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Purpose: To examine barriers and adherence to topical glaucoma medication in a pediatric glaucoma population in Saudi Arabia., Methods: This cross-sectional study was undertaken at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia during 2016-2017. Parents (father or mother) of children aged 6 months to 15 years with a history of glaucoma were interviewed. Rasch analysis was performed to assess the psychometric properties of the developed 12-item barriers-to-adherence tool (BAT-12) and to identify barriers deemed highly important. The 12-items were adapted from previous studies examining different barriers to adherence in different populations. Medication adherence was assessed by asking parents a series of closed-ended questions about the frequency of missed medications. Determinants of missed medications on at least 1 out of the last 3 days were examined using Poisson regression., Results: One hundred and six parents were interviewed. The 12-item scale had acceptable psychometric properties. Barriers deemed important were forgetfulness (logit -0.59), complex dosing regimen (logit 0.09), and being too busy with other work/activities (logit 0.14). When asked how often, on average, their child missed the prescribed medication, 26 (24.5%) reported daily, 17(16.0%) reported few times per week, and 32 (30.2%) reported once per week. A third of parents (n = 37, 34.9%) reported having missed giving all drops on at least one day in the last 3 days. Poisson regression with robust variance revealed that increase in age of the child (prevalence ratio, 1.08 [95% CI, 1.03-1.14]; p = 0.003) and increase in parents' barriers score (prevalence ratio, 2.13 [95% CI, 1.49, 3.03]; p < 0.001) were significantly associated with having missed medications on at least one out of the last three days while adjusting for the effect of father's current employment status and area of residence., Conclusions: The tool we used to examine barriers to glaucoma medication had acceptable psychometric properties and could be used and strengthened in future studies. Our study highlights poor adherence to glaucoma medications among children with glaucoma.

Purpose: The purpose of the study was to determine knowledge, practice, and resources available to primary care physicians to diagnose and manage corneal abrasion in Saudi Arabia., Methods: This cross-sectional survey was held in 2017. Family physicians and emergency physicians attending an international conference were surveyed. The questions related to demography, invagination, and tools available in their institute were collected. The questionnaire on how to diagnose and how they manage case of corneal abrasion was also collected using tablet-based software., Results: Two hundred and twenty-five participants participated in the survey. Exposure to eye patients in two-third of participants was too low (93; 39.6%). Resources for diagnosing corneal abrasion were available in limited centers (51; 21.7%). The rate of good practice to manage corneal abrasion was 21.2% (95% confidence interval 16.0; 26.5). Certified emergency physicians ( P < 0.001) and western and central regions ( P < 0.001) were positively associated with good practice. Availability of slit lamp ( P = 0.2) was not significantly associated with the level of practice to manage corneal abrasion. Fluorescein staining and use of cobalt blue light are essential for diagnosing corneal abrasion as per 40% of participants. About 44.7% of participants replied that antibiotics and lubricants should be used to treat. Nearly one-fourth of participants suggested urgent reference to the ophthalmologist. Use of specific antibiotic varied widely; however, ofloxacin was the main choice of antibiotic in treating corneal abrasion., Conclusion: The knowledge and practice among physicians about corneal abrasion were low. Integrating primary eye care into emergency services through provision of required resources and training physicians is recommended., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Middle East African Journal of Ophthalmology.)

To evaluate and compare the clinical and histopathological profile of primary and recurrent orbital-periorbital plexiform neurofibromas (OPPN) in patients with neurofibromatosis type 1. We retrospectively evaluated 43 primary or recurrent neurofibroma (NF) specimens from 26 patients (2002 to 2018) at the King Khaled Eye Specialist Hospital, Saudi Arabia. Demographics, clinical presentation, and surgical intervention data were collected. Histopathological specimens were studied with hematoxylin-eosin, Alcian blue, and immunohistochemical markers; S-100, CD44, CD117, smooth muscle actin (SMA), neurofilament, and Ki-67. Of the 43 NFs specimens, 20 were primary and 23 recurrent tumors. For primary NF, the ratio of plexiform to the diffuse type was 13:7, however in recurrent tumors was 3:8 after the first recurrence, and 1:5 after multiple recurrences. Of the 17 patients with primary tumors that had paired recurrent tumors, 12/17 (70.6%) primary NFs were plexiform and 5/17 (29.4%) were diffuse. However, when tumors recurred, 13/17 tumors (76.5%) were diffuse and only 4/17 tumors (23.5%) had a plexiform pattern. The odds of a tumor having a diffuse pattern in recurrent NF was significantly higher than the plexiform pattern [OR = 7.8 (95% confidence interval 1.69:36.1) P = 0.008]. Primary plexiform NFs underwent an excision at a significantly younger age than the diffuse type. Recurrent NFs had significantly higher CD44, CD117, and neurofilament labeling (P = 0.02, P = 0.01 and P<0.001 respectively) but had significantly decreased Alcian blue, and S-100 labeling (P = 0.03, and P = 0.02 respectively) compared to primary tumors. SMA and Ki-67 proliferation index were not different between primary and recurrent NFs (P = 0.86, and P = 0.3 respectively). There appears to be a high risk for primary plexiform NFs to develop a diffuse histologic pattern when they recur. Immunohistochemical staining suggests a role of mast cells (CD117) and expression of infiltration makers (CD44) in the transformation of plexiform tumors to the diffuse phenotype., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To study the clinical features, histopathology, and management of congenital upper eyelid coloboma (CEC) in the Saudi population., Methods: A retrospective review of health records evaluated the demographics, histopathology, and surgical outcomes of patients with CEC., Results: Thirty-nine eyelids of 27 patients were included in this study. CEC was bilateral in 12 (44.4%) patients, isolated in 17 (62.9%), and as part of a syndrome in 10 (37.1%) patients. CEC was commonly located in the medial upper lid (22 lids, 56.4%) and mostly involved the full thickness of the lid (27 lids, 69.2%). Corneal adhesion (18 eyes, 46.1%) and poorly formed eyebrows (21 eyebrows, 53.8%) were the most common ocular/adnexa associations. Histopathology was similar in all cases and the main features were scarred dermis, atrophic orbicularis oculi, and atrophic or absent tarsus. Visual acuity at the final follow-up was 20/50 or better in 13 (33.3%) eyes. Complete lid closure without lagophthalmos after one or more surgical procedures was achieved in 11 (40.7%) cases., Conclusions: CEC features in Saudi patients are similar to those described in the literature. Dermal scarring and defective orbicularis muscles are common. Achieving cosmetic and functional success after management remains challenging.

Background: Professionalism is hard to quantify but essential in medical practice. We present a survey tool for ophthalmologists that assessed professionalism using case-based scenarios in central Saudi Arabia., Methods: Ophthalmologists (resident, fellows and consultants) participated in a web-based survey in 2015. Out of 44 attributes related to professionalism, experts selected 32 attributes with validity indices of ≥0.80. To evaluate these attributes, 51 scenario-based questions were developed and included in the survey. For each attribute, participants were given choices of close ended responses: unacceptable (1), probably unacceptable (2), acceptable (3), probably acceptable (4). The attribute score was compared to the gold standard (responses of an expert group). An attribute score was generated and compared among subgroups., Results: Of the 155 ophthalmologists, responses of 147 ophthalmologists who completed more than 50% of questions were reviewed. Their mean attribute score was 84.1 ± 10.1 (Median 87.1; 25% quartile 78.1; minimum 50; and maximum 100). The variation in attribute score among consultants, fellows and resident ophthalmologists was significant (P = 0.008). The variation of attribute score by groups of attributes was also significant (P < 0.05). The score for 'Personal characteristics' was on a lower scale compared to that of other attribute groups. The variation in the scores for attribute groups; 'Personal characteristics attribute' group (p < 0.01) and 'Workplace practices & relationship' group (P = 0.03) for consultants, fellows and residents were significant., Conclusions: Professionalism among ophthalmologists and those in training was high and influenced by years of experience. The survey tool appeared to show differences in responses to specific professional attribute groups between trainees and consultants. Additional studies with a larger sample size might be helpful in validating the survey as a tool to be used to assess professionalism in graduate medical education in ophthalmology.

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 [β=-0.75, 95% confidence interval (CI): -1.22, -0.27; P=0.003]. A poor QoL was noted with mother caregivers (β=-0.46, 95% CI: -0.87, -0.04; P=0.031) and those caring for blind children (vision <20/200 in the better eye) (β=-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.

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&#95;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&#95;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., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To present the epidemiologic profile and magnitude of ocular malignant tumors (MT) representative of the Saudi population from the Tumor Registry (TR) at King Khaled Eye Specialist Hospital (KKESH)., Methods: This study evaluated the demographic information, clinical features including tumor laterality, ocular tissue of origin, and diagnosis of patients from the TR registry between 1983 and 2012 at KKESH, Riyadh, Kingdom of Saudi Arabia. The incidence of MT among Saudi adults (>/= 15 years old), and children (<15 years old) was estimated., Results: The TR recorded 4,146 neoplasms (2,509 [60.5%] benign tumors, and 1,637 [39.5%] MT). The incidence of MT in children was 3.6 per million/year (M/Y), and 2.4/M/Y for adults. Retinoblastoma (Rb) (n=763, 91%) was the most common ocular malignancy in children. In adults, the most common MT was squamous cell carcinoma (SCC) (n=363, 45.8%), basal cell carcinoma (BCC) (n=186, 23%), uvealmelanoma (n=94, 11.9%), sebaceous gland carcinoma (n=54, 6.8%), lymphomas (orbital, adnexal) (n=46, 5.8%), and others (n=53, 6.8%). The Rb (7.7/M/Y in <5 years old Saudi children) was less frequent than that reported in some Gulf countries, but higher than that reported from the West. The SCC was less frequent in countries with comparable sun exposure than in other continents, but the incidence remained unchanged over 3 decades. There was a significant increase in BCC between 1983-1992 and 2003-2012., Conclusion: The rates of all cancers remained stable over 3 decades except BCC, which showed a significant rise.

Purpose: To compare the demographic and clinical distribution of primary and secondary congenital glaucoma from a registry at King Khaled Eye Specialist Hospital., Design: Registry-based cohort study., Methods: Review of registry data that included new patients with congenital glaucoma seen between 2001 and 2003 (29 months); analysis of the demographic data and clinical features of primary and secondary congenital glaucoma at presentation., Results: A total of 325 eyes of 180 patients were included. Most patients had primary congenital glaucoma (80%). The mean (± SD) age at presentation for primary congenital glaucoma was 3.8 ± 10.7 months and for secondary congenital glaucoma was 4.3 ± 7.9 months. Most primary congenital glaucoma and secondary congenital glaucoma patients had bilateral disease (82.6%; 74.3%). Primary congenital glaucoma was equally distributed by sex but secondary congenital glaucoma was 1.5-fold more common in male patients. A positive family history was elicited in 30%, and almost 60% had a history of consanguinity in both groups. The mean intraocular pressure and corneal diameter were comparable in both groups but the axial length was significantly longer in primary congenital glaucoma and cup-to-disc (C/D) ratio greater in secondary congenital glaucoma. In the primary congenital glaucoma group, corneal haze showed a significant relationship with most clinical parameters. In primary congenital glaucoma, a positive correlation was noted between age at presentation and increasing corneal diameter and axial length but a negative relationship was noted with C/D ratio and corneal haze, whereas for secondary congenital glaucoma only axial length was positively correlated., Conclusion: The congenital glaucoma registry provides unique baseline data on primary congenital glaucoma and secondary congenital glaucoma in Saudi Arabia that will enable us to better understand the disease in the Kingdom and region., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: Primary congenital glaucoma (PCG) is an autosomal recessive ocular trait caused by mutations in the gene for cytochrome P4501B1 (CYP1B1). Although PCG is often considered to be fully penetrant, the disease shows 50% penetrance in some Saudi Arabian families. The familial segregation of the nonpenetrance suggests a genetic modifier. Recently, tyrosinase (Tyr) deficiency was found to worsen the drainage structure/ocular dysgenesis phenotype of Cyp1b1-/- mice, suggesting that Tyr is a modifier of the phenotype. In the current study, tyrosinase (TYR) was investigated in human PCG., Methods: A genome-wide screen, a single nucleotide polymorphism (SNP) analysis in the TYR chromosomal region 11q13-q21, and sequencing of the TYR gene was performed with individuals from Saudi Arabian families with multiple, clinically confirmed, molecularly proven, nonpenetrant members., Results: The study outcome did not support TYR as a modifier of the PCG phenotype in this population. The sequencing data showed no TYR mutations in the nonpenetrant family members and no difference in polymorphism frequencies between nonpenetrant or fully penetrant families., Conclusions: TYR is not a modifier of the CYP1B1-associated PCG phenotype in the Saudi Arabian population.