Evaluation of convergence, accommodation and fusional vergence in pre-presbyopes with asthenopia

Background: Pre-presbyopes may suffer from ocular symptoms such as asthenopia of near work. Aim: This study aimed to evaluate near points of convergence, amplitudes of accommodation, and fusional vergence among pre-presbyopes with asthenopia symptoms. Setting: The study was conducted at El-Walidain Eye Hospital, Khartoum, Sudan in 2022. Methods: The study was a hospital-based prospective, including 107 pre-presbyopes aged 35–40 years who complained of asthenopia symptoms. Clinical examinations included an assessment of amplitude of accommodation, near point of convergence and fusional vergence. Results: The findings showed receded in near points of convergence and a decrease in the accommodation was highly significantly associated with increased age among emerging presbyopes with asthenopia symptoms (p = 0.0001). Conversely, positive and negative fusional vergence amplitudes were not significantly correlated with age with p = 0.109 and p = 0.355, respectively. Positive and negative fusional amplitudes were not significantly different between males and females (p ˃ 0.05). Esophoria was more common in pre-presbyopia 62 (57.4%) and exophoria 45 (43.6) with p = 0.503. Conclusion: The pre-presbyopes presented with low accommodation amplitude and receded near point of convergence, but without significant changes in positive and negative fusional vergence amplitudes. Contribution: This study added by demonstrating how early presbyopia altered accommodation amplitude and near point of convergence significantly while having no significant impact on amplitudes of positive and negative fusional vergence

Building consensus for the development of child eye care services in South Darfur State of Sudan using the Delphi technique

Background: Global estimates suggest there are almost 19 million visually impaired children worldwide, most of whom reside in poor countries, with the major cause being treatable. Aim: To determine the barriers to accessing childhood eye care services and to develop an eye care plan for children in South Darfur State, Sudan. Setting: The study took place in South Darfur State, Sudan. Methods: The classical Delphi technique was used to build consensus on a list of statements, which were generated based on the themes established by the experts, as well as on an extensive literature review. Results: Response rates ranged from 90% in the first round (n = 18), 100% in the second round (n = 18) to 89% in the third and final round (n = 16). The total number of statements recommended by the Delphi panellists for development of the paediatric eye care plan, was 60 based on a consensus level of 80% agreement or more. The expert’s consensus on the following key elements for promotion and improvement of child eye care: The main barriers to accessing child eye care were high poverty rate, unavailability of child eye services and a lack of community awareness. The challenges facing visually impaired children were an absence of paediatric ophthalmologists, low vision and orthoptic services. Conclusion: The main barriers to accessing child eye care services were financial, clinical access and lack of knowledge. There should be greater collaboration between the Ministries of Health, Education and non-governmental organisations (NGOs), to work together in addressing these barriers

Parents’ Awareness of and Perspectives on Childhood Refractive Error and Spectacle Wear in Saudi Arabia

Objectives: This study aimed to assess parents’ awareness of and perspectives on childhood refractive error in Saudi Arabia. Methods: This cross-sectional study included parents from different regions of Saudi Arabia was conducted between October and November 2020 and included 358 parents. Data were collected using an online questionnaire that involved questions to assess parents’ knowledge and perceptions of childhood refractive error and spectacle wear. Results: A total of 358 completed questionnaires were obtained in this study with a response rate of 85%. Almost 38.3% of parents reported that they had never heard of refractive error. One-third (33.7%) mentioned that uncorrected refractive error did not lead to visual impairment. The majority (74.0%) cited using eyeglasses as an effective way to manage childhood refractive error. Two-thirds (63.7%) stated that they did not receive any information about paediatric eye care. Better knowledge was associated with having a higher educational level, being female, and having an older age (p˂0.001, p=0.008, and p=0.024 respectively). Regarding parents' perspective on spectacle wear, almost 13.7% felt that using eyeglasses affected their children's chances of learning. However, 82.7% supposed that eyeglasses did not affect their children's employment opportunities. Approximately 22.1% thought that using eyeglasses would decrease the eyes power resulting in childhood visual impairment. Conclusion: The level of awareness and perceptions of childhood refractive error and spectacle wear was low among parents. Therefore, a policy is needed to improve the awareness and perception of key stakeholders such as parents and teachers.  In turn such an improvement could play a crucial role in addressing the poor knowledge and bad perception of treatment for childhood refractive error. Keywords: Childhood visual impairment; spectacle wear; parental attitudes; refractive error; paediatric eye care; psychological effect; vision care; Spectacle compliance

Prevalence of visual impairment and refractive error in school-aged children in South Darfur State of Sudan

Background: Global estimates suggest there are almost 19 million visually impaired children worldwide, the major cause being uncorrected refractive error (RE). Aim: To assess the prevalence of visual impairment (VI) and RE among Sudanese school-aged children. Setting: Eight randomly selected primary schools from 21 districts in South Darfur State of Sudan were involved. Methods: A school-based cross-sectional study of RE and VI in primary schoolchildren from grades 1 to 8 (children aged 6–15 years) was investigated. A Refractive Error Study in Children (RESC) protocol was implemented to determine the prevalence of RE and VI in these schoolaged children. Participants were enrolled through stratified multistage cluster sampling of four all-male and four all-female primary schools from South Darfur State of Sudan. Examination procedures followed the RESC protocol, which included visual acuity (VA) measurements, binocular vision assessments, retinoscopy and autorefraction under cycloplegia, as well as examination of the external eye, anterior-segment, media and fundus. Results: A total of 1775 children were invited to participate in the study and 1678 were examined resulting in a participation rate of 94.5%. The findings indicated that the prevalence of uncorrected, presenting and best-corrected VA of 6/12 or worse was 6.4% (95% confidence interval [CI], 4.9–7.9), 4.4% (95% CI, 2.9–5.9) and 1.2% (95% CI, 0.3–2.7) respectively. RE was the cause of VI in 57% of participants, retinal disorders in 13.1%, amblyopia in 5.6%, corneal opacity in 0.9%, cataract in 3.7%, with the causes of reduced vision undetermined in 10.3% and various other causes contributed 9.3%. External and anterior-segment abnormalities were observed in 10.2% of children. This was mainly allergic conjunctivitis (5.3%) followed by bacterial and viral conjunctivitis (4.2%). The prevalence of myopia (≥|-0.50 D|) in one or both eyes was 6.8% (95% CI, 5.3–8.3), hypermetropia (≥ 2 D) was noted in 1.9% (95% CI, 0.4–3.4) and astigmatism (≥|-0.75 D|) prevailed in 2.5% (95% CI, 1.0–4.0). Prevalence of VI among schoolaged children were associated with the children’s age and grade levels (p = 0.00) but was not correlated with gender (p = 0.224). Prevalence of RE among school-aged children was significantly correlated with age and grade levels (p = 0.00). No significant correlation was found between gender and prevalence of RE (p = 0.833). The prevalence of VI because of myopia was associated with increasing grade levels and also the childhood age (p = 0.023), but there was no significant difference in the prevalence of VI because of myopia between male and female children. Conclusion: Uncorrected RE was a major cause of VI among children in the South Darfur State. There is thus a critical need for developing a comprehensive child eye care plan focusing on the reduction of uncorrected RE through collaboration between key stakeholders and government

Attitudes and perceptions of Sudanese high-school students and their parents towards spectacle wear

Background: Uncorrected refractive error is a major cause of avoidable vision impairment and may have significant impact on social life, education and economic prospects of people. This condition could be easily treated by wearing spectacles, but because of attitudes and misconceptions of some communities towards spectacle wear and eye care, such methods are underutilised. Aim: To assess the attitudes and perceptions of Sudanese high-school students and their parents towards spectacle wear. Setting: The study was conducted in eight randomly selected high schools from the South Darfur state of Sudan. Methods: A cross-sectional school-based study comprising 387 high-school students with age ranging from 12 to 17 years together with 47 students’ parents with age ranging from 32 to 52 years. Quantitative and qualitative methods were used to collect data from eight high schools. Semi-structured questionnaires were distributed to collect the quantitative data, and seven focus group meetings were held in the schools with students’ parents to derive the qualitative data. Results: The findings revealed that 39%, 32% and 27.1% of the students believed that wearing spectacles affected their opportunities for education, employment and marriage, respectively. A total of 36.4% of the students believed that wearing spectacles could lead to making the eyes weaker or could damage the eyes, resulting in early blindness, and 22.5% of the respondents believed that spectacles were only for older people. In general, the perception towards spectacle wear was different between genders, with females appearing to be more vulnerable to social and psychological distress when wearing spectacles compared to males. A total of 79% of the parents were aware that wearing spectacles would improve vision if an eye doctor prescribed the spectacles. However, parents reported that the disadvantages of wearing spectacles were that they reduced the power of the eyes and spectacle wear had psychological effects, particularly among females. Parents felt that their children had lost an important asset, that the community looked at them as handicapped and that their children would be blind in future. Conclusion: The fear and stigma related to the use of spectacles are widely experienced among students and their parents in Sudan, and particularly among females. Eye health education programmes should be broadcast through the public media to promote awareness and benefits about spectacle wear and eye care

Childhood eye care services in South Darfur State of Sudan: Learner and parent perspectives

Purpose: Most causes of childhood visual impairment are either treatable or preventable. Eye health education plays an important role in reducing avoidable causes of visual impairment as well as to help ensure a healthy and educated community. The main objective of this study was to assess the Knowledge, Attitudes and Practices of the students and their parents on childhood eye services and barriers for accessing child eye care. Methods: The study was conducted in South Darfur State of Sudan between January and February 2015. Both quantitative and qualitative methods were used to collect data from eight secondary schools. Four schools for boys and four schools for girls were randomly selected from a list of 21 districts of South Darfur State and the Knowledge, Attitudes and Practices surveys were conducted with the students to collect quantitative data. In addition, seven focus group discussions were conducted with the children’s parents to collect qualitative data. Results: The majority (57.5%) of the students reported that they knew about refractive error; however, 33.07% reported never hearing about refractive error. About 70.3% of the respondents believed that uncorrected refractive error leads to visual impairment, 21% believed refractive error did not cause visual impairment and 30.5% reported that wearing spectacles was not effective in the treatment of refractive error. With regard to the information about eye healthcare, 88.1% of the participants reported they did not have enough information about eye care. The reported need for more information about prevention, treatment and symptoms was 34.0%, 31.4% and 17.5%, respectively. With regard to barriers, 80.6% of the students reported never having had their eyes tested. The most cited barriers were cost, fear of wearing spectacles and fear of an eye examination. In addition, 72.6% of students reported that their health insurance did not cover eye care services. Most (53.6%) of the parents believed that the cause of refractive error in children was poor nutrition. Common themes arising from the focus group discussions included parents reporting that they looked for traditional treatment for their children and preferring to receive child eye information from an eye specialist and through the television and radio. The most frequently cited barriers by the parents were high cost of the treatment, lack of eye care specialists, lack of awareness about child eye diseases and mistrust in eye care providers. Conclusion: The level of knowledge and practices about eye care and refractive error is low and perceptions about spectacles as a method for treatment for refractive error were fraught with misconceptions amongst students. There is a need for structured educational programmes to raise awareness regarding the effect and treatment modalities for childhood eye disease and visual impairment in order to address the barriers for accessing childhood eye care. Keywords: Children; school; eye care; spectacles; refractive error; knowledge;barriers; optometris