Publications by authors named "Uchechukwu L Osuagwu"

45 Publications

Misinformation About COVID-19 in Sub-Saharan Africa: Evidence from a Cross-Sectional Survey.

Health Secur 2021 Jan-Feb;19(1):44-56

Uchechukwu L. Osuagwu, PhD, is a Research Fellow, Diabetes, Obesity and Metabolism Translational Research Unit, School of Medicine; and Kingsley Emwinyore Agho, PhD, is an Associate Professor of Biostatistics, School of Health Sciences; both at Western Sydney University, Campbelltown, Australia. Chundung A. Miner is an Associate Professor, Department of Community Medicine, College of Health Sciences; Piwuna Christopher Goson, MBBS, is a Senior Lecturer, Department of Psychiatry, College of Health Sciences; and Tanko Ishaya, PhD, is a Professor, Department of Computer Science; all at the University of Jos, Plateau State, Nigeria. Dipesh Bhattarai, PhD, is an Associate Lecturer, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Khathutshelo Percy Mashige, PhD, is a Professor, Discipline of Optometry, African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban, South Africa. Richard Oloruntoba, PhD, is an Associate Professor, Supply Chain Management, School of Management and Marketing, Faculty of Business and Law, Curtin University, Bentley, Western Australia. Emmanuel Kwasi Abu, PhD, is Dean, Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Ghana. Bernadine Ekpenyong, PhD, is Senior Lecturer, Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Cross River State, Nigeria. Timothy G. Chikasirimobi, MSc, is a Master's Student, Masinde Muliro University of Science and Technology, Kakamega, Kenya. Godwin O. Ovenseri-Ogbomo, PhD, is an Assistant Professor, Department of Optometry, College of Applied Medical Sciences, Qassim University, Saudi Arabia, and Department of Optometry, Faculty of Life Sciences, University of Benin, Benin City, Nigeria. Raymond Langsi, MBBS, is Head, Health Division, University of Bamenda, Bambili, Cameroon. Deborah Donald Charwe, MSc, is Senior Research Nutritionist, Tanzania Food and Nutrition Center, Dar es Salaam, Tanzania. Obinna Nwaeze, MBBS, is a Practicing Physician, County Durham and Darlington, National Health Service Foundation, United Kingdom. Uchechukwu L. Osuagwu, Bernadine Ekpenyong, Godwin O. Ovenseri-Ogbomo, and Kingsley Emwinyore Agho are also Conjoint Members, Discipline of Optometry, African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban, South Africa.

Misinformation about coronavirus disease 2019 (COVID-19) is a significant threat to global public health because it can inadvertently exacerbate public health challenges by promoting spread of the disease. This study used a convenience sampling technique to examine factors associated with misinformation about COVID-19 in sub-Saharan Africa using an online cross-sectional survey. A link to the online self-administered questionnaire was distributed to 1,969 participants through social media platforms and the authors' email networks. Four false statements-informed by results from a pilot study-were included in the survey. The participants' responses were classified as "Agree," "Neutral," and "Disagree." A multinomial logistic regression was used to examine associated factors. Among those who responded to the survey, 19.3% believed that COVID-19 was designed to reduce world population, 22.2% thought the ability to hold your breath for 10 seconds meant that you do not have COVID-19, 27.8% believed drinking hot water flushes down the virus, and 13.9% thought that COVID-19 had little effect on Blacks compared with Whites. An average of 33.7% were unsure whether the 4 false statements were true. Multivariate analysis revealed that those who thought COVID-19 was unlikely to continue in their countries reported higher odds of believing in these 4 false statements. Other significant factors associated with belief in misinformation were age (older adults), employment status (unemployed), gender (female), education (bachelor's degree), and knowledge about the main clinical symptoms of COVID-19. Strategies to reduce the spread of false information about COVID-19 and other future pandemics should target these subpopulations, especially those with limited education. This will also enhance compliance with public health measures to reduce spread of further outbreaks.
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http://dx.doi.org/10.1089/HS.2020.0202DOI Listing
February 2021

Prevalence and Factors Associated with Mental and Emotional Health Outcomes among Africans during the COVID-19 Lockdown Period-A Web-based Cross-Sectional Study.

Int J Environ Res Public Health 2021 01 21;18(3). Epub 2021 Jan 21.

African Vision Research Institute (AVRI), Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa.

Mental health and emotional responses to the effects of COVID-19 lockdown in sub-Saharan Africa (SSA) are of serious public health concern and may negatively affect the mental health status of people. Hence, this study assessed the prevalence of mental health symptoms as well as emotional reactions among sub-Saharan Africans (SSAs) and associated factors among SSAs during the COVID-19 lockdown period. This was a web-based cross-sectional study on mental health and emotional features from 2005 respondents in seven SSA countries. This study was conducted between 17 April and 17 May 2020 corresponding to the lockdown period in most SSA countries. Respondents aged 18 years and above and the self-reported symptoms were feeling anxious, being worried, angry, bored and frustrated. These were the main outcomes and were treated as dichotomous variables. Univariate and multivariate logistic regression analyses were used to identify the factors associated with these symptoms. We found that over half (52.2%) of the participants reported any of the mental health symptoms and the prevalence of feeling bored was 70.5% followed by feeling anxious (59.1%), being worried (57.5%), frustrated (51.5%) and angry (22.3%) during the COVID-19 pandemic. Multivariate analysis revealed that males, those aged >28 years, those who lived in Central and Southern Africa, those who were not married, the unemployed, those living with more than six persons in a household, had higher odds of mental health and emotional symptoms. Similarly, people who perceived low risk of contracting the infection, and those who thought the pandemic would not continue after the lockdown had higher odds of mental health and emotional symptoms. Health care workers had lower odds for feeling angry than non-healthcare workers. During the COVID-19 lockdown periods in SSA, about one in two participants reported mental health and emotional symptoms. Public health measures can be effectively used to identify target groups for prevention and treatment of mental health and emotional symptoms. Such interventions should be an integral component of SSA governments' response and recovery strategies of any future pandemic.
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http://dx.doi.org/10.3390/ijerph18030899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908555PMC
January 2021

Assessment of Knowledge, Practice and Guidelines towards the Novel COVID-19 among Eye Care Practitioners in Nigeria-A Survey-Based Study.

Int J Environ Res Public Health 2020 07 16;17(14). Epub 2020 Jul 16.

African Eye and Public Health Research Initiative, African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Durban 3629, South Africa.

The aim of this study was to explore knowledge, practice of risk and guidelines of the novel corona virus disease (COVID-19) infection among the eye care practitioners and the potential associated factors. A cross-sectional self-administered online survey was distributed via emails and social media networks between 2nd and 18th May 2020 corresponding to the week of the lockdown in Nigeria to eye care practitioners (ECPs). Data for 823 respondents were analyzed. Knowledge and risk practice were categorized as binary outcome and univariate and multivariate linear regression were used to examine the associated factors. The mean score for COVID-19-related knowledge of public health guidelines was high and varied across the ECPs. Ophthalmic Nurses, Ophthalmologists and Optometrists showed higher COVID-19-related knowledge than other ECPs ( < 0.001), particularly those working in the private sector. More than 50% of ECPs stated they provided essential services during the COVID-19 lockdown via physical consultation, particularly the Ophthalmologists. Most respondents reported that the guidelines provided by their Association were useful but expressed their lack of confidence in attending to patients during and after the COVID-19 lockdown. Compared to other ECPs in Nigeria, more Ophthalmic Nurses received training in the use of Personal Protective Equipment (PPE). This survey is the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Nigeria. ECPs in Nigeria displayed good knowledge about COVID-19 and provided eye care services during the COVID-19 lockdown in Nigeria, despite the majority not receiving any training on the use of PPEs with concerns over attending to patients. There is need for the government to strengthen health systems by improving and extending training on standard infection prevention and control measures to ECPs for effective control of the pandemic and in the future as essential health workers.
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http://dx.doi.org/10.3390/ijerph17145141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399827PMC
July 2020

Visual impairment among Aboriginal and Torres Strait Islander patients attending an Australian Indigenous primary health service: a cross-sectional study.

Aust J Prim Health 2020 Aug;26(4):287-292

Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, PO Box 52, Inala, Qld 4077, Australia; and Primary Care Clinical Unit, The University of Queensland, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.

This cross-sectional study aimed to identify the period prevalence of visual impairment (VI) and blindness among Aboriginal and Torres Strait Islander people attending an Indigenous urban primary healthcare service, eye care practitioner referrals for those with VI and any opportunities to improve care delivery. Visual acuity (VA) examinations, using a Snellen chart, are performed as part of routine annual health assessments offered to children and adults. This study included patients aged ≥5 years (n=1442) who had a health assessment conducted between 1 January 2015 and 31 December 2016 and provided consent for the use of their health assessment information for research. Of patients with available data, 2.4% (33/1374) experienced VI, defined as presenting VA worse than 6/12 to 6/60 in the better-seeing eye. VI was more common in those aged ≥60 years (14/136; 10.3%) and was significantly associated with increasing age (P<0.001). No patients experienced blindness, defined as presenting VA worse than 6/60 in the better-seeing eye. All patients with VI were aged ≥16 years. Nine (27%) of the 33 patients with VI in the better-seeing eye were referred to an optometrist or an ophthalmologist. The low period prevalence of VI and no blindness in this study are positive findings. The findings also indicate that routine VA testing of older adults, especially those aged ≥60 years, should be conducted to avoid missing those not having an annual health assessment.
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http://dx.doi.org/10.1071/PY19119DOI Listing
August 2020

Adverse Maternal Outcomes of Fijian Women with Gestational Diabetes Mellitus and the Associated Risk Factors.

Reprod Sci 2020 11 16;27(11):2029-2037. Epub 2020 Jun 16.

Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia.

The purpose of this study is to determine the factors associated with adverse maternal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) in urban Fiji. This cross-sectional study used data from existing records of singleton pregnant women with GDM attending the Colonial War Memorial Hospital (CWMH) Suva Fiji between June 2013 and May 2014. Data retrieved included demographic data, antenatal and intrapartum care data, route of delivery, treatment modality, and maternal risk factors. The prevalence of GDM is 3.0%, n = 255/8698, and the most frequent maternal complications were induction of labor (66%), C-section (32%), and preeclampsia (19%), and 25% had babies with birthweight > 4 kg. Older women (≥ 36 years) and those treated with insulin were 5.2 times and 10.7 times, respectively, more likely to have labor induction during childbirth compared with younger women and those on dietary management. Family history of diabetes was associated with 2.4× and/or 2.5× higher odds of cesarean delivery and/or develop hypertension in pregnancy, respectively. Parity > 5 children and diagnoses of GDM after the first trimester reduced the odds of cesarean delivery. The odds of developing preeclampsia in GDM was 3.4 times higher (95% confidence interval (CI) of adjusted odds ratio (aOR): 1.03, 18.78) among obese women than normal-weight women, and married women were less likely to have babies with birthweight > 4 kg. The prevalence of and adverse outcomes among women with GDM attending antenatal public health care in Suva Fiji were higher than previously reported from the hospital. Older and multiparous women with GDM, those insulin treated, and with a strong family history and high body mass index (BMI) need special attention and better monitoring by health care personnel to reduce adverse outcomes during pregnancy.
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http://dx.doi.org/10.1007/s43032-020-00222-6DOI Listing
November 2020

Myopia and Regional Variations in Retinal Thickness in Healthy Eyes.

J Ophthalmic Vis Res 2020 Apr-Jun;15(2):178-186. Epub 2020 Apr 6.

School of Medicine, Diabetes Obesity and Metabolism Translational Research Unit (DOMTRU), Macarthur Clinical School, Parkside Crescent, Campbelltown, Australia.

Purpose: To investigate the effects of refraction on retinal thickness measurements at different locations and layers in healthy eyes of Saudi participants.

Methods: Thirty-six randomly selected adults aged 27.0 5.7 years who attended a Riyadh hospital from 2016 to 2017 were categorized into three groups: non-myopic (spherical equivalent refraction [SER], +1.00 to -0.50 diopters [D]), low myopic (SER, -0.75 to -3.00D), and moderate to high myopic (SER -3.25D). Full, inner, and outer retinal thicknesses were measured at nine locations by spectral-domain stratus optical coherence tomography (Optovue Inc., Fremont, CA, USA) and were compared according to refractive group and sex.

Results: The mean SERs for the non-myopia, low myopia, and moderate to high myopia groups were 0.2 0.6, -1.5 0.5, and -7.5 1.9 D, respectively. Refractive error, but not sex, had significant effects on the retinal layer thickness measurements at different locations ( 0.05). The parafoveal and outer retinal layers were significantly thicker than the perifoveal and inner retina layers in all groups ( 0.05). The full foveal thickness was higher and the full parafoveal and perifoveal regions were thinner in moderate to high myopic eyes than in the non-myopic eyes ( 0.05), but were similar to those in the low myopic eyes ( 0.05). The foveal thicknesses measured in the inner and outer layers of the retina were higher but the thicknesses measured at the inner and outer layers of the parafoveal and perifoveal regions were lower in moderate to high myopic eyes.

Conclusion: There were regional differences in the retinal layer thicknesses of healthy Saudi eyes, which was dependent on the central refractions. This is important when interpreting retinal nerve fiber layer thicknesses in myopia and disease management in Saudi participants.
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http://dx.doi.org/10.18502/jovr.v15i2.6735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151503PMC
April 2020

Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus.

BMC Pregnancy Childbirth 2020 Feb 28;20(1):133. Epub 2020 Feb 28.

Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, 2560, NSW, Australia.

Background: Gestational diabetes mellitus (GDM) in Fiji is a serious public health issue. However, there are no recent studies on GDM among pregnant women in Fiji. The aim of this study was to examine prevalence of, and sociodemographic factors associated with adverse neonatal outcomes among Fijian women with GDM.

Methods: We used cross-sectional data of 255 pregnant women with GDM who gave birth to singleton infants at Colonial War Memorial Hospital (CWMH) in Suva city. Women underwent testing for GDM during antenatal clinic visits and were diagnosed using modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Multivariable logistic regression analysis was used to investigate factors associated with neonatal outcomes.

Results: Women with a previous baby weighing > 4 kg were 6.08 times more likely to experience neonatal macrosomia (Adjusted odds ratio (AOR) = 6.08; 95%CI: 2.46, 15.01). Compared to unmarried women, the odds of macrosomia among married women reduced by 71% (AOR = 0.29; 95%CI: 0.11, 0.77). Compared with delivery before 38 weeks of gestation, the infants of women who delivered between 38 and 41 weeks of gestation were 62 and 86% less likely to experience neonatal hypoglycaemia and Apgar score < 7 at 5 mins, respectively. The offspring of women who were overweight and obese had higher odds of neonatal hypoglycaemia. Late booking in gestation (≥28 weeks) was significantly associated with Apgar score < 7 at 5 min (AOR = 7.87; 95%CI: 1.11, 55.75). Maternal pre-eclampsia/pregnancy induced hypertension was another factor associated with low Apgar score in infants.

Conclusions: The study found high rates of adverse neonatal outcomes among off springs of Fijian women with GDM and showed that interventions targeting pregnant women who are overweight, had a previous baby weighing > 4 kg, had pre-eclampsia, delivered before 38 weeks of gestation, and those who booked later than 13 weeks in gestation, are needed to improve pregnancy outcomes.
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http://dx.doi.org/10.1186/s12884-020-2821-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048039PMC
February 2020

Visual impairment among adults in Saudi Arabia.

Clin Exp Optom 2020 11 4;103(6):858-864. Epub 2019 Dec 4.

Macarthur Clinical School, Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, Australia.

Background: To estimate the prevalence of visual impairment, and identify its causes and associated factors among adults aged 40 years and over, attending for eye examination at a Riyadh public hospital in Saudi Arabia.

Methods: This was a retrospective cross-sectional study conducted among 195 consecutive older adults who attended the outpatient ophthalmology clinic of King Abdul-Aziz University Hospital between 1 February and 30 June 2018. All participants underwent comprehensive ophthalmic examination: visual acuity, refraction (objective and subjective), fundus photography and automated visual field assessment. Classification of visual impairment was based on the World Health Organization criteria: mild visual impairment if best-corrected distance visual acuity < 6/12-6/18 in the better eye; moderate visual impairment if best-corrected visual acuity < 6/18-6/60 in the better eye; and severe visual impairment if best-corrected visual acuity < 6/60-3/60. Regression analysis was used to identify the factors associated with visual impairment.

Results: The study participants included 107 (54.9 per cent) females, and the mean (SD) age was 61.1 ± 10.9 years. The overall prevalence of visual impairment (14.9 per cent, 29 cases), consisting of severe (0.5 per cent), moderate (9.7 per cent) and mild (4.6 per cent) forms, correlated significantly with age (R = 0.023, p = 0.04). The main causes of visual impairment were glaucoma (48.3 per cent), cataract (31.0 per cent), refractive error, and diabetic retinopathy (24.1 per cent each). The odds of having visual impairment increased by 22 per cent and eight per cent respectively in participants who had diabetic retinopathy (adjusted odds ratio 1.22, 95% confidence interval [CI] 1.05, 1.95) and glaucoma (1.08, CI 1.02, 1.40).

Conclusions: The prevalence of visual impairment among older adults attending the ophthalmology clinic in Riyadh city was high and driven by the high rate of diabetic retinopathy and glaucoma in this region. As part of their routine checks, there is need to make dilated fundus examination and intraocular pressure measurement mandatory tests in addition to refraction and visual acuity testing, when examining Saudi adults attending the hospital eye clinics in Riyadh province.
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http://dx.doi.org/10.1111/cxo.13022DOI Listing
November 2020

Enablers and Barriers to the Utilization of Antenatal Care Services in India.

Int J Environ Res Public Health 2019 08 29;16(17). Epub 2019 Aug 29.

Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith 2571, Australia.

Antenatal care (ANC) reduces adverse health outcomes for both mother and baby during pregnancy and childbirth. The present study investigated the enablers and barriers to ANC service use among Indian women. The study used data on 183,091 women from the 2015-2016 India Demographic and Health Survey. Multivariate multinomial logistic regression models (using generalised linear latent and mixed models (GLLAMM) with the mlogit link and binomial family) that adjusted for clustering and sampling weights were used to investigate the association between the study factors and frequency of ANC service use. More than half (51.7%, 95% confidence interval (95% CI): 51.1-52.2%) of Indian women had four or more ANC visits, 31.7% (95% CI: 31.3-32.2%) had between one and three ANC visits, and 16.6% (95% CI: 16.3-17.0%) had no ANC visit. Higher household wealth status and parental education, belonging to other tribes or castes, a woman's autonomy to visit the health facility, residence in Southern India, and exposure to the media were enablers of the recommended ANC (≥4) visits. In contrast, lower household wealth, a lack of a woman's autonomy, and residence in East and Central India were barriers to appropriate ANC service use. Our study suggests that barriers to the recommended ANC service use in India can be amended by socioeconomic and health policy interventions, including improvements in education and social services, as well as community health education on the importance of ANC.
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http://dx.doi.org/10.3390/ijerph16173152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747369PMC
August 2019

Prevalence and factors associated with complementary feeding practices among children aged 6-23 months in India: a regional analysis.

BMC Public Health 2019 Aug 1;19(1):1034. Epub 2019 Aug 1.

Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.

Background: Inappropriate complementary feeding practices significantly contribute to undernutrition among children under 2 years of age in India. However, there is limited up-to-date evidence on the prevalence and factors associated with complementary feeding practices to guide policy actions at the subnational level in India. We investigated the regional prevalence and factors associated with complementary feeding practices in India.

Methods: This study used a sample of 69,464 maternal responses from the 2015-16 National Family Health Survey in India. The prevalence of complementary feeding indicators was estimated using data for each administrative region, namely: North (n = 8469), South (n = 12,828), East (n = 18,141), West (n = 8940), North-East (n = 2422) and Central (n = 18,664). Factors associated with complementary feeding by region in India were investigated using logistic regression Generalized Linear Latent and Mixed Models (GLLAMM) with a logit link and binomial family that adjusted for clustering and sampling weights.

Results: The study showed a wide variation in the prevalence of introduction of solid, semi-solid or soft foods (complementary foods) among infants aged 6-8 months in regional India; highest in the South (61%) and lowest in the Central and Northern regions (38%). Similarly, minimum dietary diversity (MDD) was highest in the South (33%) and lowest in the Central region (12%). Both minimum meal frequency (MMF) and minimum acceptable diet (MAD) varied substantially across the regions. The factors associated with complementary feeding practices also differed across Indian regions. Significant modifiable factors associated with complementary feeding practices included higher household wealth index for the introduction of complementary foods in the North and Eastern India; higher maternal education for MMF and MDD in the North and Central regions; and frequent antenatal care visits (≥4 visits) for all indicators but for different regions.

Conclusion: Our study indicates that there are wide differences in regional prevalence and factors associated with complementary feeding practices in India. The improvement of complementary feeding practices in India would require national and sub-national efforts that target vulnerable mothers, including those with no education and limited health service contacts.
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http://dx.doi.org/10.1186/s12889-019-7360-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676514PMC
August 2019

Stunting and severe stunting among infants in India: the role of delayed introduction of complementary foods and community and household factors.

Glob Health Action 2019 ;12(1):1638020

a Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus , Penrith , Australia.

: Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and associated factors are related to stunting and severe stunting among children in many low- and middle-income countries. In India, however, there is limited evidence on the relationship between delayed complementary feeding and associated factors with stunting and severe stunting to advocate for policy interventions. : The present study investigated the relationship between delayed complementary feeding and associated factors with stunting and severe stunting among infants aged 6-8 months in India. : Survey data on 13,548 infants aged 6-8 months were obtained from the 2015-16 National Family Health Survey in India. Logistic regression (Generalized Linear Latent and Mixed Models [GLLAMM] with a logit link and binomial family) models that adjusted for clustering and sampling weights were used to investigate the relationship between delayed complementary feeding and associated factors (community, household, maternal, child and health service factors) with stunting and severe stunting among infants aged 6-8 months in India. : The prevalence of stunting and severe stunting was 22.0% (95% CI: 21.0-23.7%) and 10.0% (95% CI: 9.0-11.0%) among infants aged 6-8 months who received no complementary foods, respectively. Delayed introduction of solid, semi-solid or soft foods was associated with stunting (adjusted Odd ratios [aOR] = 1.24, 95% CI: 1.09-1.41) and severe stunting (aOR = 1.21, 95% CI: 1.01-1.45) among infants aged 6-8 months. High maternal education (secondary or higher education) and household wealth (middle, richer and richest) were protective against stunting and severe stunting. : Delayed introduction of complementary foods and associated factors were related to stunting and severe stunting among infants aged 6-8 months in India. Reducing the proportion of infants who are stunted in India would require comprehensive national nutrition policy actions that target the sub-population of mothers with no schooling and limited resources.
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http://dx.doi.org/10.1080/16549716.2019.1638020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011976PMC
December 2019

Correction to: Regional prevalence and determinants of exclusive breastfeeding in India.

Int Breastfeed J 2019 4;14:22. Epub 2019 Jun 4.

5School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia.

[This corrects the article DOI: 10.1186/s13006-019-0214-0.].
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http://dx.doi.org/10.1186/s13006-019-0220-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549369PMC
June 2019

Regional prevalence and determinants of exclusive breastfeeding in India.

Int Breastfeed J 2019 16;14:20. Epub 2019 May 16.

5School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia.

Background: Exclusive breastfeeding (EBF) has important benefits for both the mother and child. In India, no nationwide studies have examined patterns of EBF in the past decade to inform national and subnational breastfeeding programmes. The present study aimed to investigate the regional prevalence and determinants of EBF in India.

Methods: This study used a total weighted sample of 21,352 from the 2015-2016 India National Family Health Survey. EBF was measured as the proportion of infants 0-5 months of age who received breast milk as the only source of nourishment, based on mother's recall on feeds given to the infant 24 h before the survey. The prevalence of EBF and other breastfeeding patterns were estimated by region, and multivariable logistic regression that adjusted for clustering and sampling weights was used to investigate the association between the study factors (child, maternal, household, health service and community factors) and EBF by regional areas in India.

Results: This study indicated that wide differences in the prevalence of EBF and other childhood feeding practices exist across regions of India, where Southern India had the highest EBF prevalence (79.2%) and the North-East reported the lowest (68.0%). EBF prevalence decreased with infant age, dropping faster in the South (43.7% at 5 months) compared to the North-East region (54.0% at 5 months). Similarly, substantial variations in key determinants of EBF were evident by region, where higher birth order was the only common factor associated with non-EBF across all regions. Key modifiable determinants of non-EBF included higher maternal education in the South and belonging to rich households in Central India, while those for EBF were higher maternal education in the Central region and frequent antenatal care (≥ 4) visits in Northern India.

Conclusion: This study demonstrates wide variations in regional prevalence and determinants of EBF in India. Improving EBF participation in India would require multifaceted national and subnational efforts that include dedicated funds and the establishment of appropriate policy and interventions that are consistently monitored and evaluated.
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http://dx.doi.org/10.1186/s13006-019-0214-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524302PMC
April 2020

A survey on knowledge and attitude of Saudi female students toward refractive correction.

Clin Exp Optom 2020 03 21;103(2):184-191. Epub 2019 May 21.

School of Medicine, Diabetes Obesity and Metabolism Translational Research Unit, Macarthur Clinical School, Western Sydney University, Campbelltown, New South Wales, Australia.

Background: To assess the general knowledge and attitude of refractive error correction methods among female Saudi university students.

Methods: One thousand, one hundred and sixty-five female university students, between 17 and 32 years of age were randomly interviewed using self-administered questionnaires with open and closed-ended questions. The questions collected information on demographics (gender, age, educational status, college of study, and occupation), addressed general knowledge/perception of the difference between the professions of ophthalmology and optometry, and attitudes toward spectacle, contact lens (CL) usage, including coloured prescription CLs, and refractive surgery for correcting refractive errors.

Results: The response rate was 90 per cent (1,052/1,165). Fifty-two per cent had never had an eye examination and only 28 per cent correctly identified the difference between an 'ophthalmologist' and 'optometrist'. Eighty-one per cent knew that CLs instead of spectacles (81.8 per cent), and coloured CLs (89.7 per cent) can be used for correcting refractive errors. Concerning refractive surgery, although a majority (90 per cent) knew that the technique corrects refractive error and reduces dependency on spectacles/CLs, only five per cent had experienced refractive surgery. Approximately, 46 per cent and 47 per cent used spectacles and CLs, respectively, and while the optometrist was the main source of CL prescriptions (41 per cent), most people visited the ophthalmologist for their eye examination (68 per cent). Surprisingly, 52 per cent had never had an eye examination, or had only had one or two eye examinations (50 per cent) in their lifetime. While 23 per cent of spectacle wearers chose to continue with spectacles at the end of the study, 64 per cent and 12 per cent preferred refractive surgery and CLs, respectively, for refractive correction. Lack of information and fear of complications, but not cost, hindered most people from uptake of CLs and refractive surgery.

Conclusion: The students demonstrated high levels of knowledge and awareness of refractive correction methods, especially for refractive surgery. Although many consulted the optometrist or ophthalmologist for their eye examinations and corrective devices, many remain uncorrected and unaware of the main difference between both professions. The lack of information about correction methods and fear of complications may have affected their interest in uptake of eye services and should be addressed to increase uptake and prevent avoidable vision loss.
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http://dx.doi.org/10.1111/cxo.12919DOI Listing
March 2020

Gender differences in factors associated with prehypertension and hypertension in Nepal: A nationwide survey.

PLoS One 2018 13;13(9):e0203278. Epub 2018 Sep 13.

Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.

Background: Nepal has one of the highest prevalence of hypertension in South Asia. However, no national studies have examined the gender differences in the determinants of prehypertension and hypertension in the country to inform targeted interventions. This study aimed to investigate gender differences in factors associated with prehypertension and hypertension in Nepal using the 2016 Nepal Demographic and Health Survey (NDHS).

Methods: Sociodemographic, behavioural, anthropometric and health status data and information on hypertension were obtained from 14,857 (males: 6,245 and females: 8,612) individuals aged 15 years or above from the biomarker sample of the 2016 NDHS. Factors associated with prehypertension and hypertension by gender were investigated using generalized linear latent and mixed models (GLLAM) with the mlogit link and binomial family that adjusted for clustering and sampling weights.

Results: The overall prevalence of prehypertension and hypertension was 26.9% [95% confidence interval (CI): 25.7, 28.1] and 17.2% (95% CI 16.1, 18.3), respectively. Prehypertension was present in 30.4% (95%CI: 28.7, 32.2) of males and 24.3% (95% CI: 23.1, 25.6) of females, while hypertension was present in 20.4%, (95% CI 18.9, 22.0) of males and 14.8% (95% CI: 13.7, 16.0) of females. Key modifiable factors that were strongly associated with prehypertension and hypertension in both genders included overweight and obesity, caffeine intake, tobacco use, no schooling, previously informed of hypertension in a health facility, and alcohol consumption (for males). Other significant factors associated with prehypertension and hypertension included increasing age (> 30 years), ecological zone (Hill), Developmental zone (Western) and being married.

Conclusion: Our results suggest that prehypertension and hypertension were higher in males compared to females. Interventions to improve awareness, screening, treatment and control of prehypertension and hypertension in Nepal are warranted and should target key modifiable factors, as well as people aged 30 years and above.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203278PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136738PMC
February 2019

Peripheral Monochromatic Aberrations in Young Adult Caucasian and East Asian Eyes.

Optom Vis Sci 2018 03;95(3):234-238

Institute of Health & Biomedical Innovation and School of Optometry & Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.

Significance: Myopia prevalence rates differ between racial groups. If the growth of the eye is sensitive to differences in optical input, the difference in spherical aberration between East Asian and Caucasian eyes found in this study may be important in understanding myopia development.

Purpose: The aim of this study was to determine differences in peripheral wavefront aberrations between two racial groups.

Methods: Wavefront aberrations were measured using a COAS-HD aberrometer across the 42 × 32° central visual field on 37 right eyes of young adults (18 Caucasians, 19 East Asians; mean age 21.5 ± 2.4 years). The mean spherical equivalent refraction was -1.94 ± 1.63 diopters (D) with a range of -5.87 to +0.16 D. Effect of race and visual field position on refractions, individual Zernike aberration coefficients up to the fourth order, higher-order root-mean-square aberration, and total root-mean-square aberration were assessed by repeated-measures analysis of covariance.

Results: Caucasians and East Asians had similar relative peripheral myopia across the visual field. All higher-order aberration coefficients were affected by visual field position. Race had no significant effect on any higher-order Zernike coefficient, but the difference in mean vertical coma coefficient (Equation is included in full-text article.)across the visual field (i.e., average of 38 field locations) approached significance, being less positive in Caucasians than in East Asians (P = .08). When correction was made for the Caucasian group being slightly less myopic than the East Asian group, spherical aberration coefficient (Equation is included in full-text article.)was less positive in Caucasians than in East Asians by 0.04 μm (P = .001). The rates of change of coma coefficients across the field were not affected by race.

Conclusions: Caucasians and East Asians had similar relative peripheral myopia, but with less positive spherical aberration coefficient in Caucasians than in East Asians. It remains to be determined whether aberrations have a role in the difference of myopia prevalence rates in different countries.
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http://dx.doi.org/10.1097/OPX.0000000000001180DOI Listing
March 2018

Peripheral aberrations in adult hyperopes, emmetropes and myopes.

Ophthalmic Physiol Opt 2017 03;37(2):151-159

Institute of Health & Biomedical Innovation and School of Optometry & Vision Sciences, Queensland University of Technology, Brisbane, Australia.

Purpose: To determine differences in peripheral aberrations in hyperopic, emmetropic and myopic groups.

Methods: Cycloplegic peripheral aberrations for 5 mm pupils were measured at 39 locations across 42° × 32° of right eye visual fields with a COAS-HD Hartmann-Shack aberrometer in nine hyperopes (mean age 29 ± 5 years, spherical equivalent refraction M + 1.47 ± 0.58 D), 20 emmetropes (28 ± 7 years, +0.06 ± 0.36 D) and 20 myopes (27 ± 6 years, -2.55 ± 1.82 D). Relative peripheral refraction error RPRE and 3rd-4th order Zernike coefficients were compared between the groups.

Results: Hyperopes and emmetropes had relative peripheral myopia across the visual field, with considerable nasal-temporal asymmetry for both groups and superior-inferior asymmetry for hyperopes. Myopes had minimal RPRE along the horizontal meridian, but myopic RPRE along the vertical meridian which was less than the other groups. There was little difference between groups in astigmatic components or higher-order Zernike coefficients, except for fourth-order spherical aberration which was more positive in hyperopes than in both emmetropes (mean difference ±95% CI = +0.05 ± 0.05 μm, p = 0.03) and myopes (+0.07 ± 0.04 μm, p = 0.003). Coma changed rapidly across the visual field with similar rates for all groups.

Conclusions: Hyperopes and emmetropes had greater relative peripheral myopia than myopes. There was asymmetry in RPRE along the vertical meridian for hyperopes which was not present in the emmetropes, suggesting there may be asymmetries in peripheral eye length along the vertical meridian for the former. Higher-order aberrations were affected by field eccentricity, but refractive error affected only the spherical aberration coefficient, which was more positive for hyperopes than for other groups.
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http://dx.doi.org/10.1111/opo.12354DOI Listing
March 2017

Clinical evaluation of two types of intracorneal ring segments (ICRS) for keratoconus.

Int Ophthalmol 2017 Oct 1;37(5):1185-1198. Epub 2016 Nov 1.

Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, 9054, New Zealand.

Purpose: To compare the outcome measures following implantation of two types of ICRS.

Methods: Forty-four eyes of keratoconic patients (aged 18-50 years) were randomly assigned to femtosecond laser-assisted Keraring ICRS (Group A) or MyoRing (Group B) implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry (K), and aberrations were compared preoperatively, at 3 and 6 months postoperatively. A survey was conducted to assess patient's satisfaction, 6 months postoperatively.

Results: In Groups A (n = 26) and B (n = 18), UDVA was increased (P < 0.05), but CDVA increased only in Group A (P < 0.05) 6 months postoperatively. The mean K was reduced by 4.55 D (P < 0.0001) in Group A and 6.51 D (P < 0.001) in Group B. Six months postoperatively, the mean refraction spherical equivalent (MRSE) decreased by 2.90 and 3.60 D in Groups A and B, respectively (P < 0.0001). Between groups, coma was more reduced (P = 0.035) in Group B than A, 6 months postoperatively. On motivation for surgery, 88.9% of patients' ranked "desire to improve unaided vision" and "relief from glasses" (77%) topmost. Seventy-seven (77%) of Group A and 89% of Group B patients were satisfied with their unaided vision at the final visit, after 6 months.

Conclusions: KeraRing (A) and MyoRing (B) corneal implants both performed well in improving vision and stabilising the cornea. Implantation of the MyoRing caused greater reduction in coma and better patient satisfaction, but CDVA improved only in the Keraring group, at the final visit.
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http://dx.doi.org/10.1007/s10792-016-0385-2DOI Listing
October 2017

Mirror Symmetry of Peripheral Monochromatic Aberrations in Fellow Eyes of Isomyopes and Anisomyopes.

Invest Ophthalmol Vis Sci 2016 06;57(7):3422-8

Purpose: To investigate mirror symmetry of peripheral ocular aberrations in fellow eyes of iso- and anisomyopes.

Methods: Peripheral aberration was measured over the central 42° × 32° visual field for a 5-mm pupil in both eyes of 19 isomyopic (spherical equivalent refraction M [right/left]: -2.5 ± 2.1 diopters [D]/-2.7 ± 2.3 D) and 10 anisomyopic (M: -4.0 ± 1.8 D/-4.3 ± 2.8 D) young adults. Isomyopes had less than 1.0 D fellow eye refraction difference and anisomyopes had between 1.0 D and 2.6 D fellow eye differences (mean difference: 1.3 ± 0.6 D). Orthogonal regression of Zernike coefficients determined right-left eye correlations in isomyopes. For anisomyopes, higher and lower myopic eye coefficients were compared.

Results: For isomyopes, the percentages of visual field locations with significant coefficient correlations between fellow eyes varied from 100% for astigmatism ( ) to 18% for tetrafoil ( ). Positive correlations were found for , , , , , and , and negative correlations were found for , , , , and coefficients, indicating that the signs are different for corresponding locations of fellow eyes for the last five of these coefficients. Slopes of correlations were not different from ± 1, except for , , and (+0.95, -0.97, and +0.52, respectively). In anisomyopes, significant but small fellow eye differences were found for only and coefficients, with significant interactions between anisometropia and field position for only two coefficients.

Conclusions: Peripheral aberration coefficients across the visual field show mirror symmetry in isomyopes, and in a pooled data set the coefficients with negative correlations require sign changes for left eye data. Anisometropia contributes no more to peripheral aberration differences between fellow eyes than could be expected on the basis of refraction differences between people.
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http://dx.doi.org/10.1167/iovs.16-19267DOI Listing
June 2016

Evaluation of visual stress symptoms in age-matched dyslexic, Meares-Irlen syndrome and normal adults.

Int J Ophthalmol 2016 18;9(4):617-24. Epub 2016 Apr 18.

Ophthalmic and Visual Optics Laboratory Group, Institute of Health and Biomedical Innovation, Department of Optometry & Vision Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4059, Queensland, Australia.

Aim: To examine the prevalence of dyslexia and Meares-Irlen syndrome (MIS) among female students and determine their level of visual stress in comparison with normal subjects.

Methods: A random sample of 450 female medical students of King Saud University Riyadh (age range, 18-30y) responded to a wide range of questions designed to accomplish the aims of this study. The detailed questionnaire consisted of 54 questions with 12 questions enquiring on ocular history and demography of participants while 42 questions were on visual symptoms. Items were categorized into critical and non-critical questions (CQ and NCQ) and were rated on four point Likert scale. Based on the responses obtained, the subjects were grouped into normal (control), dyslexic with or without MIS (Group 1) and subjects with MIS only (Group 2). Responses were analysed as averages and mean scores were calculated and compared between groups using one way analysis of variance to evaluate total visual stress score (TVSS=NCQ+CQ), critical and non-critical visual stress scores. The relationship between categorical variables such as age, handedness and condition were assessed with Chi-square test.

Results: The completion rate was 97.6% and majority of the respondents (92%) were normal readers, 2% dyslexic and 6% had MIS. They were age-matched. More than half of the participants had visited an eye care practitioner in the last 2y. About 13% were recommended eye exercises and one participant experienced pattern glare. Hand preference was not associated with any condition but Group 1 subjects (3/9, 33%) were significantly more likely to be diagnosed of lazy eye than Group 2 (2/27, 7%) and control (27/414, 7%) subjects. The mean±SD of TVSS responses were 63±14 and it was 44±9 for CQ and 19±5 for NCQ. Responses from all three variables were normally distributed but the CQ responses were on the average more positive (82%) in Group 2 and less positive (46%) in Group 1 than control. With NCQ, the responses were equally less positive in Group 1 and 2 than control. Group 2 subjects showed significantly higher TVSS (P=0.002), NCQ (P=0.006) and CQ (P=0.008) visual stress scores than control but no difference between Group 1 and control subjects, was observed for all scores (P>0.05, for all comparisons).

Conclusion: The prevalence of dyslexia and MIS among Saudi female students was 2% and 6%, respectively. Critical questions performed best for assessing visual stress symptoms in dyslexic and MIS subjects. Generally, students with MIS were more sensitive to visual stress than normal students but dyslexics were more likely to present with a lazy eye than MIS and normal readers.
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http://dx.doi.org/10.18240/ijo.2016.04.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853362PMC
May 2016

Induced Higher-order aberrations after Laser In Situ Keratomileusis (LASIK) Performed with Wavefront-Guided IntraLase Femtosecond Laser in moderate to high Astigmatism.

BMC Ophthalmol 2016 Mar 22;16:29. Epub 2016 Mar 22.

Department of Optometry & Vision Sciences, Faculty of Health, Ophthalmic and Visual Optics Laboratory Group (Chronic Disease & Ageing), Institute of Health and Biomedical Innovation, Q Block, Room 5WS36 60 Musk Avenue Kelvin Grove, Brisbane, QLD, 4059, Australia.

Background: Wavefront-guided Laser-assisted in situ keratomileusis (LASIK) is a widespread and effective surgical treatment for myopia and astigmatic correction but whether it induces higher-order aberrations remains controversial. The study was designed to evaluate the changes in higher-order aberrations after wavefront-guided ablation with IntraLase femtosecond laser in moderate to high astigmatism.

Methods: Twenty-three eyes of 15 patients with moderate to high astigmatism (mean cylinder, -3.22 ± 0.59 dioptres) aged between 19 and 35 years (mean age, 25.6 ± 4.9 years) were included in this prospective study. Subjects with cylinder ≥ 1.5 and ≤2.75 D were classified as moderate astigmatism while high astigmatism was ≥3.00 D. All patients underwent a femtosecond laser-enabled (150-kHz IntraLase iFS; Abbott Medical Optics Inc) wavefront-guided ablation. Uncorrected (UDVA), corrected (CDVA) distance visual acuity in logMAR, keratometry, central corneal thickness (CCT) and higher-order aberrations (HOAs) over a 6 mm pupil, were assessed before and 6 months, postoperatively. The relationship between postoperative change in HOA and preoperative mean spherical equivalent refraction, mean astigmatism, and postoperative CCT were tested.

Results: At the last follow-up, the mean UDVA was increased (P < 0.0001) but CDVA remained unchanged (P = 0.48) and no eyes lost ≥2 lines of CDVA. Mean spherical equivalent refraction was reduced (P < 0.0001) and was within ±0.50 D range in 61% of eyes. The average corneal curvature was flatter by 4 D and CCT was reduced by 83 μm (P < 0.0001, for all), postoperatively. Coma aberrations remained unchanged (P = 0.07) while the change in trefoil (P = 0.047) postoperatively, was not clinically significant. The 4th order HOAs (spherical aberration and secondary astigmatism) and the HOA root mean square (RMS) increased from -0.18 ± 0.07 μm, 0.04 ± 0.03 μm and 0.47 ± 0.11 μm, preoperatively, to 0.33 ± 0.19 μm (P = 0.004), 0.21 ± 0.09 μm (P < 0.0001) and 0.77 ± 0.27 μm (P < 0.0001), six months postoperatively. The change in spherical aberration after the procedure increased with an increase in the degree of preoperative myopia.

Conclusions: Wavefront-guided IntraLASIK offers a safe and effective option for vision and visual function improvement in astigmatism. Although, reduction of HOA is possible in a few eyes, spherical-like aberrations are increased in majority of the treated eyes.
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http://dx.doi.org/10.1186/s12886-016-0205-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802649PMC
March 2016

Agreement Between Autorefraction and Subjective Refraction in Keraring-Implanted Keratoconic Eyes.

Eye Contact Lens 2017 Mar;43(2):116-122

Refractive Surgery Unit (W.S.A.-T., H.R.), Elite Medical & Surgical Center, Riyadh, Saudi Arabia; Department of Medicine (K.C.O.), Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Department of Optometry and Vision Sciences (M.A.A.), College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; and Institute of Health and Biomedical Innovation (U.L.O.), Chronic Disease and Ageing, Department of Optometry and Vision Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.

Objectives: To assess the agreement between subjective refraction and autorefraction and to explore the relationship between the magnitude of higher order aberration, and visual acuity and refraction, before and after keraring implantation.

Methods: This prospective, randomized, interventional study enrolled 27 subjects (mean age 28.1±6.5 years) with keratoconus. Noncycloplegic refraction was performed subjectively by one clinician and with an autorefractor by another clinician, before and 6 months after surgery. The limit of agreement (LoA) between methods was assessed, and the relationships between the corrected distance visual acuity, logMAR on the one hand and refraction measurements and higher-order aberrations on the other, were examined.

Results: The agreement in mean spherical equivalent refraction (MSER) between methods was good postoperatively but poor preoperatively. The autorefractor gave a more myopic refraction than subjective refraction preoperatively (-3.28±3.06 D; LoA -9.27 to +2.71 D, P<0.0001) and postoperatively (-0.63±1.64 D; LoA -3.85 to +2.58 D, P=0.055), and returned higher negative cylinders preoperatively (-1.10±1.17 D; LoA -3.40 to +1.19 D, P<0.0001) and postoperatively (-1.08±1.27 D; LoA -3.60 to +1.41 D, P<0.0001) in keratoconic eyes. The difference in MSER between methods was significantly related to the refractive error at both visits (P<0.05) and to the magnitude of higher-order aberrations in keratoconic eyes preoperatively (P<0.05). The logMAR visual acuity achieved subjectively worsened as the magnitude of higher-order aberrations increased preoperatively (P<0.001).

Conclusions: The autorefractor returns values that are significantly more myopic in MSER and higher negative cylinders than subjective refraction, preoperatively, but the MSER was similar between devices postoperatively. The autorefactor seems a valid starting point for subjective refraction in keratoconic eyes treated with keraring, but the cylinder should be corrected by about +1 D. The instruments agree more in less myopic than high myopic eyes.
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http://dx.doi.org/10.1097/ICL.0000000000000244DOI Listing
March 2017

Manifestations of type 2 diabetes in corneal endothelial cell density, corneal thickness and intraocular pressure.

J Biomed Res 2015 Jul 8;30. Epub 2015 Jul 8.

AlHokama Eye Specialist Center, Riyadh 11427, Saudi Arabia.

We sought to evaluate central corneal thickness (CCT), corneal endothelial cell density (ECD) and intraocular pressure (IOP) in patients with type 2 diabetes mellitus (DM) and to associate potential differences with diabetes duration and treatment modality in a prospective, randomized study. We measured ECD, CCT and IOP of 125 patients with type 2 DM (mean age 57.1±11.5 years) and compared them with 90 age-matched controls. Measured parameters were analyzed for association with diabetes duration and glucose control modalities (insulin injection or oral medication) while controlling for age. In the diabetic group, the mean ECD (2511±252 cells/mm²), mean CCT (539.7±33.6 μm) and mean IOP (18.3±2.5 mmHg) varied significantly from those the control group [ECD: 2713±132 cells/mm² (P<0.0001), CCT: 525.0±45.3 μm (P=0.003) and IOP: 16.7±1.8 mmHg (P<0.0001)]. ECD was significantly reduced by about 32 cell/mm² for diabetics with duration of >10 years when compared with those with duration of <10 years (P<0.05). CCT was thicker and IOP was higher for diabetics with duration of >10 years than those with duration of <10 years (P>0.05). None of the measured parameters was significantly associated with diabetes duration and treatment modality (P>0.05). In conclusion, subjects with type 2 DM exhibit significant changes in ECD, IOP and CCT, which, however, are not correlated with disease duration or if the patients receive on insulin injection or oral medications.
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http://dx.doi.org/10.7555/JBR.29.20140075DOI Listing
July 2015

A new method of detecting changes in corneal health in response to toxic insults.

Micron 2015 Nov 26;78:45-53. Epub 2015 Jul 26.

Medical Genetics Unit, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 74, I-44121 Ferrara, Italy.

The size and arrangement of stromal collagen fibrils (CFs) influence the optical properties of the cornea and hence its function. The spatial arrangement of the collagen is still questionable in relation to the diameter of collagen fibril. In the present study, we introduce a new parameter, edge-fibrillar distance (EFD) to measure how two collagen fibrils are spaced with respect to their closest edges and their spatial distribution through normalized standard deviation of EFD (NSDEFD) accessed through the application of two commercially available multipurpose solutions (MPS): ReNu and Hippia. The corneal buttons were soaked separately in ReNu and Hippia MPS for five hours, fixed overnight in 2.5% glutaraldehyde containing cuprolinic blue and processed for transmission electron microscopy. The electron micrographs were processed using ImageJ user-coded plugin. Statistical analysis was performed to compare the image processed equivalent diameter (ED), inter-fibrillar distance (IFD), and EFD of the CFs of treated versus normal corneas. The ReNu-soaked cornea resulted in partly degenerated epithelium with loose hemidesmosomes and Bowman's collagen. In contrast, the epithelium of the cornea soaked in Hippia was degenerated or lost but showed closely packed Bowman's collagen. Soaking the corneas in both MPS caused a statistically significant decrease in the anterior collagen fibril, ED and a significant change in IFD, and EFD than those of the untreated corneas (p<0.05, for all comparisons). The introduction of EFD measurement in the study directly provided a sense of gap between periphery of the collagen bundles, their spatial distribution; and in combination with ED, they showed how the corneal collagen bundles are spaced in relation to their diameters. The spatial distribution parameter NSDEFD indicated that ReNu treated cornea fibrils were uniformly distributed spatially, followed by normal and Hippia. The EFD measurement with relatively lower standard deviation and NSDEFD, a characteristic of uniform CFs distribution, can be an additional parameter used in evaluating collagen organization and accessing the effects of various treatments on corneal health and transparency.
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http://dx.doi.org/10.1016/j.micron.2015.07.007DOI Listing
November 2015

Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension.

Int J Ophthalmol 2015 18;8(3):612-21. Epub 2015 Jun 18.

Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.

Aim: To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure (BP) measurements for patients in "at-risk" groups, and to sample patients' opinions regarding in-office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores. These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards detecting and monitoring hypertension.

Methods: Automated BP measurements were made twice (during the same session) at five selected optometry practices using a validated BP monitor (Omron M6) to assess the number of patients with high BP (HBP) -in at-risk groups-visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (±12.4)y and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire.

Results: A response rate of 83.6% was obtained for the survey. Ninety-three of the 443 patients (21.0%) tested for BP in this study had HBP. Of these, (62 subjects) 66.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22 (73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor.

Conclusion: Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested. We also identified 30 of 105 previously diagnosed patients whose BP was poorly controlled, twenty-two of whom were on medication. The patients who participated in this study were positively disposed toward the routine measurement of BP by optometrists.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2015.03.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458673PMC
June 2015

One-Year Clinical Outcomes of a Two-Step Surgical Management for Keratoconus-Topography-Guided Photorefractive Keratectomy/Cross-Linking After Intrastromal Corneal Ring Implantation.

Eye Contact Lens 2015 Nov;41(6):359-66

Department of Ophthalmology (W.S.A.-T., H.R.), Elite Medical and Surgical Center, Riyadh, Saudi Arabia; School of Optometry & Vision Science, Institute of Health & Biomedical Innovation (U.L.O.), Visual and Ophthalmic Optics Group (Chronic Disease & Ageing Domain), Queensland University of Technology, Brisbane, Queensland, Australia; and Department of Medicine (K.C.O.), Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

Purpose: To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen cross-linking (CXL) after intrastromal corneal ring (ISCR) implantation in patients with keratoconus.

Methods: Thirty-three patients (41 eyes) aged between 19 and 45 years were included in this prospective study. All patients underwent a femtosecond laser-enabled (Intralase FS; Abbott Medical Optics, Inc.) placement of intracorneal ring segments (Kerarings; Mediphacos, Brazil). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings remained stable for 6 months. Same-day PRK and CXL was subsequently performed in all patients.

Results: After 12 months of completion of the procedure, mean UDVA in log of minimal angle of resolution was significantly improved (0.74±0.54-0.10±0.16); CDVA did not improve significantly but 85% of eyes maintained or gained multiple lines of CDVA; mean refraction spherical equivalent improved (from -3.03±1.98 to -0.04±0.99 D), all keratometry readings were significantly reduced, from preoperative values, but coma did not vary significantly from preoperative values. Central corneal thickness and corneal thickness at the thinnest point were significantly (P<0.0001) reduced from 519.76±29.33 and 501.87±31.50 preoperatively to 464.71±36.79 and 436.55±47.42 postoperatively, respectively. Safety and efficacy indices were 0.97 and 0.88, respectively. From 6 months up until more than 1 year of follow-up, further significant improvement was observed only for UDVA (P<0.0001).

Conclusions: Same-day combined TG-PRK and CXL after ISCR implantation is a safe and effective option for improving visual acuity and visual function, and it halts the progression of the keratoconus. The improvements recorded after 6 months of follow-up were maintained or improved upon 1 year after the procedure.
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http://dx.doi.org/10.1097/ICL.0000000000000135DOI Listing
November 2015

Reliability and reproducibility of a handheld videorefractor.

Optom Vis Sci 2015 May;92(5):632-41

*PhD, FAAO †BSc ‡MSc, OD Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (KCO); Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia (WHA, AA); and Institute of Health and Biomedical Innovation, Department of Optometry and Vision Sciences, Brisbane, Queensland, Australia (ULO).

Purpose: To assess the performance of the 2Win eccentric videorefractor in relation to subjective refraction and table-mounted autorefraction.

Methods: Eighty-six eyes of 86 adults (46 male and 40 female subjects) aged between 20 and 25 years were examined. Subjective refraction and autorefraction using the table-mounted Topcon KR8800 and the handheld 2Win videorefractor were carried out in a randomized fashion by three different masked examiners. Measurements were repeated about 1 week after to assess instrument reproducibility, and the intertest variability was compared between techniques. Agreement of the 2Win videorefractor with subjective refraction and autorefraction was assessed for sphere and for cylindrical vectors at 0 degrees (J0) and 45 degrees (J45).

Results: Reproducibility coefficients for sphere values measured by subjective refraction, Topcon KR8800, and 2Win (±0.42, ±0.70, and ±1.18, respectively) were better than their corresponding J0 (±1.0, ±0.85, and ±1.66) and J45 (±1.01, ±0.87, and ±1.31) vector components. The Topcon KR8800 showed the most reproducible values for mean spherical equivalent refraction and the J0 and J45 vector components, whereas reproducibility of spherical component was best for subjective refraction. The 2Win videorefractor measurements were the least reproducible for all measures. All refractive components measured by the 2Win videorefractor did not differ significantly from those of subjective refraction, in both sessions (p > 0.05). The Topcon KR8800 autorefractometer and the 2Win videorefractor measured significantly more positive spheres and mean spherical equivalent refraction (p < 0.0001), but the J0 and J45 vector components were similar (p > 0.05), in both sessions.

Conclusions: The 2Win videorefractor compares well, on average, with subjective refraction. The reproducibility values for the 2Win videorefractor were considerably worse than either subjective refraction or autorefraction. The wide limits of reproducibility of the 2Win videorefractor probably limit its usefulness as a primary screening device.
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http://dx.doi.org/10.1097/OPX.0000000000000566DOI Listing
May 2015

Eye rubbing-induced changes in intraocular pressure and corneal thickness measured at five locations, in subjects with ocular allergy.

Int J Ophthalmol 2015 18;8(1):81-8. Epub 2015 Feb 18.

Department of Optometry & Vision Sciences, College of Applied Medical Sciences, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia.

Aim: To assess the effects of eye rubbing on corneal thickness (CT) and intraocular pressure (IOP) measurements obtained 0-30min after habitual eye rubbing in symptomatic patients.

Methods: Measurements of IOP and CT were obtained at five locations (central, temporal, superior, nasal and inferior) before, and every 5min for 30min interval after 30s of eye rubbing, for 25 randomly selected eyes of 14 subjects with ocular allergy and 11 age-matched normals. Differences in measurements were calculated in each group [Baseline measurements minus measurements recorded at each time interval after eye rubbing (for IOP), and for each corneal location (for CT)] and comparison were then made between groups (allergic versus control) for differences in any observed effects.

Results: Within groups, baseline mean IOPs in the allergic patient-group (14.2±3.0 mm Hg) and in the control group (13.1±1.9 mm Hg) were similar at all times, after eye rubbing (P >0.05, for all). The maximum reduction in IOP was 0.8 mm Hg in the control subjects and the maximum increase was also 0.8 mm Hg in the allergic subjects. Between groups (allergic versus control), the changes in IOP remained under 1 mm Hg at all times (P=0.2) after 30min of eye rubbing. Between 0 and 30min of CT measurements after eye rubbing, the mean central CT (CCT), inferior CT (ICT), superior CT (SCT), temporal CT (TCT) and nasal CT (NCT) did not vary significantly from baseline values in the control and allergic-subject groups (P>0.05, for both). Between both groups, changes in CT were similar at all locations (P>0.05) except for the TC which was minimally thinner by about 4.4 µm (P=0.001) in the allergic subjects than in the control subjects, 30min following 30s of eye rubbing.

Conclusion: IOP measured in allergic subjects after 30s of habitual eye rubbing was comparable with that obtained in normal subjects at all times between 0 and 30min. Although, CT in the allergic subjects were similar to those of the control subjects at all times, it varied between +10 and -7.5 µm following eye rubbing, with the temporal cornea showing consistent reductions in thickness in the subjects with allergy. However, this reduction was minimal and was considered to not be clinically relevant.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2015.01.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325247PMC
February 2015

Visual rehabilitation in low-moderate keratoconus: intracorneal ring segment implantation followed by same-day topography-guided photorefractive keratectomy and collagen cross linking.

Int J Ophthalmol 2014 18;7(5):800-6. Epub 2014 Oct 18.

School of Optometry & Vision Science and Institute of Health & Biomedical Innovation, Chronic Disease and Aging Domain, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove 5SW36 QLD 4059, Australia.

Aim: To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen crosslinking (CXL) after previous intrastromal corneal ring segment (ISCR) implantation for keratoconus.

Methods: An experimental clinical study on twenty-one eyes of 19 patients aged 27.1±6.6y (range 19-43y), with low to moderate keratoconus who were selected to undergo customized TG-PRK immediately followed by same-day CXL, 9mo after ISCR implantation in a university ophthalmology clinic. Refraction, uncorrected distance visual acuities (UDVA) and corrected distance visual acuities (CDVA), keratometry (K) values, central corneal thickness (CCT) and coma were assessed 3mo after TG-PRK and CXL.

Results: After TG-PRK/CXL: the mean UDVA (logMAR) improved significantly from 0.66±0.41 to 0.20±0.25 (P<0.05); Kflat value decreased from: 48.44±3.66 D to 43.71±1.95 D; Ksteep value decreased from 45.61±2.40 D to 41.56±2.05 D; Kaverage also decreased from 47.00±2.66 D to 42.42±2.07 D (P<0.05 for all). The mean sphere and cylinder decreased significantly post-surgery from, -3.10±2.99 D to -0.11±0.93 D and from -3.68±1.53 to -1.11±0.75 D respectively, while the CDVA, CCT and coma showed no significant changes. Compared to post-ISCR, significant reductions (P<0.05 or all) in all K values, sphere and cylinder were observed after TG-PRK/CXL.

Conclusion: Same-day combined topography-guided PRK and corneal crosslinking following placement of ISCR is a safe and potentially effective option in treating low-moderate keratoconus. It significantly improves all visual acuity, reduced keratometry, sphere and astigmatism, but causes no change in central corneal thickness and coma.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2014.05.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206884PMC
October 2014

Factors influencing Saudi Arabian optometry candidates' career choices and institution of learning. Why do Saudi students choose to study optometry?

Clin Exp Optom 2014 Sep 1;97(5):442-9. Epub 2014 Aug 1.

Institute of Health and Biomedical Innovation, Department of Optometry & Vision Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.

Background: Optometry is a primary health-care profession (PHCP) and this study aimed to elucidate the factors influencing the choice of optometry as a career for Saudi students, the students' perceptions of optometry and the effect of gender.

Methods: Two hundred and forty-seven students whose average age was 21.7 ± 1.5 (SD) years and who are currently enrolled in two colleges of optometry in Saudi Arabia--King Saud University (KSU) and Qassim University (QU)--completed self-administered questionnaires. The survey included questions concerning demography, career first choice, career perception and factors influencing career choices.

Results: The response rate was 87.6 per cent and there were 161 male (64.9 per cent) students. Seventy-nine per cent of the participants were from KSU (males and females) and 20.6 per cent were from QU (only males). Seventy-three per cent come from Riyadh and 19 per cent are from Qassim province. Regarding the first choice for their careers, the females (92 per cent) were 0.4 times more likely (p = 0.012) to choose optometry than males (78.3 per cent). The males were significantly more likely to be influenced by the following factors: the Doctor of Optometry (OD) programs run at both universities, good salary and prospects (p < 0.05, for all). The women were significantly less likely to be influenced by another individual (p = 0.0004). Generally, more than two-thirds of the respondents viewed the desire to help others, professional prestige and the new OD programs as the three most influential factors in opting for a career in optometry.

Conclusion: Females were more likely to opt for a career in optometry and males were more likely to be influenced by the new OD programs, good salary and job prospects. Service provision to others in the community was a primary motivation to opt for a career in optometry among young Saudis.
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http://dx.doi.org/10.1111/cxo.12182DOI Listing
September 2014