|Year : 2020 | Volume
| Issue : 1 | Page : 7-11
Level of awareness among non-medical students toward keratoconus, Abha,Saudi Arabia
Abdulrahman Mohammed Al-Amri1, Abdulhamid Saad Al-Ghamdi2, Fatimah Ibrahim Al-Khabbaz3, Amal Aziz Al-Qallaf3, Jihan Jamal Siddiqui3, Fatima Abdullah Al-Sadiq3, Maan Abdullah Al-Barry4
1 Department of Ophthalmology, College of Medicine, King Khalid University, Abha; Department of Ophthalmology, Faculty of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
2 Department of Surgery, Division of Ophthalmology, Faculty of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
3 Department of Ophthalmology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
4 Department of Ophthalmology, College of Medicine, Taibah University, Medina, Kingdom of Saudi Arabia
|Date of Submission||26-Dec-2019|
|Date of Decision||30-Jan-2020|
|Date of Acceptance||23-Feb-2020|
|Date of Web Publication||06-Mar-2020|
Prof. Abdulrahman Mohammed Al-Amri
College of Medicine, King Khalid University, P.O. Box: 641, Abha 61421
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Keratoconus (KC) is a progressive, bilateral, asymmetric, ectatic disease that leads to progressive corneal thinning and protrusion, which results in progressive visual impairment and irregular astigmatism. Early detection plays a critical role in the management and prognosis. Awareness of the population at risk improves early screening and utilization of eye health care. The aim of the present study is to assess the awareness level among non-medical students toward KC, Abha city, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among the nonmedical students from January 2019 to May 2019 in the Southern Region of Saudi Arabia. A total of 393 nonmedical students were randomly selected through the university admission deanship records. Electronic consents were obtained from all participants. Close-ended questionnaires were circulated using the university official electronic mails. Results: A total of 374 females and 19 males were responded. Among those who had poor awareness, majority were female (95.7%) and belonged to the age group of 17–21 years (68.3%). Similar pattern was seen in the study participants with fair awareness. However, 57.1% of the study participants with good awareness belonged to the age group of 22–26 years. Conclusion: Visual impairment is a common condition among young population. Onset and severity of KC are diverse among countries. Early screening for the population at risk could hasten the appropriate medical intervention and reduce the burden of this condition. The level of awareness considered a key factor for a better utilization of the eye health care.
Keywords: Awareness, keratoconus, nonmedical students, Saudi Arabia
|How to cite this article:|
Al-Amri AM, Al-Ghamdi AS, Al-Khabbaz FI, Al-Qallaf AA, Siddiqui JJ, Al-Sadiq FA, Al-Barry MA. Level of awareness among non-medical students toward keratoconus, Abha,Saudi Arabia. Saudi J Health Sci 2020;9:7-11
|How to cite this URL:|
Al-Amri AM, Al-Ghamdi AS, Al-Khabbaz FI, Al-Qallaf AA, Siddiqui JJ, Al-Sadiq FA, Al-Barry MA. Level of awareness among non-medical students toward keratoconus, Abha,Saudi Arabia. Saudi J Health Sci [serial online] 2020 [cited 2020 Oct 24];9:7-11. Available from: https://www.saudijhealthsci.org/text.asp?2020/9/1/7/280113
| Introduction|| |
Keratoconus (KC) is a progressive, bilateral disease that is characterized by corneal thinning and protrusion which causes irregular astigmatism and visual impairment. The term KC was derived from the Greek words kerato-idis (cornea) and konos (cone). John Nottingham was the first author to describe KC in 1854. Formerly, KC was classified as a noninflammatory disease. Recently, multiple studies showed the critical role of inflammation in the pathogenesis of the disease. It described an overexpression of inflammatory mediators such as cytokines and interleukin 6 in the tear film of the patients with KC.,,,,
The onset of KC is usually at puberty and tends to progress until the third decade of life. The progression varies between the affected individuals and between the two eyes of the same individual. The prevalence of KC varies worldwide depending on the geographic location, diagnostic criteria, and a cohort of patients. It ranges from 0.0003% in Russia to about 2.3% in India., The incidence reported by Hofstetter in the United States was 0.06%. The reported risk factors associated with KC are family history, ethnicity, ecological factors, mechanical trauma (e.g., eye rubbing), allergic eye disease, Down syndrome, connective tissue disorders (e.g., Marfan syndrome), and Leber's congenital amaurosis., KC reported to be sever and rapidly progressive with an early onset in Asir province (Abha City). The reported incidence was 20 cases per 100,000 population. Recently, in a cross-sectional, multicenter study, the prevalence of KC reported to be 4.79% among Saudi pediatric patients (6–21 years). Early detection, accurate diagnosis using the corneal topography technology, and timely intervention play a critical role in the control of sever visual impairment as a late complication of KC. A screening program for the high-risk group in a highly prevalent area has its great benefits in the public health planning. Awareness of the population at risk potentially contributes to a better community absorption of the educational programs and eventually a proper utilization of the available health-care facilities.,
Our study aims to assess the level of awareness among nonmedical students toward KC, Abha, Saudi Arabia.
| Materials and Methods|| |
A cross-sectional study was conducted among the nonmedical students from January 2019 to May 2019 in the Southern Region of Saudi Arabia. The students belonged to the following courses: computer science, business, engineering, humanities, languages and translation, and arts. The sample size was calculated using Raosoft software (Raosoft. Inc., US, 2011) with a Cronbach's alpha value of 0.82 and margin of error 5%. Inclusion criteria involved nonhealth sciences university students. Health sciences students and students with prior eye diseases were excluded from the study. Based on the inclusion and exclusion criteria, 393 nonmedical students were agreed electronically to participate and included in the study. The questionnaires were circulated using the university official electronic mails.
All the responses were collected and coded. The data were then tabulated and analyzed by IBM SPSS Statistics version 22.0 (IBM SPSS, V 22.0, 2015, Armonk, New York, United State of America) software. Nonparametric Chi-square test was used to analyze the data. P < 0.05 was considered statistically significant.
| Results|| |
Among 393 nonmedical students who participated in the study, 374 students were females and 19 were males. The mean age was 20.92 ± 2.07 years.
Majority (226, 57.5%) of the study participants never heard about KC; furthermore, only 32 (8.1%) got to know about KC through their doctor.
A total of 238 (60.6%) students did not know what is KC. Only 95 (24.2%) answered that it was thinning of cornea and only 132 (33.6%) knew that KC leads to myopia and astigmatism. Majority 355 (90.3%) denied the relationship between ketatoconus and allergic eye disease. Only 84 (21.4%) believe that KC has a hereditary background. 347 (88.3%) of the study participant did not know how KC treated [Table 1]. There were no statistically significant differences between males and females [Table 2]. Younger age was significantly associated with poor awareness and knowledge about KC [Table 3].
|Table 2: Response of the study participants regarding keratoconus gender wise|
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|Table 3: Response of the study participants regarding keratoconus age wise|
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Among those who had poor awareness and knowledge, majority were female (95.7%) and belonged to the age group of 17–21 years (68.3%). A similar pattern was seen in the study participants with fair awareness. However, 57.1% of the study participants with good awareness belonged to the age group of 22–26 years [Table 4].
| Discussion|| |
Visual impairment is a common clinical condition that affects children and teenagers in the second decade of life. KC is the most serious corneal ectatic disease that causes progressive visual deterioration. The prevalence, onset, and severity of KC are variable from country to another and within the same country as it was reported in Saudi Arabia. The pattern of KC in the Southern Region of Saudi Arabia is characterized by early onset, rapidly progressive, and more severe form that mandates a risk-based screening program to reduce the burden of advanced KC.,,,,,
Clinically, young patients usually present with poor distant vision, frequently changing eyeglass prescription and/or un-correctable visual acuity to 20/20. In advanced KC, usually, patients have a very poor vision with considerable impact on the patient vision-related quality of life that sometimes required keratoplasty to rehabilitate their vision. The expected lifetime cost of surgical treatment of KC keeps a significant cost to the health system., Younger age of onset, steeper cornea, vernal keratoconjunctivitis, and history of eye rubbing are risk factors that increase the affected subject likelihood demand for keratoplasty.
Worldwide, the level of awareness about the disease condition and the available modalities of treatment would improve the prognosis and reduce the economic burden and disability of affected individuals. Researchers noticed a trend of underuse of the health-care system in the developed countries as well as Saudi Arabia.,
Our study showed that two-third of the participants did not know what is KC and only one-third knew that KC may lead to astigmatism. Majority of them (90%) have poor awareness about the risk factors and the available treatment options for KC. Similar findings were reported in the urban community in Saudi Arabia with significantly poor knowledge about specific eye diseases. Young age and female gender were significantly associated with poor awareness in our study cohort. Similar findings were reported among Hail University students., Findings from developed countries showed a notable awareness and knowledge gaps among the general population.,,
Our study showed a significant awareness gap among the highly susceptible population members to KC. More than half of the study participants have poor awareness and knowledge about the incidence, symptoms, and treatment modalities of KC. It showed the huge gap in health education programs and the underutilization of the available resources to promote a directed educational material. Awareness and knowledge would enable both clinicians and affected individuals to secure timely decisions regarding the management of KC.
Our study sample has a limitation in the sample size and demographics of the participants that madates carefulness during the interpretation of the results.
| Conclusion|| |
Visual impairment is a common condition among young population. Onset and severity of KC are diverse among countries. Early screening for the population at risk could hasten the appropriate medical intervention and reduce the burden of this condition. Level of awareness considered as a key factor for a better utilization of eye health care.
The author is very thankful to all the associated personnel that contributed in/for the purpose of this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Imbornoni LM, McGhee CN, Belin MW. Evolution of keratoconus: From diagnosis to therapeutics. Klin Monbl Augenheilkd 2018;235:680-8.
Grzybowski A, McGhee CN. The early history of keratoconus prior to Nottingham's landmark 1854 treatise on conical cornea: A review. Clin Exp Optom 2013;96:140-5.
Jun AS, Cope L, Speck C, Feng X, Lee S, Meng H, et al
. Subnormal cytokine profile in the tear fluid of keratoconus patients. PLoS One 2011;6:e16437.
Lema I, Sobrino T, Durán JA, Brea D, Díez-Feijoo E. Subclinical keratoconus and inflammatory molecules from tears. Br J Ophthalmol 2009;93:820-4.
Kandel H, Pesudovs K, Watson SL. Measurement of quality of life in keratoconus. Cornea 2020;39:386-93.
Davidson AE, Hayes S, Hardcastle AJ, Tuft SJ. The pathogenesis of keratoconus. Eye (Lond) 2014;28:189-95.
Behndig A, Karlsson K, Johansson BO, Brännström T, Marklund SL. Superoxide dismutase isoenzymes in the normal and diseased human cornea. Invest Ophthalmol Vis Sci 2001;42:2293-6.
Millodot M, Ortenberg I, Lahav-Yacouel K, Behrman S. Effect of ageing on keratoconic corneas. J Optom 2016;9:72-7.
Jonas JB, Nangia V, Matin A, Kulkarni M, Bhojwani K. Prevalence and associations of keratoconus in rural maharashtra in central India: The central India eye and medical study. Am J Ophthalmol 2009;148:760-5.
Hashemi H, Heydarian S, Hooshmand E, Saatchi M, Yekta A, Aghamirsalim M, et al
. The prevalence and risk factors for keratoconus: A systematic review and meta-analysis. Cornea 2020;39:263-70.
Olivo-Payne A, Abdala-Figuerola A, Hernandez-Bogantes E, Pedro-Aguilar L, Chan E, Godefrooij D. Optimal management of pediatric keratoconus: Challenges and solutions. Clin Ophthalmol 2019;13:1183-91.
Motlagh MN, Moshirfar M, Murri MS, Skanchy DF, Momeni-Moghaddam H, Ronquillo YC, et al
corneal tomography for screening of refractive surgery Candida
tes: A review of the literature, Part I. Med Hypothesis Discov Innov Ophthalmol 2019;8:177-203.
Andreanos KD, Hashemi K, Petrelli M, Droutsas K, Georgalas I, Kymionis GD. Keratoconus treatment algorithm. Ophthalmol Ther 2017;6:245-62.
Assiri AA, Yousuf BI, Quantock AJ, Murphy PJ. Incidence and severity of keratoconus in Asir Province, Saudi Arabia. Br J Ophthalmol 2005;89:1403-6.
Torres Netto EA, Al-Otaibi WM, Hafezi NL, Kling S, Al-Farhan HM, Randleman JB, et al
. Prevalence of keratoconus in paediatric patients in Riyadh, Saudi Arabia. Br J Ophthalmol 2018;102:1436-41.
Pollard TL, Simpson JA, Lamoureux EL, Keeffe JE. Barriers to accessing low vision services. Ophthalmic Physiol Opt 2003;23:321-7.
Bakkar MM, Alzghoul EA, Haddad MF. Clinical characteristics and causes of visual impairment in a low vision clinic in northern Jordan. Clin Ophthalmol 2018;12:631-7.
Darraj A, Barakat W, Kenani M, Shajry R, Khawaji A, Bakri S, et al
. Common eye diseases in children in Saudi Arabia (Jazan). Ophthalmol Eye Dis 2016;8:33-9.
Al-Ghamdi AS. Adults visual impairment and blindness: An overview of prevalence and causes in Saudi Arabia. Saudi J Ophthalmol 2019;33:374-81.
Rebenitsch RL, Kymes SM, Walline JJ, Gordon MO. The lifetime economic burden of keratoconus: A decision analysis using a markov model. Am J Ophthalmol 2011;151:768-7300.
Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO, Collaborative Longitudinal Evaluation of Keratoconus Study Group. Changes in the quality-of-life of people with keratoconus. Am J Ophthalmol 2008;145:611-7.
Sharma R, Titiyal JS, Prakash G, Sharma N, Tandon R, Vajpayee RB. Clinical profile and risk factors for keratoplasty and development of hydrops in north Indian patients with keratoconus. Cornea 2009;28:367-70.
Al Rashed WA, Bin Abdulrahman AK, Zarban AA, Almasri MS, Mirza AS, Khandekar R. Public awareness regarding common eye diseases among Saudi adults in Riyadh city: A quantitative study. J Ophthalmol 2017;2017:9080791.
Alshammary MZ, Alshammari FS, Alsahammari HS, Alshammari TF, Alshammari AS, Shaheen M. Awareness and knowledge of poor vision among students in Hail University. Egypt J Hosp Med 2018;70:835-44.
Al-Ghamdi AS. Awareness and knowledge of poor vision among students in Taif University. Med J Cairo Univ 2011;79:53-62.
Irving EL, Sivak AM, Spafford MM. “I can see fine”: Patient knowledge of eye care. Ophthalmic Physiol Opt 2018;38:422-31.
Moshirfar M, Heiland MB, Rosen DB, Ronquillo YC, Hoopes PC. Keratoconus screening in elementary school children. Ophthalmol Ther 2019;8:367-71.
Foreman J, Xie J, Keel S, Taylor HR, Dirani M. Utilization of eye health-care services in Australia: The National Eye Health Survey. Clin Exp Ophthalmol 2018;46:213-21.
[Table 1], [Table 2], [Table 3], [Table 4]