Psychological and Social Challenges Parents of Children With Strabismus Face in Qassim Region, Saudi Arabia: A Cross-Sectional Study.

Aim Strabismus or squint is when one eye is misaligned or looking in a different direction. Some people consider strabismus as a cosmetic problem, causing patients in this condition to be mishandled, especially children, which might affect their vision and their quality of life. This study aimed to evaluate the psychological and social challenges faced by parents of children with strabismus during the years 2020-2021. Subjects and methods This is a cross-sectional study conducted among parents who have children with strabismus onset from birth till the age of 16 years. A self-administered questionnaire was distributed among parents during their visits to the vision eye specialist center. The questionnaire included socio-demographic characteristics of patients with strabismus and a 12-item questionnaire to measure the psychological impact on the parents of children with strabismus. Results Out of the 105 respondents, 65.7% were fathers, and 55.2% had children aged six years old or less. The most prominent strabismus type was esotropia (where the eye turns inward; 38.1%), while the most common nature of strabismus was intermittent (76.2%). The mean total score of psychological impact was 36.2 (SD=8.15) out of 60 points, with 62.9% considered as having an average psychological impact. Moreover, 77.1% of the respondents believed that strabismus could be treated and improved. Conclusion There was a moderate psychosocial challenge among parents of children with strabismus. Out of all the subjects, mothers who had prior visits to government hospitals were noticed to be greatly affected psychologically as compared to other subjects.

Encounter glaucoma decision Aid trial.

PURPOSE: A decision aid facilitates patient engagement in the decision-making process in ophthalmic practice. In particular, patients with open-angle glaucoma will benefit from such an intervention as it enhances their knowledge, compliance, and satisfaction with the healthcare services. METHODS: The Encounter Glaucoma Decision Aid (GDA) was delivered to 145 patients with open-angle glaucoma at the King Khaled Eye Specialist Hospital. Evaluation was done using a pre-validated, semi-structured questionnaire. We compared the patients' knowledge, compliance, and decision conflict scale at baseline, before receiving Encounter GDA, and again three months later. RESULTS: The average age of the participants was 56.82 years. Most of the participants were male (67.6%). The mean duration since the participants were diagnosed with glaucoma was 9.39 years. After using Encounter GDA, 80% of participants had a statistically significant improvement in their level of knowledge, moving from poor to good (P = 0.001). There was also a statistically significant increase in adherence to medication, from 41.4% to 65.5% (P = 0.001). The decision conflict score decreased significantly after using Encounter GDA (before it was 60.94 ± 21.60 vs. after 19.18 ± 17.83). CONCLUSION: Using GDA cards as an educational measure has a significant effect on improving patient's knowledge and adherence to medications.

Awareness and practice regarding use of digital devices and ocular health among Saudi adolescents.

PURPOSE: To review the knowledge of ocular health and practices of digital device usage among adolescent Saudi Arabia population. METHODS: This cross-sectional web-based survey was conducted in 2021 at a university in central Saudi Arabia. We asked questions regarding demographics, knowledge related to computer vision syndrome (CVS), and the use of digital devices for participants' daily activities. The acceptable grades of knowledge ("excellent" and "good") and practice scores were associated with the determinants using the nonparametric method of analysis. RESULTS: Of 521 participating students, knowledge about CVS and its relation to digital device usage were excellent in 41 students (7.9%), good in 161 (39%), poor in 300 (57.6%), and very poor in 19 (3.6%). Twenty-eight (5.4%) students scored an "excellent" grade on practices for digital device usage, 216 (41.4%) scored "good," and 277 (53.2%) scored "poor." The knowledge score median was 1.0 (interquartile range 1.0; 2.0), and the practice score median was 6.0 (4.0; 9.0). Health studies students had better knowledge than other students (P = 0.004). Smartphone users had worse knowledge than users of other devices (P = 0.017). Females (P < 0.001) and health studies students (P = 0.004) were significantly associated with acceptable practices of using digital devices. CONCLUSIONS: Awareness of ocular health because of abuse of digital devices was poor among participating students. The practice of digital device use was not healthy and needed improvement through preventive measures and counseling.

Epidemiological Characteristics and Outcome of Open Globe Injuries in Tabuk City, Kingdom of Saudi Arabia: Retrospective Cohort Study.

INTRODUCTION: The objective of this study was to assess the epidemiological characteristics, clinical features and visual outcomes of open globe eye injury (OGI) in Tabuk, Saudi Arabia. METHODS: A retrospective chart review of OGI patients who had undergone operative repair of their injuries in Tabuk, Saudi Arabia. The collected data included patients' demographics, duration between trauma and presentation and the mechanism of trauma, wound location, extent of injury, presence of intraocular foreign body, and initial and final visual acuity data. RESULTS: Sixty-three eyes of 63 patients who were admitted for traumatic globe rupture were included; 84.1% were males and 39.7% were of pediatric age. Delay in seeking medical care for > 24 h was recorded in 4.8% of patients. The most common (42.9%) mechanism was blunt trauma followed by sharp trauma (38.1%) and projectile trauma (9.5%); 55.6% had the injury in zone 1. Intraocular foreign body was reported in 9.5% of patients. Intraocular foreign bodies were significantly more common in adults (p = 0.018) compared to children. Poor visual acuity was noted in 77.8% of patients upon presentation and 60.3% on last visit. CONCLUSION: The incidence of OGI was more common in males. The most common cause of OGI was blunt injury, and half of the injuries were in zone 1. Visual outcomes are guarded for most patients with OGIs.

Comparison of Glaucoma Therapy Escalation After Penetrating Keratoplasty to Descemet Stripping Automated Endothelial Keratoplasty for the Treatment of Pseudophakic Bullous Keratopathy: A Cohort Study.

PURPOSE: The purpose of this study was to compare glaucoma therapy escalation (GTE), graft survival, vision, and glaucoma following penetrating keratoplasty (PK group) and Descemet stripping automated endothelial keratoplasty (DSAEK group) to treat pseudophakic bullous keratopathy (PBK). METHODS: This cohort included cases of PBK managed with PK from 2009 to 2014. We compared the incidences and determinants of GTE, graft survival, and visual disability. P < 0.05 was statistically significant. RESULTS: There were 58 eyes in the PK group and 117 eyes in the DSAEK group. The incidence of GTE in the PK and DSAEK groups at the last follow-up was 34.2% (95% confidence interval [CI]: 19.5-48.9) and 46.6% (95% CI: 27.7-65.4), respectively. The risk of GTE was similar between the groups (relative risk [RR] = 1.36 [95% CI: 0.94-1.98], P = 0.12). GTE was significantly associated with graft survival in the PK group (RR = 3.25 [95% CI: 1.5-7.0], P < 0.001) and the DSAEK group (RR = 3.77 [95% CI: 2.6-5.6], P < 0.001). Glaucoma (P = 0.001) and previous keratoplasty (P < 0.001) were significant predictors for GTE. At the final follow-up visit, severe visual disability was not significantly different between the groups (RR = 0.9 [95% CI: 0.3-2.9], P = 0.88). There was a statistically significant improvement in vision after DSAEK (P < 0.001) but not after PK (P = 0.67). CONCLUSION: GTE was similar in eyes with PBK managed by PK or DSAEK. Glaucoma and previous keratoplasty were predictors of GTE post-keratoplasty. DSAEK gave better visual outcomes than PK for managing PBK.

Bullous choroidal detachment requiring drainage following endoscopic cyclophotocoagulation.

Endoscopic cyclophotocoagulation is a relatively safe cyclodestructive procedure with a lower complication rate compared to trans-scleral cyclophotocoagulation. Serous choroidal detachment is a complication that has been reported following endoscopic cyclophotocoagulation; however, it is usually mild and transient. A case of bullous choroidal detachment with a flat anterior chamber requiring drainage after endoscopic cyclophotocoagulation is presented, along with a discussion on the risk factors precipitating such complication.

Magnitude and Determinants of Computer Vision Syndrome among College Students at a Saudi University.

PURPOSE: To review students' perceived symptom-based computer vision syndrome (CVS) and its determinants and to suggest preventive measures. METHODS: This cross-sectional survey was conducted in 2021 at a university in Central Saudi Arabia. The presence and severity of symptoms related to CVS were investigated. The total CVS symptom score was the outcome variable. The CVS score was correlated to participants' demographics, visual habits when using digital devices, and knowledge about CVS. Due to skewed distribution, a nonparametric method was used for analysis. RESULTS: Overall, 521 students were surveyed. The prevalence of CVS based on at least one symptom was 96% (95% confidence interval 94.3-97.7). The median score was 8.0 (interquartile range 4.0-12.0). Of the 24 possible CVS scores, 42 students (8%) had scores of 18 or more (severe CVS). Being female (Mann-Whitney [MW] P < 0.001), being older (Spearman P < 0.001), refractive error (MW P < 0.001), the presence of dry eye (MW P < 0.001), using devices other than a desktop computer (KruskalWallis) P = 0.03), and more than 6 h constantly working with a device (MW P = 0.001) were correlated with a higher CVS score. Older age, female, refractive error, and using digital devices for more than 6 h were the independent and significant predictors of CVS in college students. CONCLUSION: Most of the students suffered from mild-to-moderate CVS symptoms. Health promotion for prevention and periodic ophthalmic consultations are recommended. Identified predictors should be the focus when implementing strategies to combat CVS in the adolescent Saudi population.

Contemporary management of refractory pediatric glaucoma.

PURPOSE OF REVIEW: The management of pediatric glaucoma poses a unique challenge in terms of maintaining lifelong vision and combating an aggressive scarring response from surgery. Contemporary literature regarding the surgical management of children with pediatric glaucoma who fail, or are at a high risk of failure, from conventional surgery is limited. The aim of this review is to highlight recent developments in relation to the current opinion regarding the management of children with refractory pediatric glaucoma. RECENT FINDINGS: Some studies have reported impressive success rates with circumferential trabeculotomy, even in eyes with previous failed surgery. Early results of deep sclerectomy in populations which may not respond well to conventional angle surgery are encouraging but data is limited for the pediatric age group. In compliant patients in whom multiple postoperative examinations under anesthesia are possible, trabeculectomy remains an effective procedure. Multiple recent studies have demonstrated that glaucoma drainage device (GDD) surgery is associated with 5-year success rates of over 70% in primary childhood glaucomas. SUMMARY: Glaucoma drainage device surgery is likely to remain a mainstay of surgical management for refractory glaucoma in older children. More prospective data are needed on the success of circumferential trabeculotomy, deep sclerectomy and micropulse laser in pediatric eyes with previous failed surgery. VIDEO ABSTRACT: http://links.lww.com/COOP/A34.

Quality of Life of Caregivers of Children With Glaucoma in an Arab Population: A Cross-Sectional Study.

BACKGROUND: To evaluate the quality of life (QoL) measures of caregivers of children with glaucoma using the Caregiver's Congenital Glaucoma Quality of Life (CarCGQoL) questionnaire. MATERIALS AND METHODS: This was a cross-sectional study undertaken at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. QoL of the caregivers, the main outcome, was assessed using the 20-item CarCGQoL questionnaire. Raw QoL scores of caregivers were converted to Rasch-calibrated interval level scores. A multiple linear regression analysis was performed to identify factors associated with caregivers' QoL. RESULTS: Eighty-five caregivers (46 fathers and 39 mothers) aged 42.5±7.5 years were included in the study. The mean QoL score of caregivers was 0.63 (±1.05). The presence of additional children with glaucoma in the household had the strongest negative relationship with caregivers' QoL [ß=-0.75, 95% confidence interval (CI): -1.22, -0.27; P=0.003]. A poor QoL was noted with mother caregivers (ß=-0.46, 95% CI: -0.87, -0.04; P=0.031) and those caring for blind children (vision <20/200 in the better eye) (ß=-0.52, 95% CI: -0.98,-0.05; P=0.030) when compared with their reference groups. A 22.3% variance in the QoL score was explained by these three factors (adjusted R=0.223). CONCLUSIONS: The QoL of caregivers of children with glaucoma was poor. Caregiver's relation to patients, additional children with glaucoma in the family and patient's vision in the better eye could influence a caregiver's QoL. Periodic evaluation of QoL of caregivers is recommended to plan counseling and other support services.

Ocular coherence tomography for the diagnosis of Descemet's detachment after deep sclerectomy and resolution after intracameral air injection.

PURPOSE: to report the use of optical coherence tomography (OCT) in a case of Descemet's membrane detachment (DMD) secondary to a nonpenetrating deep sclerectomy (NPDS) and the efficacy of intracameral air injection for management. OBSERVATIONS: DMD was identified by anterior segment OCT (AS-OCT) in a 61-year-old male patient who was blind in the right eye and had advanced open angle glaucoma. This patient underwent NPDS in the left eye and developed localized corneal edema postoperatively. Air was injected into the anterior chamber resulting in reattachment of Descemet's membrane and resolution of corneal edema. CONCLUSIONS AND IMPORTANCE: This case highlights the need for a high suspicion of DMD in cases of localized corneal edema after non-penetrating surgery. Following confirmation with AS-OCT, DMD can be successfully managed with air injection. DMD is a rare complication of NPDS with all the reported cases associated with implant. To the best of our knowledge, this is the first case report of NPDS without any type of implant.

Spontaneous glaucoma drainage device extrusion after early postoperative orbital cellulitis - Case report and literature review.

A 70-year-old glaucoma patient who underwent Ahmed Glaucoma Valve (AGV) implantation developed orbital cellulitis (OC) 5 days postoperatively. On presentation, the valve was not exposed and no intraocular involvement was noted. After successful treatment of OC with intravenous and oral antibiotics, the patient presented to the clinic with the AGV completely extruded from the eye. There are only 10 previous cases of OC reported in the literature following glaucoma drainage device (GDD) implantation and no previous reports of spontaneous AVG extrusion. Close observation and thorough evaluation of the tube and plate positions are warranted to achieve better outcomes.

Functional Visual Ability and Quality of Life in Children With Glaucoma.

PURPOSE: To evaluate the effect of glaucoma and its management on the functional visual ability (FVA) and the vision-related quality of life (VR QoL) in children 8-18 years of age. DESIGN: Cross-sectional study. METHODS: FVA was assessed using the Cardiff Visual Ability Questionnaire for Children (CVAQC) and VR QoL was assessed using the Impact of Vision Impairment for Children (IVI_C) tool. RESULTS: Eighty-five children 8-18 years of age were interviewed at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. Scores for FVA and VR QoL were decreased in children with glaucoma: median of CVAQC scores, -0.68 (interquartile range [IQR], -1.27 to 0.19; range, -3.00 higher visual ability to +2.80 lower visual ability); IVI_C mean score, 55.3 (standard deviation, 13.0; normal VR QoL, 96). Factors associated with significantly lower FVA and VR QoL included, lower best-corrected visual acuity (BCVA) (P < .0001 for both FVA and VR QoL), bilateral glaucoma (P = .04 for in FVA and P = .009 in VR QoL), and 3 or more glaucoma surgeries (P < .001 for both FVA and VR QoL). CONCLUSION: FVA and VR QoL as perceived by children with glaucoma are reduced. Children with lower BCVA, those with bilateral glaucoma, and those who had undergone 3 or more glaucoma surgeries had significantly lower FVA and VR QoL. Improving the QoL with psychosocial involvement and visual rehabilitation by the use of low-vision aids among children with glaucoma should be included in the treatment plan in addition to medical and surgical treatment.

Pathophysiology and management of glaucoma associated with phakomatoses.

The phakomatoses, encephalotrigeminal angiomatosis (ETA; Sturge-Weber Syndrome), neurofibromatosis type 1 (NF1 or von Recklinghausen disease), Von Hippel-Lindau (VHL) disease, tuberous sclerosis (TSC), oculodermal melanocytosis (ODM), and phakomatosis pigmentovascularis are a group of neurocutaneous disorders that have characteristic systemic and ocular manifestations. Through many different mechanisms, they may cause glaucomatous damage of the optic nerve and subsequent vision loss varying from mild to severe. Glaucoma commonly affects patients with ETA (43-72%), orbito-facial NF1 (23-50%), and ODM (10%). Rarely, it may present as neovascular glaucoma in VHL and TSC. In ETA, glaucoma typically occurs ipsilateral to the port-wine stain, which is caused by a mutation in the GNAQ gene. Specifically, mechanical malformation of the anterior chamber angle and elevated episcleral venous pressure has been implicated as causes of glaucoma in ETA. In NF1, which is caused by a mutation in the NF1 tumor suppressor gene, glaucoma commonly occurs ipsilateral to lid plexiform neurofibromas. Histological studies of eyes with NF1 have revealed direct anterior chamber infiltration by neurofibromas, secondary angle closure, fibrovascularization, and developmental angle abnormalities as mechanisms of glaucoma. Lastly, phakomatosis pigmentovascularis is a rare combination of ODM and port-wine stain. Affected patients are at very high risk of developing glaucoma. Despite the many different mechanisms of glaucomatous damage, management follows similar principles as that for congenital glaucoma and primary open angle glaucoma. First-line therapy is topical intraocular pressure-lowering eye drops. Surgical management, including goniotomy, trabeculotomy, trabeculectomy, and tube shunt placement may be required for more severe cases.

Bilateral Deep Sclerectomy with Microperforations as a Successful Secondary Procedure in Aniridia-Associated Glaucoma.

Aniridia-associated glaucoma is often refractory to medical treatment. Glaucoma drainage device surgery is often considered after failed angle surgery. However, the potential complications of tube surgery in young children are not negligible. The failure rate of conventional trabeculectomy may be high and can require close and multiple postoperative follow-up visits. Here, we describe a child with aniridia who achieved good short-term results with deep sclerectomy. A 14-month-old girl was referred to our unit following bilateral trabeculotomies for aniridia-associated glaucoma and persistent uncontrolled intraocular pressure (IOP) in both eyes. She underwent sequential bilateral deep sclerectomies with microperforations. The patient achieved normalized IOP in both eyes after 6-month follow-up without any complications. Deep sclerectomy, with microperforations, may be a reasonable surgical procedure to perform in children with aniridia with failed angle surgery before contemplating tube shunt surgery.

Meibography of Eyes With Sequelae of Trachoma.

PURPOSE: To study the effect of trachoma on meibomian glands using infrared meibography and to correlate the results with tear film parameters. METHODS: This is a prospective cohort study in which 86 eyes of healthy volunteers and 90 eyes with trachoma were included. Clinical assessment was performed including the following: slit-lamp examination looking for signs of sequelae of trachoma, tear breakup time (TBUT), superficial punctate keratopathy (SPK), Schirmer II test (with anesthesia), and meibum score. Noncontact meibography was performed on both upper and lower eyelids separately using the meibograde system, which involved distortion of the meibomian gland, shortening, and dropout. RESULTS: Lid margin abnormalities (telangiectasia, lid margin swelling, and hyperemia) were all significantly higher in the trachoma group. The mean SPK (1.36), meibum score (1.76), meibography dropout, distortion, shortening, and total meibography (8.19 for upper eyelids and 3.81 for lower eyelids) were all significantly higher in the trachoma group (P < 0.001) compared with the normal group were SPK (0.88), meibum score (0.16), and total meibography (1.24 for upper eyelids and 0.92 for lower eyelids). Mean TBUT (4.2 s) was significantly shorter in the trachoma group than in the normal group (10.3 s) (P < 0.001). There was no significant difference between both groups in the Schirmer II test. CONCLUSIONS: Meibography of patients with sequelae of trachoma was in agreement with the histopathologic studies. Upper eyelids were much more affected than the lower eyelids. TBUT, SPK, and meibum score were correlated with the status of meibomian glands and meibography, which were significantly different in the trachoma group.

Meibography for eyes with posterior blepharitis.

PURPOSE: To study the effect of posterior blepharitis on meibomian glands using infrared meibography and to correlate the results with tear film parameters. METHODS: This is a prospective cohort study. The study included eyes from two groups: 86 eyes of healthy volunteers' eyes and 72 eyes with posterior blepharitis. Participants were examined, and diagnosis of posterior blepharitis was achieved clinically based on signs of posterior blepharitis. Clinical assessment of dryness was performed including slit lamp examination looking for signs of posterior blepharitis, tear breakup time (TBUT), superficial punctate keratopathy (SPK), Schirmer II test (with anesthesia) and meibum score. Non-contact meibography was performed for both upper and lower eyelids using the meibo-grade system which involved distortion of meibomian gland, shortening and dropout. RESULTS: Lid margin abnormalities (Telangiectasia, lid margin swelling and hyperemia) were all significantly higher in the posterior blepharitis group. SPK, meibum score, meibography dropout, distortion, shortening, and total meibography were all significantly higher in the posterior blepharitis group as well as meibum score (P value < 0.001). TBUT was significantly shorter in the posterior blepharitis group (P value < 0.001). There was no significant difference between the two groups in Schirmer's II test. CONCLUSION: Meibography can be a helpful non-invasive tool for the clinical evaluation of the extent of the anatomical damage in patients having meibomian glands loss due to posterior blepharitis. Knowing the extent of damage in meibomian glands may help in selecting the appropriate treatment modality and expect the response to treatment in patients with posterior blepharitis.