Perceptions of potential barriers to soft contact lens wear among university students in Jordan.

CLINICAL RELEVANCE: Identifying potential barriers to contact lens wear could increase awareness about contact lenses and their benefits and boost the confidence of optometrists offering contact lenses to their patients. BACKGROUND: Contact lenses provide better visual performance according to many studies. Nevertheless, resistance to wearing them remains an issue. This study will identify barriers to contact lens wear among university students in Jordan. METHODS: This study enrolled university students who wore spectacles for their refractive error correction and have had no history of contact lens wear. A questionnaire of potential barriers was constructed whereby participants were required to respond to a set of questions that asked how each suggested item was considered a barrier for contact lens wear; responses were recorded within a 5-points scale (1: strongly disagree to 5: strongly agree). RESULTS: A total of 260 participants (175 females and 85 males) were enrolled in the study. All participants showed normal findings for contact lens wear candidacy. The mean score of total barriers to contact lens wear was high, at 33.8 (±5.4 SD) (out of 55 the maximum possible score). The major identified barriers were: decision of eye care practitioners that contact lenses are unsuitable for them (64.6% of the study sample); decision of the participants that contact lens were unsuitable for their work environment (63.5%); and reported symptoms of ocular dryness (61.6%) that made participants reluctant to try contact lenses. CONCLUSION: This work identified several patient-related barriers to contact lens wear. Probing these barriers may encourage eye care providers and contact lens manufacturers to promote contact lenses as a viable option for the correction of refractive error. This in turn will increase awareness among patients about contact lenses and encourage them to try contact lenses as alternative to spectacles.

Awareness and Knowledge of the Effect of Ultraviolet (UV) Radiation on the Eyes and the Relevant Protective Practices: A Cross-Sectional Study from Jordan.

Background: Overexposure to ultraviolet (UV) radiation is linked to serious adverse health effects that are cumulative in nature and affect children more than adults. UV radiation has also been reported to have serious complications for the eye, particularly in areas with a high UV radiation index. Increasing public awareness about the harmful effects of UV radiation on the eye and promoting awareness about protection against UV radiation may prevent eye disease related to UV radiation damage and help in the improvement of public health in general. This study aims to assess public awareness and knowledge of UV radiation and practices toward UV protection in Jordan, which is a country recognized as having a relatively high UV index throughout the year. Methods: A cross-sectional study was performed using an online questionnaire using Google Forms® to assess people's awareness, knowledge, practices toward eye protection from UV radiation, and the reasons for not wearing UV-protective eyeglasses in Jordan. Sociodemographic information of participants including age, gender, education level, and employment status was also acquired. People's knowledge on UV protection and harmfulness was measured via rewarding their correctly answered knowledge questions with one mark and zero for incorrectly answered questions based on key answers defined from the literature. Results: A total of 1331 participants (77% females and 23% males) with an average age of 26(±10) years completed the online questionnaire. Participants showed generally high levels of knowledge and awareness about UV radiation and its harmful effects. Nevertheless, participants showed a low level of knowledge about the link between UV radiation and some of the ocular diseases in the questionnaire. Practices toward UV radiation protection where inadequate, with 59% of the respondents reporting that they do not use any protective eyewear from natural UV radiation. The main reported reason for not wearing UV-protective sunglasses was uncertainty in the efficiency of UV protection in sunglasses, as reported by 47% of the participants who do not wear UV-protective sunglasses. Conclusions: The awareness of UV radiation and its harmful effects is high in the studied population. Participant knowledge is also relatively high in relation to nature of solar UV radiation, other synthetic sources of UV radiation, and the most dangerous UV exposure time. However, low participant knowledge was measured on the association between UV radiation with ocular disease and the role of UV-protective eyeglasses. Participant practice toward UV radiation protection was found to be insufficient. Thus, it is important to further increase the knowledge of damaging effects of solar and synthetic UV radiation and emphasize the benefits of eye protection from UV radiation. Eye care practitioners should target youth by different strategies including health campaigns, media, and clinics.

Prevalence and Behavioral-Based Risk Factors (Eye Cosmetic and Tobacco Use) of Symptomatic Dry Eye Disease in Four Middle Eastern Countries: Lebanon, Syria, Jordan, and Palestine.

Purpose: To estimate the prevalence of symptomatic dry eye disease (DED) in four Middle Eastern Countries and investigate the association between behavioral-based risk factors and severity of DED. Patients and Methods: Population-based cross-sectional study of 1463 participants from 4 Mediterranean countries (Lebanon, Syria, Jordan, and Palestine). The Arabic version of the Ocular Surface Disease Index (ARB-OSDI) questionnaire was used to estimate the prevalence and severity of symptomatic DED using an online format survey. The survey also included demographic questions and possible behavioral risk factors (tobacco and cosmetic use). One-Way ANOVA and multivariate regression analyses were used to investigate the association between OSDI mean scores and behavioral-based risk factors. Results: The prevalence of symptomatic DED (OSDI score ≥ 13) among the overall population (332 males and 1132 females) reached 70.2%. Tobacco and cosmetic users reported a higher significant prevalence and severity of symptomatic DED than non-users (p < 0.0001). Smoking habits (eg, smoking cigarettes or Ajami, smoking in closed areas, and daily smoking) were more likely to report symptomatic DED. Bad hygiene process during the use of any cosmetic product was behind the high prevalence and severity of symptomatic DED among the females of the study population. Conclusion: Symptomatic DED is substantial in Middle Eastern countries. It is statistically associated with cosmetic and tobacco use.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice.

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

The usefulness of optics-based courses for optometry and vision science alumni: a cross-sectional online survey.

OBJECTIVES: A well-balanced curriculum is critical for ensuring that students graduate with the necessary skills. There is growing interest in evaluating the functional value of non-clinical courses compared to clinical courses. The purpose of this study was to evaluate the views of optometry and vision science professionals on the utility and relevance of optics-based courses. METHODS: A web-based survey was designed to assess the perceived significance of the optics-based courses. All respondents were alumni of two universities in Jordan that offer an undergraduate degree in optometry. The survey included questions about the professional relevance of optics courses. Respondents were asked to rate several statements related to the relevance and importance of optics courses in current optometry practice on a 5-point Likert scale. RESULTS: In total, 205 respondents completed the online survey. There were 161 (78.5%) women and 44 (21.5%) men, with an average age of 28.76 (± 4.86) years. Overall, respondents rated the perceived usefulness of optics courses for their careers with a mean collective value of 20.78 out of a possible 30 points. Female alumni perceived the courses as significantly more useful in their workplace than male alumni did (p = .020). Optometrists in different age groups perceived usefulness differently (p = .001). Alumni who preferred to learn these courses on-site and by hybrid methods perceived optics courses as significantly more useful than those who preferred to learn online (p = .006 and p < .001, respectively). CONCLUSIONS: The perceived importance of optics-based courses varied according to several factors. However, in general, these courses were deemed helpful in terms of curricular content and practical relevance to practice, regardless of specialisation or the workplace.Key messagesIn terms of the value offered to the professional competencies that an optometrist needs, the practical utility of optics courses in optometry curriculums is contested.Optometrists' perceptions of optics courses were examined using a cross-sectional survey.Respondents rated the perceived usefulness of optics courses for their career, with a mean collective value of 20.78 out 30 points.The highest percentage of respondents in this study expressed their preference for the face-to-face learning method rather than the hybrid method.Male optometrists perceived learning optics courses as significantly less helpful than female optometrists.

The effects of tobacco waterpipe smoking on the ocular surface.

CLINICAL RELEVANCE: This study was conducted to determine the effect of tobacco waterpipe smoking on the ocular surface. The findings could be useful in understanding ocular surface changes and associated symptoms in waterpipe smokers. BACKGROUND: Tobacco smoking has been reported to have many systemic and ocular adverse effects. However, the effect of specific delivery methods of tobacco using a waterpipe on the eye has not been commonly studied. METHODS: This study enrolled 33 waterpipe smokers (with no history of cigarette smoking) and 31 non-smokers of age-matched control group. Participants were tested in the following sequence: the presence of ocular symptoms using Ocular Surface Disease Index questionnaire, tear osmolarity, tear film break-up time and corneal staining. Statistical analysis using unpaired sample t-tests was performed to study the difference in ocular surface parameters obtained for each group. The prevalence of dry eye disease was also measured in each group. RESULTS: The mean tear osmolarity values and corneal staining were significantly higher (P < 0.05) in the waterpipe smoking group (314.64 ± 15.24 mOsm/L and 0.73 ± 0.94, respectively) compared to non-smokers (306.42 ± 13.48 mOsm/L and 0.10 ± 0.30, respectively). The mean values obtained from tear film break-up time test were significantly lower (P < 0.05) in the waterpipe smoking group (5.82 ± 3.77 s) compared to non-smokers (8.32 ± 3.46 s). The difference in the average Ocular Surface Disease Index scores in the study groups was not statistically significant (P > 0.05). The prevalence of dry eye disease was significantly higher (p < 0.05) in the waterpipe smoking group (57.6%), compared to the control group (35.5%). CONCLUSION: Waterpipe smoking could have a significant effect on tear film parameters and be associated with dry eye disease. Dryness also seems to be more prevalent among waterpipe smokers.

Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire.

AIM: To develop an Arabic version of the ocular surface disease index (OSDI) and to assess its reliability and validity. METHODS: A cross sectional study was carried out to validate the Arabic version of the OSDI questionnaire. Initially, forward-backward translation was used to translate the English version of OSDI into Arabic. The translated questionnaire was tested for equivalence and cultural adaptability. Totally 200 subjects were then recruited from a non-clinical population and asked to complete the Arabic version of the OSDI (ARB-OSDI). The reliability of the questionnaire was assessed using Cronbach's-α. A subgroup of 30 participants was asked to complete the questionnaire on two occasions to test the test-retest reliability. RESULTS: A total of 200 participants were enrolled in the study. The average age of the study participants was 31.21±13.2y and 57% were male. An acceptable internal consistency level for the ARB-OSDI questionnaire measured by Cronbach's-α was revealed. All questions showed good internal consistency. Test-retest reliability analysis revealed good stability (interclass correlation coefficient, r=0.832, P<0.001). The construct validity for the questionnaire was also high. CONCLUSION: The ARB-OSDI questionnaire shows very good psychometric properties (acceptable internal consistency and test-retest reliability). That makes the questionnaire a valid potential tool to use in Arabic-speaking countries to monitor symptoms of dry eye disease in a larger population.

Opportunities and threats to contact lens practice: A global survey perspective.

AIM: To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. METHODS: A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years. RESULTS: A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). CONCLUSIONS: Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

Assessment of contact lens wearers' attitude toward contact lens wear and care during Coronavirus Disease 2019 (COVID-19) pandemic: A cross-sectional online survey.

AIM: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several reports have provided conflicting recommendations regarding contact lenses (CL) use during COVID-19, causing confusion among CL wearers. The aim of this study is to assess CL wearers' attitudes toward CL wear and care during COVID-19 pandemic. METHODS: A web-based cross-sectional online survey was used to assess the participants' attitude toward CL wear and care during the COVID-19 pandemic. The survey layout was based on Google form® specifically developed for CL wearers. Demographic characteristics and CL history and profile were also collected for each participant. RESULTS: A total of 196 CL wearers completed the online survey with an average age was 26 (± 4.1) and 90.8 % of participants were females. As reported by the participants, social media was the main source of information about COVID-19. 38.8 % of the study population reported stopping CL wear during the pandemic. The main stated reason for lens discontinuation was decreased social activities during the pandemic. 61.2 % of participants continued lens wear, with the majority reported considerable changes in their behaviors toward CL wear and care during the pandemic. This includes reinforced hands cleaning before and after lens wear, disinfecting of CLs and CL case and less frequent CL aftercare visits. CONCLUSION: The majority of the study population have continued CL wear during the pandemic. Contact lens wearers reported profound changes in attitudes toward CL wear including improved care and maintenance. Additionally, changes in CL purchase habit have been reported with more tendency for online purchase. CL cessation has been associated with several perceived reasons mainly attributed to reduced outdoor activity and fear of ocular infection. Levels of compliance among CL wearers should be assessed and reinforced during the current pandemic and similar lockdown situation to reduce possible CL-related complications and dropout.

Assessment of compliance with contact lens wear and care among university-based population in Jordan.

PURPOSE: this survey aimed to assess levels of compliance with contact lens wear and care among university student's population in Jordan. METHODS: An interviewer-administered questionnaire was used to assess the extent of compliance among contact lens wearers toward contact lens care in a university population. The questionnaire included 12 questions regarding compliance with contact lens care, lens case/solution replacement, general hygiene procedures related to contact lens and adherence to aftercare visits. RESULTS: 210 contact lens wearers were interviewed. Of the study population 187 (89 %) were females and 23 (11 %) were males. The average age of the study group was 22.35 (± 3.77) years and all the study population were students (undergraduate or postgraduate).The average compliance rate of the study population was 75 %. High level of compliance was noticeable in the following aspects; not sharing lenses with others, not sleeping while wearing lenses, hand washing before lens use and not using water to clean lenses. Moderate level of compliance was reported in the following aspects; showering/swimming with lenses, using lenses longer than recommended replacement schedule and all behaviours related to contact lens care solution. However, low levels of compliance were reported in relation to cleaning and rinsing lens case and adherence to aftercare visits. CONCLUSION: High to moderate levels of compliance were reported generally by participants. However, better strategies are recommended to further increase levels of compliance among contact lens wearers in Jordan related to adherence to aftercare visits. While this study is targeted contact lens wearers from a university student's population, a future study is recommended to include larger sample of contact lens wearers from the general lay population.

Prevalence and associated risk factors of dry eye disease in 16 northern West bank towns in Palestine: a cross-sectional study.

BACKGROUND: Dry Eye Disease (DED) is a multifactorial disease of the interpalpebral ocular surface and tear film that leads to discomfort, fatigue and disturbance in vision. DED affects patients' quality of life and leads eventually to decrease of productivity. Moreover, it has a considerable socioeconomic burden. It is a growing underdiagnosed health issue and the possible associated risk factors are very common and keep growing worldwide. PURPOSE: To assess the prevalence of DED and potential associated risk factors in the Northern West Bank of Palestine. METHODS: A cross sectional study was conducted in 16 selected towns in Northern West Bank governorates during December 2016 to September 2017. An interviewer-assisted Ocular Surface Disease Index (OSDI) questionnaire was used to study DED symptoms in the study population. Further evaluation of clinical signs of DED was performed using the following objective tests: tear film break-up time (TBUT), fluorescein corneal staining (FL/S) and Schirmer test. Subjects with an OSDI score of 13 or above were considered symptomatic of DED, and DED was defined if an OSDI score ≥ 13 is accompanied by at least one of the following signs in the worse eye: TBUT ≤10 s, Schirmer score ≤ 5 mm and fluorescein corneal staining ≥ grade 1. RESULTS: Seven hundred sixty-nine subjects were recruited from the general non-clinical population in the West Bank. The mean age of participants was 43.61 ± 18.57 years ranging from 18 to 90 years. Females constitute 52.7% of the study population. Based on the diagnostic criteria, the prevalence of DED was 64% (95% confidence interval 60.6-67.3). DED was significantly associated with female gender p = (0.001) and older age p = (0.001). CONCLUSION: The prevalence of DED is high in the study population. Older age and female gender were associated risk factors with the development of DED.

Public attitudes toward corneal donation in northern Jordan.

PURPOSE: The aims of this study were to assess the knowledge and attitude toward corneal donation among Jordanian population and to report the reasons which may influence subject's decision and attitude toward corneal donation. METHODS: A self-designed questionnaire was developed. The participants were asked about reasons for both willingness and unwillingness to donate their corneas. These reasons were stated in the questionnaire and the participants had to express their agreement by one of five options: strongly disagree, disagree, neutral, agree, or strongly agree. RESULTS: A total of 500 participants (218 males and 282 females) completed the questionnaire. The average age (±SD) of the study participants was 32.8 (±11.7) years. About 67.2% of the subjects were willing to donate their corneas, whereas 32.8% were not willing to do so. The main motive for willingness was doing a good deed by helping others to see. On the other hand, fear of the body being treated badly and that other organ might be taken than the ones specified for donation were the main reasons for unwillingness to donate corneas. The age of participants, gender, and the monthly income did not significantly influence the willingness to donate (P>0.05). However, the level of education had a significant influence on people's decision to donate their corneas. CONCLUSION: Many Jordanians have positive attitude toward corneal donations. Ethical factors need to be addressed to promote for corneal donation. In addition, increasing the awareness of donation and its benefits may help increase the supply of corneal tissues.

Clinical characteristics and causes of visual impairment in a low vision clinic in northern Jordan.

AIM: The aim of the study was to identify causes of visual impairment among patients attending a low vision clinic in the north of Jordan and to study the relevant demographic characteristics of these patients. SUBJECTS AND METHODS: The retrospective study was conducted through a review of clinical records of 135 patients who attended a low vision clinic in Irbid. Clinical characteristics of the patients were collected, including age, gender, primary cause of low vision, best corrected visual acuity, and current prescribed low vision aids. Descriptive statistics analysis using numbers and percentages were calculated to summarize categorical and nominal data. RESULTS: A total of 135 patients (61 [45.2%] females and 74 [54.8%] males) were recruited in the study. Mean age ± standard deviation for the study population was 24.53 ± 16.245 years; age range was 5-90 years. Of the study population, 26 patients (19.3%) had mild visual impairment, 61 patients (45.2%) had moderate visual impairment, 27 patients (20.0%) had severe visual impairment, and 21 patients (15.6%) were blind. The leading causes of visual impairment across all age groups were albinism (31.9%) and retinitis pigmentosa (RP) (18.5%). Albinism also accounted for the leading cause of visual impairment among the pediatric age group (0-15 years) while albinism, RP, and keratoconus were the primary causes of visual impairment for older patients. A total of 59 patients (43.7%) were given low vision aids either for near or distance. The only prescribed low vision aids for distances were telescopes. For near, spectacle-type low vision aid was the most commonly prescribed low vision aids. CONCLUSION: Low vision services in Jordan are still very limited. A national strategy programme to increase awareness of low vision services should be implemented, and health care policies should be enforced to cover low vision aids through the national medical insurance.

Patient-related barriers to Rigid Gas Permeable (RGP) lens wear among keratoconus patients in Jordan.

PURPOSE: To assess potential patient-related barriers to rigid gas permeable (RGP) lens wear for vision rehabilitation in a sample of keratoconus (KC) patients in Jordan. METHODS: Barriers for RGP contact lens wear among KC patients were discussed and specified by a focus group which consisted of five optometrists who are involved in contact lens practice. The focus group addressed potential barriers for RGP lens wear from the patient's perspective. The identified barriers were then used to design the final questionnaire used in the study. The questionnaire consisted of 8 questions which ask the participant to rate, within a 5-points scale (1: strongly disagree to 5: strongly agree), how each suggested item is considered a barrier for RGP lens wear. RESULTS: 204 KC patients (86 females, 118 males) were involved in a semi-structured interview to answer the questionnaire. The average age of participants was 30.85 (±8.74) years old and ranged from 18 to 62 years. The average age of diagnosis of KC (±standard deviation) is 21.96 (±7.22) years old with a range of 12-52 years. All participants reported that they had never tried RGP lenses for their vision rehabilitation; however, other management options were reported such as glasses, keratoplasty, collagen cross linking and Intacs. The mean score of total barriers to RGP wear was high at 3.8 (±0.4) (out of 5). The major identified barriers were: lack of awareness of the benefits of RGP lenses, fear of possible lens complications, lack of medical insurance and high cost of the lens. CONCLUSIONS: The study reveals that several barriers were identified as prevalent. Consequently, there is an imperative need to adopt better planning strategies for management protocol of KC in order to assure best eye care service for KC patients in Jordan.

Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in Jordan.

BACKGROUND: Increasing the level of awareness of diabetic retinopathy among individuals with type 2 diabetes mellitus is considered an important factor for early diagnosis and management of diabetic retinopathy. The aim of this study was to evaluate awareness of diabetic retinopathy among a sample of type 2 diabetes mellitus patients in Jordan. PATIENTS AND METHODS: The study period was from August to December 2015. The sample was selected randomly from patients with type 2 diabetes mellitus from the general population in three main cities of Jordan (Amman, Irbid, and Zarqa). A questionnaire was distributed to 237 participants with diabetes to assess their awareness and knowledge of diabetes and diabetic retinopathy. The questionnaire included questions to assess awareness about diabetic retinopathy, sources of knowledge about the disease, and patients' knowledge and compliance with available treatments and routine eye examinations. Patients were also questioned about the barriers that may interfere with early eye examination. RESULTS: A total of 237 participants (107 [45.1%] females and 130 [54.9%] males) with type 2 diabetes were interviewed. Mean age±SD for the study population was 54.51±10.28 years. Of the study population, 88.2% were aware that diabetes can affect the eyes and 81% reported that diabetic retinopathy can lead to blindness. Higher level of patients' awareness of diabetic retinopathy was related to higher level of formal education (p<0.05). The main source of information about diabetic retinopathy as reported by 47.3% patients was general practitioners. Patients' compliance with diabetes management was relatively high; however, their compliance with routine retinal assessment was poor, with only a total of 29.5% of participants having had an eye examination in the previous year. CONCLUSION: Awareness of the nature and consequences of diabetic retinopathy among patients with diabetes in Jordan is relatively high. However, patients' motivation to undergo retinal assessment was poor in the sample, thus hindering early diagnosis and management.

Public awareness of common eye diseases in Jordan.

BACKGROUND: Cataract, glaucoma, diabetic retinopathy and dry eye disease are common with high prevalence in Jordan. This study aims to assess the awareness of these ocular diseases among Jordanian population. METHOD: A self-designed questionnaire was developed in Arabic and used to interview people in different provinces of Jordan. Socio-demographic data e.g. age, gender and level of education was reported. Public awareness of four ocular diseases; cataract, glaucoma, diabetic retinopathy (DR) and dry eye disease (DED) was assessed. Questions about familiarity with the diseases, familiarity with their risk factors and participants' source of knowledge were asked. Moreover, awareness of the effect of these disease on the eye whether they are blinding, preventable, treatable and/or the vision is back to normal following treatment was also assessed. RESULTS: A total of 802 participants (232 males and 570 females) completed the questionnaire. The average age (± standard deviation) of the study participants was 28 ± 11.6 (range 18 to 80 years old). Awareness of cataract, glaucoma, DR and DED was reported by 31%, 38%, 37% and 52% of the study population, respectively. Family/relatives/friends and mass media appeared to be the most common sources of knowledge. Age and level of education of the participants were significantly associated with the level of disease awareness. CONCLUSION: This work shows that the level of awareness of the four ocular diseases among Jordanians is good and compares with many reports in the developed and developing countries. Familiarity and knowledge about ocular diseases is essential as it would increase the chance of the subject being tested and thus diagnosed early enough if any problem occurred. Better understanding of the disease would encourage subjects to seek medical care sooner which in turn would prevent visual impairment. Therefore, awareness campaigns should be made to target unaware population.

Epidemiology of symptoms of dry eye disease (DED) in Jordan: A cross-sectional non-clinical population-based study.

PURPOSE: To describe the prevalence of dry eye disease (DED) symptoms and to identify associated risk factors in a general non-clinical population in Jordan. METHODS: In this cross-sectional study, participants were selected randomly from the general non-clinical population in Jordan. Participants aged 18 years or over completed the Arabic version of Ocular Surface Disease Index (OSDI) questionnaire on dry eye symptoms. RESULTS: The OSDI questionnaire was completed by 1039 subjects (609 female and 430 male). The mean OSDI score for the study population was 27, with 59% of subjects showed OSDI score ≥20 (a cut off score for mild DED symptoms). Females showed significantly higher mean OSDI score than males in the older age group (p=0.01). The prevalence of all dryness symptoms was markedly reported in older age group >45 years and contact lens wearers (p<0.05). The most commonly reported DED symptom was sensitivity to light and intense symptoms were markedly reported during windy conditions. Vision-related quality of life was also affected in subjects with dryness symptoms. Working with computers and ATM was among those that highly affected. CONCLUSION: The results show that symptoms of dry eye were prevalent in this non-clinical population. Contact lenses wear and older age were found to be associated with dry eye symptoms.

The cellular basis for biocide-induced fluorescein hyperfluorescence in mammalian cell culture.

Clinical examination of the ocular surface is commonly carried out after application of sodium fluorescein in both veterinary and medical practice by assessing the resulting 'staining'. Although localized intensely stained regions of the cornea frequently occur after exposure to 'adverse' clinical stimuli, the cell biology underlying this staining is unknown, including whether intense fluorescein staining indicates the presence of damaged cells. Ocular exposure to certain contact lens multipurpose solutions (MPS) gives rise to intense fluorescein staining referred to as solution induced corneal staining (SICS), and we have made use of this phenomenon with Vero and L929 cell culture models to investigate the fundamental biology of fluorescein interactions with cells. We found that all cells take up fluorescein, however a sub-population internalize much higher levels, giving rise to brightly staining 'hyperfluorescent' cells within the treated cultures, which contain fluorescein throughout the cell cytoplasm and nucleus. The numbers of these hyperfluorescent cells are significantly increased after exposure to MPS associated with SICS. Surprisingly, hyperfluorescent cells did not show higher levels of staining with propidium iodide, a marker of lysed cells. Consistently, treatment with the cytolytic toxin benzalkonium chloride resulted in almost all cells staining with propidium iodide, and the complete abolition of fluorescein hyperfluorescence. Finally we found that internalization of fluorescein and its loss from treated cells both require cellular activity, as both processes were halted after incubation at 4 °C. We conclude that fluorescein hyperfluorescence can be replicated in three diverse cell cultures, and is increased by MPS-treatment, as occurs clinically. The process involves the concentration of fluorescein by a sub-population of cells that are active, and does not occur in lysed cells. Our data suggest that corneal staining in the clinic reflects active living cells, and is not directly caused by dead cells being produced in response to adverse clinical stimuli.