The Effects of Cataract Surgery on Children's Vision: A Systematic Review.

Background: Five-fifths of all incidents of blindness in Saudi Arabia may be attributed to cataracts. Cataracts are the second major cause of blindness, responsible for 35.5% of cases. Therefore, the purpose of the research was to measure the visual acuity improvement after cataract surgery in children. Materials and Methods: This systematic review followed PRISMA guidelines for reporting systematic reviews. All procedures followed the recommendations of the Cochrane handbook. Studies of varying study designs, both published and unpublished, are included. Retrospective studies with outcomes of pediatric cataract surgery were identified from various databases. Result: After an initial screening, 108 out of 167 items were deemed unsuitable for publication. There were 59 full-text papers assessed for inclusion, and only seven matched the criteria. All the articles included were of a very high standard. Both the duration of therapy and the target population varied widely between the studies. Conclusion: The results indicated that the majority of childhood cataracts are hereditary. Primary posterior capsulectomy and anterior vitrectomy combined with cataract extraction and intra-ocular lens implantation is the treatment of choice for pediatric cataracts. It is recommended that surgery be performed in a properly equipped facility staffed by trained, cooperative personnel and that different procedures be used to enhance post-operative follow-up.

Satisfaction Rate After Laser Correction of Presbyopia (Presbyond) Among Patients Aged 40 Years and Older in Taif, Saudi Arabia.

Background Presbyopia is a physiological condition arising due to the loss of accommodation within the crystalline lens. One of the most widely accepted theories of the mechanism of accommodation was that in response to ciliary muscle contraction, the crystalline lens thickness increases, the lens diameter decreases, and both the anterior and posterior curvature of the lens increase, resulting in an increase in lenticular power therefore, accommodation. A contrasting theory suggests that ciliary muscle contraction leads to a selective increase in equatorial zonular tension, with the lens equator moving toward the sclera and the equatorial diameter of the lens increasing. This results in a change of lens optical power. Until now, clinical approaches to correct presbyopia have included monovision, multifocality, and extended depth of focus, all three of which can be achieved surgically on the cornea or by lens surgery. Methods This was a cross-sectional study adopted among patients who had Presbyond surgery in Taif City, Saudi Arabia, and were aged 40 years and older. The data was collected by conducting phone interviews to increase the response rate with a prepared questionnaire that was studied to achieve equality between participants to determine whether they were satisfied or not about the results after this surgery. The contact information was retrieved based on hospital records about patients who underwent Presbyond surgery. Data was analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). The data was collected for the period beginning on the first of January 2019 until the first of February 2023. Results From the study findings, a significant number of participants (28.1%, n=25) reported experiencing complete improvement and returning to normal life within 1-30 days after surgery. A slightly larger percentage (39.2%, n=35) experienced this within 1-3 months. Most of the participants (80.9%, n=72) reported an overall improvement in their quality of life after the surgery. This included activities such as reading and using a mobile phone. This indicates that the surgery had a positive impact on their daily lives and activities. In terms of recommendations, a total of 49 (55.1%, n=49) participants stated that they were very likely to recommend refractive surgery to a family member or friend experiencing vision problems. The study found that the mean patients' satisfaction score after one month of surgery is 2.494 units higher than the mean satisfaction score before surgery. This difference was statistically significant (p < .001). Conclusion The majority of participants did not experience any problems during the surgery, and most were able to resume their normal activities within a relatively brief period of time. The surgery achieved its goals for the majority of participants, resulting in an improvement in their quality of life. However, some short-term discomfort or adjustment period was reported. Overall, the participants were satisfied with the surgery, with the majority being very likely to recommend it to others. There is room for improvement in addressing concerns such as blurred vision, the need for glasses, and dry eyes. The study also found that patient satisfaction increased significantly after one month of surgery, and the timing of complete improvement and perception of achieving surgical goals were strongly associated with perceived outcomes.

Prevalence of refractive errors in school-going children of Taif region of Saudi Arabia.

PURPOSE: To determine the prevalence of refractive errors in the pediatric population in Taif, Saudi Arabia. METHODS: This cross-sectional study included 7356 eyes of 3678 primary and secondary school children (males = 1837; females = 1841) with a mean age of 11.8 ± 2.2 years (range: 7-18) (males = 11.4 ± 2.0 [range: 8-16]; females = 12.2 ± 2.3 [range: 7-18]). All participants were selected from the school registers. The participants underwent noncycloplegic refraction to determine refractive errors. Students who refused visual acuity assessment or eye examination and were inconsistent in visual acuity assessment were excluded. RESULTS: The manifest refraction spherical equivalent of the study population was 0.37 ± 1.52 D (range from - 18.4 to 8.8 D) (males = -0.32 ± 1.4 D [range - 15.88-8.8 D]; females = -0.42 ± 1.6 D [range - 18.38-8.0 D]). The overall prevalence of uncorrected refractive errors among school children in this study was 50.91%. The overall distribution of astigmatism (cylinder error of ≥0.50 D) in the current study population was found to be 50.14% (3688/7356 eyes). CONCLUSION: Nearly half of the study population in this area was affected with at least one type of refractive error. The findings reveal the necessity for implementing timely and sensitive screening programs/methods to identify and correct refractive errors in this age group.

Smartphone Use and its Impact on Ocular Health among University Students in Saudi Arabia.

BACKGROUND: People are increasingly using mobile phones rather than fixed telephones. Nearly everyone has a mobile phone and the vast majority of these are smartphone. The patterns of smartphone activities may put a significant number of populations especially students at risk of negative ocular problems. To determine the prevalence, pattern, and impact of smartphone use on ocular health among University students. METHODS: A cross-sectional study was conducted and 760 male and female students were selected from Medical and Pharmacy Colleges by multistage random sampling. A self-administered structured questionnaire including sociodemographic and visual manifestations data was used to collect data. SPSS program version 22 was used to analyze data. RESULTS: Out of 760 students selected, 546 (71.8%) responded. The overall prevalence of smartphone use was 90.84%. However, the age range for the beginning of smartphone use was 12-18 years old (68.3%). In addition, the daily duration of smartphone use was 4-6 h/day (30.2%). Furthermore, females believed that they use smartphone more than usual compared to males. Moreover, ocular pain and/or dryness after prolonged time spent on smartphone use were more among smartphone users (39.7%). Finally, most of the students (66.0%) had one or more ocular problems after smartphone use. CONCLUSIONS: There is an association between smartphone use and occurrence of ocular manifestations. Health education programs on smartphone use and its ocular hazards are highly recommended.

Prevalence of keratoconus among patients seeking laser vision correction in Taif area of Saudi Arabia.

PURPOSE: To determine the prevalence of keratoconus among patients seeking laser vision correction (LVC). METHODS: Retrospective study of 1374 eyes of 687 patients (335 males, 352 females) who underwent keratoconus screening as a part of routine preoperative evaluation prior to LVC at the Tadawi surgical centre, Taif, Saudi Arabia from January 2014 to June 2015. The diagnosis of keratoconus was based on evaluation of Pentacam derived parameters. RESULTS: Manifest keratoconus was found in 59 subjects (out of 687 subjects) representing a prevalence rate of 8.59%. Of the 687 subjects, 45 subjects (6.55%) had bilateral manifest keratoconus (manifest keratoconus in both eyes or manifest keratoconus in one eyes and sub-clinical in contralateral eye) and remaining 14 patients (2.04%) had unilateral manifest keratoconus (with normal fellow eye). Sub-clinical keratoconus was diagnosed in 65 patients representing a prevalence rate of 9.46%. Of the 687 patients, 20 cases (2.91%) with subclinical keratoconus were bilateral and 45 (6.55%) were unilateral. Overall, 19.70% males (66/335) and 16.48% (58/352) females had either manifest or sub-clinical keratoconus, representing no statistically significant difference in the gender predisposition of the keratoconus disease process (Chi Square test; p = .277). CONCLUSION: High prevalence of keratoconus was found among patients seeking LVC. Possible factors contributing to the high prevalence were recognized to be highly selective population (patients seeking LVC for myopia/hyperopia/astigmatism), ethnicity (high prevalence of consanguinity) and geographical location (high altitude) of the study subjects.

Relative Proportion Of Different Types Of Refractive Errors In Subjects Seeking Laser Vision Correction.

BACKGROUND: Refractive errors are a form of optical defect affecting more than 2.3 billion people worldwide. As refractive errors are a major contributor of mild to moderate vision impairment, assessment of their relative proportion would be helpful in the strategic planning of health programs. PURPOSE: To determine the pattern of the relative proportion of types of refractive errors among the adult candidates seeking laser assisted refractive correction in a private clinic setting in Saudi Arabia. METHODS: The clinical charts of 687 patients (1374 eyes) with mean age 27.6 ± 7.5 years who desired laser vision correction and underwent a pre-LASIK work-up were reviewed retrospectively. Refractive errors were classified as myopia, hyperopia and astigmatism. Manifest refraction spherical equivalent (MRSE) was applied to define refractive errors. OUTCOME MEASURES: Distribution percentage of different types of refractive errors; myopia, hyperopia and astigmatism. RESULTS: The mean spherical equivalent for 1374 eyes was -3.11 ± 2.88 D. Of the total 1374 eyes, 91.8% (n = 1262) eyes had myopia, 4.7% (n = 65) eyes had hyperopia and 3.4% (n = 47) had emmetropia with astigmatism. Distribution percentage of astigmatism (cylinder error of ≥ 0.50 D) was 78.5% (1078/1374 eyes); of which % 69.1% (994/1374) had low to moderate astigmatism and 9.4% (129/1374) had high astigmatism. CONCLUSION AND RELEVANCE: Of the adult candidates seeking laser refractive correction in a private setting in Saudi Arabia, myopia represented greatest burden with more than 90% myopic eyes, compared to hyperopia in nearly 5% eyes. Astigmatism was present in more than 78% eyes.

Comparison of microkeratome assisted sub-Bowman keratomileusis with photorefractive keratectomy.

PURPOSE: To compare the outcomes of photorefractive keratectomy (PRK) and thin-flap Laser-Assisted in Situ Keratomileusis/sub-Bowman keratomileusis (SBK) with intended flap thicknesses of 100 µm using the One Use-Plus SBK microkeratome. METHODS: Ninety-eight eyes of 52 subjects with myopic manifest refraction spherical equivalent (MRSE) of up to -5 diopters (D), a stable refraction for 1 year and a corrected distance visual acuity (CDVA) of at least 20/20 in each eye which had undergone SBK or PRK were reviewed retrospectively. Primary outcome measures were MRSE, uncorrected distance visual acuity (UDVA), CDVA, pachymetry and higher order aberrations (HOA). All patients were seen at 1 and 3 days, 1 week, and 1, 3, and 6 months after surgery. RESULTS: Both MRSE and UDVA showed a statistically significant improvement at postoperative 1, 3 and 6 months from baseline in both SBK and PRK groups. At postoperative 6 months, 100% of eyes were within ±0.50 D of attempted correction in both groups. However, SBK group demonstrated better outcomes with 81% of eyes within ±0.13 D, compared to 70% eyes in the PRK group. Both SBK and PRK group demonstrated similar refractive astigmatism accuracy at postoperative 6 months, with 88% of eyes having cylindrical error ⩽0.25 D. None of eyes lost any lines of CDVA in the PRK, and 2% eyes lost one line of CDVA in SBK group at postoperative 6 months. CONCLUSION: The visual and refractive outcomes after both PRK and microkeratome assisted SBK are comparable, albeit with a higher complication rate in the SBK group.

Viscoelastic substance in prefilled syringe as an etiology of Toxic Anterior Segment Syndrome.

CONTEXT: Toxic Anterior Segment Syndrome (TASS) is an acute postoperative inflammatory reaction in which a noninfectious substance enters the anterior segment and induces toxic damage to the intraocular tissues. OBJECTIVE: To present etiologic investigation of two consecutive clusters of TASS. TASS outbreak and investigation: This paper presents two consecutive clusters of TASS in 15 of the 24 uneventful surgeries and the investigation carried out to find the etiology. After the occurrence of first cluster of TASS, sterilization-related etiology was explored; however, we did not find any lacunae in the sterilization and cleaning process in the operating theater (OT). Nevertheless, multiple changes in cleaning process were implemented. Still a second cluster of TASS was encountered in the following session of OT. Several other factors which include preservatives, hand gloves, intraocular lenses, medications/solutions, intraocular penetration of topically administered drugs, and viscoelastics were investigated as the possible etiology of the second consecutive cluster of TASS; however, most of them were ruled out. The newly introduced viscoelastic I-visc® 1.4% sodium hyaluronate (I medical, i-Medical Ophthalmic International GmbH, Heidelberg, Germany) was thought to be the most likely cause and was replaced with previously in use sodium hyaluronate 1.5% and lidocaine hydrochloride 1% (Visthesia, CZ, Germany) in the following session of OT. No further TASS incident was encountered after replacing the viscoelastic. CONCLUSION: Investigation revealed that 1.4% sodium hyaluronate in prefilled syringe (PFS) (I-visc® 1.4%) was the etiologic factor of two consecutive clusters of TASS. While TASS due to residual denatured ophthalamic viscosurgical devices (OVDs) is a common knowledge, current study brings out that even disposable viscoelastic material supplied in PFSs can be an etiology of TASS. It is important to recognize that contamination of OVDs with endotoxins can occur at the time of manufacturing. Therefore, in the absence of appropriate guidelines for ophthalmic preparations, endotoxin limit for medical preparations (i.e. <0.5 endotoxin units/ml) must be considered during OVD manufacture.

Reproducibility of flap thickness in sub-Bowman keratomileusis using a mechanical microkeratome.

PURPOSE: To examine the predictability of flap thickness using a mechanical microkeratome (One Use-Plus) and identify factors related to variations in flap thickness in sub-Bowman keratomileusis (SBK). SETTING: Tadawi Surgical Center, Taif, Saudi Arabia. DESIGN: Retrospective case series. METHODS: Patients with a stable refraction for 1 year, corrected distance visual acuity (CDVA) of at least 20/20 in each eye, and minimum central corneal thickness of 480 µm in each eye had microkeratome-assisted SBK. Parameters included manifest refraction, uncorrected distance visual acuity (UDVA), CDVA, pachymetry, and higher-order aberrations (HOAs). RESULTS: Seventy eyes (36 patients) were enrolled. The mean flap thickness was 88.74 µm ± 15.40 (SD) and the mean change in HOAs, 0.11 ± 0.30 µm(2). There was no correlation between flap thickness and age (r = -0.10), preoperative manifest refraction spherical equivalent (MRSE) (r = -0.08), preoperative cylinder (r = 0.13), postoperative CDVA (r = -0.17), or postoperative change in HOAs (r = -0.07). A strong positive correlation with preoperative pachymetry (r = 0.41) and a weak negative correlation with preoperative sphere (r = -0.21) were observed. There was no or a moderate negative correlation of pachymetry with age (r = -0.14), preoperative sphere (r = -0.36), cylinder (r = -0.04), or MRSE (r = -0.36). CONCLUSIONS: The microkeratome was reliable with reasonable predictability for SBK flap creation. Extra caution in handling the flaps to avoid flap striae or tears is advised. Flap thickness correlated positively with preoperative pachymetry; however, the variation in flap thickness did not affect visual outcomes. FINANCIAL DISCLOSURE: The author has no financial or proprietary interest in any material or method mentioned.

Posterior chamber toric phakic IOL implantation for the management of pediatric anisometropic amblyopia.

PURPOSE: To report the outcomes of toric posterior chamber phakic intraocular lens (PIOL) implantation in children for the treatment of amblyopia due to anisometropia with astigmatism. METHODS: Six eyes of 6 amblyopic patients aged 5 to 15 years underwent toric PIOL (Visian Toric ICL; STAAR Surgical Company, Monrovia, CA) implantation for refractory anisometropic amblyopia. Preoperative and postoperative clinical evaluation included slit-lamp microscopy, visual acuity, anterior/posterior segment examination, and cycloplegic refraction. RESULTS: After a mean follow-up of 23 months (range: 15 to 34 months), mean spherical equivalent cycloplegic refraction improved from -10.21 ± 4.62 diopters (D) (range -7.5 to -19.5 D) preoperatively to -0.42 ± 0.39 D (range: -0.625 to +0.125 D) postoperatively. Corrected distance visual acuity ranged from 20/40 to 20/200 preoperatively and 20/20 to 20/60 postoperatively. Five of the 6 eyes gained more than 3 lines of corrected distance visual acuity with a maximum gain of 8 lines in one eye. One eye showed an improvement of more than 2 lines (change in preoperative visual acuity of 20/100 to 20/60 postoperatively). No patients lost any lines of visual acuity. All eyes remained quiet. All PIOLs remained well centered throughout the follow-up period. CONCLUSION: Toric PIOL implantation may be a viable therapeutic modality in children with clinically significant anisometropic ametropia and astigmatism with secondary amblyopia who have been refractory to medical treatment including spectacles or contact lenses. Longer follow-up visits with larger sample populations will evaluate more effectively the long-term efficacy and late-onset of complications.