Neck and upper back pain among eye care professionals.

BACKGROUND: Ophthalmologists and optometrists have reported a higher prevalence of neck, hand/wrist and lower back pain than family medicine physicians. Work-related musculoskeletal disorders have not previously been studied in Saudi eye care professionals. AIMS: To determine the magnitude and determinants of neck and upper back pain among eye care professionals at a tertiary hospital in Saudi Arabia in 2013. METHODS: A cross-sectional study using a close-ended questionnaire to determine the frequency of neck and back pain and its association with age, sex, weight, comorbidities, duration of professional work, history of injury and physician sub-speciality. RESULTS: The response rate was 82% and 165 eye care professionals participated, 70% (113) of whom reported neck and back pain. The rate was similar in ophthalmologists and allied eye care professionals and among surgical and medical ophthalmologists. The prevalence rate of neck and upper back pain was not associated with number of years in the profession, comorbidities, self-reported weight or injury. Pain appeared to be associated with reported physical discomfort during professional activities (P < 0.01) but not with mental stress. Pain was thought to be work related by 50% of participants. A lower rate of neck and upper back pain was associated with regular exercise [odds ratio = 0.5 (95% confidence interval 0.2-0.9)]. CONCLUSIONS: Neck and back pain was reported by 70% of eye care professionals. The pain was graded as mild to moderate and improved when on holidays. Regular physical exercise appeared to prevent or reduce neck and upper back pain.

Lid surgery for trachomatous trichiasis is negatively associated with visual disabilities and visual impairment in Oman.

Oman is at the threshold of eliminating blinding trachoma. We conducted a community-based survey in 2009-10 to study the association of trachomatous trichiasis (TT) status with visual acuity and blindness among the Omani population aged 40+ years. A total of 8191 eyes were examined and participants' demographic data were collected. TT was absent in 7890 eyes but 227 of these eyes had had lid surgery for TT in the past. TT was detected in 301 eyes, for the first time in 154 eyes and following lid surgery in 147 eyes. The rate of blindness was significantly lower in eyes that had undergone lid surgery in the past (OR = 0.54). In regression analysis the predictors of blindness were participant's age (adjusted OR = 1.01), sex (aOR = 2.01), history of lid surgery (aOR = 3.09) and residence in a hyperendemic trachoma area (aOR = 10.6). Promotion of TT surgery might be beneficial in reducing blindness.

Lid surgery for trachomatous trichiasis is negatively associated with visual disabilities and visual impairment in Oman

Oman is at the threshold of eliminating blinding trachoma. We conducted a community-based survey in 2009-10 to study the association of trachomatous trichiasis [TT] status with visual acuity and blindness among the Omani population aged 40+ years. A total of 8191 eyes were examined and participants' demographic data were collected. TT was absent in 7890 eyes but 227 of these eyes had had lid surgery for TT in the past. TT was detected in 301 eyes, for the first time in 154 eyes and following lid surgery in 147 eyes. The rate of blindness was significantly lower in eyes that had undergone lid surgery in the past [OR = 0.54]. In regression analysis the predictors of blindness were participant's age [adjusted OR = 1.01], sex [aOR = 2.01], history of lid surgery [aOR = 3.09] and residence in a hyperendemic trachoma area [aOR = 10.6]. Promotion of TT surgery might be beneficial in reducing blindness

Determination of toxic metals in Indian smokeless tobacco products.

This study targets the lesser-known ingredients of smokeless tobacco products, i.e., the toxic metals, in Indian brands. The metals selected in the study included lead (Pb), cadmium (Cd), arsenic (As), copper (Cu), mercury (Hg), and selenium (Se). The differential pulse anodic stripping voltammetry (DPASV) technique was used for estimating the metals Pb, Cd, and Cu; square wave voltammetry for As; and the cold vapor atomic absorption technique for Hg. The resulting levels of the metals were compared to the daily consumption of the smokeless tobacco products. It was observed that almost 30% of gutkha brand samples exceeded the permissible levels of metals Pb and Cu, when compared to the provisional tolerable intake limits determined by the FAO/WHO. The reliability of data was assured by analyzing standard reference materials.

Analysis of heavy metals in marine fish from Mumbai Docks.

Seafood containing heavy metals as a result of environmental contamination causes toxicity in human beings. To evaluate such kind of contamination, our study targeted the analysis of metals such as lead, copper, cadmium, mercury, and arsenic in muscle tissue of the fish. The fish commonly consumed such as Brama brama (Pomfret), Rachycentron canadus (Surmai/King Fish), Rastrelliger kanagurta (Mackerel), Eleutheronema tetradactylum (Ravas/Indian salmon), and Metapenaeus monoceros (Brown Prawn) were collected from four different docks in the city. The heavy metals in tissue samples of fish were estimated using voltammeter and cold vapor atomic absorption spectrophotometer. Heavy metal concentration in the tissues varied significantly depending upon the locations from where the fish were collected. Although the concentration of arsenic, copper, cadmium, and lead were in normal range, the concentration of mercury was found to exceed the daily permissible levels (1 microg/g) as a food source for human consumption. We have analyzed heavy metals from different locations in Mumbai-Versova dock, Sassoon dock, Navi Mumbai dock, and Mazgaon dock.

Retinal examination of diabetic patients: knowledge, attitudes and practices of physicians in Oman.

Knowledge, attitudes and practices of 40 randomly selected physicians was assessed in the North Sharqiya region of Oman in 2003. We evaluated non-ophthalmologist physicians' knowledge of techniques of eye examination of diabetic patients, attitudes towards fundus examination and practices of detailed eye examination. Knowledge about different parts of the eye was satisfactory in only 58% of physicians and knowledge about method of fundus examination for diabetic retinopathy was poor in 40%. Attitudes towards eye examination by non-ophthalmologists at primary level were positive. In practice 20 physicians had attempted to use an ophthalmoscope and only 9 could see details of the retina. Our general physicians would need detailed training if they are to be involved in early detection of diabetic retinopathy.

Oman Eye Study 2005: validity of screening tests used in the glaucoma survey.

We carried out a validity assessment study for glaucoma screening procedures used during the survey conducted in Oman in 2005 on 6644 eyes in 3324 people > or = 30 years. Ocular pressure and fundus changes were the screening parameters used: glaucoma was found in 433 eyes. Sensitivity for ocular pressure was 49.7% and specificity 95.6%. For optic disc changes, sensitivity was 48.4% and specificity 97.9%. Combining both through parallel testing, sensitivity improved to 67.3% and specificity to 96.5%. An eye may, thus, be declared as not having glaucoma, but cannot be labelled as having glaucoma, using these parameters.

Oman Eye Study 2005: prevalence and determinants of glaucoma.

This community-based study was carried out to estimate the prevalence and identify the determinants of glaucoma in the Omani population in 2005-06. Residents of 75 randomly selected houses in 25 clusters participated in the survey. We interviewed and examined 3324 individuals aged > or = 30 years in their homes and in eye clinics to note personal details, glaucoma status and presence of selected risk factors: 180 were diagnosed as having glaucoma. Projected prevalence of glaucoma among the Omani population > or = 30 years was 4.75%. Open angle and angle closure types of glaucoma contributed 40.6% and 37.8% respectively. History of hypertension was negatively, and older age and family history of glaucoma were positively, associated with glaucoma.

Oman Eye Study 2005: validity of screening tests used in the glaucoma survey

We carried out a validity assessment study for glaucoma screening procedures used during the survey conducted in Oman in 2005 on 6644 eyes in 3324 people >/= 30 years. Ocular pressure and fundus changes were the screening parameters used: glaucoma was found in 433 eyes. Sensitivity for ocular pressure was 49.7% and specificity 95.6%. For optic disc changes, sensitivity was 48.4% and specificity 97.9%. Combining both through parallel testing, sensitivity improved to 67.3% and specificity to 96.5%. An eye may, thus, be declared as not having glaucoma, but cannot be labelled as having glaucoma, using these parameters

Oman Eye Study 2005: prevalence and determinants of glaucoma

This community-based study was carried out to estimate the prevalence and identify the determinants of glaucoma in the Omani population in 2005-06. Residents of 75 randomly selected houses in 25 clusters participated in the survey. We interviewed and examined 3324 individuals aged >/= 30 years in their homes and in eye clinics to note personal details, glaucoma status and presence of selected risk factors: 180 were diagnosed as having glaucoma. Projected prevalence of glaucoma among the Omani population >/= 30 years was 4.75%. Open angle and angle closure types of glaucoma contributed 40.6% and 37.8% respectively. History of hypertension was negatively, and older age and family history of glaucoma were positively, associated with glaucoma

Retinal examination of diabetic patients: knowledge, attitudes and practices of physicians in Oman

Knowledge, attitudes and practices of 40 randomly selected physicians was assessed in the North Sharqiya region of Oman in 2003. We evaluated non-ophthalmologist physicians' knowledge of techniques of eye examination of diabetic patients, attitudes towards fundus examination and practices of detailed eye examination. Knowledge about different parts of the eye was satisfactory in only 58% of physicians and knowledge about method of fundus examination for diabetic retinopathy was poor in 40%. Attitudes towards eye examination by nonophthalmologists at primary level were positive. In practice 20 physicians had attempted to use an ophthalmoscope and only 9 could see details of the retina. Our general physicians would need detailed training if they are to be involved in early detection of diabetic retinopathy

Magnitude and causes of unilateral absolute blindness in a region of Oman: a hospital-based study.

PURPOSE: To report the magnitude and causes of unilateral absolute blindness (no light perception) and barriers faced by persons with unilateral blindness in the South Batinah region of Oman. METHODS: Between January and June 2002, 12,000 patients were evaluated for visual acuity, ocular pressure, anterior ocular biomicroscopic examination, and posterior segment indirect ophthalmoscopy examination by ophthalmologists at Al Rustaq hospital in Oman. Patients having no perception of light in at least one eye were included in the cohort. A closed-ended questionnaire was used to collect data on the personal profile, history of blindness, barriers perceived as the cause of blindness, and participants' attitude towards eye care and quality of life following visual disability. RESULTS: In the 12,000 patients studied, absolute unilateral blindness (no perception of light) was present in 122 persons, a rate of 1.0% in our series. The onset of blindness was gradual in 78 (63.9%) persons and 64 (54.9%) persons had unilateral blindness for more than 10 years. The main causes of blindness e phthisis/absent/disorganized blind eye, which was present in 64 (52.5%) persons; glaucoma, seen in 49 (40.2%) participants; and corneal opacity, seen in 8 (6.5%) persons. Eighty 4.8%) persons had <3/60 vision in the fellow eye. Thirty (24.6%) persons had cataract and 19 (15.6%) persons glaucoma in the fellow eye. Forty-eight (39.3%) persons had undergone cataract surgeries while 2 (1.6%) persons were operated for glaucoma in the fellow eye. Lack of access to ophthalmic services and use of traditional medicines during the onset of blindness were reported by nearly half of the cohort. The attitude towards blindness was negative in two thirds of subjects. CONCLUSIONS: Cataract and glaucoma were important determinants of visual impairment in the fellow eyes of this cohort. These patients are at higher risk of developing bilateral impairment and need special care to prevent/treat visual disabilities in the fellow eyes. Using appropriate services, one can attempt attitudinal changes, rehabilitate them, and create a positive attitude towards life.

Determinants of the progress of myopia among Omani school children: a historical cohort study.

PURPOSE: This study was conducted in 2002-2003 at selected schools of eight health regions of Oman. The authors present risk factors and predictors of progression of myopia between the 7th and 10th grades. METHODS: This was a historical cohort study. A total of 1304 students in 10th grade, both with and without progression of myopia, were examined by the refractionists. Vision, refraction, and physical measurements of each student were recorded. The health records of all students were reviewed to note the same parameters measured when they were in 7th grade. The odds of progression in height, progression in weight, protein energy malnutrition status, sex, age, history of refractive error in parents and sibling, evidence of trachoma, and allergic conjunctivitis were calculated to associate them to the progression of myopia. RESULTS: Mean progression of myopia was 0.37 D per year (SD = 0.27D). The mean progression of myopia among students with history of myopia in 7th grade was 0.21 D more than that of students not having myopia in 7th grade (95% CI 0.12-0.29). Multivariate regression analysis suggested that weight of student in the 7th grade (t=-2.2, p=0.031), positive history of myopia in one of the siblings (t=2.44, p=0.015), and myopia in the 7th grade (t=4.56, p<0.001) were associated with the progression of myopia. CONCLUSIONS: Family history of myopia and myopia at younger age were predictors for progressive myopia in teenaged Omani children. However, the role of body mass index at a younger age to predict progressive myopia was not conclusive.

National Register for the Blind: a tool for health programme management.

We carried out a retrospective analytical study of 3525 bilaterally blind people registered in Oman to the end of 2000. We described the examination method, maintenance of the register and analysis of data. Lists of different categories of blind people were distributed to various organizations for management and rehabilitation purposes. The role of the national register in addressing blinding cataract, corneal blindness, eradication of congenital rubella syndrome and care of blind people in Oman was also examined. The register was useful in identifying candidates for rehabilitation and also for monitoring regional efforts to manage curable blindness. This multiple use of the register could make it an important tool for health programme management in Oman.

National Register for the Blind: a tool for health programme management

We carried out a retrospective analytical study of 3525 bilaterally blind people registered in Oman to the end of 2000. We described the examination method, maintenance of the register and analysis of data. Lists of different categories of blind people were distributed to various organizations for management and rehabilitation purposes. The role of the national register in addressing blinding cataract, corneal blindness, eradication of congenital rubella syndrome and care of blind people in Oman was also examined. The register was useful in identifying candidates for rehabilitation and also for monitoring regional efforts to manage curable blindness. This multiple use of the register could make it an important tool for health programme management in Oman

Active trachoma, face washing (F) and environmental improvement (E) in a high-risk population in Oman.

Oman aims to eliminate blinding trachoma by 2010. As a part of a study to review the health institution approach of trachoma surveillance, "F" (facial cleanliness) and "E" (environmental improvement) components of the SAFE trachoma control strategy were assessed in a high-risk population in Nizwa wilayat. Thus 50 households with 1 member treated for active trachoma in the last 6 months were evaluated for active trachoma and forwater and sanitation facilities. In all, 229 children under 15 years of age were clinically examined; the rate of active trachoma was 3.5% in the children. Clean face was found in 97.8% of the children and 70% of houses had piped water or water supplied by tankers. The status of "F" and "E" in the study area was generally high.

One year recurrence of trachomatous trichiasis in routinely operated Cuenod Nataf procedure cases in Vietnam.

BACKGROUND: Recurrence of trichiasis following surgery remains unacceptably high, regardless of the surgical procedure. Few prospective studies of sufficient size are available to assess the rate of recurrence and the factors contributing to recurrence. A prospective study of the modified Cuenod Nataf surgical procedure was conducted in Vietnam to determine recurrence and co-factors. METHODS: The prospective study of Cuenod Nataf surgery for trachomatous trichiasis took place in four districts of Vietnam. All patients from identified villages who had surgery were followed for a period of 1 year. 10 Surgeons using standard techniques and recording procedures carried out the surgery. The presence of an eyelash touching the eyeball in the operated eye was considered as recurrence. Information on all subjects was recorded preoperatively, intraoperatively, and postoperatively. An independent examiner recorded postoperative information. Relative risks were calculated to assess the contribution of various risk factors to recurrence (by eye and by person). Cox proportional hazards modelling was used to assess the independent contribution of relevant factors to the outcome. RESULTS: 471 individuals had trichiasis surgery; 463 were followed for a period of 1 year. Overall, the recurrence rate was 10.8% (95% CI 8.0 to 13.6). Among people having surgery recurrence (one or both eyes) was most common in the most elderly (relative risk (RR) 2.49) and among those with a history of previous surgery (RR = 2.49). Cox proportional hazards analysis (by eye) revealed that visual acuity, conjunctival scarring, and suture adjustment were associated with recurrence at 1 year. CONCLUSION: The Cuenod Nataf procedure, which is well accepted in the community and by eye care providers in Vietnam, has an acceptable 1 year success rate. Individuals with severe conjunctival scarring have the highest rate of recurrence suggesting that other surgical approaches are needed to manage these patients or that these patients need to be educated regarding the risk of recurrence. Active follow up of these patients would be warranted. The association with suture adjustment requires further investigation.

Glaucoma among Omani diabetic patients: a cross-sectional descriptive study: (Oman diabetic eye study 2002).

PURPOSE/METHODS: A cross-sectional study was carried out to review the ocular status of 2,063 diabetic patients in Oman. A part of this study is presented to highlight the magnitude and determinants of glaucoma. The study also recommends policies for comprehensive care of glaucoma among diabetic patients. The ocular pressure, disc changes, and field changes were noted by ophthalmologists. The diabetes profile was noted by physicians. RESULTS: The rate of glaucoma among diabetic patients was 8.87% (95% CI 8.12 to 9.62). Male diabetic patients had significantly higher rates of glaucoma than female diabetic patients. The rate was significantly higher in higher age groups. The mean ocular pressure in glaucomatous eyes was 28.6 mm Hg. The rate was not significantly different in patients with type I and type II diabetes (RR 1.03 [95% CI 0.61 to 1.79]). The risk of visual disability was higher among diabetic patients with glaucoma than diabetic patients without glaucoma (RR 1.56 [95% CI 1.14 to 2.13]). CONCLUSIONS: Ocular pressure measurement could be a simple and reliable first-level screening tool. Diabetic patients with glaucoma should be given special care to reduce visual disability. All patients with diabetes should be thoroughly checked periodically to rule out glaucoma.

Distichiasis and dysplastic eyelashes in trachomatous trichiasis cases in Oman: a case series.

The study was a prospective evaluation of the prevalence of distichiasis and/or dysplastic eyelashes among trachomatous trichiasis cases at the oculoplasty unit of a hospital in Oman over 3 months in 2000. An oculoplasty surgeon examined and photographed cases using a bio-microscope. Out of 80 cases, 58 (72.5%) had abnormal eyelashes in addition to trachomatous trichiasis. The rate of distichiasis and dysplastic lashes were 13.8% (95% CI 6.2%-21.3%) and 33.8% (95% CI 23.5%-44.1%) respectively; 25.0% (95% CI 15.5%-34.5%) had both. Dysplastic and distichiasis eyelashes were significantly more prevalent in trachomatous trichiasis cases aged < 50 years and those with entropion. Presence of distichiasis and/or dysplastic eyelashes in trachomatous trichiasis cases warrants further analytical studies to confirm the observation and establish any causal association.