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Hashem Abu Serhan,1 Jehad Feras AlSamhori,2 Abdelmonem Siddiq,3 Abdul Rhman Hassan,4 Sara Irshaidat,5 Leen Abu Serhan,6 Abdullah Alawadhi,7 Abdelaziz Abdelaal,8 Wejdan Al-Thawabieh9 1Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar; 2Faculty of Medicine, University of Jordan, Amman, Jordan‬‬‬‬‬‬; 3Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; 4Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA; 5Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan; 6Faculty of Medicine, Hashemite University, Zarqa, Jordan; 7Department of Ophthalmology, Islamic Hospital, Amman, Jordan; 8Harvard Medical School, Postgraduate Medical Education, Boston, MA, USA; 9Department of Ophthalmology, Dr. Sulaiman Al Habib Hospital, Riyadh, Saudi ArabiaCorrespondence: Hashem Abu Serhan, Department of Ophthalmology, Hamad Medical Corporations, PO 3050, Doha, Qatar, Tel +974-77912335, Email HAbuserhan@hamad.qaPurpose: Congenital nasolacrimal duct obstruction (CNLDO) is fairly common in newborns. The main aim of this cross-sectional study is to assess the preferred practice patterns of CNLDO among ophthalmologists in Jordan.Methods: This cross-sectional study was conducted across all ophthalmological practices in Jordan, using convenience sampling. An online questionnaire, designed through Google Forms, was distributed through social media. The survey contained four domains: baseline characteristics of participants and the diagnosis (7 items), medical management (3 items), and surgical management (11 items) of CNLDO. Descriptive statistics were conducted using SPSS (IBM SPSS Corp, SPSS Statistics ver. 26, USA).Results: Eighty-three physicians responded to the survey, with an average age of 40.6 ± 8.6. More than half of the participants (53.0%, n = 44) were general ophthalmologists. Only 37.3% of our sample (n = 31) regularly evaluated the refraction of a child presenting with epiphora suggestive of CNLDO. Criggler’s nasolacrimal duct massage was recommended by 62.7% of respondents (n = 52) for up to 12 months. In addition, 72.3% of respondents (n = 60) recommended 12 months as the minimum age for primary probing of CNLDO. Silicon intubation was considered for primary probing starting at 24 months by 31.3% of ophthalmologists (n = 20). Monocanalicular stent was preferred by 42.2% of respondents (n = 27) while 31.3% (n = 20) preferred bicanalicular stent.Conclusion: There is considerable variability in preferred practice patterns regarding the diagnosis and management of CNLDO in Jordan. Our findings highlight the gaps in optimum practices which need to be addressed for better management.Keywords: nasolacrimal duct obstruction, CNLDO, lacrimal system, practice patterns, congenital

Luai Abu-Ismail,1 Mohammad T Abuawwad,2 Mohammad J Taha,2 Almu’atasim Khamees,3 Dima Y Abu Ismail,4 Mohammad Sanwar,5 Yaqeen Al-Bustanji,6 Abdulqadir Nashwan,7 Omran Hamdan Alameri,8 Hamzeh Mohammad Alrawashdeh,9 Hashem Abu Serhan,10 Jocob Abu-Ismail11 1Department of Ophthalmology, Islamic Hospital, Amman, Jordan; 2Department of Clinical Medicine, Cairo University, Cairo, Egypt; 3Department of General Surgery, King Hussein Cancer Center, Amman, Jordan; 4Department of Clinical Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan; 5Department of Medicine, Jordan University Hospital, Amman, Jordan; 6Department of Clinical Medicine, School of Medicine, The University of Jordan, Amman, Jordan; 7Department of Nursing Education and Research, Hamad Medical Corporation, Doha, Qatar; 8Department of Pathology and Public Health, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, Jordan; 9Sharif Eye Centers, Irbid, Jordan; 10Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar; 11Department of Ophthalmology, Specialty Hospital, Amman, JordanCorrespondence: Abdulqadir Nashwan, P.O. Box 3050, Doha, Qatar, Tel +974 40240487 ; +974 66473549, Email anashwan@hamad.qaIntroduction: Dry eye disease (DED) is a common and multifactorial disease of the ocular surface which causes visual disturbance and feelings of discomfort among patients. The prevalence rate among medical students is an important issue to consider. This study investigates the relationship between caffeine consumption, sleeping habits, use of electronic devices, and DED among a convenient sample of medical students in Jordan.Methods: This cross-sectional online survey enrolled medical students from all six medical schools in Jordan. The questionnaire, which was shared via social media platforms, assessed socio-demographics, caffeine consumption amounts and patterns, sleep quality, and the use of electronic devices and their relation to ocular discomfort, DED, and related symptoms. The ocular surface disease index (OSDI) questionnaire was also administered to quantify the symptoms of DED.Results: A total of 1223 students participated in this study (RR=24.46%); 64% were females, and 43% were in their clinical placement years. Of the participants, 317 (25.92%) had normal eyes, and 906 (74.08%) had symptomatic DED. Of the students, 1206 (98.6%) used electronic devices directly before bed, and only 399 (32.62%) used blue-light-protective glasses. Lower DED risk was linked to male gender (OR=0.535, 95% CI 0.392– 0.73, p < 0.01), clinical years of medical school (OR=0.564, 95% CI 0.424– 0.75, p< 0.01). Poor sleep quality corresponded to more incidence of DED, regardless of sleeping for 5– 6 hours (OR=3.046, 95% CI 1.299– 7.139, p=0.01) or for less than 5 hours (OR=3.942, 95% CI 1.824– 8.519, p< 0.01). Also, caffeine consumption only marginally affected its incidence, but the results were statistically insignificant.Conclusion: Female gender, basic science years, and spending more than 6 hours looking at screens were significantly associated with symptomatic DED. Caffeine consumption did not pose any significant risk to the incidence of DED.Keywords: caffeine, dry eye, medical students, screen exposure, sleep quality

Omar Solyman,1,2 Hashem Abu Serhan,3 Hesham F Kamel,1 Amgad Eldib,1,4– 6 Ahmed S Abo Obaia,1 Amr Aref,1 Ibrahim Osama Sayed-Ahmed,7,8 Mohamed Khashaba,9 Mohamed M Khodeiry,1,8 Mokhtar M Abushanab1 1Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt; 2Department of ophthalmology, Qassim University Medical City, Al-Qassim, Saudi Arabia; 3Department of Ophthalmology, Islamic Hospital, Amman, Jordan; 4Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA; 5UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 6University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 7Department of Ophthalmology, Baylor College of Medicine, Houston, TX, 77030, USA; 8Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; 9Department of Anesthesiology, Research Institute of Ophthalmology, Giza, EgyptCorrespondence: Omar Solyman, Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt, Email o.solyman@rio.edu.egIntroduction: We describe and validate a low-cost simulation model for practicing anterior lens capsule continuous curvilinear capsulorhexis (CCC).Methods: A simulation model for CCC was developed from widely available low-cost materials. Ophthalmologists attending the annual scientific meeting of the Research Institute of Ophthalmology, Giza, Egypt, were asked to perform a five CCC model task and then anonymously answer a questionnaire that assessed the realism and training utility of the model using a five-point Likert scale (1 = unacceptable, 2 = poor, 3 = acceptable, 4 = favorable and 5 = excellent).Results: Twenty-seven ophthalmologists completed the task and the anonymous questionnaire. Overall, participants felt that the model simulated CCC step in cataract surgery well (mean: 3.5) and was comparable to other kinds of CCC simulation models (mean: 3.3). The model scored highly for its overall educational value (mean: 4.00) and for enlarging a small CCC (mean:3.7), while the feasibility of this model in practicing the management of a runaway leading edge of CCC scored 2.9.Conclusion: This model may provide an alternative method for training for CCC and other anterior lens capsule-related maneuvers. This option may be particularly helpful for residency training programs with limited access to virtual reality simulators or commercially available synthetic eye models.Keywords: cataract simulation, capsulorhexis, capsulotomy, microsurgical model