Undergraduate Ophthalmology Teaching in Saudi Arabia: Assessment, Analysis, and Comparisons.

BACKGROUND: The International Council of Ophthalmology (ICO) considers ophthalmology a core curriculum subject for medical students. To date, there is no unified guideline assessing the efficacy of ophthalmology curricula in Saudi medical schools. Hence, we aimed to investigate the adequacy of undergraduate ophthalmology education in Saudi Arabia compared with the ICO guidelines. METHODS: In this cross-sectional study, an online questionnaire was distributed randomly to medical graduates in different Saudi medical schools. We reached 31 medical schools (public and private) in different regions of Saudi Arabia. RESULTS: From medical schools across Saudi Arabia, 317 participants were enrolled in the study. Our study outcomes followed the ICO guidelines in multiple areas, including having ophthalmology training during medical school (93.4%), ophthalmology course duration of 2 weeks (56.2%), necessary knowledge for patients' referral (55.8%), competency in most basic ophthalmic skills, and participants receiving different teaching methods (theoretical lectures and clinical settings). In addition, 58.7% of the participants considered ophthalmology education a significant factor in choosing a future residency program. CONCLUSION: In our study, most Saudi medical schools followed the ICO guidelines, as numerous graduates are competent in many basic ophthalmic skills. A structured national guideline must be established to ensure that future general practitioners can deal with ophthalmic patients and to establish a Saudi gold-standard eyesight health program.

Aflibercept versus Ranibizumab as a Second Line Therapy After Bevacizumab for Diabetic Macular Edema.

PURPOSE: To compare the visual and anatomic outcomes of aflibercept versus ranibizumab as a second line treatment for persistent diabetic macular edema (DME) after initial bevacizumab injections. METHODS: In this retrospective cohort study, patients with center-involved DME of ≥ 300 µm thickness after bevacizumab intravitreal injections in 2015-2019 were included. Those treated with ranibizumab (R) and aflibercept (A) were grouped as group R and group A, respectively. The change in central macular thickness (CMT) measured by optical coherence tomography (OCT) and the best corrected distance visual acuity (BCVA) before and after three-monthly anti-VEGF injections (anti-VEGF) in group R and group A were compared and reviewed. RESULTS: There were 80 eyes of 75 patients in group R and 80 eyes of 72 patients in group A. The initial bevacizumab injections in group R and group A varied significantly (p = 0.01). The median change of the CMT after the three injections was not significantly different in group R (80 µm) and group A (81.5µm) (p = 0.7). The improvement of BCVA in group R and group A was not significant (p = 0.5). Dry macula was noted in 1 vs 14 eyes in group R vs group A. CONCLUSION: After treating refractory DME with initial bevacizumab injections, 3 injections of either aflibercept or ranibizumab had similar anatomic and functional outcomes. Aflibercept achieved dry macula in more eyes with refractory DME compared to ranibizumab.

Poor Outcome in Camel-Related Eye Trauma with Ruptured Globe.

PURPOSE: To report the poor visual outcome of ruptured globe caused by camel bites. OBSERVATIONS: A 48-year-old camel caregiver presented to the emergency department after being bitten by a camel in the left side of his face. Ophthalmic examination revealed a superior scleral wound from 9 to 2 o'clock, about 6 mm from the limbus extending to the equator with prolapse of uveal and vitreous tissues, an opaque cornea, total hyphema, diffuse subconjunctival hemorrhage, and a lower lid laceration involving the lid margin and the nasolacrimal duct. The patient has undergone surgical repairs of ruptured globe and lid laceration, followed by retinal detachment surgery. Following these surgical interventions, the patient preserved a light perception vision with flat retina. CONCLUSION: Camel-related injuries might primarily involve the ophthalmic structures, especially in camel bites. Camel-related eye trauma might lead to poor visual and anatomical outcomes which might not improve following surgical interventions.