyopia, binocular fixation preference testing was graded from 1 (strong preference) to 4 (free alteration), with grade 1 or 2 considered predictive of amblyopia and the examiner masked to visual acuity. These results were compared to the presence/absence of true strabismic amblyopia. Ocular dominance and hand dominance were assessed, and previous patching history was documented.

RESULTS

Of 114 enrolled subjects (mean age, 7.9 years; range, 3.4-22.4; 63 males), 98 (86%) had esotropia and 16 (14%) had exotropia (mean primary position horizontal strabismus, 27.9(Δ); range, 8(Δ)-70(Δ), with only one <10(Δ)). For the 39 false positives (34%), the fixating eye correlated with ipsilateral ocular dominance (79.5%; P < 0.0001 [χ(2)]) but not with hand dominance or recent patching history. Positive predictive value was poor (45.8%; 95% CI, 34.0%-58.0%), but negative predictive value was high (97.6%; 95% CI, 87.4%-99.6%). Subgroup analysis revealed no significant correlations with degree or type of strabismus.

CONCLUSIONS

False positives during binocular fixation preference testing of strabismic patients are common and likely due to contralateral ocular dominance. The test is more useful for predicting the absence rather than the presence of strabismic amblyopia.

Postoperative suprachoroidal hemorrhage in a glaucoma patient on low molecular weight heparin

Suprachoroidal hemorrhage is a complication associated with intraocular surgery that can occur both intraoperatively and postoperatively. Several intraoperative or postoperative risk factors have been indentified. The use of low-molecular weight heparin (LMWH) is considered one of the risk factors in surgical cases (ocular or non ocular) and non-surgical cases. Here we present a case of suprachoroidal hemorrhage in a glaucoma patient that occurred after preoperative prophylactic LMWH for deep venous thrombosis. The use of LMWH has been reported to cause suprachoroidal hemorrhage even in patients without any risk factors. The use of LMWH continues to increase, hence it is important to be aware of the possibility of suprachoroidal hemorrhage and to determine the risk/benefit ratio, especially in patients with other risk factors.