bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Vitamin D deficiency with primary glaucoma among Saudi population – A pilot study
Authors: Bokhary Kholoud A. , Alqahtani Loujain Y. , Aljaser Feda S. , Abudawood Manal , Almubarak Faisal , Algowaifly Shatha , Jamous Khalid F. , Fahmy Rania 
Published: May 2024

PURPOSE:
Glaucoma is a complex multifactorial disorder that is influenced by various systemic conditions. Several studies investigated the association between systemic factors such as Vitamin D deficiency for glaucoma development and reported contradicted findings. The aim of this study was to assess Vitamin D levels in glaucomatous Saudi subjects and its association with cup/disc ratio in primary open- and closed-angle glaucoma.

METHODS:
This was a pilot study that included subjects aged 41–78 years from both genders recruited from a tertiary hospital, Riyadh city, Kingdom of Saudi Arabia. Subjects were divided into three groups: Group 1: subjects with primary open-angle glaucoma (POAG), Group 2: subjects with primary angle-closure glaucoma (PACG), and Group 3: control subjects. All participants underwent detailed ophthalmic examinations including visual acuity, intraocular pressure measurement (IOP), gonioscopy, and fundus examinations. In addition, blood samples were collected from glaucoma patients and controls to measure the serum 25-hydroxyvitamin D levels.

RESULTS:
A total of 75 subjects were included in this study. Measurement of IOP was within the range of 9–27 for all subjects. Mean serum 25-hydroxyvitamin D levels were 72.58 ± 31.79, 69.20 ± 24.24, and 67.14 ± 29.02 in Groups 1, 2, and 3, respectively. There were insignificant differences in Vitamin D levels among the three groups (P > 0.05). Moreover, no significant correlation was noted between Vitamin D levels and cup/disc ratio in Groups 1 and 2.

CONCLUSION:
No association was found between Vitamin D deficiency and both POAG and PACG among Saudi population despite low serum level of Vitamin D in glaucomatous and control subjects. This study suggested that Vitamin D level may not contribute in augmenting the severity and progression of glaucoma.
Validation of the Arabic version of the quality of life impact of refractive correction questionnaire
Authors: Bokhary Kholoud A. , Alshamrani Elham S. , Jamous Khalid F. , Fahmy Rania 
Published: May 2024

PURPOSE:
To validate the Arabic version of the quality of life impact of refractive correction (QIRC) questionnaire.

METHODS:
This was a cross-sectional study included participants with refractive errors (myopia, hypermetropia, or astigmatism) aged between 19 and 40 years who were pre or postrefractive surgeries. Uncorrected distance visual acuity, refraction, and corneal topography were collected. The 20-item QIRC questionnaire was translated to the Arabic language and then back translated to the English language. Participants were asked to answer all items of the Arabic QIRC. The validity and reliability of the translated questionnaire were tested using Rasch analysis.

RESULTS:
A total of 145 participants with refractive errors participated in this study. The mean age ± standard deviation of participants was 26.29 ± 5.1 years. Person separation (2.01) and reliability (0.80) indicates good precision and stability of the Arabic QIRC questionnaire. Item infit was ranged between 0.82 and 1.23; and item outfit was range between 0.76 and 1.32. The items were well targeted to the persons with a mean difference of 0.30. Skew and kurtosis values were within the normal limits (−2.00 to + 2.00). Cronbach's α for the scale was 0.79, which indicates good reliability of the Arabic 20-item QIRC.

CONCLUSION:
The Arabic 20-item QIRC questionnaire is a valid tool to assess the impact of refractive correction on Arabian participants’ quality of life.
Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes
Authors: Helayel Halah B. , Alyahya Ahmed A. , Al Owaifeer Adi M. , Khan Abdullah M. , Al Zahrani Abdullah T. , Badawi Abdulrahman H. , Khandekar Rajiv , Al-Swailem Samar A. 
Published: May 2024

PURPOSE:
To study the risk factors, visual outcomes, and sequelae of phacoemulsification surgery complicated by retained lens fragments (RLFs).

METHODS:
This single-center case–control study enrolled consecutive eyes complicated by RLF and compared them to age- and gender-matched uneventful cataract surgery cases at a tertiary care teaching hospital. Biometric, intraoperative, and postoperative data were collected. The primary outcome measures were risk factors, visual outcomes, and rate of postoperative complications.

RESULTS:
The study and control groups included 282 and 289 eyes, respectively. The estimated incidence of RLF was 1.47% during the study. We found a statistically higher risk of RLF among diabetics (P < 0.001), those with a history of intravitreal injections (P = 0.001), eyes with dense nuclear sclerosis, anterior capsular cataract (P < 0.001), and posterior polar cataract (P = 0.01). There was a statistically higher risk of RLF in eyes with a higher mean preoperative visual acuity (logarithm of the minimum angle of resolution) (P < 0.001) and in cases performed by trainees (P < 0.001). Most eyes in the RLF group (n = 207, 73.4%) retained their preoperative vision or experienced a one-line improvement in visual acuity and 14 eyes (5.3%) experienced more than one-line improvement in vision.

CONCLUSION:
Although RLFs are rare, they can affect the quality of postoperative vision and outcomes of complicated phacoemulsification surgery.
Agreement between swept-source optical biometry and Scheimpflug-based tomography in eyes with previous myopic refractive surgery
Authors: Karmiris Efthymios , Gartaganis Panos S. , Ntravalias Thomas , Manousakis Evangelos , Giannakis Ioannis , Chalkiadaki Evangelia 
Published: May 2024

PURPOSE:
The purpose of the study is to evaluate the comparability of corneal power measurements, anterior chamber depth (ACD), and white-to-white (WTW) distance between a high-resolution Scheimpflug-based tomography (Pentacam HR; Oculus GmbH, Wetzlar, Germany) and a swept-source optical biometry, IOL Master 700; Carl Zeiss Meditec AG, Jena, Germany) in patients having undergone a myopic refractive surgery.

METHODS:
This prospective, interinstrument reliability analysis included 31 individuals with a previous myopic laser refractive correction. Standard keratometry and total keratometry (TK) of the flattest and steepest axis of the IOL Master 700 were compared with standard keratometry (simulated keratometry [SimK]), true net power (TNP), equivalent keratometer readings (EKR), and total corneal refractive power of the Pentacam. The Bland–Altman analysis evaluated the agreement between the measurements of both devices. A paired t-test was performed to compare the mean values of the variables obtained by the two devices.

RESULTS:
Mean age of the participants was 31.87 ± 13.17 years. Ten patients (32.3%) had undergone laser in situ keratomileusis surgery, and 21 (67.7%) had undergone photorefractive keratectomy surgery. The two devices generated statistically significant differences in almost all the comparisons between their corneal keratometry values, ACD, and WTW. The two devices agreed in some of the flat axis values and more specifically on SimK1 and K1, EKR K1 along 1 mm-zone and K1, as well as on the comparison between the EKR keratometry values along 1, 2, and 3 mm-zone with their corresponding TKs.

CONCLUSION:
IOL Master 700 and Pentacam HR do not show good concordance and cannot be used interchangeably when measuring keratometry values in postrefractive eyes, rendering the IOL power calculation in postrefractive eyes really challenging.
Conditional analysis on new tumor formation with solitary unilateral retinoblastoma in 482 consecutive patients
Authors: Shields Carol L. , Dockery Philip W. , Ruben Megan , Sunday Madalyne A. , Calotti Martin , Yaghy Antonio 
Published: May 2024

PURPOSE:
The objective of the study was to understand dynamic risk (conditional analysis based on patient age) for new tumor development in patients with solitary unilateral retinoblastoma.

METHODS:
This was a retrospective analysis.

RESULTS:
Of 482 patients with solitary unilateral retinoblastoma, 55 new tumors developed in 20 patients (4%). Comparison (new tumor vs. no new tumor development) revealed those with new tumor demonstrated younger mean age at presentation (10 vs. 36 months, P < 0.001), greater likelihood of family history of retinoblastoma (35% vs. 3%, P < 0.001), and greater probability of primary tumor location in the macula (50% vs. 15%, P = 0.003). Conditional risk for new tumors (at age 6, 9, 12, 18, and 24 months) declined for those who presented at 0–3 months old (25%, 15%, 15%, 8%, and 0%), >3–6 months old (17%, 14%, 6%, 6%, and 0%), >6–9 months old (not applicable [na], 6%, 6%, 0%, and 0%), and >9–12 months (na, na, 3%, 3%, and 0%). Younger patients showed greater development of bilateral tumors (P < 0.001). Of patients with new tumors, those that occurred within 1 year from presentation were located in the preequatorial region in 46%, whereas those that occurred more than 1 year from presentation were preequatorial in 78%. Patients ≤24 months at initial presentation demonstrated all new tumors by 24 months of age. Older patients (>24 months at presentation) showed new tumors up to 56 months of age.

CONCLUSION:
Children (≤24 months) with solitary unilateral retinoblastoma showed decreasing risk for new tumors up to 24 months of life. Later onset of new tumor was more likely located in preequatorial region.
Three-year clinical outcomes of phacoemulsification combined with excisional goniotomy using the kahook dual blade for cataract and open-angle glaucoma in Saudi Arabia
Authors: Albuainain Abdulrahman , Al Habash Ahmed 
Published: May 2024

PURPOSE:
The aim of this study was to describe the changes in intraocular pressure (IOP), IOP-reducing drugs, and visual acuity (VA) through up to 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) by a single surgeon in Saudi Arabia.

METHODS:
The health records of 55 eyes of 47 patients undergoing KDB-phaco by a single surgeon were reviewed. Data were extracted from visits occurring preoperatively (n = 55), intraoperatively (n = 55), and 1-day (n = 55), 2 weeks (n = 55), 4–6 weeks (n = 49), 2–3 months (n = 55), and 6 (n = 55), 9 (n = 55), 12 (n = 55), 18 (n = 49), 24 (n = 46), and 36 months (n = 16) postoperatively. Data collection included IOP, IOP-lowering medications, and VA at each time point. Adverse events were also collected. Paired t-tests were used to compare IOP, medications, and VA at each time point to preoperative values.

RESULTS:
Mean (standard error) baseline IOP was 20.4 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.1 [1.0] months) ranged from 13.6 to 14.1 mmHg; significant reductions (P < 0.0007) of 5.7–7.0 mmHg (23.0%–29.5%) were achieved at every time point. Medications were reduced from 3.2 (0.1) to 0.2–2.0 (reductions of 1.2–3.1 medications [50.0%–94.9%]; P < 0.0001 at every time point). At months 24 and 36, the mean IOP was 13.9 (0.3) and 13.9 (0.5) mmHg and mean medications were 1.4 (0.2) and 2.0 (0.4). Mean logMAR VA improved from 1.0 (0.1) preoperatively to (0.2 [0.0]; P < 0.001) by month 6 and remained stable thereafter through the duration of follow-up.

CONCLUSION:
KDB-phaco significantly lowered IOP approximately 30% by day 1 with consistency and durability through 3 years. Medication use was reduced by >50% through 36 months. Mean logMAR VA improved from 1.0 to 0.2 (Snellen equivalent 20/200–20/32). This procedure provides meaningful long-term reductions in IOP and the need for IOP-lowering medications without compromising visual rehabilitation in Saudi Arabian eyes with cataract and glaucoma.
Cataract in keratoconus
Authors: Said Reeda B. , Farah Chahid , Chanbour Wassef , Jarade Elias 
Published: May 2024

PURPOSE:
To report the results of cataract surgeries in keratoconus patients at 1 and 6 months postoperatively, and to compare the standard intraocular lens (IOL) calculation formulas in this population.

METHODS:
This is a retrospective study, carried out in 44 eyes of 26 patients known to have keratoconus who underwent cataract surgery at Beirut Eye and ENT Specialist Hospital between 2010 and 2021. The patients were divided into groups based on Dr Jarade updated algorithm. Visual acuities before and after cataract surgery, at 1 and 6 months were recorded, as well as spherical equivalent. The difference between the expected spherical equivalent with each formula was subtracted from the actual resultant refraction, and its absolute value deduced. The means of the values were calculated and the 4 standard formulas (SRK/T, SRK/II, Holladay, and Hoffer Q) were compared.

RESULTS:
Six eyes had similar topographic and manifest axes (category 1) and underwent toric IOL implantation. Corrected distance visual acuity (CDVA) at 1 and 6 months was 0.2 and 0.1 logMAR, respectively. 26 eyes had mismatching axes and had monofocal IOL placement. CDVA at 1 and 6 months was 0.3. Six eyes required intrastromal corneal ring placement before operating (category 3). CDVA was 0.3 and 0.2 at 1 and 6 months, respectively. Regarding category 4, requiring keratoplasty and cataract extraction, CDVA was 0.4 at both follow-ups. No statistically significant difference was found between the different formulas.

CONCLUSION:
Categorization of keratoconus patients gave favorable results after cataract surgery. No superior IOL formula was found.
Variability of ophthalmology residents’ perception toward different major training programs in Saudi Arabia
Authors: Alkatan Hind M. , AlEnezi Saad H. , Tabbara Khaled F. , Al-Othman Ahmed Y. , AlFawaz Abdullah M. 
Published: May 2024

PURPOSE:
The constant demand for ophthalmologists has nationally resulted in creating more programs in different regions of the kingdom. We have previously reported the overall residents’ satisfaction with the current local ophthalmology curriculum and the competency of the ophthalmic training (clinical and surgical) in our local programs in Saudi Arabia compared to international standards. In this study, we aim at comparing the major local training programs and analyze the differences among them aiming at improving our training.

METHODS:
This is a cross-sectional study using a questionnaire that was completed by residents and graduates of the local ophthalmology programs in Riyadh, Eastern and Western regions. A closed-ended questionnaire was validated and circulated online and a hard copy was distributed to residents and recently graduated ophthalmologists (2009-2015). Data were categorized by demographic variables, and basic statistics were done. The study has been approved by the Institutional Review Board (IRB) and Human Ethics Committee (HEC) of King Saud University.

RESULTS:
Of the 200 individuals surveyed, 175 (87.5%) completed their responses. The average age was 29.6 years (range: 24-39) with 67.5% males and 32.5% females. The overall satisfaction among senior residents and graduates showed a statistically significant higher result among graduates in Riyadh area (P=<0.001). Satisfaction of senior residents with the program director’s support was higher in the Eastern region (P=<0.001). Clinic-based training was generally satisfactory. Refractive surgery was reported to be significantly insufficient in 70.6% (P=0.003). Most of the graduates in Riyadh area achieved the surgical requirements for training compared to other regions.

CONCLUSION:
Saudi postgraduate ophthalmology training programs show a variable level of satisfaction among senior residents and graduates. Better surgical exposure has been observed in Riyadh region, however reassessment of the current curriculum and the parameters for training are needed to fulfill the requirements with special attention to the surgical training in all programs.
Why are we not doing retinoscopy in the school eye screening? Is distant visual acuity a sensitive tool for making referrals?
Authors: Chottopadhyay Tonmoy , Kaur Hardeep , Shinde Amit J. , Gogate Parikshit M. 
Published: May 2024

PURPOSE:
School eye screening program is an integrated part of SarvaShikshyaAbhiyan. Distance visual acuity was the only tool used in such school eye screening for making referrals. We aim to evaluate the referral rate when only distance visual acuity was used as the screening tool versus using retinoscopy.

METHODS:
School children were earlier screened using distant visual acuity as the sole criteria. They were again examined as per the guidelines recommended by State of Alaska and American Academy of Pediatrics, and the results of the two examinations were compared. Microsoft Excel 2007 was used for the statistical analysis.

RESULTS:
Earlier 384 school children of class first to fourth (aged 6–10 years) had been screened using distant visual acuity. Of them, 87 (22.6%) were referred. The rest 297 (male 183 61.6%) students with a mean age of 7.8 years (standard deviation ± 1.23) were again examined and 42/384 (11%) were detected as having visual anomaly that were false negative/or missed during the initial screening. Refractive errors were detected in 33/42 (78.6%) students by retinoscopy. Retinoscopy showed the highest sensitivity (78.6%) and negative predictive value (96.6%) to detect all types of refractive error among all types of tests. Of 42 pair of eyes, 36 right eyes and 39 left eyes had refractive errors, mostly astigmatic, or hyperopic, which were missed earlier.

CONCLUSION:
Only distance visual acuity failed to detect hyperopia and astigmatism properly. Introduction of retinoscopy would increase the validity of school eye screening.
Compliance with contact lens care and factors driving noncompliance in health-care students in Jeddah, Saudi Arabia
Authors: Naaman Nada K. , Alharbi Suzan Y. , Khan Muhammad A. , Alghamdi Saeed A. 
Published: May 2024

PURPOSE:
This study aimed to assess compliance to contact lens care behaviors and determine common factors influencing noncompliance among a population of university students in Jeddah, Saudi Arabia.

METHODS:
This is an observational, cross-sectional study in which a previously validated self-administered questionnaire consisting of 12 questions addressing compliance to contact lens wear and care was E-mailed through the university message center.

RESULTS:
A total of 388 participants completed the questionnaire. Of those who completed the survey, 150 were contact lens users with an experience of 1 month or more. The average compliance rate to contact lens care was around 66%. High levels of compliance were reported in sharing contact lenses, sleeping with contact lenses, showering/swimming with contact lenses, and using water to clean contact lenses. Moderate levels of compliance were shown in overuse of contact lenses, adherence to instructions of lens cleaning, cleaning the lens case, and adherence to aftercare visits. The lowest levels of compliance were noted in washing hands before lens use and lens case replacement. Gender, smoking, contact lens experience, type and modality of contact lens usage, and contact lens purchase site were found to have a significant association with behaviors showing poor compliance. Believing there is no harm in wearing lenses for longer than the recommended replacement schedule was the primary reason given for overusing contact lenses.

CONCLUSION:
Moderate levels of compliance were generally reported by respondents, necessitating the need for better strategies to reinforce the importance of compliance to contact lens care in the Saudi population.
Safety and efficacy of sodium cromoglycate-fluorometholone fixed combination eye drops in allergic conjunctivitis
Authors: Alwadani Saeed 
Published: May 2024

PURPOSE:
This study aimed to assess the efficacy and safety of sodium cromoglycate with fluorometholone in patients with allergic conjunctivitis.

METHODS:
We conducted a single-arm phase IV open-label trial where fifty patients who received the eye drops were followed for 4 weeks. Treatment efficacy was assessed using the ocular itching score, conjunctival assessment score, total symptom and sign (TSS) score, and Visual Analog Scale (VAS).

RESULTS:
Patients who received sodium cromoglycate-fluorometholone eye drops experienced significant improvements in their ocular itching score (mean difference [MD]: 1.14, P < 0.001) and conjunctival redness score (MD: 1.18, P < 0.001). Statistically significant improvements in TSS and VAS were achieved in 78% of the patients reporting no conjunctivitis by the end of the study. The overall therapeutic response to the drug was as follows: 16% improved and 84% much improved. No serious adverse events were reported.

CONCLUSION:
Sodium cromoglycate with fluorometholone eye drops achieved 100% therapeutic response among patients with allergic conjunctivitis. The eye drops improve the ocular itching, and conjunctival irritation without serious adverse events. This combination appears effective and tolerable for treatment of allergic conjunctivitis.
Performance of deep-learning artificial intelligence algorithms in detecting retinopathy of prematurity
Authors: Bai Amelia , Carty Christopher , Dai Shuan 
Published: May 2024

PURPOSE:
Artificial intelligence (AI) offers considerable promise for retinopathy of prematurity (ROP) screening and diagnosis. The development of deep-learning algorithms to detect the presence of disease may contribute to sufficient screening, early detection, and timely treatment for this preventable blinding disease. This review aimed to systematically examine the literature in AI algorithms in detecting ROP. Specifically, we focused on the performance of deep-learning algorithms through sensitivity, specificity, and area under the receiver operating curve (AUROC) for both the detection and grade of ROP.

METHODS:
We searched Medline OVID, PubMed, Web of Science, and Embase for studies published from January 1, 2012, to September 20, 2021. Studies evaluating the diagnostic performance of deep-learning models based on retinal fundus images with expert ophthalmologists' judgment as reference standard were included. Studies which did not investigate the presence or absence of disease were excluded. Risk of bias was assessed using the QUADAS-2 tool.

RESULTS:
Twelve studies out of the 175 studies identified were included. Five studies measured the performance of detecting the presence of ROP and seven studies determined the presence of plus disease. The average AUROC out of 11 studies was 0.98. The average sensitivity and specificity for detecting ROP was 95.72% and 98.15%, respectively, and for detecting plus disease was 91.13% and 95.92%, respectively.

CONCLUSION:
The diagnostic performance of deep-learning algorithms in published studies was high. Few studies presented externally validated results or compared performance to expert human graders. Large scale prospective validation alongside robust study design could improve future studies.