Oman Journal of Ophthalmology

: 2008  |  Volume : 1  |  Issue : 1  |  Page : 35--38

Selected Abstracts


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 Influence of Diabetes on the Validity Glaucoma Screening by Frequency Doubling Perimetry: A Hospital-Based Study in Oman

Diabetes Technol Ther. 2008 Aug;10(4):278-282

Khandekar R, Zutshi R, Ali M, Raisi AA, Dass H

Eye & Ear Health Care, Department of Non-Communicable Diseases Control, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman., British Columbia Center for Epidemiologic & International Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.

Background: A hospital-based study was conducted in 2007 in Oman to determine the validity of frequency doubling perimetry (FDP). The authors have compared the ability of FDP to detect glaucoma among patients with and without diabetes.

Methods: This was a validity study of the screening procedure. An ophthalmologist and an optometrist examined Omani persons >30 years of age with and without diabetes. They determined glaucomatous field changes by using FDP. The glaucoma specialist labeled the eye and the person as suffering from glaucoma if two criteria were present: (1) optic cup disc and other retinal changes suggestive of glaucoma and (2) field changes on automated perimeter suggestive of glaucoma. Ocular pressure was measured with a Tono-Pen((R)) (Medtronic Ophthalmics, Jacksonville, FL). We calculated the validity of glaucoma screening by FDP among persons both with diabetes and without diabetes.

Results: We examined 111 eyes of 56 Omani patients (55 eyes of 28 patients with diabetes and 56 eyes of 28 persons without diabetes). Two persons had a history of glaucoma in both eyes. Glaucoma screening by FDP detected five eyes (two eyes of patients with diabetes and three eyes of persons without diabetes) with glaucoma. The specificity of glaucoma screening among those with and without diabetes was 97.4% and 97.3%, respectively. The sensitivity was 6% and 11%, respectively, in these two groups.

Conclusions: Validity of glaucoma screening by FDP is not different among those with and without diabetes. In countries with high rates of diabetes, FDP could be used as a first-level screening tool for glaucoma.

 Should the health information glaucoma be hospital based or community based?

Saudi Med J. 2008 Aug;29(8):1156-8

Khandekar RB, Jaffer MA, Al-Harthy H

Department of Non-Communicable Disease Control, Director General of Health Affairs, Ministry of Health (Head Quarters) PO Box 393, Pin 113, Muscat, Oman. Tel. +968 (9) 2392070. Fax. +968 (2) 4601832.

E-mail: rajshpp @ omantel . net . om.

Objective: To compare the prevalence and incidence of glaucoma in 2005 of ≥ 30 years-old Omani population.

Methods: This was a retrospective review of health data type of study conducted in 2007. The study was conducted in the Eye & Ear Health Care Section, Department of Non-Communicable Disease Control, Ministry of Health, The prevalence of glaucoma was estimated through community based modified cluster type of survey. Incidence was estimated from Health Information and Management System (HIMS) Formula to calculate the prevalence from incidence of a chronic disease to compare these 2 estimates.

Results: We examined 3,324 persons of >30 years of age. The prevalence was 4.75% (95% confidence intervals 4.02-5.47) with an estimated 20,700 glaucoma cases in Oman. Ophthalmologists reported 1,290 new cases of glaucoma in the same age group. The incidence was 0.30%. The prevalence if calculated from the incidence rates among the population ≥ 30 years of age would be 0.30x16.1=4.8%.

Conclusion: The survey results are more reliable for policy making. However, HIMS could also generate reliable, periodic, low cost information on glaucoma that could help in estimating the prevalence, and monitoring the program approach to control glaucoma.

 A Survey of Community Members' Perceptions of Medical Errors in Oman

BMC Med Ethics. 2008 Jul 29;9(1):13. [Epub ahead of print]

Al-Mandhari AS, Al-Shafaee MA, Alazri M, Al-Zakwani IS, Khan M, Al-Waily AM,Rizvi S.

Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Oman.

Background: Errors have been the concern of providers and consumers of health care services. However, consumers' perception of medical errors in developing countries is rarely explored. The aim of this study is to assess community members' perceptions about medical errors and to analyse the factors affecting this perception in one Middle East country, Oman.

Methods: Face to face interviews were conducted with heads of 212 households in two villages in North Al-Batinah region of Oman selected because of close proximity to the Sultan Qaboos University (SQU), Muscat, Oman. Participants' perceived knowledge about medical errors was assessed. Responses were coded and categorised. Analyses were performed using Pearson's 2, Fisher's exact tests, and multivariate logistic regression model wherever appropriate.

Results: Seventy-eight percent (n=165) of participants believed they knew what was meant by medical errors. Of these, 34% and 26.5% related medical errors to wrong medications or diagnoses, respectively. Understanding of medical errors was correlated inversely with age and positively with family income. Multivariate logistic regression revealed that a one-year increase in age was associated with a 4% reduction in perceived knowledge of medical errors (CI: 1% to 7%; P=0.045). The study found that 49% of those who believed they knew the meaning of medical errors had experienced such errors. The most common consequence of the errors was severe pain (45%). Of the165 informed participants, 49% felt that an uncaring health care professional was the main cause of medical errors. Younger participants were able to list more possible causes of medical errors than were older subjects (Incident Rate Ratio of 0.98; PConclusion: The majority of participants believed they knew the meaning of medical errors. Younger participants were more likely to be aware of such errors and could list one or more causes.

 Orbital Infarction in Sickle Cell Disease

Am J Ophthalmol. 2008 Jul 26. [Epub ahead of print]

Ganesh A, Al-Zuhaibi S, Pathare A, William R, Al-Senawi R, Al-Mujaini A, Hussain S, Wali Y, Alkindi S, Zachariah M, Knox-Macaulay H

Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman.

Purpose: To determine the role of hematological and genetic factors in the development of orbital infarction in sickle cell disease.

Design: Retrospective, noncomparative case series.

Methods: Fourteen sickle cell disease patients were diagnosed with orbital infarction during a vaso-occlusive crisis. Clinical and radiological findings were reviewed retrospectively. Sickle cell disease patients without orbital infarction were recruited as controls after matching for disease severity. Sickle haplotypes were determined for all patients. Differences between groups were evaluated statistically.

Results: Patients with orbital infarction in sickle cell disease presented with acute periorbital pain and swelling with or without proptosis, ophthalmoplegia, and visual impairment during a vaso-occlusive crisis. Radiological findings included orbital soft tissue swelling (100%), hematoma (orbital, 36%; intracranial, 21%), and abnormal bone marrow intensities. Severity of orbital involvement was unrelated to that of the systemic disease (Pearson correlation coefficient, -0.1567). Affected patients predominantly had the Benin haplotype (P Conclusions: Orbital infarction is a potential threat to vision in sickle cell disease patients. Magnetic resonance imaging is more specific than computed tomography or nuclear scintigraphy in the evaluation of orbital changes. The degree of severity of the orbital manifestations appears unrelated to the severity of sickle cell disease. Patients with the Benin haplotype are more likely to develop orbital infarction during vaso-occlusive crises.

 Clinical Outcomes of Corneal Vertex versus Central Pupil References with Aberration-free Ablation Strategies and LASIK

Invest Ophthalmol Vis Sci. 2008 Jul 24. [Epub ahead of print]

Arbelaez MC, Vidal C, Arba Mosquera S.

Muscat Eye Laser Center, Muscat, Muscat, Oman.

Purpose: To compare the clinical outcomes of aberration-free ablation profiles based on the normal corneal vertex (CV) and the pupil center (PC) in relation to laser in situ keratomileusis. Aberration-free aspheric ablation treatments were performed in all cases.

Methods: Two myopic astigmatism groups (CV centered using the offset between pupil center and normal corneal vertex and PC centered using the pupil center) comprised of 24 and 29 eyes (16 and 19 patients), respectively, with a 6- month follow-up, were included. All enrolled eyes had 200 microns. In all cases, we performed standard examinations, and preoperative and postoperative wavefront analysis. Custom ablation software was used to plan aberration-free aspheric treatments, and a flying spot excimer laser system was used to perform ablations. The clinical outcomes were evaluated for predictability, refractive outcome, safety, ocular wavefront aberration, and asphericity.

Results: 38% of the CV eyes improved BSCVA compared with 24% of the PC eyes (comparison CV/PC P=0.38). Induced ocular coma was on average 0.17 micron for the CV group and 0.26 micron for the PC group (comparison CV/PC P=0.01 favouring CV). Induced ocular spherical aberration was on average +0.01 micron for the CV group and +0.07 micron for the PC group (comparison CV/PC P=0.05 favouring CV). Change in asphericity was on average +0.56 for the CV group and +0.76 for the PC group (comparison CV/PC P=0.05 favouring CV). No significant shift was observed in the pupillary offset after treatments.

Conclusions: In myopic eyes with moderate to large pupillary offset, CV-centered treatments performed better in terms of induced ocular aberrations and asphericity, but both centrations were identical in terms of photopic visual acuity.

 Knowledge and perceptions of diabetes in a semi-urban Omani population

BMC Public Health. 2008 Jul 22;8:249

Al Shafaee MA, Al-Shukaili S, Rizvi SG, Al Farsi Y, Khan MA, Ganguly SS, Afifi M, Al Adawi S.

Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Oman.

E-mail: [email protected]

Background: Diabetes mellitus is a major public health problem in the Sultanate of Oman. This study aimed to evaluate the knowledge and perception of diabetes in a sample of the Omani general population, and the associations between the elements of knowledge and perception, and socio-demographic factors.

Methods: The study was carried out in two semi-urban localities. A total of 563 adult residents were interviewed, using a questionnaire specifically designed for the present study. In addition to demographic information, the questionnaire contained questions on knowledge related to diabetes definition, symptoms, risk factors, complications and preventative measures, as well as risk perception for diabetes.

Results: Knowledge of diabetes was suboptimal. The percentages of correct responses to questions on diabetes definition, classical symptoms, and complications were 46.5%, 57.0%, and 55.1%, respectively. Only 29.5%, 20.8% and 16.9% identified obesity, physical inactivity and a positive family history, respectively, as risk factors for diabetes. A higher level of education, a higher household income, and the presence of a family history of diabetes were found to be positively associated with more knowledge.

Conclusion: This study demonstrated that there is lack of awareness of major risk factors for diabetes mellitus. Level of education is the most significant predictor of knowledge regarding risk factors, complications and the prevention of diabetes. Given that the prevalence of diabetes has increased drastically in Oman over the last decade, health promotion seems essential, along with other means to prevent and control this emerging health problem.

 Ipsilateral autorotational keratoplasty and cataract extraction in patients with trachoma and trauma in Oman: Report on visual rehabilitation

Ophthalmologe. 2008 Jul 12. [Epub ahead of print]

[Article in German] Bialasiewicz AA, Wali U, Shenoy R, Thakral A, Al-Fadhil N, Syed GR.

Department of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, Muscat, Oman, E-mail: [email protected]

Aim: To report on the results of visual rehabilitation by ipsilateral rotational keratoplasty (IRK) and cataract extraction in 17 patients with trachoma and with trachoma and trauma in Oman over 3 years.

Patients: Of 25 patients operated from 2001-2004 with IRK, extracapsular cataract extraction, and intraocular lens implantation, 17 eyes of 17 patients with cicatricial trachoma (WHO stage CO) could be followed up after 1 year. Group 1 comprised 11 eyes with ciatricial trachoma. In group 2, six eyes had additional traumatic corneal scars.

Methods: Surgery was performed using a motor trephine Keratron (Geuder), the Accurus 800 (Alcon) phacovitrectomy machine, and calculation for intraocular lens implantation (IOL: MZ60BD, Alcon) with a topography (Atlas, Humphrey Zeiss)-supported SRK II formula (OcuScanRxP, Alcon). RESULTS: Although only four of 17 patients had preoperative visual acuity (VA) at 5 m and one of 17 had VA at 1 m, postoperatively seven of 17 patients gained VA at 5 m and six of 17 at 1 m. Ambulatory vision was regained in 13 of 17 (78%) patients. Patients with trachoma and trauma benefited more from the surgery [vision increase in trachoma: eight of 11 eyes (73%); trachoma and trauma: five of five eyes (100%)]. Postoperative spherical refraction was -12.0D to +4.0D (median:+4.0D), and astigmatism ranged from 10D to 0.3D (median 5.35D). One eye was lost because of uncontrolled keratitis.

Conclusions: IRK with cataract extraction may provide ambulatory vision in patients with cicatricial trachoma and secondary dry eye syndrome living in developing countries where donor grafts are difficult to obtain and where postoperative follow-up of high-risk keratoplasty is impaired.

 Valsalva retinopathy in pregnancy: A case report

J Med Case Reports. 2008 Apr 7;2:101

Al-Mujaini AS, Montana CC.

Department of Ophthalmology, Sultan Qaboos University Hospital, Alkhod, Muscat, Sultanate of Oman. E-mail: [email protected]

Introduction: Valsalva retinopathy is a unilateral or bilateral condition that occurs when increased intra-thoracic or intra-abdominal pressure transmitted to the eye causes a sharp rise in the intra-ocular venous pressure, and rupture of superficial retinal capillaries. The patient often gives a history of a recent strenuous physical act, which could have increased the intra-thoracic pressure. Pregnancy is known to be a risk factor for Valsalva retinopathy.

Case Report: A 23-year-old woman in her seventh month of pregnancy presented with a history of decreased vision in her left eye of one-week duration. Examination of the affected eye showed best corrected visual acuity of 20/50, and fundus examination revealed a pre-retinal hemorrhage located in the macula. Based on clinical findings, the diagnosis of Valsalva retinopathy was made.

Conclusion: Retinal hemorrhages can be generated by Valsalva maneuvers. Pregnancy is a known risk factor for Valsalva retinopathy; however, the diagnosis should be made only after excluding other causes of retinal hemorrhages. It is a self-limited event. We report a case of Valsalva retinopathy complicating normal pregnancy and confirm that, to date, there is no evidence to indicate that there is a risk of recurrence following spontaneous vaginal delivery.

 Post-traumatic inflammation with an intraocular foreign body

Ophthalmologe. 2008 Jul;105(7):669-73

[Article in German] Bialasiewicz AA, Al-Zuhaibi SM, Ganesh A.

Department of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, 123, Al Khod/Muscat, Oman, E-mail: [email protected]

Background: To report on the diagnosis and management of a"firecracker" injury presenting with a post-traumatic intraocular inflammation.

Case Report: A 10-year-old boy sustained a penetrating 16-mm cornea-sclera blast injury to his left eye with uveal prolapse and hemophthalmus and doubtful light perception. The cranial computed tomography revealed a metallic intraocular foreign body (IOFB), retinal detachment, and subretinal and subchoroidal hemorrhage. After primary wound closure and antibiotic treatment for 1 week, increasing cell infiltration and amaurosis developed, and a lensectomy, pars plana vitrectomy, and extraction of the 17x7x7-mm encapsulated IOFB via a scleral tunnel was indicated.

Results: A vitreous specimen did not reveal microbial growth; however, plenty of polymorphonuclear cells, macrophages, and lymphocytes were observed. Spectroscopy of the IOFB showed copper, zinc, silicon, lead, and other metals. A diagnosis of noninfectious inflammation due to heavy metals, primarily copper (=chalcosis), was made. The postoperative course was unremarkable, the intraocular lens in place, fundus CDR 0.2, retina and macula attached, intraocular pressure 9 mmHg. Three weeks after surgery, the flash VEP showed absent potentials.

Conclusions: Large projectiles or parts should be removed from the eye immediately in order to prevent complications from toxic metallosis and early fibrotic reactions.

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

Eastern Med Health J. 2008 Jul-Aug;14(4)

Khandekar R, Shah S, Lawatti J

Department of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, 123, Al Khod/Muscat, Oman. E-mail: [email protected]

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

Publications with-out abstract:

Care of Diabetic Retinopathy Patients in Oman

Rajiv Khandekar, Ali Jaffer Mohammed, Jawad A Al-Lawati

SQUMJ March 2008 - Vol. 8, No. 1, p.5-9

Intraorbital Foreign Body: Clinical Presentation, Radiological Appearance and Management

Abdullah Al-Mujaini, Rana Al-Senawi, Anuradha Ganesh, Sana Al-Zuhaibi, Humoud Al-Dhuhli

SQUMJ March 2008 - Vol. 8, No. 1, p. 69-74