Visual acuity and refractive status of Omani students with refractive error in grades 1, 4 and 7: A retrospective cohort study.

BACKGROUND: The visual and refractive status were assessed for grade 7 students in seven governorates in Oman. The health records were reviewed to assess the rationale for their previous school-based vision screening. METHODS: A representative sample of 7(th) grade students with a refractive error (RE) was examined by optometrists in 2012. Their compliance with spectacle wear was also reviewed. Each student's vision and refractive status in grades 1 and 4 were compared with the status in grade 7. Each student's use of eye care services between grade 4 and 7 was evaluated to determine the uptake of existing eye services for vision problems. RESULTS: This study had 286, 7(th) grade students with RE (myopia [94%], hyperopia [4%] and astigmatism [>1D] [2%]). The types of RE between genders in each grade were not significant (P > 0.05). During their vision screening when they were in grade 4, 5 of 13 moderate myopes (>-2D to - 6D) and 3 of 4 high myopes (>-6D) were detected and managed. Ten students with moderate and high myopia were already using spectacles before they were screened in grade 7. The compliance for spectacle wear was 62% in grade 7. Between grades, 4 and 7, 140 (49%) students did not visit eye clinics or an optician. CONCLUSIONS: Refractive services in grade 4 were an additional initiative from the eye health care systems in Oman to the actual World Health Organization recommendations of conducting vision screening and RE corrections at grade 7 and 10. However, this was not proved to be significantly effective in early detection, and even the uptake of eye care services by school children was also low.

The impact of spectacle wear compliance on the visual function related quality of life of Omani students: A historical cohort study.

BACKGROUND: Eye screening and refractive services to students are part of a school health initiative in Oman. We evaluated the impact of the compliance of spectacle wear on the vision related quality of life (VFQ) among 12-13 years old and 15-16 years old Omani students with refractive error. MATERIALS AND METHODS: This historical cohort study was conducted in 2012. Students using spectacles and those not using spectacles after 1 year of prescribing/providing spectacles were interviewed to assess their VFQ. The VQ 20 questionnaire with 5 graded close-ended responses was adopted for this purpose. The responses for the VFQ related to different visual functions of students who were/were not spectacle wear compliant, were compared. RESULTS: Our cohort had 124 students in each group. The overall VFQ was significantly higher among the compliant spectacle wearers (compliant group) compared with the non-complaint wearers (non-compliant group) (relative risk [RR] =4.7% [95% of the confidence interval (CI): 2.8-6.6]). The association of gender and the grade level was not significant (P > 0.05). However, the variation of governorate was significantly associated to the difference of VFQ in both groups (χ(2) = 16.6, degrees of freedom = 4, P = 0.0003). The VFQ related to the near work (RR = 1.3) and school related activities (RR = 1.3) was better in the compliant group. CONCLUSION: VFQ was better among those students who were spectacle wear compliant compared with those who were not. VFQ related to near work and school related activities seem to be the most influenced by spectacle wear compliance.

Knowledge of Primary Prevention of Diabetic Retinopathy among General Ophthalmologists, Mid Level Eye Care Personnel and General Physicians in Oman.

OBJECTIVE: We present the outcomes of knowledge of diabetes and associated ocular complications among personnel comprising the eye care team in Oman. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Oman's progress towards reaching "Ultimate Intervention Goals" for the surgery "S" component of SAFE strategy for the elimination of blinding trachoma in 2008.

BACKGROUND: A community based survey for Trachomatous Trichiasis (TT) was conducted in the high (TT >5% in 1997) and meso endemic areas (TT 1% to 5% in 1997) of Oman during 2008-09. METHODS: Investigators examined Omanis 40 age years and older from randomly selected villages. Eyes were examined for TT and vision. The medical history of surgery and advice given for TT surgery were recorded. The TT cases that were unadvised by health staff were defined as un-approached cases. Cluster adjusted prevalence of TT and risk of TT by gender were estimated. RESULT: We examined 4,951 of 5,268 persons in high-endemic areas and 965 of 993 (97.2%) persons in meso-endemic areas. The cluster adjusted prevalence of TT in the high and meso endemic areas were 7.54% (95% Confidence Interval [CI] 6.78-8.30) and 1.69% (95% CI 0.88-2.50) respectively. There were 5 TT patients in high endemic areas and none in meso-endemic areas who were not approached or managed in the past. The prevalence of TT across all ages was less than 1 per 1,000 of the population in all wilayats of Oman. Females had a significantly higher risk of cluster adjusted TT compared to males (Odds Ratio = 1.87 [95% CI 1.85-1.89]). The prevalence of blindness was 0.5% among TT cases in high endemic areas. CONCLUSION: Oman seems to have reached the Ultimate Intervention Goals (UIGs) of the "S" (Surgery) component in 2008 in high and meso-endemic areas. The efforts of existing eye services could be better evaluated if un-approached TT cases are used to calculate the TT prevalence. Oman needs to focus more on females with TT to reach the UIGs.

Eye and vision defects in under-five-year-old children in Oman: A public health intervention study.

PURPOSE: To identify under-five-year-old children with vision or ocular defect in two provinces (Wilayats) of central Oman in 2006. STUDY DESIGN: Public health intervention study. MATERIALS AND METHODS: Ocular examination in Manah Wilayat was conducted by nursing staff of the primary health center (PHC) and in Mudhaiby Wilayat was conducted by a trainee Omani optometrist. Abnormal sized eyeball, strabismus, nystagmus and white pupil were recorded. Visual acuity was tested by LOGMAR chart with Lea's symbols in children >2 years of age and preferential viewing was assessed by Lea's grating paddle or 'Hiding Heidi' picture in children /=0.32 in 386/448 (86.2%) eyes. Preferential looking test suggested that half of the children had defective vision (>2cpcm). Screening at '1-2 year' and '3-4 years' age group could significantly predict eye problems (P

Hearing Health Practices and Beliefs among over 20 year-olds in the Omani Population.

OBJECTIVES: The objective of this study was to investigate hearing health practices and beliefs among people over 20 years old in the Omani population. METHODS: This descriptive study was conducted in Oman during 2007-2008. Arabic speaking health staff interviewed a total of 598 selected people from urban and rural Oman and also industrial workers using a closed ended questionnaire with 15 questions. Participants' responses to the hearing practice related questions were graded into excellent (≥20 points), average (10 to 19) and poor (<10 points). The responses to the questions about hearing beliefs were grouped into excellent (≥25 points), good (5 to 24), average (-4 to 4), poor (-24 to -5) and very poor (<-25) grades. We calculated the frequencies, percentage proportions and 95% confidence intervals of the different grades of beliefs and hearing practice. The rates were also compared among different subgroups. We performed regression analysis to identify predictors of good hearing practice and scientific beliefs. RESULTS: Among the 598 participants, an 'excellent' grade of hearing practice and belief was noted in 386 (64.5% [95% CI 60.7-68.4]) and average in 205 (34.3% [95% CI 29.5 - 37.1]). Being in the 20 to 39 years age group (OR =1.67) and an urban resident (OR= 0.53) were both predictors of an excellent grade of hearing practice, while male gender (OR = 1.71) and illiteracy (OR= 1.80) were predictors of scientific beliefs. CONCLUSION: We noted high levels of good hearing practice and low levels of modern scientific beliefs among Omani participants. The Ear Health Care program of Oman should focus on improving the knowledge about healthy hearing so that attitudes and hearing practices are improved and noise-induced hearing loss can be prevented or delayed.

Diabetic retinopathy and ocular co-morbidities among persons with diabetes at Sumail Hospital of Oman.

PURPOSE: We evaluated the magnitude of diabetic retinopathy (DR) and other ocular co-morbidities among patients with diabetes in 2006. We also assessed resources for eye care at Oman's Sumail Hospital. METHODS: We reviewed the DR register in May 2008. Physicians diagnosed diabetes. Ophthalmologists used a biomicroscope to identify ocular co-morbidities. The best-corrected vision of each eye was noted. DR grading, as recommended by the World Health Organization, was adopted. The prevalence of DR was calculated. Grades of DR were correlated to vision. Projections of patients with diabetes mellitus and DR were compared to the study outcomes. RESULTS: We randomly picked 418 (49%) of the 843 registered persons with diabetes for our study. The prevalence of DR was 7.9% (95% confidence interval 6.6, 9.2). Sight-threatening DR was found in 43 of 689 (5.3%) eyes. Prevalence of DR was 6.3% among persons with diabetes who were screened for the first time; it was 9.3% among those rescreened. Diabetic macular edema was present in 42 (5%) eyes. Patients with DR had a higher risk of blindness (vision less than 6/60) compared to those without DR (odds ratio 5.0; 95% confidence interval 3.74, 6.69). Laser surgery had to be used for 85 (20.3%) DR patients. Early cataract and trachomatous corneal opacities were main co-morbidities. CONCLUSIONS: The coverage of screening for diabetes and DR in our study area was less than the national coverage. Better management facilities for DR could improve patients' eye care at Sumail Hospital. Good vision in persons with diabetes could be a reason for them not accepting regular eye check-ups and laser treatment.

Visual function and ocular status of children with hearing impairment in Oman: a case series.

Visual functions of children with hearing disability were evaluated in a school of Muscat, Oman in 2006. Two hundred and twenty-three children were tested for near vision, distant vision, contrast sensitivity, color vision, field of vision, motion perception and crowding. Profound and severe hearing loss was noted in 161 and 63 students respectively. Thirty-five (81%) students with refractive error were using spectacles. Color vision and field of vision was defective in one student each. In 286 (64.1%) eyes, contrast sensitivity was defective. Abnormal contrast sensitivity was not associated with the severity of hearing loss [RR = 1.04 (95% CI 0.91 to 1.29)]. Children with hearing impairment should be assessed for visual functions. Refractive error and defect in contrast sensitivity were unusually high among these children. In addition to visual aids, we recommend environmental changes to improve illumination and contrast to improve the quality of life of such children with double disability.

Prevalence and pattern of alternative medicine use: the results of a household survey.

BACKGROUND AND OBJECTIVES: Alternative medicine (AM) encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community. SUBJECTS AND METHODS: A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire. RESULTS: Of 1408 individuals participating in the study, 39% were men. The mean (+/-SD) age for the study population was 35.5 (+/-13.9) years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM (50.3%), followed by honey (40.1%), black seed (39.2%) and myrrh (35.4%). The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians. CONCLUSIONS AND RECOMMENDATIONS: There is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system.

Prevalence and distribution of active trachoma in children of less than five years of age in trachoma endemic regions of Oman in 2005.

BACKGROUND: Oman aims to achieve "Elimination of Blinding Trachoma" by 2010. For accreditation purposes, a trachoma survey was conducted in Oman in 2005, targeting children younger than five years. It was conducted in twenty wilayats (districts) of three trachoma endemic regions. The Omani children were surveyed at health institutions during a 'Polio Supplementary Immunization Campaign.' The authors present the outcome of this survey and recommend policies for trachoma control in the study area. METHODS: Eye health care supervisors examined Omani children sequentially in health centers. However, the timings and days of visit to these health centers were selected randomly. The presence of trachoma follicular (TF) was noted in the tarsal area. The prevalence of TF was calculated and its distribution was mapped. RESULTS: The coverage for the immunization of children of less than five years of age residing in the study area was greater than 97%. For trachoma evaluation, 4,205 children were examined. The prevalence of TF in children of less than five years of age was 0.59% (95% CI; 0.40-0.88). Sumail, Hamra and Izki wilayats of Dhakhiliya region and Barka and Al Awabi Wilayats of South Batinah region had a prevalence of TF greater than 1%. No wilayat of North Sharqiya region had > or =1% TF. The gender variation in TF was not significant. (RR = 0.97 [95% CI 0.46-2.05]). CONCLUSIONS: All the Wilayats of trachoma endemic regions of Oman seem to have a prevalence of TF lesser than 5%. The data on TF in children aged between six and ten will enable us to determine whether Oman has achieved the Ultimate Intervention Goals (UIGs) for the provision of antibiotic treatment for acute infection (the "A" component of the SAFE strategy for the "Elimination of Blinding Trachoma" for the year 2005). Such initiatives of trachoma screening during a supplementary vaccination campaign could prove a cost-effective approach for determining the trachoma status of a country.

Recurrence of trachomatous trichiasis 17 years after bilamellar tarsal rotation procedure.

PURPOSE: In 1989, World Health Organization consultant operated on trachomatous trichiasis (TT) cases in Dhakhiliya region of Oman. We evaluated their current ocular status. DESIGN: This was an historic cohort study. METHODS: This study was conducted in an in-house setting. Ninety-one patients with TT who underwent operation by the bilamellar tarsal rotation procedure (BTR) were our study population. Their preoperative, operative, and immediate postoperative data were retrieved from the register. Staff members located and visited these patients. They examined the eyes and determined their visual, TT, and corneal status. They interviewed participants with a close-ended questionnaire to assess the quality of life and satisfaction for the TT services that were offered. RESULTS: Sixty-three patients could be followed. Among 72 eyes that had undergone operation 17 years earlier, the recurrence rate was 47.2% (95% CI, 35.7-58.8). In 21 unoperated eyes (55%), TT was noted. The association of TT recurrence to age, gender, type of TT, conjunctivitis, and active trachoma was tested. The BTR for minor trichiasis was the risk factor for recurrence of TT (adjusted odds ratio, 3.9; 95% CI, 1.4-10.8). CONCLUSION: The high recurrence rate of TT, 17 years after BTR surgery and high rates of TT in eyes that did not undergo surgical procedure earlier suggest that the causes of high recurrence should be identified and addressed. The ongoing pathologic condition of scarring of upper lids of both operated and unoperated eyes could be responsible for lid status after 17 years of BTR surgeries. High percentage of refusals because of long-term high recurrence could pose a challenge to reach the "elimination of blinding trachoma" by 2020.

Determinants of myopia among Omani school children: a case-control study.

BACKGROUND: Our aim was to determine risk factors for myopia in students of 10th grade of eight regions of Oman. METHODS: This was a case control study. Students of 10th grade with and without myopia were cases and controls respectively. In 2002 to 2003, their vision, refractive status, and physical measurements were recorded. The health records of all students were reviewed for their ocular and physical status in the 7th grade. The association of myopia to anthropometric variables, "Protein Energy Malnourishment" status, gender, history of myopia in parents and sibling, trachoma, and allergic conjunctivitis were analyzed. RESULTS: Myopia in students was significantly associated to myopia in parents [OR = 2.11 (95% CI 1.8-2.47)] and their siblings [OR = 2.87 (95% CI 2.45-3.35)]. Height was significantly higher in myopes compared to non-myopes both at the 10th and 7th grades. Weight and body mass index were greater in myopes than non-myopes only at 7th grade. Myopia in parents and siblings and female gender were predictors of myopia in the students. CONCLUSIONS: Hereditary and anthropometric factors seem to be associated with myopia in Omani children. The genetic etiology needs further confirmation.