« Previous Article
Next Article »

Original Research (Original Article) 


Abdulmalik H. Alghamdi et al, 2019;3(10):053–058.

International Journal of Medicine in Developing Countries

A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia

Abdulmalik H. Alghamdi1, Mohammed A. Alzahrani1, Abdulla S. Alhamami1, Adel K. Altalhi1, Ali M. Alkhathami2, Batool M. Alosaimi1, Tahani A. Bukhari1, Abdulrahim K. Turkistani1, Qusay Z. AlQurashi1, Saeed S. Basharahil 1, Talal A. Althomali3*

Correspondence to: Talal Abdulrahman Althomali

*Consultant of Ophthalmology and Pediatric Ophthalmology and Professor at Faculty of Medicine in Taif University, Taif, Saudi Arabia

Email: tthomali [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 04 July 2018 | Accepted: 06 August 2019


ABSTRACT

Background:

Refractive error is a problem with accurate focus of light on the retina due to the shape of the eye. There are several types of refractive error; refractive surgery is used to correct common vision problems. The aim of the current study was to evaluate the Saudi society's awareness about refractive surgery.


Methodology:

This was a questionnaire-based study that was conducted among the general population. The questions tested their awareness of refractive surgery. Data were collected through paper and electronic questionnaires.


Results:

The study included 2,600 participants, 40.7% of the participants had myopia and 49% were using either glasses or contact lens. The primary source of knowledge was family and friends in 68% of the participants. Majority of the participants (53%) had a high level of knowledge. Age, sex, city, education level were factors affecting the level of knowledge.


Conclusion:

There was a moderate level of knowledge that was noticed in post-graduates.


Keywords:

Refractive surgery, Refractive error, knowledge, general population, awareness.


Introduction

Refractive error, which also known as refraction error, is defined as the focusing of light precisely on to the retina due to the eye shape [1]. Refractive error has several types; the most common types are Hyperopia, Myopia, astigmatism, and presbyopia [2]. The general symptoms, including headache, eye strain, and double vision [1]. Affected parents can transfer these refractive errors to their children [1]. The prevalence of global individuals with refractive errors was estimated to be 1–2 billion individuals [3]. However, the rates vary with various region, wherein Asian regions, it was as high as 80%, whereas in the European region, it was 235% [3]. Diagnosis is performed by examination of the eye [1]. Refractive errors can be corrected by several methods, such as contact lenses, eyeglasses, or surgery.

Contact lenses provide a full field of vision, but there is a risk of infection. Whereas glasses are the easiest and safest method of correction, refractive surgery involves a permanent change in the shape of the cornea [1].

Refractive eye surgery improves the refraction of the eye and reduces the dependency on the contact lenses and glasses. It can occur by several methods such as surgical remodeling of the cornea that known as keratomileusis, lens implantation, or even lens replacement. The most common method used nowadays is excimer laser to reshape the curvature of the cornea. This surgery can cure myopia, hyperopia, astigmatism, and other degenerative disorders [4]. One study from Iran showed that 82.5% of participants didn’t know that their eyesight

can be improved by refractive surgery [5]. According to another study on the awareness among Goan Population about refractive surgery, about 64% of the participants were not aware of the possibility of refractive surgery for improving their sight, whereas the awareness about refractive surgery’s adverse effects were only 12% [6]. So, there were few studies conducted on the perception of the population about refractive surgery, we did this study to assess the awareness of Saudi society about refractive surgery.


Subjects and Methods

It is a cross-sectional study that was conducted in the western region of Saudi Arabia, including Makkah, Jeddah, and Taif in the time from (1 Feb to 28 Apr 2019). Data were collected using an electronic questionnaire and paper questionnaire. The survey included questions about demographics, clinical history, and awareness.

SPSS program version 21 was used to analyze the data. Categorical variables were represented as number and percent. The correlations were performed using T-test, p-value was considered as significant at ≤0.05.


Results

The present study included 2,600 participants, the highest percent 28.5% included those with an age range of 41–50 years, followed by those in the age range of 31–40 years (23.4%). More than half of participants were females 55.2%, participants from Jeddah were dominant among other participants 34.2%, followed by those from Makkah 27.2%, and then Taif 26.4%. Most of the participants (63.2%) had a university education. Regarding clinical history, 40.7% of the participants had myopia, whereas 14.5% didn’t know if they had a problem, 13% had hyperopia, 5.3% had presbyopia, and 3.5% had astigmatism. There were 49% using glasses or contact lens, 11.8% only performed refractive surgery, Table 1 shows the demographics and clinical history of patients.

Regarding the knowledge of participants, there were 93.5% reported that they knew the refractive surgery, and more than half 57.8% said that they prefer LASEK to correct the errors of refraction. Only 32.2% expected that refractive surgeries are dangerous; 9.5% reported that the complication of the surgery is advanced. More than half of the participants (56.2%) thought that the refractive surgery could replace glasses. There were 68% of the participants reported that family and friends were the sources of their knowledge; only 30.7% had knowledge from their physicians. The most common reason not performing the surgery was high cost 43.2%. There were 58.7% of the participants wondered why ophthalmologists prefer glasses over refractive surgery. The most common type of surgery known was LASEK (45.7%), followed by superficial laser (16.2%). There were 76.4% of the participants reported that poor vision after 40 is physiological and 42.6% thought that laser after this age is not useful. More than half (61%) thought that vision weakness come back after period of laser procedure (Table 2).

The overall knowledge was found to be high among 53% of the participants, whereas 47% had low knowledge (Figure 1).

Table 1. Demographics and clinical history of participants.

Characteristics Description (n = 2,600)
Age
18–25 558 (21.5)
26–30 394 (15.2)
31–40 609 (23.4)
41–50 741 (28.5)
51–60 195 (7.5)
>60 103 (4)
Sex
Male 1,165 (44.8)
Female 1,435 (55.2)
City
Jeddah 889 (34.2)
Mecca 708 (27.2)
Taif 687 (26.4)
Other 316 (12.2)
Educational level
Primary 25 (1)
Intermediate 132 (5.1)
Secondary 643 (24.7)
University 1,644 (63.2)
Postgraduate 156 (6)
Error of refractions
Myopia 1,058 (40.7)
Hyperopia 339 (13)
Astigmatism 91 (3.5)
Presbyopia 138 (5.3)
No errors of refractions 731 (28.1)
I don’t know 376 (14.5)
Use of glasses or contact lenses
Yes 1,275 (49)
No 1,325 (51)
Do you perform any refractive surgery?
Yes 307 (11.8)
No 2,293 (88.2)

Table 2. The detailed knowledge of participants about refractive surgery.

Questions and answers Description (n = 2,600)
Do you know refractive surgeries?
Yes 2,432 (93.5)
No 168 (6.5)
Preferable tool to correct errors of refractions
Glasses 883 (34)
Contact lenses 213 (8.2)
LASEK 1,504 (57.8)
Do you expect that refractive surgeries are dangerous?
Yes 837 (32.2)
No 1,763 (67.8)
Complications of refractive surgeries
Simple 948 (36.5)
Advanced 248 (9.5)
I don’t know 1,404 (54)
Do you think that refractive surgeries can replace glasses
Yes 1,462 (56.2)
May be 1,009 (38.8)
No 129 (5)
Knowledge source
Physicians 798 (30.7)
Family and Friends 1,769 (68)
Social media 830 (31.9)
Causes of not performing refractive surgeries
High cost 1,123 (43.2)
Fear from complications 952 (36.6)
Lack of information 942 (36.2)
Rumors 426 (16.4)
Have you ever wondered why ophthalmologists uses glasses and did not perform refractive surgeries?
Yes 1,525 (58.7)
No 1,075 (41.3)
Types of LASEK do you know?
LASEK 1,187 (45.7)
Superficial laser 420 (16.2)
Femto LASEK 356 (13.7)
SMILE 98 (3.8)
I don’t know 1,064 (40.9)
Poor vision after forty is
Physiological 1,986 (76.4)
Pathological 614 (23.6)
Do you think laser after age forty is of no benefits?
Yes 1,108 (42.6)
No 1,492 (57.4)
Do you think that vision weakness comes back after a period of laser procedure?
Yes 1,586 (61)
No 1,014 (39)

Figure 1. Prevalence of the level of knowledge among participants.

The factors that affected the level of awareness are shown in Table 3. Regarding age, those with age of 31–40 years were substantially had a high level of knowledge (p = 0.007), whereas those with older age (>50) had significantly lower level of knowledge (p = 0.0001, 0.006, respectively). Regarding sex, females significantly had a higher level of knowledge than males (p = 0.0001). Regarding city the individuals from, individuals from Makkah significantly had lower knowledge (p = 0.032), whereas those from Taif tended to have considerably higher knowledge (p = 0.001). According to education level, individuals with intermediate and secondary education had a significantly lower level of knowledge (p = 0.012, 0.047, respectively), while postgraduates had a significant higher level of knowledge (p-value = 0.011). Individuals who had no presbyopia had higher knowledge (p-value = 0.0001), whereas those who had no errors of refraction had a lower level of knowledge. Individuals who did not report that they did not know their case had a higher level of knowledge (p-value = 0.0001). More individuals who said that they were not using glasses or contact lens had significantly higher knowledge (p-value = 0.0001).

Table 3. Factors affecting awareness for refractive surgeries.

Factors Awareness for refractive surgeries p value
High (n = 1,378) Low (n = 1,222)
Age
18–25 299 (21.7) 259 (21.2) 0.755
26–30 199 (14.4) 195 (16) 0.282
31–40 352 (25.5) 257 (21) 0.007
41–50 412 (29.9) 329 (26.9) 0.093
51–60 75 (5.4) 120 (9.8) 0.000
>60 41 (3) 62 (5.1) 0.006
Sex
Male 540 (39.2) 625 (51.1) 0.000
Female 838 (60.8) 597 (48.9)
City
Jeddah 458 (33.2) 431 (35.3) 0.275
Mecca 351 (25.5) 357 (29.2) 0.032
Taif 400 (29) 287 (23.5) 0.001
Other 169 (12.3) 147 (12) 0.855
Educational level
Primary 11 (0.8) 14 (1.1) 0.365
Intermediate 56 (4.1) 76 (6.2) 0.012
Secondary 319 (23.1) 324 (26.5) 0.047
University 894 (64.9) 750 (61.4) 0.065
Postgraduate 98 (7.1) 58 (4.7) 0.011
Myopia
Yes 554 (40.2) 504 (41.2) 0.590
No 824 (59.8) 718 (58.8)
Hyperopia
Yes 176 (12.8) 163 (13.3) 0.668
No 1202 (87.2) 1059 (86.7)
Astigmatism
Yes 48 (3.5) 43 (3.5) 0.961
No 1330 (96.5) 1179 (96.5)
Presbyopia
Yes 50 (3.6) 88 (7.2) 0.000
No 1328 (96.4) 1134 (92.8)
No errors of refractions
Yes 457 (33.2) 274 (22.4) 0.000
No 921 (66.8) 948 (77.6)
I don’t know
Yes 168 (12.2) 208 (17) 0.000
No 1210 (87.8) 1014 (83)
Use of glasses or contact lenses
Yes 603 (43.8) 672 (55) 0.000
No 775 (56.2) 550 (45)

Bold values implies significant p value<0.05.


Discussion

The present study included 2,600 individuals having age from 18 to 60 years and above. The most common errors of refraction among participants were myopia (40.7%), hyperopia (13%), presbyopia (5.3%), and astigmatism (3.5%). In a previous Saudi study [7], it was reported that refractive errors were prevalent among 45.8% of adults in Arar city; the most common types were myopia (24.4%), hyperopia (11.9%), and astigmatism (9.5%). Another Saudi study conducted on medical students from Aljouf region demonstrated that 83.1% were suffering from refractive errors, 74.13% of them were myopic, and 53.73% of them were astigmatic [8]. Another study conducted on adolescents reported an overall prevalence of refractive error of 9.8%, with variation in the prevalence of each type, myopia represented 4.5%, followed by hyperopia 1.5%, then astigmatism 6.5% and amblyopia 0.65% [9]. A study from Riyadh, KSA, showed that 55.5% of the participants had some form of refractive errors and myopia was the most common type (53.3%), followed by hyperopia (2.2%) and then astigmatism (15%) [10]. A study from India conducted on medical students showed that myopia was the most common refractive error (89.42%) [11]. In the current study, 49% of the participants were using either glasses or contact lens to correct their refraction error, whereas 11.8% reported that they performed a refractive surgery; however, more than half of individuals (57.8%) preferred LASEK, the few percent of those performed surgery regarding to the higher percent preferred LASEK can be attributed to the high cost of the surgery, where 43.2% reported that the barrier not performing the surgery was the high cost, 36.6% and 36.2% reported that fear of complications and lack of information were other two barriers, respectively. A previous study [11] showed that 65.92% of participants showed no desire to perform the surgery, and the main reason feared of complications [11]. A study from India showed that none of the medical students participated in the study performed refractive surgery. However, 84.14% were using glasses, 13.21% were using contact lens, and 0.88% were using both for correction of refraction [11]. In our study, only 32.2% thought that refractive surgery was dangerous and 9.5% though that it causes advanced complications. The overall knowledge among participants showed that 53% had a high level of knowledge regarding refractive surgery. There are a limited number of studies conducted to assess the level of knowledge about refractive surgery. A study from India conducted on medical students reported high knowledge, whereas 92.51% were aware of refractive surgery [11]. A study from India showed that 64% of participants did not know that refractive surgery able to improve their vision [6]. Another study conducted on medical students showed that 85.7% have heard of the surgery [12]. By investigating the factors that affected the level of knowledge, we found factors including young age, being female, living in Taif, postgraduate, having no presbyopia and wearing neither contact lens nor glasses were associated with a higher level of knowledge, whereas older age, living in Makkah and having either intermediate or secondary education were significantly associated with a lower level of knowledge. There was no previous study reported factors related to the level of knowledge.


Conclusion

There was a moderate knowledge about refractive surgery among participants. However, the primary source of information was friends and family, so physicians should provide patients information about this type of surgery and increase their awareness.


Acknowledgment

The authors gratefully acknowledge the support provided by the officials of the studied colleges for facilitating the administrative aspects of this research. Special thanks to all the students who participated in this study.


Conflicts of interests

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The ethical approval was obtained from the research ethics committee from Taif university with ethical application number 41-36-0004.


Author details

Abdulmalik H. Alghamdi1, Mohammed A. Alzahrani1, Abdulla S. Alhamami1, Adel K. Altalhi1, Ali M. Alkhathami2, Batool M. Alosaimi1, Tahani A. Bukhari1, Abdulrahim K. Turkistani1, Qusay Z. AlQurashi1, Saeed S. Basharahil 1, Talal A. Althomali3

  1. Medical Student, Medical College, Taif University, Saudi Arabia
  2. Medical Intern, Medical College, Taif University, Saudi Arabia
  3. Departments of ophthalmology, Faculty of Medicine, Taif University, Saudi Arabia

References

  1. Facts about refractive errors [Internet]. Bethesda, MD: National Eye Institute. U.S. Department of Health and Human Services; 2010. Available from: https://nei.nih.gov/health/errors/errors
  2. What is a refractive error? [Internet]. Geneva, Switzerland: World Health Organization; 2013. Available from: https://www.who.int/features/qa/45/en
  3. Denniston A, Murray P. Oxford handbook of ophthalmology. 4th ed. Oxford, UK: OUP; 2018. p 926. https://doi.org/10.1093/med/9780198804550.001.0001
  4. Vision surgery [Internet]. All about vision. Available from: https://www.allaboutvision.com/visionsurgery
  5. Saber Moghaddam Ranjbar AK. Awareness and attitude toward refractive error correction methods: a population based study in Mashhad. J Patient Saf Qual Improvement. 2013;1(1):23–9.
  6. Usgaonkar UPS, Tambe P. Awareness and attitude toward refractive error correction methods, among Goan population. J Dental Med Sci. 2018;17(3):04–10.
  7. Parrey MU, Elmorsy E. Prevalence and pattern of refractive errors among Saudi adults. Pak J Med Sci. 2019;2:35(2). https://doi.org/10.12669/pjms.35.2.648
  8. Alruwaili WS, Alruwaili MS, Alkuwaykibi MK, Zaky KA. Prevalence and awareness of refractive errors among Aljouf University medical students. Egypt J Hospital Med. 2018;1:70(1). https://doi.org/10.12816/0042958
  9. Rowaily AI, Alanizi BM. Prevalence of uncorrected refractive errors among adolescents at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. J Clin Exp Ophthalmol. 2010;1:114.
  10. Alsaqr A, Sharha AA, Fagehi R, Almutairi A, Alosaimi S, Almalki A, et al. The visual status of adolescents in Riyadh, Saudi Arabia: a population study. Clin Ophthalmol. 2018;12:965. https://doi.org/10.2147/OPTH.S162319
  11. Puri SK, Elangovan S. Perception of refractive surgery among undergraduate medical students and their preferred method of refractive correction. Int J Res Med Sci. 2016;4(4):1031–4. https://doi.org/10.18203/2320-6012.ijrms20160680
  12. Gameiro Filho AR, Aquino NM, Pacheco EB, Oguido AP, Casella AM. Knowledge in refractive surgery among medical students State University of Londrina. Rev Bras Oftalmol. 2013;72(3):172–7. https://doi.org/10.1590/S0034-72802013000300006


How to Cite this Article
Pubmed Style

Alghamdi AH, Alzahrani MA, Alhamami AS, Altalhi AK, Alkhathami AM, Alosaimi BM, Bukhari TA, Turkistani AK, AlQurashi QZ, Basharahil SS, Althomali TA. A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. IJMDC. 2019; 3(10): 53-58. doi:10.24911/IJMDC.51-1562241479


Web Style

Alghamdi AH, Alzahrani MA, Alhamami AS, Altalhi AK, Alkhathami AM, Alosaimi BM, Bukhari TA, Turkistani AK, AlQurashi QZ, Basharahil SS, Althomali TA. A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. http://www.ijmdc.com/?mno=55387 [Access: October 18, 2019]. doi:10.24911/IJMDC.51-1562241479


AMA (American Medical Association) Style

Alghamdi AH, Alzahrani MA, Alhamami AS, Altalhi AK, Alkhathami AM, Alosaimi BM, Bukhari TA, Turkistani AK, AlQurashi QZ, Basharahil SS, Althomali TA. A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. IJMDC. 2019; 3(10): 53-58. doi:10.24911/IJMDC.51-1562241479



Vancouver/ICMJE Style

Alghamdi AH, Alzahrani MA, Alhamami AS, Altalhi AK, Alkhathami AM, Alosaimi BM, Bukhari TA, Turkistani AK, AlQurashi QZ, Basharahil SS, Althomali TA. A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. IJMDC. (2019), [cited October 18, 2019]; 3(10): 53-58. doi:10.24911/IJMDC.51-1562241479



Harvard Style

Alghamdi, A. H., Alzahrani, . M. A., Alhamami, . A. S., Altalhi, . A. K., Alkhathami, . A. M., Alosaimi, . B. M., Bukhari, . T. A., Turkistani, . A. K., AlQurashi, . Q. Z., Basharahil, . S. S. & Althomali, . T. A. (2019) A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. IJMDC, 3 (10), 53-58. doi:10.24911/IJMDC.51-1562241479



Turabian Style

Alghamdi, Abdulmalik H., Mohammed A. Alzahrani, Abdulla S. Alhamami, Adel K. Altalhi, Ali M. Alkhathami, Batool M. Alosaimi, Tahani A. Bukhari, Abdulrahim K. Turkistani, Qusay Z. AlQurashi, Saeed S. Basharahil, and Talal A. Althomali. 2019. A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 53-58. doi:10.24911/IJMDC.51-1562241479



Chicago Style

Alghamdi, Abdulmalik H., Mohammed A. Alzahrani, Abdulla S. Alhamami, Adel K. Altalhi, Ali M. Alkhathami, Batool M. Alosaimi, Tahani A. Bukhari, Abdulrahim K. Turkistani, Qusay Z. AlQurashi, Saeed S. Basharahil, and Talal A. Althomali. "A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 53-58. doi:10.24911/IJMDC.51-1562241479



MLA (The Modern Language Association) Style

Alghamdi, Abdulmalik H., Mohammed A. Alzahrani, Abdulla S. Alhamami, Adel K. Altalhi, Ali M. Alkhathami, Batool M. Alosaimi, Tahani A. Bukhari, Abdulrahim K. Turkistani, Qusay Z. AlQurashi, Saeed S. Basharahil, and Talal A. Althomali. "A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia." International Journal of Medicine in Developing Countries 3.10 (2019), 53-58. Print. doi:10.24911/IJMDC.51-1562241479



APA (American Psychological Association) Style

Alghamdi, A. H., Alzahrani, . M. A., Alhamami, . A. S., Altalhi, . A. K., Alkhathami, . A. M., Alosaimi, . B. M., Bukhari, . T. A., Turkistani, . A. K., AlQurashi, . Q. Z., Basharahil, . S. S. & Althomali, . T. A. (2019) A study of general population awareness about refractive surgery in the Western Region of Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 53-58. doi:10.24911/IJMDC.51-1562241479