Tarsal switch using an anterior approach to correct severe ptosis

BACKGROUND: To present the outcomes of the tarsal switch procedure using an anterior approach to correct severe ptosis with poor levator muscle function ( < 4 mm) with absent or poor Bell’s phenomenon. METHODS: This retrospective case series included 11 patients with severe neurogenic or acquired myogenic palpebral ptosis. All patients underwent the tarsal switch procedure through an anterior approach from 2012 to 2015. Margin reflex distance (MRD1 and MRD2) and the palpebral fissure were evaluated preoperatively and postoperatively. Data were compared using the Wilcoxon signed-rank test. P-values < 0.05 were considered to indicate statistical significance. RESULTS: Surgery was performed on 18 eyelids (11 patients). The median age at surgery was 57 years (range, 29-86 years). Four patients had unilateral ptosis and seven had bilateral ptosis. Nine patients had myogenic ptosis and two had neurogenic ptosis. Postoperatively, the chin-up position improved in all patients. The MRD1 increased statistically significantly, from 0 mm preoperatively to 1.0 mm postoperatively (P=0.001). The MRD2 decreased statistically significantly, from 4.5 mm preoperatively to 3.0 mm postoperatively (P=0.001). The palpebral fissure did not change (4.0 mm preoperatively to 4.0 mm postoperatively) (P=0.13). CONCLUSIONS: The tarsal switch procedure through an anterior approach is an effective alternative for correcting severe ptosis, especially neurogenic or acquired myogenic ptosis. This procedure can be performed with minimal risk of ocular surface exposure and provides stable outcomes.

Vision screening of ophthalmic nursing staff in a tertiary eye care hospital: outcomes and ocular healthcare-seeking behaviours

Objectives: This study aimed to evaluate ocular healthcare-seeking behaviours and vision screening outcomes of nursing staff at a tertiary eye care hospital

Methods: This study was conducted between April and September 2016 among all 500 nurses employed at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Data were collected on age, gender, use of visual aids, the presence of diabetes, a history of refractive surgery and date of last ocular health check-up. Participants were tested using a handheld Spot[Trade Mark Sign] Vision Screener [Welch Allyn Inc., Skaneateles Falls, New York, USA]

Results: A total of 150 nurses participated in the study [response rate: 30.0%]. The mean age was 41.2 +/- 8.9 years old. Distance spectacles, reading spectacles and both types of spectacles were used by 37 [24.7%], 32 [21.3%] and 10 [6.7%] nurses, respectively. A total of 58 nurses [38.7%] failed the vision screening test. Visual defects were detected for the first time in 13 nurses [8.7%]. With regards to regular eye checkups, 77 participants [51.3%] reported acceptable ocular healthcare-seeking behaviours; this factor was significantly associated with age and the use of visual aids [P <0.01 each]

Conclusion: A high proportion of participants failed the vision screening tests and only half displayed good ocular healthcare-seeking behaviours. This is concerning as ophthalmic nurses are likely to face fewer barriers to eye care services than the general population

Attitudes of Saudi Arabian undergraduate medical students towards health research

Objectives: This study aimed to evaluate attitudes, perceptions and perceived barriers towards health research among Saudi Arabian undergraduate medical students

Methods: This cross-sectional study took place between August and October 2014 and included 520 students from five medical schools across Saudi Arabia. An anonymous online survey with 21 close-ended questions was designed to assess students' attitudes towards research, contribution to research-related activities, awareness of the importance of research, perception of available resources/opportunities for research, appreciation of medical students' research contributions and perceived barriers to research. Responses were scored on a 5-point Likert scale

Results: A total of 401 students participated in the study [response rate: 77.1%]. Of these, 278 [69.3%] were female. A positive attitude towards research was reported by 43.9% of the students. No statistically significant differences were observed between genders with regards to attitudes towards and available resources for research [P = 0.500 and 0.200, respectively]. Clinical students had a significantly more positive attitude towards research compared to preclinical students [P = 0.007]. Only 26.4% of the respondents believed that they had adequate resources/opportunities for research. According to the students, perceived barriers to undertaking research included time constraints [n = 200; 49.9%], lack of research mentors [n = 95; 23.7%], lack of formal research methodology training [n = 170; 42.4%] and difficulties in conducting literature searches [n = 145; 36.2%]

Conclusion: Less than half of the surveyed Saudi Arabian medical students had a positive attitude towards health research. Medical education policies should aim to counteract the barriers identified in this study

Resources for eye care at secondary and tertiary level government institutions in Saudi Arabia

To evaluate the number of healthcare personnel and equipment resources for eye care at government institutions in different administrative zones of the Kingdom of Saudi Arabia [KSA] and to recommend measures for increasing resources to address deficiencies. Data on resources [personnel and equipment] for eye care were collected from all governmental eye units in 2012. The data was regrouped by zones and administrative areas. The mid-2012 population projections were used to calculate the ophthalmologist to population ratio and optometrist to population ratio. The equipment available for eye care was reviewed. All 60 institutions in 13 administrative areas and five zones of KSA participated in this study. There were 407 ophthalmologists and 147 optometrists. The ophthalmologist to population ratio was 1:43,000 [1:12,900 in the northern zone to 1:80,300 in the western zone]. By 2015, 700 ophthalmologists will be required, and by 2020, 1,100 ophthalmologists will be required. The optometrist to population ratio was 1:95,000 [1:34,100 in the northern zone to 1:146,700 in the western zone]. Nearly 2,800 and 4,400 allied eye care personnel will be needed by 2015 and 2020. Diagnostic and treatment equipment such as lasers, electrophysiologic and ultrasound equipment, and fundus cameras were not available at all institutions. Data from the private sector need to be included to draw conclusions on the human resource index for eye care in the Kingdom. An unequal distribution of resources in different zones and administrative areas requires attention. Better utilization of available resources is recommended before fulfilling the demand for additional resources.

Development of a web-based glaucoma registry at King Khaled eye specialist hospital, Saudi Arabia: a cost-effective methodology

In this brief communication, we present the steps used to establish a web-based congenital glaucoma registry at our institution. The contents of a case report form [CRF] were developed by a group of glaucoma subspecialists. Information Technology [IT] specialists used Lime Survey softwareTM to create an electronic CRF. A MY Structured Query Language [MySQL] server was used as a database with a virtual machine operating system. Two ophthalmologists and 2 IT specialists worked for 7 hours, and a biostatistician and a data registrar worked for 24 hours each to establish the electronic CRF. Using the CRF which was transferred to the Lime survey tool, and the MYSQL server application, data could be directly stored in spreadsheet programs that included Microsoft Excel, SPSS, and R-Language and queried in real-time. In a pilot test, clinical data from 80 patients with congenital glaucoma were entered into the registry and successful descriptive analysis and data entry validation was performed. A web-based disease registry was established in a short period of time in a cost-efficient manner using available resources and a team-based approach.

status of childhood blindness and functional low vision in the eastern mediterranean region in 2012

Childhood blindness and visual impairment [CBVI] are major disabilities that compromise the normal development of children. Health resources and practices to prevent CBVI are suboptimal in most countries in the Eastern Mediterranean Region [EMR]. We reviewed the magnitude and the etiologies of childhood visual disabilities based on the estimates using socioeconomic proxy indicators such as gross domestic product [GDP] per capita and <5year mortality rates. The result of these findings will facilitate novel concepts in addressing and developing services to effectively reduce CBVI in this region. The current study determined the rates of bilateral blindness [defined as Best corrected visual acuity[BCVA]] less than 3/60 in the better eye or a visual field of 10° surrounding central fixation] and functional low vision [FLV] [visual impairment for which no treatment or refractive correction can improve the vision up to >6/18 in a better eye] in children <15 years old. We used the 2011 population projections, <5year mortality rates and GDP per capita of 23 countries [collectively grouped as EMR]. Based on the GDP, we divided the countries into three groups high, middle- and low-income nations. By applying the bilateral blindness and FLV rates to high, middle- and low-income countries from the global literature to the population of children <15 years, we estimated that there could be 238,500 children with bilateral blindness [rate 1.2/1,000] in the region. In addition, there could be approximately 417,725 children with FLV [rate of 2.1/1,000] in the region. The causes of visual disability in the three groups are also discussed based on the available data. As our estimates are based on hospital and blind school studies in the past, they could have serious limitations for projecting the present magnitude and causes of visual disabilities in children of EMR. An effective approach to eye health care and screening for children within primary health care and with the available resources are discussed. The objectives, strategies, and operating procedures for child eye-care are presented. Variables impacting proper screening are discussed. To reach the targets, we recommend urgent implementation of new approaches to low vision and rehabilitation of children

Magnitude and determinants of refractive error among school children of two districts of Kathmandu, Nepal

The purpose of this study is to assess the magnitude and determinants of refractive error among school children of Lalitpur and Bhaktapur districts in Kathmandu Valley of Nepal. A descriptive study was carried out in 2003 in four schools; two in each district. A detailed ocular examination was conducted of all children attending these schools and that included visual acuity testing, slit lamp examination, fundus evaluation, retinoscopy cycloplegic refraction and subjective refraction. Myopia was defined as more than -0.5 D and hypermetropia was defined as error of more than +1 D. A total of 2000 students of 5-16 years of age were examined. The prevalence of refractive error was 8.60% [95% confidence interval [CI] 7.37-9.83]. The prevalence of myopia was 6.85% [95% CI 5.74-7.96]. The best-corrected visual acuity was 6/9 or less in the eye of 12.8% children with refractive error. Refractive error is of public health magnitude among school children of 14-16 years of age. School screening program in countries like Nepal for early detection of treatable disease is useful to detect and correct refractive error in older students

Magnitude and causes of low vision disability [moderate and severe visual impairment] among students of Al-Noor institute for the blind in Al-Hassa, Saudi Arabia: a case series

This study aimed to estimate the magnitude and causes of low vision disability [severe visual impairment [SVI] and moderate visual impairment [MVI]] among students at Al-Noor Institute for the Blind [NIB] in Al-Hassa, Saudi Arabia in 2006. An optometrist conducted refraction of 122 eyes of the 61 students [27 boys and 34 girls] with MVI [vision <6/18 to 6/60] and SVI [vision <6/60 to 3/60]. Ophthalmologists examined the anterior and posterior segments, and analysed the outcomes of additional investigations to finalise the diagnosis. The results were categorised as 'preventable', 'treatable' and 'not amenable to treatment'. The low vision care was also reviewed. In 12 [9.8%] eyes, visual acuity was >/= 6/18 and in 28 [23%] eyes, it was <3/60. MVI and SVI were found in 82 eyes [67.2%]. Hereditary retinal disorders were found in 68 [55.7%] eyes. Although refractive errors were found in 112 [91.8%] eyes, isolated refractive error was found in only 9 students. Congenital glaucoma and cataract were responsible for visual impairment in 16 [13.1%] and 9 [7.4%] eyes. These students were prescribed optical and non-optical low vision aids. Retinal disease was the main cause of SVI and MVI in our series. Some students at Al-Noor Institute for the Blind have curable low vision conditions. Rehabilitation of low vision disability should be different from that offered to the absolutely blind

Screening and public health strategies for diabetic retinopathy in the Eastern Mediterranean Region

Diabetic retinopathy [DR] is a complication of diabetes mellitus that can cause blindness. As the prevalence of diabetes increases globally and patients live longer, the cases of DR are increasing. To address the visual disabilities due to DR, screening of all diabetics is suggested for early detection. The rationale and principles of DR screening are discussed. Based on the available evidence, the magnitude of DR in countries in the Eastern Mediterranean region [EMR] is presented. Public health strategies to control visual disabilities due to DR are discussed. These include generating evidence for planning, implementing standard operating procedures, periodic DR screening, focusing on primary prevention of DR, strengthening DR management, health information management and retrieval systems for DR, rehabilitating DR visually disabled, using low-cost technologies, adopting a comprehensive approach by integrating DR care into the existing health systems, health promotion/counseling, and involving the community. Although adopting the public health approach for DR has been accepted as a priority by member countries of EMR, challenges in implementation remain. These include limitations in the public health approach for DR compared to that for cataract, few skilled workers, poor health systems and lack of motivation in affecting health-related lifestyle changes in diabetics.Visual disabilities due to DR are likely to increase in the coming years. An organized public health approach must be adopted and all stakeholders must work together to control severe visual disabilities due to DR

retrieval system for patients with avoidable blindness due to diabetic retinopathy who do not present for ophthalmic assessment in Oman

Many patients with diabetes do not present for eye examinations, foregoing the recommended management for diabetic eye care. Proactive steps are being taken in Oman to retrieve defaulters [patients who do not present or [no-show]] with Sight Threatening Diabetic Retinopathy [STDR]. We present the outcomes of the defaulter retrieval system in five regions of Oman in 2009. Ophthalmologists examine eyes periodically, family physicians focus on primary prevention of Diabetic Retinopathy [DR] and medical retina specialists manage DR in Oman. A person with proliferative stage of DR [PDR] and/or Diabetic Macular Edema [DME] in either eye is considered as STDR and is registered at regional hospitals. The eye care staff identify the defaulters and the hospital staff help them retrieve the defaulters. The reminder of reappointment is sent using the text messages on telephone. The glycemic control of STDR cases was also noted in Nizwa Hospital. We registered 654 STDR cases, of which 494 [75%] were defaulters. Lack of awareness, transport, absence of a decision maker, and fear of laser treatment were the main causes for defaulting. We successfully retrieved 328 [66.4%] defaulters. The retrieval rates among male and female patients were 51.2% and 82%, respectively. The retrieval varied by region. In Nizwa hospital, 114 of 131 STDR cases [85%] had poor glycemic control. Defaulter retrieval system could help healthcare providers to identify and motivate patients with STDR towards better compliance. Primary prevention measures among STDR cases were poor and need further focus

Prevalence and determinants of glaucoma in citizens of Qatar aged 40 years or older: a community-based survey

We present the prevalence and determinants of glaucoma among subjects 40 years of age and older in Qatar. This community-based survey was held in 2009 at 49 randomly selected clusters. Demographic details and history of glaucoma was collected by the nurses. Ophthalmologists evaluated the optic disc and retina using a digital camera housed in a mobile van. Visual field was tested with an automated perimeter, the intraocular pressure with an applanation tonometer and the angle of the anterior chamber by gonioscopy. A panel of glaucoma experts diagnosed subjects with glaucoma. This survey enrolled 3,149 [97.3%] participants. The age- and sex-adjusted prevalence of glaucoma in the population aged 40 years and older was 1.73% [95% confidence intervals [CI] 1.69-1.77]. Accordingly, 5,641 individuals in this age group in Qatar would have glaucoma. Chronological age of 60 years and older [Odds ratio [OR] 11. l] and the presence of myopia [OR 1.78] were predictors of glaucoma. Open-angle glaucoma was diagnosed in 44 [65.7%] individuals with glaucoma. In nine [13.4%] and 15 [20.9%] subjects, angle closure glaucoma and other [post-traumatic, pseudoexfoliation] glaucoma were present. Bilateral blindness [vision <3/60] and severe visual impairment [<6/60] were found in four [6%] and three [4.5%] subjects with glaucoma, respectively. Glaucoma was treated in 36 [54%] subjects. The prevalence of glaucoma among citizens of Qatar aged 40 years and older was 1.71%. Glaucoma was associated with the age of 60 years and older and the presence of myopia

Prevalence and causes of avoidable blindness and severe visual impairment in a tribal district of Maharashtra, India

We present the outcomes of a survey conducted in Nandurbar, a tribal district of Maharashtra, India. It was based on "Rapid Assessment for Avoidable Blindness" methodology and conducted in 2009 in Nandurbar, a tribal district of Maharashtra, India. We examined persons of 50 years and older ages. Ophthalmic assistants noted the distant vision [best corrected vision [BCV] and as presented]. Ophthalmologist examined eyes of persons with vision less than 6/18. The principal cause of impairment in each eye and the most "preventable" or "treatable" cause were assigned. We calculated the prevalence rates of bilateral blindness, severe visual impairment [SVI], and moderate visual impairment [MVI]. We examined 2,005/2,300 persons [response rate 87.2%]. The prevalence of blindness, SVI, and MVI for the BCV was 1.63% [95% CI 1.11-2.15], 5.93% [95% CI 4.96-6.90], and 14.6% [95% CI 13.2-16.1], respectively. The prevalence of blindness, SVI, and MVI for the presented vision was 1.87% [1.32-2.42], 6.72% [95% CI 5.70-7.74], and 19% [95% CI 17.4-20.6], respectively. Unoperated cataract was responsible for 77% of different visual disabilities. The coverage of existing cataract surgery service was 9.4%. Lack of knowledge about cataract surgery was the main cause of unoperated cataract among 41% of interviewed participants with cataract and SVI. Unoperated cataract was the main curable cause of visual disabilities in tribal population of India. Increasing awareness and offering cataract surgeries at affordable cost in the district would reduce visual disabilities

Ocular status and functional adaptation of visually challenged children of a special school in Oman

We assessed the ocular status and visual adaptation among children studying at a school for visually disabled children in Muscat, Oman. This descriptive study was conducted in 2009-2010. We assessed the visual and ocular status of the participants. They were interviewed to elicit the past history of eye problems and management. They also expressed their visual adaptation in their 'day-to-day' life, and their ambitions. We examined and interviewed 47 participants [29 male and 18 female]. The mean age of the participants was 19.7 years [Standard deviation 5.9 years]. Twenty-six of them were blind since birth. Phthisical eyes, disfigured eyes and anophthalmic sockets were noted in 19, 58, and six eyes of participants. Twenty-six [55.5%] participants had visual disabilities due to genetic causes, since birth. In 13 participants, further investigations were needed to confirm diagnosis and determine further management After low vision training, 13 participants with residual vision could be integrated in the school with normal children. One participant was recommended stem cell treatment for visual restoration. Five children were advised reconstructive orbital surgery. The participants were not keen to use a white cane for mobility. Some participants, 16 / 28 [57%], with absolute blindness, were not able to read the Braille language. Singing and playing music were not very well-accepted hobbies among the participants. Nineteen participants were keen to become teachers. Children with visual disabilities need to be periodically assessed. The underlying causes of visual disabilities should be further explored to facilitate prevention and genetic counseling. Participants had visual adaptation for daily living and had ambitions for the future

Knowledge of primary prevention of diabetic retinopathy among general ophthalmologists, mid level eye care personnel and general physicians in Oman

We present the outcomes of knowledge of diabetes and associated ocular complications among personnel comprising the eye care team in Oman. A closed ended questionnaire was administered during November 2008 and November 2009 to eye care team members in six regions of Oman, where trainings were held. All participants of these trainings were included in our study. The questionnaire comprised 15 questions that tested the knowledge of the diagnosis and treatment of diabetes and its ocular complications. They circled the most suitable reply for a list of choices. The replies were compared with the gold standard [answers from a medical retina specialist, a diabetologist's and general ophthalmologists answers]. The participants were divided into two groups; acceptable [more than 50% score compared to gold standard] and less than desired [less than 50% score compared to gold standard.] We estimated the areas of acceptable level of knowledge in different subgroups. All 87 [100%] of eye care team members participated. Of the 42 general ophthalmologists, 30 [71.4%] had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complication of diabetes. The acceptable level of knowledge among mid level eye care providers and general physicians was found in 15 [54.5%] and 4 [33.3%] respondents respectively. Less than the desired number of participants of the eye care team had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complications of diabetes. The training of eye care personnel need to enhance knowledge in the weak areas is identified in this study

Patient satisfaction regarding eye care services at tertiary hospital of central India

To evaluate patients' satisfaction regarding eye care services and suggest policy changes accordingly. Descriptive study. This study was conducted between September 2005 and June 2006. Patients attending the eye clinic of Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India, and admitted as in-patients in this hospital were our study population. Randomly selected patients were interviewed by trained staff. Close-ended questionnaire was used to conduct these structured interviews. Their responses were grouped into one of five categories and evaluated to determine satisfaction for different components of eye care services. Three hundred and twenty persons were interviewed. The satisfaction was of excellent grade among 77 [48.1%] patients attending clinic and 156 [97.5%] patients who were admitted in the hospital. The participants expressed dissatisfaction for the long waiting period in clinics, poor cleanliness, and insufficient toilet facilities. Those admitted in the hospital felt that food facilities were less than the expected quality. Child-friendly facilities received high satisfaction scores. Although eye care services both in clinics and in the wards were satisfactory according to the end-users, there are scopes for improvement. Patient satisfaction survey should be encouraged in hospitals for better accountability and also for strengthening the quality of eye care services

Refractive error and visual functions in children with special needs compared with the first grade school students in Oman

We evaluated the refractive status and visual function of children with special needs [other handicap] in 2010 and compared them with healthy 1[st] grade school students in Oman. This was a cohort study. Optometrists recorded vision using a logarithm of minimum angle of resolution [LogMAR] chart. Preferential looking method was used for testing 31 children. Cycloplegic refraction was performed on all children. Contrast sensitivity was tested using 2.5%, 10%, and 100% contrast charts. Ocular movement, alignment, and anterior segment were also assessed. A pediatrician reviewed the health records of all the children at the time of their enrollment in this study to determine if the child had been diagnosed with a systemic condition or syndromes. The visual functions were assessed by study investigators. We estimated the rates and the risk of different visual function defects in children with special needs. The prevalence of refractive error in 70 children [4.7 +/- 0.8 years] with special needs [group 1] and 175 normal healthy first grade students [group 2] were 58.5% and 2.9%, respectively. The risk of refractive error was significantly higher in children with special needs [relative risk, 48.1 [95% confidence interval, 17.54-131.8]]. Hyperopia [>1.00 D], myopia [? 1.00D] and astigmatism [>/= +/- 1.00 D] were found in 18.6%, 24.3%, and 27.1%, respectively, in group 1. Six children in this group had defective near vision. Sixteen [80%] children with Down syndrome had refractive error. Seven [50%] children with developmental disorder showed decreased contrast sensitivity. Prevalence of uncorrected refractive error was much higher in children with special needs. Prevalence of strabismus, nystagmus, and reduced contrast sensitivity was also higher in children with special needs. Early vision screening, visual function assessment, correction of refractive error, and frequent follow-up are recommended

Knowledge, attitude and practice regarding eye complications and care among Omani persons with diabetes - a cross sectional study

We present the level of Knowledge, Attitude and Practice [KAP] among diabetic patients regarding eye complications and their care. A cross sectional study was conducted in 2008 at seven regions of Oman. Arabic speaking nurses interviewed diabetics at clinics. They used a closed ended questionnaire with 15 questions. The responses were analyzed and the KAP were grouped into excellent [>80%], good [60 to 79%], average [40 to 59%], poor [20 to 39%] and very poor [<20%]. They were also compared among epidemiologic variants. Of the 750 participants, 'Excellent', grade of knowledge about diagnosis and eye care was present in 547 [72.9%] and 135 [18%] persons respectively. The 'excellent' grade of attitude about eye involvement and eye care was found in 135 [18%] and 224 [29.9%] participants. The practice for undergoing eye check up and accepting treatment was of 'excellent' grade in 390 [52%] and 594 [79.2%] respectively. Age [OR = 0.98], Sharqiya region [OR = 25] and '5 to 9' duration of DM [OR = 2.1] were associated with the knowledge. '<1 year' duration [OR = 0.3] and Dhakhiliya region [OR = 39] were associated with the attitude while '5 to 9 year' duration [OR = 3.4] was associated with better practices. Knowledge about eye complications and care is satisfactory among persons with diabetes. However, levels of attitude and practice were less than desired and should be improved. This could strengthen program approach for early detection and care of eye complications of diabetes in Oman