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.

Assessment of knowledge, perception, and practice patterns of Jordanian optometrists during COVID-19 pandemic: a cross-sectional online survey.

AIM: To investigate knowledge, risk perception, and attitude towards corona virus disease 2019 (COVID-19) and infection control measures among optometrists in Jordan. METHODS: A cross-sectional survey was distributed through social media platforms to optometrists registered with the Jordanian syndicate and Jordanian association of optics. Information on participants' socio-demographic characteristics, knowledge of clinical features of COVID-19, risk assessment and infection control measures for preventing disease transmission were collected. RESULTS: A total of 135 optometrists (80 females and 55 males) with a mean age of 32±10y responded to the survey. Most optometrists were aware of COVID-19 symptoms, modes of transmission and measures for preventing COVID-19 and transmission in the ophthalmic setup. However, more than half of the optometrists did not receive any training about protection or infection control by their employers at their work place. Social media was the most common source of information on COVID-19 (76%). Most optometrists (85.2%) thought that the virus could be detected in tears, and 45.9% thought that red eye is a symptom of COVID-19. CONCLUSION: Optometrists in Jordan are aware of the clinical features and preventive measures related to COVID-19 infection. However, training on infection control is lacking and needs to be improved. Guidelines by international professional optometric associations should be promoted through regional and national associations to all registered optometrists and access to peer review. Journals should be encouraged to ensure that the knowledge about the pandemic is up to date and accurate.

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.

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.

Trends of contact lens prescribing in Jordan.

PURPOSE: To evaluate contact lens prescribing trends among optometrists in Jordan. METHODS: Optometrists from 173 practices in Jordan were surveyed about prescribing contact lenses in their practice. Practitioners were required to record information for the last 10 patients that visited their practice. Demographic data such as age and gender was obtained for each patient. In addition, data relating to lens type, lens design, replacement methods and the care regime advised to each patient were recorded. Practitioners were required to provide information relating to their education and years of experience. The influence of education and experience with respect to lens prescribing trends was explored using linear regression models for the proportions of lens types fitted for patients. RESULTS: A total of 1730 contact lens fits were analyzed. The mean (±SD) age of lens wearers was 26.6 (±7.9) years, of whom 65% were female. Conventional hydrogel lenses were the most prescribed lenses, accounting for 60.3% of the fits, followed by silicone hydrogel lenses (31.3%), and rigid lenses (8.4%). In terms of lens design, spherical lenses appeared to be most commonly prescribed on monthly basis. Daily disposable lenses were second most prescribed lens modality, accounting for 20.4% of the study sample. Multi-purpose solution (MPS) was the preferred care regimen, with a prevalence of 88.1% reported in the study sample, compared to hydrogen peroxide (1-step and 2-step), which represented only 2.8% of the patients in this study. A relationship was established between the two educational groups for rigid lens prescribing (F=17.4, p<0.0001), while the experience of the optometrist was not a significant factor (F=0.4, p=0.54). CONCLUSION: This work has provides an up-to-date analysis of contact lens prescribing trends among optometrists in Jordan. Contact lens prescribing in terms of lens type, lens design, modality of wear and care regimen agree with global market trends with small variations. This report will help practitioners and the industry to detect any deficiencies in the contact lens market in Jordan, which will ease implementing current and future plans in developing contact lens practice and patient eye care in the region.

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.

A comparison of ventricular function during high right ventricular septal and apical pacing after his-bundle ablation for refractory atrial fibrillation.

This study compares LV performance during high right ventricular septal (RVS) and apical (RVA) pacing in patients with LV dysfunction who underwent His-bundle ablation for chronic AF. We inserted a passive fixation pacing electrode into the RVA and an active fixation electrode in the RVS. A dual chamber, rate responsive pulse generator stimulated the RVA through the ventricular port and the RVS via the atrial port. Patients were randomized to initial RVA (VVIR) or RVS (AAIR) pacing for 2 months. The pacing site was reversed during the next 2 months. At the 2 and 4 month follow-up visit, each patient underwent a transthoracic echocardiographical study and a rest/exercise first pass radionuclide ventriculogram. We studied nine men and three women (mean age of 68 +/- 7 years) with congestive heart failure functional Class (NYHA Classification): I (3 patients), II (7 patients), and III (2 patients). The QRS duration was shorter during RVS stimulation (158 +/- 10 vs 170 +/- 11 ms, P < 0.001). Chronic capture threshold and lead impedance did not significantly differ. LV fractional shortening improved during RVS pacing (0.31 +/- 0.05 vs 0.26 +/- 0.07, P < 0.01). RVS activation increased the resting first pass LV ejection fraction (0.51 +/- 0.14 vs 0.43 +/- 0.10, P < 0.01). No significant difference was observed during RVS and RVA pacing in the exercise time (5.6 +/- 3.2 vs 5.4 +/- 3.1, P = 0.6) or the exercise first pass LV ejection fraction (0.58 +/- 0.15 vs 0.55 +/- 0.16, P = 0.2). The relative changes in QRS duration and LV ejection fraction at both pacing sites showed a significant correlation (P < 0.01). We conclude that RVS pacing produces shorter QRS duration and better chronic LV function than RVA pacing in patients with mild to moderate LV dysfunction and chronic AF after His-bundle ablation.

Patient discomfort following pectoral defibrillator implantation using conscious sedation.

BACKGROUND: The miniaturization of implantable cardioverter defibrillators (ICDs) has made pectoral implantation possible. However, postoperative pain following the procedure has not been systematically studied. The aim of the current study was to prospectively assess patient discomfort and identify factors influencing pain perception during follow-up. METHODS: Pain related to device implantation was quantified in 21 consecutive patients (age, 61 +/- 11 years; 17 men and 21 women; 16 of 21 had coronary artery disease; left ventricular ejection fraction, 32% +/- 15%) undergoing pectoral ICD implantation with conscious sedation (fentanyl 118 +/- 72 micrograms midazolam 14 +/- 9 mg). Patients completed the Visual Analogue Scale (VAS, 0-100) and the McGill Pain Questionnaire 24 hours and 1 month postoperatively. Regression analysis was used to define clinical and procedure related variables affecting patient discomfort and frequency of postoperative analgesic use. RESULTS: The mean VAS score was 34 +/- 20 24 hours postoperatively. A single (4.8%) patient described postoperative pain as severe. Pain was reported to be moderate by 10 (47.6%) patients and mild by 10 (47.6%) patients. Intraoperative fentanyl requirement was a predictor of postoperative pain (R = 0.51, P = 0.036), and procedural duration was a strong predictor of postoperative analgesic use (R = 0.75, P < 0.001). Pain at 1 month decreased to a VAS score of 19 +/- 18 (P = 0.002 vs 24 hours) and was rated to be severe, moderate, and mild by 1, 3, and 17 patients, respectively. Late pain was related to a VAS score at 24 hours (R = 0.67, P = 0.004). CONCLUSIONS: (1) Pectoral ICD implantation using conscious sedation is well tolerated. (2) Postoperative discomfort correlates with longer procedural times and larger intraoperative narcotic requirements.

Transvenous cardioverter defibrillator lead malfunction due to terminal connector damage in pectoral implants.

Lead failure places patients with implantable cardioverter defibrillators (ICD) at risk for sudden cardiac death or results in delivery of inappropriate shocks. This study describes a mechanism of lead malfunction occurring at the junction of the terminal ring with the conductor coil of the rate sensing terminal connector in one specific model of a transvenous ICD lead. We detected the problem in a population of 179 patients with a mean age of 61 +/- 10 years and a mean lead implant duration of 16 +/- 11 months. All patients underwent pectoral ICD implantation using a submuscular approach. The implanting physician chose to place the ICD on the left side in 155 patients (87%) and on the right side in 24 patients (13%). Cephalic vein cutdown provided central venous access in 147 patients (82%), and subclavian vein puncture provided access in 32 patients (18%). Follow-up examination detected lead failure in six patients (3.5% over 31 months) due to insulation damage with or without conductor coil fracture at the junction of the terminal ring and conductor coil of the IS-1 rate sense terminal. We detected lead disruption 17 +/- 9 months (range 5-31 months) after implantation. Multiple nonsustained arrhythmia episodes exhibiting nonphysiologic intervals associated with noisy rate sensing electrograms during pocket manipulation led to discovery in three patients. The other three patients presented with inappropriate device discharges confirmed by stored high-energy lead electrograms showing normal rhythm. Pacing lead impedance abnormally dropped in two patients. Impedance remained stable in the other four patients. In conclusion, the generator pocket represents an important site of ICD transvenous lead vulnerability. Lead failure may result from conductor coil and/or insulation disruption at the interface with the rate sensing terminal connector.

Right ventricular outflow tract tachycardia as a result of blunt chest trauma.

Two patients presented with monomorphic ventricular tachycardia after blunt chest trauma. In both cases, the arrhythmia had a left bundle branch block, inferior axis morphology comparable to that seen with idiopathic ventricular tachycardia originating from the right ventricular outflow tract (RVOT). In one patient, the arrhythmia persisted and required catheter ablation. A history of cardiac trauma should be considered in patients presenting with RVOT tachycardia.

Protrusion without fracture of the Accufix atrial "J" lead retention wire.

The Telectronics Accufix atrial "J" lead has been associated with injury and death. These complications have occurred as the result of retention wire fracture, extrusion, and perforation of cardiac or vascular structures. This report describes a patient who was found to have protrusion of the proximal end of a nonfractured retention wire during fluoroscopic surveillance. The wire extrusion appeared to result from angulation of the lead. The lead was extracted and replaced without adverse consequences. Further prospective analysis will be needed to determine the clinical implications and approach to this complication.

Incidence and implications of abrasion of implantable cardioverter-defibrillator leads.

Severe abrasion of implantable cardioverter-defibrillator leads is frequently found during abdominal generator replacement and occasionally results in lead system failure. Careful inspection of leads at the time of generator replacement will identify such abrasions, and, in some cases, lead repair or replacement may be indicated.

[An autopsy case of double cancer (Hepatocellular carcinoma and mixed germ cell tumor of the testis)--significance of alpha-fetoprotein and human chorionic gonadotropin as tumor markers].

A 43-year-old male suffering from liver cirrhosis was admitted with complaints of general malaise and anorexia. Admission laboratory data evidenced high levels of serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Histopathologically, the resected left testis and supraclavicular enlarged lymph nodes revealed mixed germ cell tumor. After castration, the serum HCG level normalized, but AFP continued to increase. Autopsy findings did not unequivocally show mixed germ cell tumor, however, massive type hepatocellular carcinoma was present. These findings suggest that the hepatocellular carcinoma produced AFP, while the mixed germ cell tumor produced HCG.