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Purpose: To address the human resources challenge for the provision of low vision services in Saudi Arabia, this study sought to investigate the knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision services. The knowledge and attitudes to low vision services can influence the provision of low vision services by optometrists. Methods: A prospective cross-sectional survey of optometrists practicing in Saudi Arabia was undertaken using an online questionnaire designed to elicit the opinions of respondents. The online questionnaire was sent out to optometrists on the official mailing list of registered optometrists and those on the mailing list of the Saudi Society of Optometry. Results: Only 26.5% of the respondents correctly indicated the correct designation of low vision in terms of visual acuity. Although 95.8% indicated that optical low vision devices could help people with low vision, 81.6% reported that low vision devices were expensive, and 42.9% felt low vision practice was not profitable. Only 10.4% of respondents provide low vision services in their practice. Insufficient training in low vision care was the main barrier militating against the provision of low vision services. Conclusion: The pertinent finding in this study is that about a quarter of the respondents could correctly designate low vision in terms of visual acuity using the World Health Organization (WHO) definition. The study concluded that there was poor knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision, which has implications for the provision of low vision services by optometrists.

BACKGROUND: The mortality rate due to road traffic accidents (RTA) is significantly high in Saudi Arabia (SA) compared to other countries. The visual function which includes good visual acuity (VA) and binocular vision are very important factors that can contribute to the incidence of RTA. AIM: The aim of this study is to investigate the association between refractive errors (REs) and the RTA in SA. METHODS: A total of 354 participants (mean age 22.67 ± 3.22 years) were recruited randomly to participate in this study from the population of Qassim district. Data collected using the questionnaire included participants’ age, sex, and education level, ocular and medical history, driving history as well as history of RTA. Ocular health examination including VA, RE measurements, and binocular vision function vision was measured and analyzed. RESULTS: The results of this study show that 48.3% of drivers had some form of REs with 3.4% being visually impaired. 217 (61.3%) of participants have had an RTA, and 119 (54.9%) of them have had more than two accidents in the past two years. The findings show no significant association between the occurrence of RTA and uncorrected REs or binocular vision dysfunction. CONCLUSION: Our data showed significantly higher rate of RTA among Saudi drivers which is much higher than any country in the world. The current Saudi regulations for obtaining driving license need to be modified, with implementing a comprehensive eye examination prior to acquiring or renewing drivers’ licenses.

BACKGROUND: Certain occupations and career paths require potential candidates who meet certain visual standards that allow them to apply or hold realistic possibilities for career advancement. AIM: This study aims to assess the visual function requirements for public jobs in Saudi Arabia and compare them with international standards. METHODS: Interview with eye care specialists in the fields of optometry and ophthalmology was conducted. This interview was consisted of seven pre-approved questions on current vision health requirements for eyesight-dependent careers. RESULTS: Interview responses revealed the existence of several visual requirements which were visual acuity, color vision, and visual field. These requirements are essential for various government jobs and functions, with examinations of applicants being necessary for acceptance of a vacancy or subsequent career progression. CONCLUSION: Many government positions of employment require predefined level visual standards which are not widely known. Defining what these standards are and making them publicly accessible will aid both future candidates in better planning their employment options and specialists in providing the required standards on request.

Introduction: The aim of this review was to estimate the prevalence of refractive errors (RE) and uncorrected refractive error (URE) in school-aged children of 4 to 14 years of age in Saudi Arabia. Methods: An extensive search was performed for peer-reviewed studies with data from the Saudi population during the past 20 years. The Cochrane Library, Pubmed, and Embase databases were used. Two independent reviewers evaluated publications and extracted the data. The quality of the studies was evaluated based on a critical appraisal tool designed for systematic reviews. The pooled prevalence of refractive error, uncorrected refractive error and different types of refractive error were estimated by using the random-effects meta-analysis. Results and Discussion: Eight school-based studies were included in this review. Among the overall pooled population of 12,247childern, the estimated prevalence of refractive error was 17.5% (95% CI: 11.1- 25). In the five studies that reported uncorrected refractive error (N=10,198), the pooled prevalence was 16.8% (95% CI: 11.4 – 21.3). The overall prevalence of refractive errors was very similar among boys, 16.8 (95% CI: 10.8- 24.1), and girls, 17.7% (95% CI: 10.2 – 25.9). Myopia was the most prevalent refractive error and was present in 40.8% (95% CI: 16.1 – 69.9) followed by astigmatism 29.7% (95% CI: 6.1- 61.7) and hyperopia 28.3% (95% CI: 16.9 – 41.2). Conclusion: This review highlights the high prevalence of refractive errors and uncorrected refractive error among children in Saudi Arabia. More studies are required using standardised methods in different regions where there is a lack of information on UREs. It is recommended that vision screening programs of children for RE should be implemented at the community level and integrated into school health programmes in order to detect UREs and prevent amblyopia, which is one of the debilitating consequences of URE.

Naveen Kumar Challa,1,2 Waleed M Alghamdi1 1Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia; 2Lotus Eye Care Hospital, Coimbatore, IndiaCorrespondence: Naveen Kumar ChallaQassim University, P.O. Box: 1162, Buraidah, Saudi ArabiaTel +966531177518Fax +966(16)3800050Email N.challa@qu.edu.saAim: To determine the absolute and relative ocular protrusion values in normal south Indian population, and its relation to age, gender and type of refractive error.Methods: A total of 387 subjects aged 7– 70 years were included in this study. Both right and left absolute ocular protrusion values were measured by a single physician using Luedde exophthalmometer in primary gaze. Right eye ocular protrusion data were used for reporting the absolute ocular protrusion values, and difference between right and left eye absolute ocular protrusion values of the same individual was used to report the relative ocular protrusion values. Subject age was grouped as decades. Measurement values were evaluated by descriptive and inferential statistics.Results: The mean absolute ocular protrusion of right eye was 14.67 ± 1.70 mm and left eye was 14.32 ± 1.75 mm. The mean right absolute ocular protrusion values from 1st to 7th decade were 12.73 ± 1.21 mm, 14.8 ± 1.25 mm, 15.79 ± 1.31 mm, 15.77 ± 1.36 mm, 15.87 ± 1.28 mm, 15 ± 1.03 mm and 14.36 ± 0.88 mm respectively. One-way analysis of variance showed that there was a significant difference in the ocular protrusion among the age groups (p < 0.005). The mean relative ocular protrusion was 0.35 ± 0.64 mm. The type of refractive error (up to ± 6.00D) has no significant effect on the absolute ocular protrusion values and showed a weak correlation between magnitude of myopia and hyperopia on absolute ocular protrusion. There was a statistically significant difference in absolute ocular protrusion among the female and male subjects.Conclusion: Age and gender seems to significantly influence the absolute ocular protrusion and need to be considered for clinical evaluation of bilateral proptosis. The refractive error up to ± 6.00D seems to have no significant effect on the absolute ocular protrusion.Keywords: absolute, relative, ocular protrusion, exophthalmometer, refractive status, proptosis

Waleed M Alghamdi, Saif H Alrasheed, Vishakh Nair, Muhammed S Alluwimi Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi ArabiaCorrespondence: Saif H AlrasheedQassim Unversity, P.O. Box 1162, Buraydah, Saudi ArabiaTel +966505201475Fax +966-16-3800050Email s.rasheed@qu.edu.saPurpose: To assess the effects of 0.5% and 1% cyclopentolate on the main parameters of the anterior segment (central corneal thickness (CCT), anterior chamber angle (ACA), depth (ACD) and volume (ACV)) in low/moderate myopia and hyperopia along with the effect on IOP.Patients and Methods: Both eyes of 30 subjects (15 myopic and 15 hyperopic) with mean age±standard deviation of 21.4± 3.6 years were enrolled. Each participant was administered two drops of cyclopentolate 1% in the right eye and two drops of cyclopentolate 0.5% in the left eye, 15 minutes apart. All participants underwent intraocular pressure (IOP) measurement using noncontact tonometry, and anterior chamber parameter measurement using Pentacam.Results: Following the use of 0.5% and 1% cyclopentolate among the hyperopic group, there was a statistically significant increase in ACD for 1% (pre 2.762± 0.28 mm and post 2.89± 0.25 mm) and 0.5% (pre 2.71± 0.28 and post 2.86± 0.27 mm) and ACV for 1% (pre 141.40± 20.59 mm3 and post 154.35± 19.69 mm3) and 0.5% (pre 137.40± 20.48 mm3 and post 152.93± 20.50 mm3). In contrast, ACA decreased with both doses 1% and 0.5%, but was not statistically significant (p for both > 0.05%). With 0.5% and 1% cyclopentolate among the myopia group, there was a significant increase in ACD following cyclopentolate 1% (pre 3.18± 0.22 mm and post 3.25± 0.21 mm) and 0.5% (pre 3.200± 0.22 mm and post 3.26± 0.05 mm), p˂0.05. The ACV was significantly increased following 1% cyclopentolate, p˂0.001. The ACA showed a statistically significant decrease following cyclopentolate 1%, P=0.01, but not a significant decrease after cyclopentolate 0.5%, P=0.170. There was a significant increase in the IOP after 1%, p˂0.001, while a decrease with 0.5%, p=0.008.Conclusion: A topical dosage of cyclopentolate 1% showed significant changes in ACA and ACV among the hyperopia and myopic groups compared to 0.5%. Therefore, it is important to consider the use of a 0.5% cyclopentolate dosage to minimize changes to anterior chamber parameters.Keywords: cycloplegic, anterior chamber angle, anterior chamber volume depth, central corneal thickness

Childhood visual impairment is a global public health problem, especially in low and middle-income countries. Its most common causes are avoidable by early diagnosis and treatment.To assess prevalence of refractive error and visual impairment among school-aged children in Hargeisa, Somaliland, Somalia.This was a cross-sectional study of 1204 students (aged 6-15 years) in 8 randomly selected primary schools in Hargeisa from November 2017 to January 2018. We used the modified Refractive Error Study in Children to determine prevalence of refractive error and visual impairment, including the following investigations: distance visual acuity, assessed by Snellen Tumbling E-chart; refraction, assessed by retinoscope binocular vision assessment; and examination of anterior and posterior segments.Prevalence of uncorrected, presenting and best-corrected visual impairment of 6/12 or worse was 13.6%, 7.6% and 0.75%, respectively. Only 16 of 91 (17.6%) children were using spectacles and the rest were unaware of the problem. Refractive error was the cause of visual impairment in 76.8% of participants, amblyopia in 22.0%, trachoma in 2.4%, and corneal opacity and cataract in 0.6%. Anterior segment abnormalities were found in 8.3%, mainly vernal keratoconjunctivitis, while posterior abnormalities were observed in 0.7%. Prevalence of myopia was 9.1%, hypermetropia 2.7% and astigmatism 3.9%. Prevalence of visual impairment because of Refractive Error was associated with increasing age, but there was no significant association with school grade or sex.Prevalence of visual impairment among school-aged children in Hargeisa was high, and the leading cause was uncorrected Refractive Error. There are barriers to care and it is critical that they are overcome.معدل انتشار الخطأ الانكساري وضعف البصر بين الأطفال في سن الدراسة في هرجيسا، صوماليلاند (الصومال).زهرة عبدي أحمد، سيف الرشيد، وليد الغامدي.يُعَدُّ ضعف البصر في مرحلة الطفولة مشكلةً من مشكلات الصحة العامة على الصعيد العالمي، ولا سيَّما في البلدان المنخفضة الدخل. ويمكن تجنب أسبابه الأكثر شيوعاً عن طريق التشخيص والعلاج المُبكرَيْن.هدفت هذه الدراسة إلى تقييم معدل انتشار الخطأ الانكساري وضعف البصر بين الأطفال في سن الدراسة في هرجيسا، صوماليلاند (الصومال).شملت هذه الدراسة المقطعية 1204 طلاب (تتراوح أعمارهم بين 6 سنوات و 15 سنة) في 8 مدارس ابتدائية مختارة عشوائياً في هرجيسا خلال الفترة من نوفمبر/تشرين الثاني 2017 إلى يناير/كانون الثاني 2018. واستخدمنا دراسة الخطأ الانكساري المعدَّلة لدى الأطفال لتحديد معدل انتشار الخطأ الانكساري وضعف البصر، بما في ذلك الاستقصاءات التالية: حدة البصر عن بُعد، التي تم تقييمها بواسطة مخطط Snellen Tumbling E-chart، والانكسار، الذي تم تقييمه من خلال تقييم رؤية العينين بمنظار الشبكية، وفحص الأجزاء الأمامية والخلفية.بلغ معدل انتشار ضعف البصر بقيمة 6/12 أو أقل غير المُصحَّح والمُستعلِن والمُصحَّح على أفضل وجه 13.6٪ و 7.6٪ و 0.75٪ على التوالي. وكان 16 فقط من بين 91 طفلاً (17.6٪) يستخدمون النظارات وكان الباقون غير مدركين للمشكلة. وكان سبب ضعف البصر هو الخطأ الانكساري في 76.8٪ من المشاركين، والغَمَش في 22.0٪ منهم، والتراكوما في 2.4٪ منهم، وعَتَامة القَرْنِيَّة والسادّ في 0.6٪ من المشاركين. ووُجدت تشوهات في الجزء الأمامي في 8.3٪ من المشاركين، وعلى وجه الخصوص التهاب القَرْنِيَّة والملتحمة الربيعي، في حين لوحظت تشوهات في الجزء الخلفي في 0.7٪ منهم. وبلغ معدل انتشار الحَسَ 9.1٪، ومد البصر 2.7٪، واللابؤرية 3.9٪. وارتبط معدل انتشار ضعف البصر الناجم عن الخطأ الانكساري بزيادة العمر، ولكن لم يكن هناك ارتباط مهم بالصف المدرسي أو نوع الجنس.كان معدل انتشار ضعف البصر بين الأطفال في سن الدراسة في هرجيسا مرتفعاً، وكان السبب الرئيسي وراءه الخطأ الانكساري غير المُصحَّح. وثَمَّة عوائق تحول دون تقديم الرعاية، ومن الأهمية بمكان أن يتم التغلب عليها.Prévalence du vice de réfraction et de la déficience visuelle chez les enfants d’âge scolaire de Hargesia, au Somaliland (Somalie).Les troubles visuels chez l’enfant constituent un problème de santé publique mondial, en particulier dans les pays en développement. Ses causes les plus courantes sont évitables par un diagnostic précoce et la mise en place rapide d’un traitement.La présente étude avait pour objectif d’évaluer la prévalence du vice de réfraction et de la déficience visuelle chez les enfants d’âge scolaire à Hargeisa, au Somaliland (Somalie).Il s’agissait d’une étude transversale menée auprès de 1204 élèves (âgés de 6 à 15 ans) de huit écoles primaires sélectionnées de manière aléatoire à Hargeisa, entre novembre 2017 et janvier 2018. Nous avons utilisé l’étude modifiée sur le vice de réfraction chez les enfants afin de déterminer la prévalence de cette affection et de la déficience visuelle, comprenant les examens suivants : acuité visuelle à distance, évaluée par l’échelle de Snellen avec des E ou C directionnels ; la réfraction, évaluée par examen de la vision binoculaire par rétinoscopie ; et examen des segments antérieurs et postérieurs.La prévalence de la déficience visuelle non corrigée, détectée et la mieux corrigée de 6/12 ou un score inférieur était respectivement de 13,6 %, de 7,6 % et de 0,75 %. Seuls 16 enfants sur 91 (17,6 %) portaient des lunettes tandis que les autres n’avaient pas conscience du problème. Le vice de réfraction était la cause de la déficience visuelle chez 76,8 % des participants, l’amblyopie dans 22,0 % des cas, le trachome chez 2,4 % des enfants, et l’opacité cornéenne et la cataracte chez 0,6 % d’entre eux. Des anomalies du segment antérieur ont été observées chez 8,3 % des participants à l’étude, principalement des kératoconjonctivites vernales, tandis que des anomalies du segment postérieur ont été observées dans 0,7 % des cas. La prévalence de la myopie était de 9,1 %, celle de l’hypermétropie de 2,7 % et celle de l’astigmatisme de 3,9 %. La prévalence de la déficience visuelle due à un vice de réfraction était associée à un âge supérieur, sans toutefois que l’on puisse noter de corrélation significative avec le niveau scolaire ou le sexe.La prévalence de la déficience visuelle chez les enfants d’âge scolaire de Hargesia était élevée, principalement en raison d’un vice de réfraction non corrigé. Il existe des obstacles aux soins et il est essentiel de les surmonter.

To investigate the association between levels of MMP-9, a common marker of inflammation in tears, and changes to the meibomian glands accompanying soft contact lens (CL) wear.Flush tears were collected from: (1) three groups of CL wearers who had worn CLs on a daily basis for different durations (Short: 2 ± 1 years, Moderate: 5 ± 1 years and Long experience: 10 ± 2 years); (2) a group of previous CL wearers (PWs) who had ceased wear for at least 6 months; and (3) healthy non-wearers (NW) as a control group. Total MMP-9 and its inhibitor, tissue inhibitor of MMPs-1 (TIMP-1) concentration were established using sandwich enzyme-linked immunosorbent assay. The MMP-9: TIMP-1 ratio was calculated for every individual, and then the average of all ratios for each group were compared. The non-parametric statistical Kruskal Wallis one-way analysis of variance was used for comparison, with Dunn's testing post-hoc.Tear samples from 100 participants (51 females; mean age ± SD: 25.4 ± 4.1 years) were analysed. MMP-9 concentrations and MMP-9:TIMP-1 ratio were significantly different between groups (Kruskal Wallis p = 0.001 and p 0.001 respectively), while the concentration of TIMP-1 did not vary statistically between study groups (Kruskal Wallis, p = 0.32). Post hoc analysis indicated that only CL wearers with short experience had MMP-9 concentrations that were significantly high compared to NWs (23.1 ± 17.9 ng/mL and 4.1 ± 4.1 ng/mL, respectively, Dunn p 0.001). Additionally, the ratio of MMP-9 to TIMP-1 concentration was only significantly greater in CL wearers with short experience (mean ratio ± SD = 1.15 ± 0.76) when compared to NWs (0.19 ± 0.29, Dunn P 0.001), CL wearers with moderate experience (0.37 ± 0.41; P = 0.01) and PWs (0.38 ± 0.36; P = 0.02).The early years of CL wear appear to be associated with increased expression of MMP-9 relative to its inhibitor TIMP-1. This may be indicative of low-level inflammation during this phase of wear. The role this plays in propagating dry eye disease and MGD in CL wear requires further exploration.

Background: Visual impairment is disproportionately distributed between rural and urban dwellers. Rural dwellers have limited access to the eye care services that are available in urban cities. Aim: The aim of this study was to determine the prevalence and causes of visual impairment in Dariyah, a rural community in the Qassim region, Saudi Arabia. Setting: This research comprised a population-based assessment of the vision and visual status of the inhabitants of Dariyah community. Methods: A cross-sectional descriptive study was conducted amongst the inhabitants of the community of Dariyah. A comprehensive eye examination consisting of visual acuity, ocular health examination, objective and subjective refraction was performed. The examinations were conducted by registered ophthalmologists and optometrists from the Qassim University. Vision impairments were categorised according to the International Classification of Diseases (ICD), Section 9D90, ‘Vision impairment including blindness’ (2018). Results: In all, 68 (24.5%) participants had vision impairment (using the better-seeing eye), with refractive errors being the main cause of vision impairment. Other causes of vision impairment included cataract (20, 7.2%), trichiasis (5, 1.8%) and glaucoma (2, 0.7%). Refractive errors were present in 193 (69.7%), with astigmatism being the commonest refractive error. About 60% of those with refractive errors presented without spectacles for correction, and 20% reported that they had never had an eye examination. Refractive errors could not be determined in 19 (6.9%) of the subjects because of conditions such as matured cataract and other ocular abnormalities. Conclusion: Uncorrected refractive error was found to be the leading cause of vision impairment in this rural community in Saudi Arabia.

PURPOSE To investigate the effect of soft contact lens (CL) wear on the morphology of the epithelial-lamina propria junction as well as the possible association with symptoms of discomfort. METHODS Ninety-two subjects were recruited, including 60 soft CL wearers, 16 previous wearers, and 16 non-wearers. Additionally, subjects were classified as symptomatic or asymptomatic using the Contact Lens Dry Eye Questionnaire 8 for the CL wearers (a score ≥ 12 was considered symptomatic) and the Dry Eye Questionnaire 5 for the previous wearers and non-wearers (a score ≥ 5 was considered symptomatic). In vivo confocal microscopy of the tarsal conjunctiva was performed on a single occasion. Papillae density, shortest diameter, longest diameter, area, circularity, lumen/wall brightness ratio, irregularity, reflectivity, inhomogeneous appearance of wall and inhomogeneous appearance of rete ridges were evaluated. Effects of CL wear, symptoms and their interaction were analysed using two-way analysis of variance. Correlations were investigated using Spearman's coefficient. Data are presented as mean (standard deviation) or median [interquartile range]. RESULTS Contact lens wearers, compared to previous wearers and non-wearers, showed higher circularity [0.65 (0.08) vs 0.59 (0.10) vs 0.57 (0.11), p = 0.003]. Subjects with symptoms, compared to asymptomatic participants, showed higher circularity [0.64 (0.08) vs 0.61 (0.10), p

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

Aim To investigate the expression of the keratinization-related protein, filaggrin, in the lid margin epithelium of contact lens (CL) wearers compared with nonwearers. Methods This was a cross-sectional study of 100 individuals with different exposures to CL wear: short, moderate, and long experience; previous CL wearers; and nonwearers as controls. Impression cytology samples were collected from the lid wiper (LW) area of the central upper lid margin. After fixing, an equal, random sample was selected from each group (n=13) for immunocytochemistry analysis using antihuman primary anybody (mouse filaggrin), then stained with secondary antibody (fluorescein isothiocyanate-conjugated donkey anti-mouse immunoglobulin G horseradish peroxidase) to detect filaggrin. Imaging was performed with the 3i-Vivo 2-photon microscope equipped with a Zeiss 20×-objective and SlideBook-reader software. Results Sixty-five samples from 65 participants (37 women; mean age±SD: 25.1±4.1 years) were collected. Filaggrin was detected in all 65 randomly selected immunostained marginal epithelium samples. All samples were similar in showing patchy areas of filaggrin immunostaining, regardless of CL wear, symptoms or epithelium morphology. Because the filaggrin immunostaining showed similar patterns across almost all the observed samples, comparison between subject groups was impractical. The presence of filaggrin in the healthy LW was additionally confirmed by an independent laboratory. Conclusion Filaggrin expression seems to be a normal part of epithelial cell differentiation in the lid margin and may not be a useful keratinization/stress biomarker in the marginal epithelium. Investigating other keratinization biomarkers that are not detected in the normal mucocutaneous junction/LW may help to understand the keratinization nature of LW epithelium changes in CL wearers.

Background: Global estimates suggest that nearly 60 million people suffer from Computer Vision Syndrome (CVS). Aim: The goal of this research was to evaluate the effectiveness of an educational intervention using the 20/20/20 rule to reduce CVS symptoms. Setting: The study was conducted in the Qassim University eye clinic. Methods: An experiential intervention study was conducted amongst 40 patients with CVS, with their age ranging from 21 to 38 years. The sample was divided into two groups: (1) intervention patients ( n = 20), who were given a structured advice booklet about how to reduce CVS symptoms using the 20/20/20 rule, and (2) control ( n = 20) with CVS, who were given advice to simply drink more water. Both groups completed two questionnaires, namely, the CVS-Q and Dry Eye Questionnaire-5 (DEQ-5). Dry eye clinical tests were performed. The same procedures were repeated after 20 days to compare the outcomes before and after intervention. Results: The study findings revealed that patients complaining from dry eye symptoms showed significant changes after the educational intervention (pre-intervention: 9.05 ± 4.32; post-intervention: 7.10 ± 3.61) ( p = 0.04). The symptoms of CVS were slightly reduced after educational intervention, from 9.00 ± 3.03 to 8.35 ± 1.89 ( p = 0.38). However, TBUT showed a significant increase after the educational intervention (pre-intervention: 6.20 ± 2.02 s; post-intervention: 8.55 ± 2.84 s) ( p = 0.005). Conclusion: The educational intervention of the 20/20/20 rule induces significant changes in dry eye symptoms and tear film and some limited changes for ocular surface integrity.

SIGNIFICANCE This cross-sectional study presented a link between contact lens wear and changes on the cellular morphology characteristics of the lid wiper (LW) epithelium, which was not visible by LW staining. PURPOSE The aim of this study was to establish if the duration of contact lens (CL) wear affects the cellular morphology of the LW epithelium. METHODS This was a cross-sectional study of 100 individuals with different exposures to CL wear: short, moderate, and long experience of CL wear; previous CL wearers; and nonwearers (NWs) as controls. Impression cytology samples were collected from the central upper lid margin (LW area). After fixing, samples were stained with periodic acid-Schiff and haematoxylin for cell morphology analysis and subsequently graded according to the Nelson 0- to 3-point scale. Lid wiper staining was assessed with the aid of lissamine green and graded using the Korb (0- to 3-point) scale. One-way Kruskal-Wallis analysis followed by the Dunn multiple-comparisons test was used for statistical comparison. RESULTS The Nelson grade for LW epithelium morphology was significantly different between groups (P = .003). Abnormal epithelial morphology as defined by grade 2 or 3 was evident in 66.7% of CL wearers with short experience and 76.5% of CL wearers with moderate experience. This was significantly higher than NWs of whom only 21.5% showed greater than grade 1 (P = .02 and .005, respectively). There was no significant difference between NWs and other groups. Lid wiper staining did not significantly differ between groups (P = .50) or correlate with the Nelson grade (Spearman r = 0.02, P = .08). CONCLUSIONS Metaplasia of the LW epithelium was significantly greater in the early to moderate stages of CL. This supports the view that mechanical irritation is responsible for LW changes in CL wear. Ceasing CL wear seems to lead to recovery. Lid wiper staining did not reflect the underlying morphological changes.

It has been reported that refractive errors (RE) and binocular vision (BV) anomalies are common among university students. In this study we aimed to assess RE and BV status among university students in Saudi Arabia, and its relation to the academic performance. We recruited 109 participants (aged from 18 to 21 years). Visual acuity (VA) and objective refraction were used to assess the refractive status. Cover test, near-point convergence (NPC) and stereopsis tests were used to assess the BV status. Convergence insufficiency symptom survey (CISS) was applied to quantify near-work related symptoms. Mann-Whitney U test (p value was set as p < 0.05) was used to compare VA, CISS, NPC and the academic performance between the groups who had heterophoria versus orthophoria. We found that there was only 38% emmetrope, while the percentage of heterophoria was 45.8%. The academic performance was not statistically different among the two groups, but CISS and stereopsis scores were significantly different (p < 0.03). We concluded that RE and BV anomalies were common among university students in Saudi Arabia, but did not affect the academic performance. More studies are warranted to understand the low scores of CISS and stereoacuity, and their association with RE and BV anomalies.

Chinese hamster ovary (CHO) cell lines are the most widely used in vitro cells for research and production of recombinant proteins such as rhGH, tPA, and erythropoietin. We aimed to investigate changes in protein profiles after cryopreservation using 2D-DIGE MALDI-TOF MS and network pathway analysis. The proteome changes that occur in CHO cells between freshly prepared cells and cryopreserved cells with and without Me2SO were compared to determine the key proteins and pathways altered during recovery from cryopreservation. A total of 54 proteins were identified and successfully matched to 37 peptide mass fingerprints (PMF). 14 protein spots showed an increase while 23 showed decrease abundance in the Me2SO free group compared to the control. The proteins with increased abundance included vimentin, heat shock protein 60 kDa, mitochondrial, heat shock 70 kDa protein 9, protein disulfide-isomerase A3, voltage-dependent anion-selective channel protein 2. Those with a decrease in abundance were myotubularin, glutathione peroxidase, enolase, phospho glyceromutase, chloride intracellular channel protein 1. The main canonical functional pathway affected involved the unfolded protein response, aldosterone Signaling in Epithelial Cells, 14-3-3-mediated signaling. 2D-DIGE MALDI TOF mass spectrometry and network pathway analysis revealed the differential proteome expression of FreeStyle CHO cells after cryopreservation with and without 5% Me2SOto involve pathways related to post-translational modification, protein folding and cell death and survival (score = 56, 22 focus molecules). This study revealed, for the first time to our knowledge the proteins and their regulated pathways involved in the cryoprotective action of 5% Me2SO. The use of 5% Me2SO as a cryoprotectant maintained the CHO cell proteome in the cryopreserved cells, similar to that of fresh CHO cells.

Lin-28 is an RNA-binding protein that is known for its role in promoting the pluripotency of stem cells. In the present study, Arabian camel Lin-28 (cLin-28) cDNA was identified and analyzed. Full length cLin-28 mRNA was obtained using the reverse transcription polymerase chain reaction (RT-PCR). It was shown to be 715 bp in length, and the open reading frame (ORF) encoded 205 amino acids. The molecular weight and theoretical isoelectric point (pI) of the cLin-28 protein were predicted to be 22.389 kDa and 8.50, respectively. Results from the bioinformatics analysis revealed that cLin-28 has two main domains: an N-terminal cold-shock domain (CSD) and a C-terminal pair of retroviral-type Cysteine3Histidine (CCHC) zinc fingers. Sequence similarity and phylogenetic analysis showed that the cLin-28 protein is grouped together Camelus bactrianus and Bos taurus. Quantitative real-time PCR (qPCR) analysis showed that cLin-28 mRNA is highly expressed in the lung, heart, liver, and esophageal tissues. Peptide mass fingerprint-mass spectrometry (PMF-MS) analysis of the purified cLin-28 protein confirmed the identity of this protein. Comparing the modeled 3D structure of cLin-28 protein with the available protein 3D structure of the human Lin-28 protein confirmed the presence of CSD and retroviral-type CCHC zinc fingers, and high similarities were noted between the two structures by using super secondary structure prediction.

AIM: To assess the prevalence of uncorrected refractive error (RE) and binocular vision (BV) anomalies in school-aged children in Uyoun Aljawa, a small urban town in Saudi Arabia. METHODS: This was a cross-sectional study of 417 students (aged 6–13 years old) conducted in two primary schools in Uyoun Aljawa from November 2019 to January 2020. All students underwent comprehensive eye examination that include: distance visual acuity (VA), Non- cycloplegic refraction, ocular alignment assessment with the cover test; Near Point of Convergence (NPC) evaluation, Near stereo-acuity with Titmus-fly Stereotest, and finally, colour vision was screened with Ishihara plates. RESULTS: A total of 417 male schoolchildren (mean age ± SD: 9.2 ± 1.9) were included. In this study, 78 (18.4%) students had reduced vision (VA of ≤6/9) of which only 21 (27%) students had spectacles at the time of the study and 19.2% had uncorrected RE (VA of

Studying the interactions of nanoparticles (NPs) with serum proteins is necessary for the rational development of nanocarriers. Optimum surface chemistry is a key consideration to modulate the formation of the serum protein corona (PC) and the resultant immune response. We investigated the constituent of the PC formed by hyaluronic acid-coated chitosan NPs (HA-CS NPs). Non-decorated chitosan NPs (CS NPs) and alginate-coated chitosan NPs (Alg-CS NPs) were utilized as controls. Results show that HA surface modifications significantly reduced protein adsorption relative to controls. Gene Ontology analysis demonstrates that HA-CS NPs were the least immunogenic nanocarriers. Indeed, less inflammatory proteins were adsorbed onto HA-CS NPs as opposed to CS and Alg-CS NPs. Interestingly, HA-CS NPs differentially adsorbed two unique anti-inflammatory proteins (ITIH4 and AGP), which were absent from the PC of both controls. On the other hand, CS and Alg-CS NPs selectively adsorbed a proinflammatory protein (Clusterin) that was not found on the surfaces of HA-CS NPs. While further studies are needed to investigate abilities of the PCs of only ITIH4 and AGP to modulate the interaction of NPs with the host immune system, our results suggest that this proof-of-concept could potentially be utilized to reduce the immunogenicity of a wide range of nanomaterials.

Small heat shock protein beta-1 (HSPB-1) plays an essential role in the protection of cells against environmental stress.Elucidation of its molecular, structural, and biological characteristics in a naturally wild-type model is essential. Although the sequence information of the HSPB-1 gene is available for many mammalian species, the HSPB-1 gene of Arabian camel (Arabian camel HSPB-1) has not yet been structurally characterized. We cloned and functionally characterized a full-length of Arabian camel HSPB-1 cDNA. It is 791 bp long, with a 5′-untranslated region (UTR) of 34 bp, a 3′-UTR of 151 bp with a poly(A) tail, and an open reading frame (ORF) of 606 bp encoding a protein of 201 amino acids (accession number: MF278354). The tissue-specific expression analysis of Arabian camel HSPB-1 mRNA was examined using quantitative real-time PCR (qRT-PCR); which suggested that Arabian camel HSPB-1 mRNA was constitutionally expressed in all examined tissues of Arabian camel, with the predominately level in the esophagus tissue. Peptide mass fingerprint-mass spectrometry (PMF-MS) analysis of the purified Arabian camel HSPB-1 protein confirmed the identity of this protein. Phylogenetic analysis showed that the HSPB-1 protein of Arabian camel is grouped together with those of Bactrian camel and Alpaca. Comparing the modelled 3D structure of Arabian camel HSPB-1 protein with the available protein 3D structure of HSPB-1 from human confirmed the presence of α-crystallin domain, and high similarities were noted between the two structures by using super secondary structure prediction.

Reversible phosphorylation regulates the majority of intracellular networking and pathways. The study of this widely explored post-translational modification is usually challenged by low stoichiometric levels of modification. Many approaches have been developed to overcome this problem and to achieve rigorous characterization of protein phosphorylation. We describe a method for enhanced detection of low-abundance protein phosphorylation that uses selective introduction of (18)O label into phosphorylation sites with H(2)(18)O and mass spectrometric detection. The method was applied to introduce (18)O label into bacterially expressed Aurora A kinase phosphorylation sites and resulted in the representation of phosphorylated peptides as doublets or triplets according to the number of phosphate groups. A total of 28 phosphopeptides were observed by this method.

Purpose To investigate the effects of the duration of contact lens (CL) wear on the meibomian glands (MGs), eyelid and tear film. Methods This was a cross-sectional study of CL wearers and non-wearers (NWs) aged between 18 and 35 years. The sample comprised of: (i) Three groups of CL wearers of different duration profiles (short, moderate and long experience of CL wear); (ii) a group of previous CL wearers (PWs) who had ceased wear for at least 6 months prior to the present study; (iii) healthy non-wearers as a control group. Study procedures were conducted in the order from least invasive to most invasive as follows: symptom assessment, lipid assessment, non-invasive break-up time, tear meniscus area, tear osmolarity and evaporation, Phenol red thread, MG expressibility, ocular surface and eyelid assessments, meibography, Marx line and lid wiper assessment using lissamine green. For statistical comparison of continuous data, one-way analysis of variance was used with Bonferroni post-hoc correction, where appropriate. Kruskal–Wallis test and Pearson Chi-Square respectively were used for ordinal and categorical variables. Results A total of 100 participants (49 males and 51 females; mean age ± SD: 25.4 ± 4.1) were enrolled across the five groups, such that each was composed of 20 age/sex matched individuals. Significant differences between the study groups were found for MG expressibility (p

PURPOSE: It is widely known that visual impairment (VI) is a risk factor for falls, but patients or their eye care practitioners may not recognize other kinds of incidents as being problematic because of their vision. Consequently, older people with VI may have unmet needs for advice on how to carry out activities of daily living safely. Therefore, the purpose of this study was to understand whether older people with VI consider their vision as a causative factor of incidents they experience and their perceptions regarding the prevention of future incidents. If sample size permitted, a secondary aim was to evaluate whether quantitative findings supported their perceptions. METHODS: The study design was a prospective cohort study evaluating injurious and damaging incidents and related near misses using open questions in a written 2-weekly large-print diary with active follow-up over 8 weeks in older people (>60 years, n = 80) with and without VI. Baseline measures included habitual binocular visual acuity, contrast sensitivity, visual fields, 3-m walk test, and Short Form 12 physical and mental component scores. Participants' diary entries were coded. Factor analysis and binary logistic analysis were used to investigate whether baseline measures were predictive of incident occurrence. Risk and preventative factors identified were compared. RESULTS: Participants perceived that their vision was implicated in bump and fall incidents. Quantitative analysis indicated that contrast sensitivity and fitness were significant predictors of incident occurrence. Six vision-related and five non-vision-related causative factors were identified by participants as contributing factors. Participants frequently stated "don't know" when asked to identify solutions to prevent incident recurrence. CONCLUSIONS: Participants had unmet needs for advice in relation to incident prevention. It would be prudent for eye care practitioners to raise incident prevention in eye care consultations regardless of voiced patient concerns. Language: en