Evaluation of awareness about corneal refractive surgery to correct refractive error in a sample of Syrian private university students

doi:10.21203/rs.3.rs-3011846/v1

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Evaluation of awareness about corneal refractive surgery to correct refractive error in a sample of Syrian private university students

https://doi.org/10.21203/rs.3.rs-3011846/v1

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Background

Methods

This cross-sectional study was conducted in March 2023 on students of the Syrian Private University from all disciplines. Students were asked to participate voluntarily. A self-administered and filled out questionnaire in Arabic was used, distributed to students of the Syrian Private University, regarding awareness about refractive surgery. The questionnaire includes demographic information. It included questions about: gender, college, age, and academic year. Questions about awareness about refractive surgery. Questions about the source of information on awareness about refractive surgery for refractive errors.

Results

Out of 604 participants in the questionnaire, 37.9% were males and 62.1% were females, and most of their ages were from the age group of 18–22 with a rate of 89.2%. Most of the participants were from the Faculty of Human Medicine 44%, Pharmacy 33.8%, and Dentistry 20.2%, respectively. 24.5% of the students mentioned suffering from nearsightedness, 9.4% mentioned suffering from hyperopia, 1% suffering from astigmatism, while the majority (65.1%) stated that they did not complain of any refractive defect. Also, about 83% mentioned that they use medical glasses, and 17% that they do not use them. Only 4.2% of the students reported having had corneal refractive surgery, most of whom were satisfied with the outcome at 99%. The majority of the students were aware of the surgical procedures to correct refractive defects 86%, but nearly 61% were not ready to undergo the surgery for the following reasons: cost of the procedure 6.4%, fear of complications 30.6%, lack of information about the procedure 39.5%. The results showed a statistically significant relationship between prior knowledge about corneal refractive surgery and demographic factors.

Conclusion

The study recommends conducting other studies that examine knowledge about corneal refractive surgery in other samples such as employees, school students, and others, as the medical literature indicates that we still lack such studies, whether at the local level or at the Arab level. Conducting seminars and intensive educational programs to improve knowledge and awareness about the worst refraction and its various treatment methods, including corneal refractive surgery.

Ophthalmology

Corneal refractive surgery

Refractive errors

medical students

Awareness

The cornea is a transparent, avascular tissue that acts as a structural barrier and protects the eye from infections. Together with the tear film, it provides a suitable anterior refractive surface for the eye. The cornea contributes two-thirds of the refractive power of the eye [1]. Important functions of the cornea in the eye include protecting the structures within the eye, contributing to the refractive power of the eye, as well as focusing light rays on the retina with minimal scattering and visual degradation. Significant progress has been made in understanding the organization of collagen in the corneal stroma and its clinical significance [1]. Refractive disorder is a condition in which the rays emanating from the visible object do not converge on the retina, due to the lack of proportionality between the refractive power of the eye and its anterior-posterior length, which leads to the absence of clear vision [2]. Refractive surgery reduces or eliminates the individual's dependence on glasses or contact lenses. It is generally a safe route and gives good results, but it is not without risks and complications can occur [3].

Aim of the study:

Evaluation of knowledge and awareness about corneal refractive surgery among Syrian private university students and its association with social and demographic characteristics and identify factors associated with awareness about corneal refractive surgery.

Study Design and participants

This cross-sectional study was conducted in March 2023 on students of the Syrian Private University of all specializations. Students were asked to participate voluntarily, and written informed consent was obtained from all participants. They were informed that all their responses were recorded anonymously, that it was not mandatory to respond to all questions, and that they were allowed to opt out of the survey at any time. The inclusion criteria included students who are studying at the Syrian private university at the age of 18 years and over, and the objectives of the study were explained to the students in a written form attached to the questionnaire. The sample size of 246 was calculated for a population of 3000 students, using the sample size calculator. The necessary approvals have been obtained.

Tools

A self-administered questionnaire in Arabic distributed to students of the Syrian Private University was used regarding awareness about refractive surgery, and reliability was assessed by Cronbach's alpha test at 0.651.

The questionnaire included: Demographic information included questions about: gender, college, age, and academic year. Questions about awareness about refractive surgery. Questions about the source of information on awareness about refractive surgery for refractive errors.

Statistical analysis: Patients' data was tabulated and entered into the computer, and then the statistical package for social sciences SPSS version (26) was used to analyze this data, and the following statistical methods were relied upon in the analysis: Descriptive statistics: it is to find the relative frequency distributions of the categorical study variables (sex, academic year, ...) and adding graphic forms to enrich the results. Inferential statistics: This part of the analysis aims to present and interpret the results and infer them in order to reach the goal of the study, by conducting the Chi Square independence test to study whether there is a relationship between two descriptive variables, through the application of the chi square statistic. The Chi-Square independence test was also used to test the independence of qualitative variables, and correlation tests were used according to the Cramer coefficient to study the relationship between qualitative variables and the Spearman coefficient to study the relationship between quantitative variables.

Descriptive analysis:

Participant demographics: Out of 604 participants in the questionnaire, 37.9% were males and 62.1% were females, and most of their ages were from the age group of 18–22, with a rate of 89.2%. Most of the participants were from the Faculty of Human Medicine 44%, Pharmacy 33.8%, and Dentistry 20.2%, respectively. The majority were within their second year of study, 24.2%, and the third, 23.5%, respectively. (Table 1)

Table 1
Gender
Male	229 (37.9%)
Female	375 (62.1%)
Age
18–22	539 (89.2%)
23–25	56 (9.3%)
> 25	8 (1.3%)
Collage
Medicine	266 (44%)
Dentist	122 (20.2%)
Pharmacy	204 (33.8%)
Other	12 (2%)
academic year
First	111 (18.4%)
Second	146 (24.2%)
Third	142 (23.5%)
Fourth	108 (17.9%)
Fifth	83 (13.7%)
Sixth	14 (2.3%)

Attitude and behavior around refraction and its treatment: 24.5% of the students mentioned suffering from nearsightedness, 9.4% mentioned suffering from hyperopia, 1% suffering from astigmatism, while the majority (65.1%) stated that they did not complain of any refractive defect. About 83% mentioned that they use medical glasses, and 17% did not use them, 58.8% of them were comfortable with their medical glasses, and 41.2% were not comfortable with their glasses. 55.3% of the students considered the glasses comfortable and easy to use. On the other hand, 44.4% of the students stated that medical glasses are uncomfortable because of their impact on daily life. 40.8% of the students mentioned their desire to continue using the medical glasses if they wear them, and in contrast, the majority of 43% of the students preferred to undergo refractive surgery if they wore the medical glasses. Also, 57.1% of the students indicated that they did not use contact lenses and do not think of using them. (Table 2)

Table 2
Do you suffer from a refractive defect in the eye?
nearsightedness	148 (24.5%)
farsightedness	57 (9.4%)
astigmatism	6 (1%)
I do not suffer	393 (65.1%)
Questions for patients with refractive errors:
Do you use prescription glasses?
Yes	175 (83%)
No	36 (17%)
Are you comfortable with prescription glasses?
Yes	103 (58.8%)
No	72 (41.2%)
Why are medical glasses comfortable?
Ease of use	57 (55.3%)
free maintenance	4 (4%)
otherwise	42 (40.7%)
Why aren't medical glasses considered comfortable?
require more maintenance	9 (12.5%)
Impact on daily life	32 (44.4%)
Cosmetic reasons	13 (18%)
otherwise	18 (25%)
If you wear glasses, which of the treatment options do you prefer:
Continue to wear glasses	98 (40.8%)
Wear contact lenses	38 (15.8%)
Refractive surgery	104 (43.3%)
Are you comfortable using contact lenses?
Yes, I am comfortable wearing contact lenses	31 (13.8%)
No, I have tried contact lenses and they are not comfortable	18 (8%)
I haven't used it but am thinking of doing so	47 (21%)
I have not used contact lenses and am not thinking of using them	128 (57.1%)

Awareness about corneal refractive surgery: Only 4.2% of the students reported having had corneal refractive surgery, most of whom were satisfied with the outcome at 99%. The majority of the students were aware of the surgical procedures to correct refractive defects 86%, but nearly 61% were not ready to undergo the surgery for the following reasons: cost of the procedure 6.4%, fear of complications 30.6%, lack of information about the procedure 39.5%. It is interesting that the majority of students were aware of corneal refractive surgery from friends and acquaintances 34.7%, and social networking sites 24.8%. Students reported contraindications for corneal refractive surgery as follows: keratoconus 12.4%, age under 18 years 73.5%, thin cornea 50.4%, unstable and progressive refractive index during the previous two years 31.5%. Students also reported complications of corneal refractive surgery: foreign body sensation in the eye 44.3%, dry eye 45.8%, infection 43.8%, and post-treatment refractive defect 18.8%. (Table 3)

Table 3
Have you previously undergone refractive surgery?
Yes	25 (4.2%)
No	579 (95.4%)
If you underwent the operation before, are you satisfied with the result?
Yes	24 (99%)
No	1 (1%)
Are you aware of the surgical procedures to correct refractive errors?
Yes	509 (86%)
No	83 (14%)
Are you aware of the following corneal refractive surgery procedures?
PRK (photocurrent keratectomy)	168 (28.5%)
Layek (epithelial keratomileusis correction)	460 (78.1%)
LASIK (laser in situ keratomileusis correction)	424 (72%)
LASIK (Keratomileusis correction using FEMTO)	63 (10.7%)
If you are aware of corneal refractive surgery, are you willing to undergo it?
Yes	226 (38.4%)
No	363 (61.6%)
If the answer is no, state the most likely reason:
The cost of the procedure	25 (6.4%)
Fear of complications	120 (30.6%)
Lack of information about the procedure	155 (39.5%)
otherwise	92 (23.5%)
Source of information about refractive surgery?
Friends and acquaintances	207 (34.7%)
Social media	148 (24.8%)
Physician	124 (20.8%)
Lecture or seminar	69 (11.6%)
otherwise	49 (8.2%)
Do you expect corneal refractive surgery to be dangerous?
Yes	125 (20.8%)
No	477 (79.2%)
Complications of corneal refractive surgery:
Simple	304 (50.5%)
serious	66 (11%)
I don't know	232 (38.5%)
Do you think that the low vision relapses after a period of surgery?
Yes	143 (23.8%)
No	458 (76.2%)
Do you think that corneal refractive surgery can substitute for wearing glasses?
Yes	389 (64.5%)
No	55 (9.1%)
maybe	159 (26.4%)
Contraindications for corneal refractive surgery:
Keratoconus	75 (12.4%)
Age under 18 years old	443 (73.5%)
Thin cornea	304 (50.4%)
Unstable and progressive refractive errors within the previous two years	190 (31.5%)
I don't know	123 (20.4%)
Complications of corneal refractive surgery:
Feeling of a foreign body in the eye	266 (44.3%)
Dry Eye	275 (45.8%)
infection	263 (43.8%)
residual refractive errors after treatment	113 (18.8%)
I don't know	167 (27.8%)

Inferential analysis:

Studying the relationship between knowledge about refractive corneal surgery with sample demographics: When examining the relationship between prior knowledge about corneal refractive surgery and demographic factors, the results showed a statistically significant relationship as follows: The majority of students from the Faculty of Medicine, 48.2%, showed knowledge about refractive surgery significantly, compared to students from the Faculty of Dentistry, 22.3%, and Pharmacy, 29.4%. Knowledge was also associated with the academic year of the students, as knowledge increased with the gradual increase in the years of university study. Prior knowledge about refractive surgery was also linked to the main source of information about it. The majority of students learned about refractive surgery through friends and acquaintances 35.8% and social media 24.1%. (Table 4)

Table 4
		Are you aware of corneal refractive surgery?		Chi- square	p- value
		Yes	No	Chi- square	p- value
Gender	Male	202 (39.7%)	24 (28.9%)	3.507	0.061
Gender	Female	307 (60.3%)	59 (71.1%)	3.507	0.061
Age	18–22	459 (90.2%)	71 (86.6%)	2.288	0.319
	23–25	46 (9%)	9 (11%)
	> 25	4 (0.8%)	2 (2.4%)
Collage	Medicine	244 (48.2%)	18 (24.3%)	33.507	0.000
	Dentist	113 (22.3%)	9 (12.2%)
	Pharmacy	149 (29.4%)	47 (63.5%)
Academic year	First	87 (17.1%)	19 (22.9%)	14.512	0.013
	Second	115 (22.6%)	29 (34.9%)
	Third	120 (23.6%)	20 (24.1%)
	Fourth	98 (19.3%)	9 (10.8%)
	Fifth	79 (15.5%)	4 (4.8%)
	Sixth	10 (2%)	2 (2.4%)
Source of information about refractive surgery	Friends and acquaintances	181 (35.8%)	21 (26.6%)	29.838	0.000
	Social media	122 (24.1%)	24 (30.4%)
	Physician	116 (22.9%)	5 (6.3%)
	Lecture or seminar	55 (10.9%)	13 (16.5%)
	otherwise	32 (6.3%)	16 (20.3%)

The aim of this study is to assess awareness about corneal refractive surgery among Syrian university students and to determine the method they chose to correct macular refraction. This study also shows the importance of raising and increasing public awareness about a variety of eye diseases, especially refractive errors and surgery. Where the majority of the participating students mentioned their reliance on friends, acquaintances, and social media to obtain knowledge about corneal refractive surgery, as some of these sources are considered unreliable or sometimes inaccurate.

Of the 604 undergraduate students, 34.9% reported suffering from refraction. Similar to the findings of the Saudi study, where 47% of university students had some type of refraction. [4] Similarly, studies indicate a high and wide prevalence of refractive errors among university students. [5, 6] Studies also confirm that the worst refraction is more prevalent in higher university levels. [7] The length of the study period and students suffering from eyestrain were also contributing factors to the increased prevalence. [8, 9]

Our results showed that among those with the worst refraction, most had myopia at 24.5%, followed by hyperopia at 9.4%. It is similar to the results of the study in Saudi Arabia, where most of the university students suffered from myopia prominently. Studies also consistently show that myopia is the dominant type of refractive error [5, 6, 7], and in particular, myopia has been shown to be closely related to the student's educational level. [7].

Eyeglasses, contact lenses, and refractive surgery are the treatment options available to correct refractive errors [10]. Most of the students in our study used glasses (83%), while 13.8% reported using contact lenses, and 4.2% had already performed corneal refractive surgery to correct the refractive error. In a similar way to the findings of the Saudi study, the use of medical glasses was the most common, followed by contact lenses, and then corneal refractive surgery [4].

Refractive surgery has become increasingly popular over time and due to increased awareness on social media, but this has not affected the use of eyeglasses in the treatment of refractive disorders. Our results indicated that more than half of the students (58.8%) found their use of medical glasses comfortable, and the main reason was ease of use (55.3%). It corresponds to another study conducted in the Kingdom of Saudi Arabia, where more than half of the university students were comfortable with their medical glasses, due to the ease of access to them, which contributes to a better quality of life. [4]

On the other hand, the main reason for the discomfort of medical glasses was their impact on life or daily activities 44.4%, and that they were not aesthetically pleasing 18%. Several studies showed similar barriers to wearing eyeglasses as our study, indicating that eyeglasses caused some inconvenience in daily activities and did not appeal to some participants cosmetically. [11, 12]

86% were aware of corneal refractive surgery. This awareness rate is similar to the awareness rate in studies conducted among undergraduates in Saudi Arabia 92.1%, 92.5% in India [13], and 92.8% in Brazil [14]. However, about 38.4% of the students in our study were willing to undergo corneal refractive surgery which is similar to the study in India at 36.6%, and less than the rate of readiness of undergraduate students in Saudi Arabia for the surgery at 69.5%. [4]

Those who did not find themselves ready to undergo refractive surgery stated that the main obstacle was the lack of information about the procedure (39%). These findings herald a gap in knowledge about corneal refractive surgery. Compared to the results of the Saudi study, fear of complications was the most reason preventing them from undergoing surgery. [4]

It is interesting that the majority of students considered that the complications from this surgery were minor (50.5%) and not serious.

As for the type of surgeries they have heard about before, the most popular types of surgery are epithelial keratomileusis LASEK 78.1%, local laser keratomileusis LASIK 72%. This is similar to the results of the study in Saudi Arabia.[4] As for a previous study among the general population in Saudi Arabia, it showed that less than half of the individuals know about LASIK (45.7%) [5].

Declarations Ethical statement:

The ethical consent was obtained from Syrian private university ethical committee Competing Interest: the authors declare no competing of interests.

Availability of data and materials:

All data are available from the corresponding author on reasonable request.

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Evaluation of awareness about corneal refractive surgery to correct refractive error in a sample of Syrian private university students

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Version 1

Abstract

Background

Methods

Results

Conclusion

Background

Aim of the study:

Methods

Results

Descriptive analysis:

Inferential analysis:

Discussion

Declarations

References

Status:

Version 1