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A prevalence survey of blindness and low vision was conducted in Oman in 2005. Here, we present the prevalence and determinants of blindness and low vision among the populationor= 40 years of age. The results are then compared with those of the survey in 1997 and the changes following the 'VISION 2020' initiatives are assessed.The survey covered 24 randomly selected clusters (75 houses in each). Teams assessed the distance vision of subjects while wearing glasses. The ophthalmologists examined the anterior segment and fundus to determine the causes of disability. The visual field was tested in those suspected of glaucoma. The prevalence rates of blindness (3/60 on presentation), legal blindness (6/60) and low vision (6/18) were calculated. The data from the 1997 survey was then analyzed to obtain similar rates in the populationor= 40 years of age.The prevalence of blindness was 8.25% (95% CI 7.14-9.36) in theor= 40 year-old population in 2005. The rate would be 6.95% (95% CI 5.92-7.98) if blindness were defined as vision with best possible correction. The prevalence of legal blindness and low vision were 12% and 45.12%, respectively. In the 1997 survey, the prevalence of blindness in same age group was 7.23% (95% CI 5.91-8.55). Between the two surveys, the prevalence of blindness due to corneal pathology declined from 1.9% to 1.1% but that of blindness due to unoperated cataract increased from 1.8% to 2.3%.The rate of disability has declined but the number of blind people has increased in Oman. The causes of blindness have changed from communicable/avoidable eye diseases to non-curable/chronic eye diseases, and the number with visual disabilities has increased. An increasing number of operations for cataract and improvements in the care for glaucoma and diabetic retinopathy are recommended.

Purpose: To compare the success rates for congenital nasolacrimal duct obstruction (CNLDO) treated with conventional probing versus endoscope-assisted probing. Methods: A retrospective nonrandomized comparison of the success rates in children (0 to 12 years) with CNLDO who underwent conventional probing or endoscope-assisted probing. Success was defined as absence of tearing or negative fluorescein dye disappearance test. Stent was evaluated. Results: A total of 270 patients with CNLDO comprised the study population. The mean age was 37 months in the conventional probing group and 48.5 months in the endoscope-assisted probing group. The subjective and objective success rates were 76.1% and 75.9%, respectively, in the conventional probing group and 95.7% and 95.7%, respectively, in the endoscope-assisted probing group. The success rates were higher for both methods in the endoscope-assisted probing group ( P < .005). The success rate decreased in older children in the conventional probing group (100% < 6 months; 62.5% > 48 months) and remained stable in the endoscope-assisted probing group (100% < 6 months; 97% > 48 months). Stent did not improve success. Conclusions: Endoscope-assisted probing increased success in older children and children with bilateral obstruction. [ J Pediatr Ophthalmol Strabismus . 2016;53(5):292–299.]

Purpose: To compare outcomes of two techniques of frontalis silicone sling surgery. Methods: This retrospective, nonrandomized chart review was performed on patients undergoing frontalis sling surgery between 2008 and 2011. Silicone rods were sutured to the tarsal plate through an eyelid crease incision (open method) or stab incisions (closed method). Data were collected on age, gender, type of surgery, preoperative and postoperative margin reflex distance (MRD), and complications. A successful outcome was defined as a postoperative score of 2 to 4 for MRD or an improvement in MRD. Results: A total of 155 eyelids of 146 patients with ptosis were included. There were 60 patients in the open method group and 85 patients in the closed method group, respectively. Successful outcomes were seen in 30 (50%) patients in the open method and 44 (51.8%) patients in the closed method groups. There were 61 (71.8%) patients in the open method group and 45 (75%) patients in the closed method group who had improved MRD at last follow-up. The main complications were exposure keratitis, eyelash ptosis, and eyelid crease abnormalities that occurred only in the closed method group. Conclusions: The silicone frontalis sling procedure had the same success rates in both the open and closed methods. Eyelash and eyelid crease abnormalities were unique to the closed method. [ J Pediatr Ophthalmol Strabismus . 2017;54(1):52–58.]

PURPOSE: To describe a 29-year-old man presenting with acute-onset endophthalmitis caused by Rhizobium (formerly Agrobacterium ) radiobacter after uneventful implantable collamer lens implantation for myopia. METHODS: Case report. RESULTS: The patient was treated with intravitreal injections of vancomycin and ceftazidime, as well as topical and systemic antibiotics. The patient had a good response with a final visual acuity of 20/50 at the last follow-up visit 25 months postoperatively. CONCLUSIONS: This case represents the first case report of endophthalmitis caused by Rhizobium radiobacter following implantable collamer lens implantation. [ J Refract Surg. 2015;31(8):561–563.]

PURPOSE: To compare the incidence and characteristics of retinal complications following implantation of two types of phakic intraocular lenses (PIOLs) in patients with myopia. METHODS: In this comparative, retrospective study, 603 eyes of 344 patients with myopia underwent implantation of either an Artisan iris-fixated phakic intraocular lens IOL (Artisan; Ophtec, Groningen, Netherlands) (Artisan group) or a Visian implantable collamer lens (ICL; STAAR Surgical Company, Monrovia, CA) (ICL group) between June 2005 and December 2013. Preoperative, operative, and postoperative clinical data were collected on the incidence of retinal complications, including rhegmatogenous retinal detachment (RRD) or choroidal neovascular membrane (CNVM). RESULTS: The Artisan lens was implanted in 185 (30.68%) eyes and 418 (69.32%) eyes underwent ICL implantation. Mean follow-up was 26.78 months (range: 9 days to 98 months). Mean preoperative spherical equivalent (SE) was −12.44 ± 4.43 D (range: −1.13 to −31.00 D). The overall rate of retinal complications was 1%. Postoperatively, 3 (0.7%) eyes developed RRD in the ICL group, and no eyes developed RRD in the Artisan group. Submacular hemorrhage was observed in 1 (0.24%) eye in the ICL group. Two (1%) eyes developed CNVM in the Artisan group. The mean time from PIOL implantation to retinal complications was 15.6 months (range: 0.03 to 43 months). CONCLUSIONS: Implantation of ICL or Artisan phakic IOL demonstrated comparable rates of retinal complications. Anterior chamber PIOL does not increase the risk of retinal detachment or CNVM in patients with myopia. [ J Refract Surg. 2015;31(12):814–819.]

As part of the national plan for elimination of rubella and congenital rubella syndrome (CRS), Oman established a national registry of CRS cases. As of May 2005, the registry included 43 surviving CRS cases, with a mean age of 11.9 years. Clinical examinations found that 84% had ocular defects, 84% had auditory/speech defects, 70% had neurological manifestations, and 42% had cardiac defects. Lifetime medical, special education, and rehabilitation costs were assessed. Using a discount rate of 3%, the average direct lifetime cost per surviving CRS patient was estimated at 18,644 US dollars. When including predicted lost productivity due to CRS, the average discounted direct and indirect lifetime costs per surviving CRS patient amounted to 98,734 US dollars.

Oman aims to achieve "Elimination of Blinding Trachoma" by 2010. For accreditation purposes, a trachoma survey was conducted in Oman in 2005, targeting children younger than five years. It was conducted in twenty wilayats (districts) of three trachoma endemic regions. The Omani children were surveyed at health institutions during a 'Polio Supplementary Immunization Campaign.' The authors present the outcome of this survey and recommend policies for trachoma control in the study area.Eye health care supervisors examined Omani children sequentially in health centers. However, the timings and days of visit to these health centers were selected randomly. The presence of trachoma follicular (TF) was noted in the tarsal area. The prevalence of TF was calculated and its distribution was mapped.The coverage for the immunization of children of less than five years of age residing in the study area was greater than 97%. For trachoma evaluation, 4,205 children were examined. The prevalence of TF in children of less than five years of age was 0.59% (95% CI; 0.40-0.88). Sumail, Hamra and Izki wilayats of Dhakhiliya region and Barka and Al Awabi Wilayats of South Batinah region had a prevalence of TF greater than 1%. No wilayat of North Sharqiya region hador =1% TF. The gender variation in TF was not significant. (RR = 0.97 [95% CI 0.46-2.05]).All the Wilayats of trachoma endemic regions of Oman seem to have a prevalence of TF lesser than 5%. The data on TF in children aged between six and ten will enable us to determine whether Oman has achieved the Ultimate Intervention Goals (UIGs) for the provision of antibiotic treatment for acute infection (the "A" component of the SAFE strategy for the "Elimination of Blinding Trachoma" for the year 2005). Such initiatives of trachoma screening during a supplementary vaccination campaign could prove a cost-effective approach for determining the trachoma status of a country.

Glaucoma is a priority eye disease in Oman. In order to revise the existing policies for eye care, a study was conducted to review the noncompliance rates among glaucoma patients.Using the random method, we selected 105 glaucoma patients from among those visiting glaucoma clinics during 2003. They were interviewed by trained health professionals. A closed-ended questionnaire with 42 questions was used to note their responses. The questions dealt with their personal characteristics along with the patients' glaucoma treatment and their knowledge of and attitudes towards different components of noncompliance with medical treatment. The field staffs also observed the 'practice' of instilling placebo eyedrops. The responses were analyzed to grade the compliance, knowledge, attitude and practice of each patient.Excellent compliance was found in 26 patients. Discontinuation of medication in the past was reported by 87 patients. Missing instillation of eyedrops and irregular visits to the ophthalmologist were noted in 10 and 14 patients, respectively. Adequate knowledge about glaucoma and its complications was negatively associated with noncompliance [RR 2.05 (95% CI 1.07-3.93)].The high rates of noncompliance among glaucoma patients in Oman demand a systematic programmed approach. Longitudinal studies are needed to confirm the causal association between noncompliance and Knowledge, Attitude and Practice. Health education, communication while dispensing medication, reducing the frequency of medication and using devices for the easy administration of eyedrops could further improve compliance.

A cross-sectional descriptive survey to determine the magnitude and determinants of knowledge and practice in relation to trachoma among children in Vietnam is presented. Interviews were conducted with 358 children ages 6 to 15 years in three districts of Northern Vietnam using a closed-ended questionnaire. Responses related to causes prevention methods consequences and observed preventive practices were standardized. The knowledge of causes of trachoma and prevention methods was assessed as "excellent" in 61.1% and 69.45% of female and male children respectively. Mode of transmission and consequences of trachoma were very well known to 68.70% and 57.74% of female and male children respectively. Trachoma control practice was excellent in 54.72% of children. Females had better knowledge and practice of trachoma control was better in female than male children. Ten- to 15-year-olds had better knowledge and practices than 6- to 10-year-old children. Trachoma knowledge and practice was better in children of Vinh Loc District of Thanh Hoa Province than in those in Tu Ky District of Hai Duong Province. The schools were the best source of the information. Mass media had a limited role. The outcome suggested a limited positive impact of the 6 months intense initiatives of a health education campaign. Based on the study results the campaign could be reorganized to focus on high-risk groups and to improve the impact. The findings could be compared to the results of a similar study after 2 years of the campaign. (authors)

A survey to estimate the magnitude and causes of blindness and hearing loss was undertaken in Oman in 1996–97. An analysis correlating blindness with hearing loss is presented. Twenty-eight subjects among 11 400 examined had double disability, with a prevalence rate of 2.46/1000 (95% CI 1.55–3.36). Females and older age groups had a higher risk of double disability than did males (relative risk (RR) 3.95, 95% CI 1.34–8.1) and younger age groups (RR 9.91, 95% CI 3.9–21.2). Twentyfive per cent of subjects with double disability had curable blindness, while 33% had preventable blindness. Only 10% of subjects with double disability had curable causes of hearing loss. The number of cases with double disabilities in Oman might decrease, due to the improved healthcare in last two decades. However, the increase in the aging population necessitates intervention to prevent double disability. An emphasis on the prevention of blindness could address the problem more effectively.

To estimate the magnitude and determinants of cataract prevalence and cataract surgical coverage and to evaluate their role in visual disability in Oman.A cross-sectional study was conducted on 11,413 subjects in Oman in 1997. The presence and stage of cataract was noted on the basis of the history and an examination. The patient's phakic, pseudophakic or aphakic status and visual status were determined. The prevalence of cataract and the cataract surgical coverage were estimated. A causal relation was assumed between a backlog of cataract and age, gender and area of residence. The Attributable Risk (AR) and Population Attributable Risk (PAR) for these factors were estimated.The prevalence of cataract was 29.3/1000 (95% CI: 27.76 to 30.84). This was 4.97/1000 (95% CI: 3.68 to 6.26) for blinding cataract (vision3/60). The cataract surgery services covered 70.18% (95% CI: 69.52 to 70.84) of the blinding cataracts and 28.76% (95% CI: 28.11 to 29.41) of all cataracts. The AR and PAR of female gender in the cataract backlog were 35.5% and 1.06%, respectively. The AR and PAR of the residents of 'Group B' regions were 40.5% and 1.26%, respectively. The AR and PAR of subjects "less than 60 years old' were 55.6% and 1.66%, respectively. If the gaps in cataract surgery due to gender, regions and age groups were to be filled, the prevalence of cataract could be reduced by 1.06%, 1.21% and 1.66%, respectively.The health program should identify and address the barriers to cataract surgery among identified high-risk groups.

Purpose We studied the validity, usefulness, and relative cost to detect diabetic retinopathy (DR) and sight-threatening DR (STDR) by using a hand-held electrophysiologic tool compared to digital fundus photography. Method Patients with diabetes attending the screening unit of King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia were evaluated by "RETeval", Amsler grid, and digital dilated fundus photography. Fundus images were evaluated by a retina specialist to determine grade of DR. The sensitivity and specificity of STDR and DR screening compared to photography were calculated, as well as "RETeval" combined with Amsler grid testing. The area under the curve (AUC) of "RETeval" screening outcome was calculated. Result We analyzed data of 400 diabetic patients. The prevalence of DR of any grade was 48.8% (95% confidence interval [CI], 43.9-53.7) while the prevalence of STDR was 27% (95% CI, 22.6-31.4). The outcome of RETeval test was "fail" (based on 20 μV or more amplitude of electrophysiologic spikes) in 351 (87.8%; 95% CI, 84.5-91.0) eyes. The sensitivity of the device was 95.4% and the specificity was 17.5%. Thus, the sensitivity of sequential testing with RETeval and Amsler grid test was 30.1% and the specificity was 80.1%. The AUCs for STDR and DR in general were 76.6% and 50.6%, respectively. Conclusions "RETeval" is a rapid screening device with excellent sensitivity for detecting STDR. It has potential as a first level screening tool to detect patients who require further evaluation. Translational relevance Retinal function, such as electrophysiology, can be used as a new concept for screening for DR.

Purpose: The aim is to present the incidence and determinants of neovascular glaucoma (NVG) in Saudi Arabia. Methods: A retrospective review of NVG cases (2002–2012) was included to estimate the incidence. The determinants included gender, age, comorbidities, lens status, type of NVG, and visual acuity on presentation. The impact of antiangiogenic therapy on NVG incidence was studied. Results: We studied 597 eyes with NVG. The incidence was 6.6/10,000. It declined from 13/10,000 in 2008–0.1/10,000 in 2012 (P < 0.001). The decline in 2008 coincided with the introduction of intravitreal injection bevacizumab in Saudi Arabia. Males had a significantly higher NVG risk (odds ratio [OR] = 2.2). Diabetes and hypertension were associated with NVG in 88% and 42.7% of cases, respectively. In 377 (72%) diabetic patients, the glycemic control was poor (HbA1C >7%). Visual acuity was 20/20–20/40 in 14 (2%), 20/50–20/200 in 79 (13%), 20/200–20/400 in 456 (76%), and 0.8 in 86 (14%) eyes. During the early period (2002–2007) and later period (2008–2012), CD ratio (χ2 = 4, P = 0.09) and anterior chamber angle (P = 0.8) were not different. The presence of NVG in contralateral eye (OR = 0.8, P = 0.3) in both periods was similar. Conclusions: NVG was associated with diabetes in a very large proportion of patients. It was significantly associated with males, and with poor glycemic control and poor vision at presentation. The incidence of NVG declined after the introduction of intravitreal bevacizumab.

Purpose: To study the outcomes and impact of a mobile unit for retinopathy of prematurity (ROP) screening and management at urban Neonatal Intensive Care Units (NICUs). Study Design: Public health intervention study. Methods: This study was conducted in 2012. Staff of a mobile unit assessed all infants aged 32 weeks or less and/or weight 1250 g or less admitted in five NICUs between 2009 and 2011. An ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscopy. ROP was graded and managed as per the International Classification of ROP treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade, and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the mobile unit. Result: The study sample included 104 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32.7% (95% confidence intervals: 23.7–41.7). ROP Stage I was present in 75% of these eyes. The mobile unit could help in preventing/reducing visual disability in 5 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP, and addressing visual disability due to ROP was US $310, 950, and 6500, respectively. Conclusion: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention in urban areas with limited resources.

Background Sympathetic ophthalmia is a rare form of bilateral uveitis that develops following an ocular penetrating injury to one eye. Several cases of sympathetic ophthalmia have been reported after non-penetrating cyclodestructive procedures including Nd:YAG and diode laser cyclophotocoagulation (CPC) but information on inciting factors and outcome is limited. In this case series we investigated the inciting factors, clinical features, course and outcome of six patients who developed sympathetic ophthalmia after diode CPC. Methods Six patients who developed sympathetic ophthalmia after diode CPC were identified from the King Khaled Eye Specialist Hospital uveitis database between 2008 and 2013. The medical records of these patients were reviewed for demographic information, ocular history, diode laser parameters, clinical presentation, treatment and outcome. Results Six patients were diagnosed with sympathetic ophthalmia following treatment with diode laser CPC, an incidence of 0.001% during the study period. Two patients had a history of accidental trauma and all patients had undergone at least one ocular surgery that included a variety of procedures. At presentation, two patients had predominantly posterior segment findings in the sympathising eye, one patient had only anterior segment findings and the rest had panuveitis. All patients were treated with topical and systemic corticosteroids and/or immunosupressive therapy that resulted in complete resolution of inflammation and return to baseline vision in the sympathising eye within 2–48 months of treatment. Conclusions Sympathetic ophthalmia after diode CPC is rare and is seen in patients with a history of intraocular surgery with or without previous trauma. Early recognition of sympathetic ophthalmia and aggressive management with immunosuppressive therapy results in good outcomes for these patients.

Background: Eye screening and refractive services to students are part of a school health initiative in Oman. We evaluated the impact of the compliance of spectacle wear on the vision related quality of life (VFQ) among 12-13 years old and 15-16 years old Omani students with refractive error. Materials and Methods: This historical cohort study was conducted in 2012. Students using spectacles and those not using spectacles after 1 year of prescribing/providing spectacles were interviewed to assess their VFQ. The VQ 20 questionnaire with 5 graded close-ended responses was adopted for this purpose. The responses for the VFQ related to different visual functions of students who were/were not spectacle wear compliant, were compared. Results: Our cohort had 124 students in each group. The overall VFQ was significantly higher among the compliant spectacle wearers (compliant group) compared with the non-complaint wearers (non-compliant group) (relative risk [RR] =4.7% [95% of the confidence interval (CI): 2.8-6.6]). The association of gender and the grade level was not significant (P > 0.05). However, the variation of governorate was significantly associated to the difference of VFQ in both groups (χ2 = 16.6, degrees of freedom = 4, P = 0.0003). The VFQ related to the near work (RR = 1.3) and school related activities (RR = 1.3) was better in the compliant group. Conclusion: VFQ was better among those students who were spectacle wear compliant compared with those who were not. VFQ related to near work and school related activities seem to be the most influenced by spectacle wear compliance.

The prevalence of long-term trichiasis recurrence following tarsal rotation and electro-epilation procedures has not been determined. A non-concurrent prospective study of surgical cases of trichiasis was therefore undertaken in Oman.A sample of 603 surgical cases of trichiasis (approximately half tarsal rotation and half electro-epilation) was followed for an average of 3.1 years to determine recurrence. Recurrence was defined as either mild (5 lashes touching the globe) or severe (5 or more lashes touching the globe).Overall, 56% (95% confidence interval of 50.6%-61.0%) of all surgical cases recurred; ranging from 61.8% of tarsal rotation patients to 50.6% of electro-epilation patients. Severe recurrence was detected among 27% of tarsal rotation patients and 10% of electro-epilation patients. Recurrence was associated with female sex, residence in a high-risk region, and time since surgery.The risk of recurrence after electro-epilation and bilamellar tarsal rotation surgery is high; strategies that account for recurrence need to be introduced.

An 8-year-old girl presented with complaints of bilateral epiphora since birth. The patient had congenital punctal and canalicular atresia combined with congenital fistula. She was treated successfully with surgery. A review of the literature indicated very few reports of surgical treatment of such cases.

Oman is at the threshold of eliminating blinding trachoma. We conducted a community-based survey in 2009-10 to study the association of trachomatous trichiasis (TT) status with visual acuity and blindness among the Omani population aged 40+ years. A total of 8191 eyes were examined and participants' demographic data were collected. TT was absent in 7890 eyes but 227 of these eyes had had lid surgery for TT in the past. TT was detected in 301 eyes, for the first time in 154 eyes and following lid surgery in 147 eyes. The rate of blindness was significantly lower in eyes that had undergone lid surgery in the past (OR = 0.54). In regression analysis the predictors of blindness were participant's age (adjusted OR = 1.01), sex (aOR = 2.01), history of lid surgery (aOR = 3.09) and residence in a hyperendemic trachoma area (aOR = 10.6). Promotion of TT surgery might be beneficial in reducing blindness.

What Is Known and Objective: Physical bottle characteristics differ of brand name topical glaucoma medications and local generic equivalents. This study compares the bottle characteristics of international topical glaucoma brands versus local brands from the Kingdom of Saudi Arabia. Methods: Data were collected on bottle drum volume, drop volume, bottle "squeezability," bottle tip diameter, labels and instructions, cap color coding, and clarity of the drug label. Density-based calculations of drops in bottle volume were assessed using an analytic balance. Bottle tip diameter was measured using 0.05 mm Vernier calipers. A Likert scale-based questionnaire was used to evaluate the subjective opinions of patients on bottle squeezability, clarity of usage and storage instructions, and the consistency of the cap color coding. Results: The volumes of international brands were statistically significantly higher than the local brands (P < 0.001). A number of drops per bottle and tip diameter were comparable between the international local brands. Cap color coding was inconsistent for international and local brands. Patients were dissatisfied with the label font size. Patients reported that the international and local brands were similar in terms of the ease of opening the bottle, instilling a drop, and the clarity of the instructions; but the local brands were subjectively easier to squeeze than international brands. What Is New and Conclusions: This is the first study to compare bottle characteristics of local Saudi Arabia brands with international brands. The bottle characteristics and patient feedback were similar between the local and international topical glaucoma medications. However, there were differences between the local and international brands in drug volume, bottle squeezability. Hence, patient compliance and drop dosage may differ based on the origin of manufacture.

Purpose: Educating patients about their diagnosis and proposed management is integral part of healthcare. Often patient noncompliance is due to a lack of knowledge that could result in irreversible ocular damage. In an era where access to information is virtually unlimited, an understanding of the preferred method of eye care education among patients is required for greater effectiveness in lowering morbidity and mortality of diseases. Subjects and Methods: Patients visiting the ophthalmology clinics of a tertiary hospital in Riyadh, Saudi Arabia, were interviewed. This cross-sectional study was conducted between December 2014 and March 2015. A representative sample of 200 patients was enrolled. Close-ended questionnaire covering current and client preferred health promotion methods were used to collect clients' response. Data were analyzed with descriptive statistics. Results: Out of the 200 participants, 110 (55%) were males. The majority (n = 154; 77%) listed an ophthalmologist as their current primary source of information regarding their eye condition. Approximately half of the participants (n = 95; 48%) were keen to be educated regarding the causes of the eye disease. The top four educational methods preferred by patients were one-on-one session with an eye care provider (n = 116; 58%), a group session with an eye care provider (n = 30; 15%), an application on a smartphone (n = 53; 27%), video lectures on eye health and diseases (n = 8; 4%). Conclusion: Majority of patients in ophthalmic care prefer a one-on-one session with an eye care provider for their eye care education.

Purpose: To evaluate the level of knowledge, attitudes, and barriers to diabetic retinopathy (DR) screening among diabetic healthcare staff at a tertiary eye hospital in central Saudi Arabia. Methods: This was a descriptive survey using a closed.ended questionnaire. A. 5.grade. Likert scale was used for responses to each question. Data were collected on patient demographics and the status of diabetes. Survey responses related to knowledge, attitude, and barriers were grouped. Results: The study sample was comprised of 45 diabetics employed at the hospital. The mean age was 49 ± 11 years and 33 diabetics were males. One-third of the study population was referred to the eye clinic for DR screening. DR screening was performed in 25% of diabetics over the previous year. Twenty-nine (64%; 95% confidence intervals: 50–78) participants had excellent knowledge of eyecare for diabetic complications. Thirteen percent of participants had a positive attitude toward periodic eye checkups. Travel distance to an eyecare unit, no referral from family physicians for annual eye checkups and the lack of availability of gender-specific eyecare professionals were the main perceived barriers. Conclusion: Annual DR screening needs to be promoted to primary healthcare providers and diabetic patients. Barriers should be addressed to improve the uptake of DR screening.

Objective : We present the outcomes of knowledge of diabetes and associated ocular complications among personnel comprising the eye care team in Oman. Materials and Methods : A closed ended questionnaire was administered during November 2008 and November 2009 to eye care team members in six regions of Oman, where trainings were held. All participants of these trainings were included in our study. The questionnaire comprised 15 questions that tested the knowledge of the diagnosis and treatment of diabetes and its ocular complications. They circled the most suitable reply for a list of choices. The replies were compared with the gold standard (answers from a medical retina specialist, a diabetologist's and general ophthalmologists answers). The participants were divided into two groups; acceptable (more than 50% score compared to gold standard) and less than desired (less than 50% score compared to gold standard.) We estimated the areas of acceptable level of knowledge in different subgroups. Results : All 87 (100%) of eye care team members participated. Of the 42 general ophthalmologists, 30 (71.4%) had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complication of diabetes. The acceptable level of knowledge among mid level eye care providers and general physicians was found in 15 (54.5%) and 4 (33.3%) respondents respectively. Conclusion : Less than the desired number of participants of the eye care team had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complications of diabetes. The training of eye care personnel need to enhance knowledge in the weak areas is identified in this study.

Endeavor to improve (i) the quality of Primary Eye Care with the aid of an Eye Health Care Programme and (ii) the resourcing Primary Eye Care in Ministry of Health Institutions in 2001.In this descriptive study, staff were randomly selected from 84 health institutions and representing 136 primary health institutions to carry out quality assurance procedures. Ophthalmologists trained in this evaluation were field staff who evaluated the resource status, such as health staff, space for eye care delivery, instruments, materials for health education, referring cases (for continuous medical education of the primary health staff), drugs for eye care, etc., in each health institution. In addition to availability, the standards of eye care delivery were also estimated.The health institutes of Oman have adequate resources for Primary Eye Care. Additional requirement of ophthalmic loupes and medicaments would further improve Primary Eye Care in Oman.It is recommended that such a review of the health care programme and its resources and quality be periodically conducted as a part of a system of quality assurance in primary health care.

Background : Many patients with diabetes do not present for eye examinations, foregoing the recommended management for diabetic eye care. Proactive steps are being taken in Oman to retrieve defaulters (patients who do not present or no-show) with Sight Threatening Diabetic Retinopathy (STDR). We present the outcomes of the defaulter retrieval system in five regions of Oman in 2009. Materials and Methods : Ophthalmologists examine eyes periodically, family physicians focus on primary prevention of Diabetic Retinopathy (DR) and medical retina specialists manage DR in Oman. A person with proliferative stage of DR (PDR) and/or Diabetic Macular Edema (DME) in either eye is considered as STDR and is registered at regional hospitals. The eye care staff identify the defaulters and the hospital staff help them retrieve the defaulters. The reminder of reappointment is sent using the text messages on telephone. The glycemic control of STDR cases was also noted in Nizwa Hospital. Results : We registered 654 STDR cases, of which 494 (75%) were defaulters. Lack of awareness, transport, absence of a decision maker, and fear of laser treatment were the main causes for defaulting. We successfully retrieved 328 (66.4%) defaulters. The retrieval rates among male and female patients were 51.2% and 82%, respectively. The retrieval varied by region. In Nizwa hospital, 114 of 131 STDR cases (85%) had poor glycemic control. Conclusion : Defaulter retrieval system could help healthcare providers to identify and motivate patients with STDR towards better compliance. Primary prevention measures among STDR cases were poor and need further focus.

We should address visual disabilities in children instead of only the childhood blindness. Diseases related to nutritional, communicable diseases should be addressed through strategies for achieving 'Millennium Development Goals'. Facilities in African countries and countries with populations like India and China must be strengthened to address curable/preventable visual disabilities in children. Even though all efforts are done to strengthen, we will have 0.93 million blind children by 2020. Role of family physicians and paediatricians in trans-disciplinary approach to address visual disabilities in children is very crucial. If rational distribution of skilled human resource is not planned visual disabilities will not reduce effectively. Rehabilitation of visually disabled children should be integral part of addressing childhood blindness. All stakeholders including parents of children with visual disabilities should work together to achieve the goals.

A community based survey for Trachomatous Trichiasis (TT) was conducted in the high (TT5% in 1997) and meso endemic areas (TT 1% to 5% in 1997) of Oman during 2008-09.Investigators examined Omanis 40 age years and older from randomly selected villages. Eyes were examined for TT and vision. The medical history of surgery and advice given for TT surgery were recorded. The TT cases that were unadvised by health staff were defined as un-approached cases. Cluster adjusted prevalence of TT and risk of TT by gender were estimated.We examined 4,951 of 5,268 persons in high-endemic areas and 965 of 993 (97.2%) persons in meso-endemic areas. The cluster adjusted prevalence of TT in the high and meso endemic areas were 7.54% (95% Confidence Interval [CI] 6.78-8.30) and 1.69% (95% CI 0.88-2.50) respectively. There were 5 TT patients in high endemic areas and none in meso-endemic areas who were not approached or managed in the past. The prevalence of TT across all ages was less than 1 per 1,000 of the population in all wilayats of Oman. Females had a significantly higher risk of cluster adjusted TT compared to males (Odds Ratio = 1.87 [95% CI 1.85-1.89]). The prevalence of blindness was 0.5% among TT cases in high endemic areas.Oman seems to have reached the Ultimate Intervention Goals (UIGs) of the "S" (Surgery) component in 2008 in high and meso-endemic areas. The efforts of existing eye services could be better evaluated if un-approached TT cases are used to calculate the TT prevalence. Oman needs to focus more on females with TT to reach the UIGs.

Aim : To compare determinants for recurrence of trichiasis at one and two years following lid surgery in Vietnam. Study Design : Community-based intervention study. Methods : This study was carried out between 2000 and 2003 in four trachoma-endemic districts of Vietnam. Trained trichiasis surgeons performed modified Cuenod Nataf lid surgery on 648 eyes of 472 patients with Trachomatous trichiasis (TT). Trained investigators collected information on ocular and lid status before surgery and at one and two years following surgery. Trichiasis recurrence was calculated after adjusting for one or both eyes of each operated individual. Results : Fifty-six eyes developed recurrence at one year with adjusted prevalence of 8.8% (95% CI 6.60-11.01). One hundred and one eyes [15.9% (95% CI 13.04-18.72)] had recurrence two years following surgery. Female gender, older age group, study area, severe grade of trachomatous scarring (TS), past history of lid surgery, postoperative suture adjustment and surgeon were risk factors for recurrence at the end of one year. Study area and previous lid surgery were risk factors for recurrence in the second year. Recurrence at one year could be predicted if study area and severity of Trachomatous Scarring (TS) are known. Conclusions : One and two year recurrence rates with modified Cuenod Nataf lid surgeries for TT in Vietnam were acceptably low. Early recurrence could be reduced by proper case selection. However, late recurrence seems to be dependent on interaction of risk factors. Only age of the patient was the reliable predictor of recurrence.

Rapid Assessment for the Avoidable Blindness (RAAB) was conducted in Qatar during 2009. We present the prevalence and determinants of visual disabilities and status of cataract among citizens aged 50 years and older.Residents of randomly selected houses and clusters participated in the survey. Opticians noted the presenting and the best corrected vision of participants from 49 clusters. Ophthalmologists examined participants with additional instruments like bio-microscope, digital camera, auto-perimeter and auto-refractor in a mobile van. World Health Organization recommended principal cause of blindness (Visual acuity [VA] 3/60 in better eye), Severe visual impairment (SVI) (6/60), low vision (VA 6/18) and unilateral blindness (VA 3/60) were designated. Persons with VA 6/18 and cataract were interviewed to calculate coverage and barriers for cataract surgeries. Age sex adjusted prevalence of visual disabilities and their 95% Confidence Intervals (CI) were estimated.We examined 2,433 (97.3%) participants. The age sex adjusted prevalence of bilateral blindness was 1.28% [95% CI 1.22-1.35], SVI (1.67%), low vision (3.66%) and unilateral blindness (3.61%) in 50 years and older population. Female and older age groups were significant risk factors of visual disabilities. Cataract and glaucoma were the main causes of visual disabilities. The coverage of cataract services was 68.2%. Believing that cataract as an aging process (25) and adequate vision in the fellow eye (15) were the reasons for delay in surgery.To reduce avoidable blindness, un-operated cataract should be addressed. Primary and secondary eye care systems should be strengthened to improve the care of blinding eye diseases in Qatar.

Purpose : The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman. Study Design : Retrospective review of data collection instruments. Materials and Method : The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools. Results : In 1996, the prevalence of bilateral blindness in ≥ 40 years of age was higher in females [Odd's Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 - 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 - 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 - 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant.But males were associated with higher prevalence of cataract [OR = 1.26 (95% CI 1.00 - 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls. Conclusions : Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.

We evaluated the magnitude of diabetic retinopathy (DR) and other ocular co-morbidities among patients with diabetes in 2006. We also assessed resources for eye care at Oman's Sumail Hospital.We reviewed the DR register in May 2008. Physicians diagnosed diabetes. Ophthalmologists used a biomicroscope to identify ocular co-morbidities. The best-corrected vision of each eye was noted. DR grading, as recommended by the World Health Organization, was adopted. The prevalence of DR was calculated. Grades of DR were correlated to vision. Projections of patients with diabetes mellitus and DR were compared to the study outcomes.We randomly picked 418 (49%) of the 843 registered persons with diabetes for our study. The prevalence of DR was 7.9% (95% confidence interval 6.6, 9.2). Sight-threatening DR was found in 43 of 689 (5.3%) eyes. Prevalence of DR was 6.3% among persons with diabetes who were screened for the first time; it was 9.3% among those rescreened. Diabetic macular edema was present in 42 (5%) eyes. Patients with DR had a higher risk of blindness (vision less than 6/60) compared to those without DR (odds ratio 5.0; 95% confidence interval 3.74, 6.69). Laser surgery had to be used for 85 (20.3%) DR patients. Early cataract and trachomatous corneal opacities were main co-morbidities.The coverage of screening for diabetes and DR in our study area was less than the national coverage. Better management facilities for DR could improve patients' eye care at Sumail Hospital. Good vision in persons with diabetes could be a reason for them not accepting regular eye check-ups and laser treatment.

Visual disabilities due to diabetes are on the rise, especially in urban areas of developing countries. Proper health planning will need evidence-based information.We estimated the prevalence and identified the determinants of eye complications among persons with diabetes screened in Ahmedabad, India, during 2007-2008. This was a review of the data from a health institution-based project. Physicians collected information on diabetes, and ophthalmologists examined the patients for visual acuity, diabetic retinopathy (DR), glaucoma, and cataracts. World Health Organization-recommended grading of DR was used. Frequencies, prevalence, and 95% confidence interval (CI) values were calculated.Of 40,919 persons who we examined for diabetes, 9,246 (66.6%) persons knew that they had diabetes, whereas 4,641 (33.4%) persons were detected with diabetes for the first time. The prevalence of DR, early cataract, and glaucoma among those who knew that they had diabetes was 14.6% (95% CI 13.9-15.3), 44.4% (95% CI 43.4-45.4), and 5.4% (95% CI 4.9-5.9), respectively. The prevalence of DR among persons with diabetes (new and old) was 10.1% (95% CI 9.6-10.6). Although poor vision was positively associated with DR (chi2 = 706), 40% of those with DR had vision better than 20/60. Male sex (odds ratio [OR] = 1.31), longer duration of diabetes (chi2 = 1,808), hypertension (OR = 1.13), good sugar control (OR = 0.09), and nephropathy (OR = 2.16) were the factors associated with DR. Regression analysis suggested that longer duration of diabetes and poor control of diabetes were the predictors of DR.The prevalence of DR was low. Long duration of diabetes, poor control of blood sugar, presence of nephropathy, and hypertension were associated with DR. Good vision could mislead about the severity of DR.

Objectives: The corneal disease is a priority problem in Oman. We present patients with contact lens (CL) induced severe keratitis, admitted in the corneal unit of Al Nahdha Hospital in Oman. Methods: The study was conducted in 2005-2006. Ophthalmologists examined the eyes using slit lamp bio-microscope. Visual acuity was noted using Snellen’s distance vision chart. Specimens of corneal scraping and CLs were sent for culture and sensitivity tests. Patients with severe keratitis were admitted and treated with medicines. Corneal and visual statuses were noted at the time of discharge from hospital and after six weeks. Numbers, percentages and their 95% confidence intervals were calculated. Pre- and post-treatment vision were compared using a scattergram. Results: The 52 eyes of 15 males and 37 female patients with corneal ulcers were examined. Thirty-two patients were between 20 to 30 years of age. Only 13 (25%) patients had visited an ophthalmologist within 24 hours of developing severe keratitis. Seventeen (33%) had central ulcers and six (11.5%) had ulcer ≥5 mm in size. Pseudomonas was found in 29 (55.8%) of CL and corneal material scraped from the eyes of 15 (28.8%) patients. Vision was

The post-operative vision is used as benchmark to determine the quality of cataract surgery. However, late presentation and co-morbidities influence the visual gain and they should also be considered while auditing cataract surgeries. The authors present method of analysis of cataract surgeries for older than 30 years of aged patients performed by ophthalmologists in Oman during 2003.Ophthalmologists evaluated visual and ocular status of eyes with cataract. Cataract was operated using operative microscope and lens was implanted in the eye. The vision was recorded six weeks after surgery and visual gain was grouped from postoperative vision in relation to the preoperative vision. Presence of co-morbidities like glaucoma, corneal opacities, macular degenerations and others were considered while evaluating visual outcomes.3,485 eyes operated were included in our study. 3,003 (86.2%) of them were operated by extra-capsular cataract extraction and lens implantation. Following surgery, 960 (27.5%) eyes had vision ³6/18. 1,483 (42.6%) eyes had vision between 6/60 and 6/18. 233 (6.8%) eyes had vision3/60. Excellent grade of vision gain in relation to preoperative visual status was found in 2,250 (64.6%) eyes, 'good' visual gain was in 422 (12.1%) eyes and 'poor' visual gain was in 335 (9.6%) eyes. Postoperative visual status was significantly associated to the co-morbidities. (p0.001). Nearly 14% of persons were lost to the follow up.In countries like Oman with high prevalence of trachoma, glaucoma and diabetes, the proposed grading of visual gain that accounts for the preoperative vision and the presence of co-morbidity could be better option for auditing the cataract surgery.

A hospital-based study was conducted in 2007 in Oman to determine the validity of frequency doubling perimetry (FDP). The authors have compared the ability of FDP to detect glaucoma among patients with and without diabetes.This was a validity study of the screening procedure. An ophthalmologist and an optometrist examined Omani persons30 years of age with and without diabetes. They determined glaucomatous field changes by using FDP. The glaucoma specialist labeled the eye and the person as suffering from glaucoma if two criteria were present: (1) optic cup disc and other retinal changes suggestive of glaucoma and (2) field changes on automated perimeter suggestive of glaucoma. Ocular pressure was measured with a Tono-Pen (Medtronic Ophthalmics, Jacksonville, FL). We calculated the validity of glaucoma screening by FDP among persons both with diabetes and without diabetes.We examined 111 eyes of 56 Omani patients (55 eyes of 28 patients with diabetes and 56 eyes of 28 persons without diabetes). Two persons had a history of glaucoma in both eyes. Glaucoma screening by FDP detected five eyes (two eyes of patients with diabetes and three eyes of persons without diabetes) with glaucoma. The specificity of glaucoma screening among those with and without diabetes was 97.4% and 97.3%, respectively. The sensitivity was 6% and 11%, respectively, in these two groups.Validity of glaucoma screening by FDP is not different among those with and without diabetes. In countries with high rates of diabetes, FDP could be used as a first-level screening tool for glaucoma.

In the era of Direct Observation Treatment (DOT) for tuberculosis, clinicians need to focus on high-risk groups. We present sputum conversion rate at one and two months following DOT and its predictors in Oman.Hospital-based clinical intervention type of case series.Chest physicians in a referral hospital examined sputum-positive cases of tuberculosis between 2001 and 2006. Patients with HIV infection and treated in the past were excluded. History of smoking, diabetes and duration of symptoms were noted. Sputum was tested for bacillus density. Blood was tested for platelet count and blood sugar levels. One and two months following treatment, the sputum was retested to determine sputum conversion. Regression analysis was done to identify the predictor of late conversion.Of the 112 sputum-positive TB cases, 39 (34.8%) and 49 (43.7%) cases were sputum negative one and two months respectively after DOT. Lower platelet count was significantly associated with early sputum conversion. (Diff of mean = 38.3 cells x 9/L (95% CI 36.9 - 39.7). On univariate analysis, duration of symptoms, history of diabetes, smoking and ESR were not associated with the early sputum conversion. Knowledge of platelet count seems to assist the clinician to predict the early sputum conversion following DOT for pulmonary TB.Sputum conversion rate among tuberculosis patients treated with DOT for one and two months in Oman was 34.8% and 78.6% respectively. Platelet count could assist in predicting early sputum conversion.

Objectives: As client feedback is useful to improve health service delivery, assessments should be undertaken periodically. This study aimed to determine the level of satisfaction among expectant mothers visiting health institutions for antenatal care services in the Ministry of Health, Musandam region of Oman in 2005. Methods: This was a cross sectional survey in a hospital setup. Women registered in the antenatal clinics of different health institutions of Musandam region were interviewed. Arabic speaking investigators in six health institutions of Musandum region collected personal profiles, details of different antenatal services offered and responses regarding the satisfaction with these services. The number and percentage of responses were calculated to grade the level of satisfaction. Results: Eighty-three registered women who visited antenatal clinics in six health institutions were interviewed. The overall satisfaction for antenatal care was of excellent grade in 49 (59% - 95% confidence interval 48.5 - 69.6) participants. Sixtyseven (81%) women were happy with services at antenatal clinics mainly because of the attitude of the doctors and nursing staff. The leading causes of dissatisfaction were the laboratory services and overcrowding during morning hours. Conclusion: The women attending antenatal care services in Musandam were highly satisfied with the services offered; however, there was scope for further improvement. The Ministry of Health in consultation with the caregivers should focus on improving antenatal services.

DIABETES MELLITUS IS A PUBLIC HEALTH problem in both developing and developed countries with one of its complications being diabetic retinopathy (DR). As the life expectancy of people with diabetes has increased owing to improved health care, the prevalence of DR is rising. DR is therefore now included in the list of priority diseases of the WHO’s VISION 2020 strategy to eliminate all preventable cases of blindness by the year 2020. In Oman, a comprehensive programme approach to DR was adopted in 1998. Oman’s system of screening for and treating DR is considered to be a good model in the region. The programme approach for eye care of people with diabetes in Oman has strengths and weaknesses. This editorial describes these, along with future challenges and solutions to handle them, including the use in Oman of modern technology to manage the eye complications of diabetes. However, strategies for educating people about their role in primary prevention of DR and the development of rehabilitation services for visually impaired diabetics still need urgent implementation.

This study was conducted in 2002-2003 at selected schools of eight health regions of Oman. The authors present risk factors and predictors of progression of myopia between the 7th and 10th grades.This was a historical cohort study. A total of 1304 students in 10th grade, both with and without progression of myopia, were examined by the refractionists. Vision, refraction, and physical measurements of each student were recorded. The health records of all students were reviewed to note the same parameters measured when they were in 7th grade. The odds of progression in height, progression in weight, protein energy malnutrition status, sex, age, history of refractive error in parents and sibling, evidence of trachoma, and allergic conjunctivitis were calculated to associate them to the progression of myopia.Mean progression of myopia was 0.37 D per year (SD = 0.27D). The mean progression of myopia among students with history of myopia in 7th grade was 0.21 D more than that of students not having myopia in 7th grade (95% CI 0.12-0.29). Multivariate regression analysis suggested that weight of student in the 7th grade (t=-2.2, p=0.031), positive history of myopia in one of the siblings (t=2.44, p=0.015), and myopia in the 7th grade (t=4.56, p0.001) were associated with the progression of myopia.Family history of myopia and myopia at younger age were predictors for progressive myopia in teenaged Omani children. However, the role of body mass index at a younger age to predict progressive myopia was not conclusive.

Background : A review of pediatric cataract cases operated between January 2003 and March 2005 in the tribal belt of central India was carried out. Aim : We present the profile of cataract cases in children ≤18 years and postoperative visual status in the eyes operated upon. Settings and design : This was a retrospective medical record retrieval type of cohort study in a hospital setting. Materials and Methods : Pediatric ophthalmologists examined children and operated eyes with cataract. The personal profile, preoperative, intraoperative and postoperative details were noted. The surgical procedures included cataract extraction, intraocular lens implantation, posterior capsulorrhaxis and anterior vitrectomy in most of the cases. We evaluated the visual status of eyes with cataract before and 6 weeks after surgery. Statistical analysis: We used univariate type of parametric type of statistical analysis. Results: A total of 575 eyes of 502 children had cataract. Cataract in 65 children was bilateral and in 437 cases it was unilateral. Congenital cataracts were in 88 (17.5%) eyes. Traumatic cataracts were noted in 170 (33.9%) eyes. The proportion of cataract was higher in males than in females. Variation in ′number of cataracts′ among different age groups was noted. Vision following surgery was more than 6/18 in 84 (16.4%) eyes. The vision could not be assessed in 256 (44%) eyes. Conclusion: Improvement of child health care is needed for early detection of cataract in children. Role of rubella and trauma in childhood cataract should be investigated and addressed. Visual assessment and postoperative care should be further improved.

Background: We present the outcomes of bilateral myectomy and tucking of the proximal end of the muscle for the treatment of asymmetric primary inferior oblique (IO) overaction. Methods: This was a one-armed prospective cohort study. An ophthalmologist and orthoptist evaluated cases of primary IO muscle overaction presenting between January 2010 and December 2013. All eyes underwent bilateral myectomy and tucking of the proximal end of the IO muscle. Data were collected on ocular motility, the angle of deviation, postoperative complications, and status of hypertropia at 6 months postoperatively. The 95% confidence intervals (CI) were calculated. The statistical significance was indicated by P < 0.05. Results: The patient cohort was comprised of 51 patients with primary IO muscle overaction. Preoperatively, all eyes had +2 or greater overaction of the IO muscle except one patient with +1 and +3 overaction in the right and left eyes, respectively. At 6 months postoperatively, the reduction in the angle of deviation for distance and near was 32.6 prism diopters (PD) ([95% CI 30.3–34.9], P < 0.001) and 32.6 PD ([95% CI: 29.8–35.3], P < 0.001), respectively. There was no significant difference in the postoperative variation of the reduction in the angle of deviation based on gender, right or left eye, and type of horizontal strabismus. There were no cases of “A” or “V” patterns, clinically a significant IO underaction or “adherence syndrome” postoperatively. Conclusion: Bilateral myectomy and tucking of the proximal end of the muscle is likely an effective method of treating asymmetric primary IO muscle overaction.

Background: We present the incidence and determinants of endophthalmitis between July 2010 and June 2012 at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. On its basis, we recommended recommendations to strengthen the infection prevention and control strategies. Methods: This is a retrospective review of health records type of study. The details of cases reported having endophthalmitis among those operated in 2 years of study period were studied. The incidence of endophthalmitis was calculated for different eye surgeries and epidemiological variables. The causative organisms in vitreous tap were reviewed. The visual outcomes 6 weeks following intervention/treatment of endophthalmmitis were also studied. Results: Of the 22,554 cases operated, 17 developed endophthalmitis. The incidence was 0.08% (95% confidence interval [CI] 0.04-0.11). The incidence of endophthlamitis among cataract surgeries was 0.12% (95% CI 0.04-0.21). Five specimens did not show any bacteria or fungus. Staphylococcus epidermis (3 cases) was the main pathogen identified. In 8 (47%) eyes, vision deteriorated in spite of treatment. In 5 (29%) eyes, it became stable and in 4 (23.5%) eyes, it improved following treatment. Signs of infection were noted in 1 st week, 3 weeks and 12 weeks in 4, 6 and 5 eyes respectively. Late presentation of infection (6 months postoperatively) was reported in two eyes. Conclusions: A vigilant infection control unit in a large eye hospital helps in monitoring endophthalmitis related catastrophes and suggests timely preventive measures to reduce the occurrence and appropriate measures to limit visual disabilities following eye surgery related endophthalmitis.

Background: To assess the visual outcomes following cataract surgeries at a Private Eye Hospital in Riyadh, Saudi Arabia. Methods: This was a cohort study of cataract surgeries performed from January to June 2014. Preoperative data were collected on patient demographics presenting and best corrected distance visual acuity (BCVA) and ocular comorbidity. Data were also collected on the type of surgery, type of intraocular lens (IOLs) implanted, and complications. BCVA and refractive status at 6–8 weeks postoperatively were noted. The predictors of vision ≥6/18 were identified. Results: Four hundred eyes of 400 patients underwent cataract surgery. There were 235 (59%) males. Presenting preoperative vision was 2 D was present in 33 (8%) eyes. Conclusion: The recent trend of intentional overcorrection in one eye following modern cataract surgery in order to provide some functional near vision indicates that benchmark for success in getting “good visual outcomes” postoperatively (vision of ≥6/18) may need to be revised.

Dear Sir, We thank the reader for raising queries and the editor for giving us the opportunity to respond to these queries.[1] Please find each query and its reply; Question 1: Randomization: Allotment and masking? Whether surgeons chose their anesthesia. Answer 1: The randomization schedule for each surgeon was generated by EpiTable software for 1000 cataract surgeries.[2] Each patient was randomly assigned to either topical or peribulbar route of anesthesia by opening an envelope on entering the recovery (preanesthetic) room. Patients were explained about both the routes of anesthesia, and that they would undergo cataract surgery by use of any one of these two routes. A written informed consent was obtained. Patients refusing to consent were excluded from the study. The randomization was not equal due to surgeons not being present in operation theater at times, patients refusal, and patients who could not bear topical anesthesia. Question 2: Time of surgery? Answer 2: In peribulbar group, the surgery was done about 7–8 min after injection; in topical group, the drops were instilled 5 min before surgery and repeated just before commencing surgery. Question 3: Conjunctival congestion more in peribulbar? Answer 3: Subconjunctival hemorrhage occurring in the topical group was mainly due to forceps trauma in few cases with poor akinesia led to conjunctival congestion. They were more in topical anesthesia group. Question 4: Visual acuity why after 4–6 weeks? Few hours more imp Answer 4: Day 1 visual acuity comparison was done with respect to surgeons and cataract grade and day 1 visual acuity did not differ significantly in the two groups. However, cases of the topical group are having better vision but the difference was not statistically significant. Question 5: Pain Scale: Likert scale? Purely subjective? Intraoperative discomfort more in peribulbar group? How was it asked? Answer 5: Pain score grading was done using a scale wherein patients were asked to grade score of the pain on a scale of 1–10. It was subjective in nature. We inquired about intraoperative discomfort soon after completing the surgery. Intraoperative discomfort more in peribulbar group. We have not mentioned this in the paper. We agree with the observations made that topical anesthesia is suitable to a certain group of patients, and that is the reason we had certain inclusion and exclusion criteria. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A prevalence study was conducted in 2001 as part of the SAFE Trachoma Control initiatives in twelve districts of eight northern provinces of Vietnam. The authors present the magnitude and some risk factors of trachomatous trichiasis (TT), trachomatous scarring (TS) and trachomatous corneal opacity (TCO).Ophthalmologists examined 43,677 people of more than 34 years of age, randomly selected. Ophthalmic loupe, torchlight and the trachoma grading card recommended by WHO were used for this examination.The prevalence of TT was 7.31% (95% CI 7.07-7.55) and 382,950 persons with TT were included in the study population. The rate was higher in females (8.92%) than in males (5.35%). The rate was 13.7% in the district of Me Linh in Vinh Phuc province and in the districts of Ha Tay and Khoai Chau in Hung Yen province, while in the districts of Na Ri (Bac Kan province), Cam Xuyen (Ha Tinh province) and Van Yen (Yen Bai province), the prevalence of TT was less than 2%. The TT rate in the plains was 13%, while in mountainous, coastal and delta terrains, the rate fell to 2.4%, 3.5% and 9.4% respectively. The prevalence of TS and TCO was 8.42% (95% CI 8.21-8.61) and 1.1% (95% CI 1.00-1.20) respectively.Although the magnitude of TT is high, the problem of TCO seems to be less serious. The goal of eliminating blinding trachoma from the study area by 2010 represents a big challenge. Based on these survey estimates, the national program could plan resources for the 'S' strategy of trachoma control (surgery for those at immediate risk of blindness).

To determine the prevalence of intestinal parasitic infections among primary school children in Dhahira region of Oman.The study took place in the Dhahira region of Oman from September 2004 to March 2005. We randomly recruited 436 students of 9-10 years of age. Their anthropometric measurements were noted. We collected the stool sample of each student and examined for different intestinal parasites. Stereoscopic microscopy and the World Health Organization's approved KATO-KATZ technique were used.Of the 436 students examined, 65 children (15%) were undernourished (body mass index (BMI)14 kg/m(2)). The prevalence of intestinal parasitic infections was 38.7% (95% CI 33.2-42.2). The prevalence of protozoan infection was 36% while helminth infection was 9.4%. The prevalence of Entamoeba histolytica/Entamoeba dispar was 24%, Giardia species 10.5% and Escherichia coli 1.4%. The hookworm (Ancylostoma duodenale, Necator americanus), Ascariasis lumbricoides, Trichuris trichiura, Hymenolepiasis nana, Taenia species, Enterobius vermicularis and Strongyloides infections in our study had very low prevalence. Only 29 (6.4%) students had parasitic infection by more than one parasite. The wet zone was significantly associated to the intestinal parasitic infections [Adjusted odds ratio (OR)=3.2 (95% CI 1.9-5.2)].Dhahira region could be classified as low prevalence and low intensity area for soil transmitted helminths infections. However, the magnitude of the protozoan infection was high. The school health program should focus on parasitic infection treatment and addressing the underlying causes of this problem.

A public health intervention study in Vietnam was conducted between 2002 and 2005 to assess the impact of improved water and sanitation facilities and increased awareness about active trachoma in the community.In My Thon village (MT), all four components of the SAFE strategy were implemented. In Xom Ngoai village (XN), only the SA components of the trachoma control strategy were implemented. The villagers improved water and sanitation facilities in MT. Women's Union and school authorities assisted in increasing awareness in the community. Ophthalmologists examined the residents for trachoma. The decline in active trachoma and other water-related diseases was determined by pre- and post-intervention assessments. The impact of the differential FE strategy on two villages was evaluated.The active trachoma prevalence in MT (SAFE) and XN (SA) at baseline was 13.3% and 10.2%, respectively. In two years, the masons constructed or improved 281 double-vault and three septic tank latrines, 241 bathrooms, 273 dug wells and 252 water tanks in MT. The prevalence in MT (SAFE)XN (SA) after two years was 1.4% and 6.7%, respectively. The additional decline of active trachoma due to the differential FE strategy among children under the age of 15 was 6.8%. The FE strategy was responsible for 58.7% of the decline at all ages and 37.4% in children under the age of 15. Knowledge of the prevention of trachoma had improved in two years. However, the attitude towards and practice of trachoma control were not different in the two villages.'F''E' implementation made a significant contribution to the reduction of active trachoma. Community participation and collaborative efforts of partners are crucial. The indicators used to monitor FE strategies are interrelated and therefore should be evaluated together.

Purpose In 1989, World Health Organization consultant operated on trachomatous trichiasis (TT) cases in Dhakhiliya region of Oman. We evaluated their current ocular status. Design This was an historic cohort study. Methods This study was conducted in an in-house setting. Ninety-one patients with TT who underwent operation by the bilamellar tarsal rotation procedure (BTR) were our study population. Their preoperative, operative, and immediate postoperative data were retrieved from the register. Staff members located and visited these patients. They examined the eyes and determined their visual, TT, and corneal status. They interviewed participants with a close-ended questionnaire to assess the quality of life and satisfaction for the TT services that were offered. Results Sixty-three patients could be followed. Among 72 eyes that had undergone operation 17 years earlier, the recurrence rate was 47.2% (95% CI, 35.7–58.8). In 21 unoperated eyes (55%), TT was noted. The association of TT recurrence to age, gender, type of TT, conjunctivitis, and active trachoma was tested. The BTR for minor trichiasis was the risk factor for recurrence of TT (adjusted odds ratio, 3.9; 95% CI, 1.4–10.8). Conclusion The high recurrence rate of TT, 17 years after BTR surgery and high rates of TT in eyes that did not undergo surgical procedure earlier suggest that the causes of high recurrence should be identified and addressed. The ongoing pathologic condition of scarring of upper lids of both operated and unoperated eyes could be responsible for lid status after 17 years of BTR surgeries. High percentage of refusals because of long-term high recurrence could pose a challenge to reach the “elimination of blinding trachoma” by 2020.