INTRODUCTION

Refractive error is one of the chief causes of visual damage in diverse parts of the world [1]. The World Health Organization (WHO) has considered refractive error correction precedence in the global initiative to reduce not inevitable blindness [2]. Uncorrected errors of refraction are a chief cause of visual damage and sightlessness, internationally. It is assessed that 153 million individuals worldwide have distance vision inferior to 20/60 due to uncorrected refractive errors [3]. The utmost modern method existing for the improvement of refractive error is refractive surgery. “Freedom from glasses” and cosmoses are creating refractive surgeries striking for young people [4].

Refractive corneal surgery and refractive lens surgery are two widely developed surgical procedures for the correction of refractive error [5]. Many people are not eligible for LASIK and any of the other treatments is a better option for them. However, the LASIK procedure is the most popular procedure being performed [6]. Even though the awareness about refractive surgery is high among students the preference and readiness to experience refractive surgery among undergraduate medical scholars were less due to the terror of complications and the price of the process [7]. There was a substantial correlation between educational rank and cognizance about refractive surgery [8]. One study from Iran revealed that 82.5% of contributors didn’t know that their eyesight can be upgraded by refractive surgery; therefore, physicians should offer patients information regarding this category of surgery and raise their awareness [1].

 An additional previous study on the Goan general population's awareness of errors of refraction correction by surgical dealing, 64% of applicants did not have information regarding the errors of refraction correction by surgery to improve their vision, while only 12% were aware of the adverse effects of refractive surgery [8]. A previous study in KSA to assess the Saudi population's knowledge regarding errors of refraction correction surgery found that; the majority of participants (53%) had a high level of knowledge, family, and friends were the main source of information, the level of knowledge was affected by the age, sex, area and educational level of the respondents. There was a modest degree of awareness that was found in postgraduates [9].

Rationale

According to the changes in the quality of life after a vision correction operation, it is important to address the impression of the general population (as they are may be affected by refractive errors) about these operations in Arar, Northern Saudi Arabia.

Aims and Objectives

This study was conducted to obtain information about the public awareness and perception of the discipline of the errors of refraction correction surgery in Arar, Northern Saudi Arabia.

Objectives

1. To study the prevalence of errors of refraction in the general population in Arar, KSA.
2. To analyze the awareness and perception of the discipline of the errors of refraction correction surgery in the general population in Arar, Northern Saudi Arabia.
3. To assess the preferences for the errors of refraction correction surgery in the general population in Arar, Northern Saudi Arabia.

MATERIALS AND METHODS

Study Design and Setting

A population-based cross-sectional study was carried out among the general population in Arar, Northern Saudi Arabia. The study will be during the period from October 1, 2022, to December 31, 2022.

Inclusion criteria include the Saudi general population aged 19-65, both males and females.

Exclusion criteria include non-Saudi, less than 18 and above 65 years, and who refused to participate in the study.

Sampling Method

Conveniences sampling technique

Sample Size

The minimum sample size for this study was found to be 380 and was decided according to the Swinscow equation, the selected level of confidence is 95%, the estimated prevalence was 50%, the maximum acceptable error = 0.05. So, the calculated minimum sample size was 384.

Data Collection

Data will be collected by a pre-designed online questionnaire sent to individuals with inclusion criteria self-filling the questionnaire that will compose of sociodemographic characteristics of the participants as age, gender, marital status, educational level, occupation, residence, and questions about the errors of refraction correction surgery. Data was collected using a self-administered questionnaire that was designed to assess the sociodemographic factors associated with knowing and doing vision correction surgery. The questionnaire included questions on age, sex, marital status, educational level, working status, whether they had visited an ophthalmologist in the last year, whether they had been diagnosed with hypermetropia or myopia, which eye suffered from myopia or hypermetropia, whether they had been diagnosed with color blindness, whether they were wearing optical glasses, reading glasses or contact lenses, whether they had been prescribed optical glasses but did not buy them, and whether they had done correction surgery before. The questionnaire was distributed to the participants during their visit to the hospital.

Pilot Study

A pilot study was conducted on 10% of the gathered sample to test the reliability and applicability of the study to ascertain the feasibility, applicability, and clarity of the tool, and no modifications were done.  Participants in the pilot study were excluded from the study.

Data Management

The collected data will be cleaned and analyzed using the Statistical Package for the Social Science (SPSS Inc. Chicago, IL, USA) version 23. Descriptive and analytical statistics will be utilized. Qualitative variables will be presented as percentages and proportions. Suitable tests of significance will be used. The P-value will be considered significant if < 0.05.

Ethical Considerations

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board. All participants were informed of the study's purpose and provided written informed consent. The confidentiality of the participants' information was maintained throughout the study.

RESULTS AND DISCUSSION

Table 1 presents the sociodemographic characteristics of the participants in this study (n=385). The sample is primarily composed of young adults aged 18-30 (53.8%), with a smaller proportion of participants aged 30-40 (18.4%) and 40-68 (27.8%). The majority of participants were female (82.6%), with a smaller proportion of males (17.4%). In terms of marital status, the majority of participants were married (50.1%), followed by single (46.8%), divorced (2.3%), and widow (0.8%). Educational level was diverse, but the majority of participants had University and more (80.3%), followed by intermediate education (4.9%) and Secondary education (14.5%), and only (0.3%) of participants with primary education. The majority of the participants were not working (59%) and a minority were working (41%).

Table 2 provides information on the medical history of the participants regarding ophthalmologic conditions. The majority of participants (72.2%) reported visiting an ophthalmologist in the last year, while 27.8% had not. The majority of participants (77.7%) had not been diagnosed with hypermetropia, while 22.3% had. A similar proportion of participants had been diagnosed with myopia (49.9%) and had not been diagnosed with myopia (50.1%). In terms of which eye suffered from myopia or hypermetropia, the majority of participants reported that neither eye was affected (50.4%), while 37.7% reported that both eyes were affected, 6.8% reported that the left eye was affected, and 5.2% reported that the right eye was affected. The majority of participants (97.7%) had not been diagnosed with color blindness, while 2.3% had. The majority of participants (68.1%) were not wearing optical glasses, while 31.9% were. Similarly, the majority of participants (79.2%) were not wearing reading glasses, while 20.8% were. The majority of participants (77.7%) were not wearing contact lenses, while 22.3% were. A large majority of participants (84.2%) had not been prescribed optical glasses but did not buy them, while 15.8% had. A large majority of participants (40.3%) had not been diagnosed with any ophthalmologic conditions, while the others had been diagnosed for different periods (5.7% for four years, 10.1% for less than a year, 4.9% for three years, 32.2% for five years or more, and 6.8% for two years). The majority of participants (80.8%) reported not having astigmatism, while 19.2% reported having astigmatism.

Table 3 presents the participants' knowledge of vision correction surgeries. The majority of participants (57.7%) reported that they knew about vision correction surgeries, while 42.3% did not. Among those who knew about vision correction surgeries, the majority (78.2%) believed that correction surgeries were the best method for correcting vision, compared to 3.6% who believed that contact lenses were the best method and 18.2% who believed that optical glasses were the best method. The majority of participants (80.8%) believed that correction surgeries were not dangerous, while 19.2% believed that they were. The majority of participants (39.2%) were not sure about the complications of correction surgeries, while 32.5% believed that the complications were mild, 6.8% believed that the complications were severe, and 21.6% believed that the complications were moderate. The majority of participants (82.9%) believed that correction surgeries could replace optical glasses, while 17.1% believed that they could not. The majority of participants (94.5%) reported knowing about different types of correction surgeries, but not all of them were sure about the type of surgery, and the most common surgeries that they knew were LASIK (63.4%), PRK (36.9%), and SMILE (7%). The reasons for not doing corrective surgery were Expensive (43.4%), Fear of complications (48.6%), Rumours that it is unsafe (25.5%), and Lack of information (26.5%). The majority of participants (43.4%) were not sure about the correction surgeries that they considered safe, while 3.4% considered SMILE safe, 23.1% considered PRK safe, and 42.3% considered LASIK safe. The source of the participants' knowledge was primarily friends and family (51.9%), physicians (48.3%), and social media platforms (39.5%). The majority of participants (55.1%) believed that recurrence could occur after correction surgeries, while 44.9% believed that recurrence could not occur. Finally, the majority of participants (37.7%) rated correction surgeries as 5 out of 5, while 33.2% rated them as 4 out of 5, 23.6% rated them as 3 out of 5, 3.6% rated them as 2 out of 5, and 1.8% rated them as 1 out of 5.

Table 4 provides information on the participants' history of vision correction surgery. The majority of participants (88.3%) reported that they had not undergone vision correction surgery before, while 11.7% had. Of those who had undergone surgery, the majority (7%) had undergone LASIK, 3.4% had undergone PRK, 0.5% had undergone SMILE, and 0.8% were not sure about the type of surgery. Among those who had undergone surgery, the majority (8.8%) reported that their experience was excellent, 1% reported that their experience was average, 1.3% reported that their experience was good, and 0.5% reported that their experience was poor. The majority of participants (88.3%) did not suffer from any complications after the surgery, 8.8% reported that they did not suffer from any complications, and 2.9% reported that they suffered from complications. The majority of participants (88.3%) did not have any problem with doing another correction surgery in the future, 7.8% reported that they did not have any problem with doing another correction surgery, and 3.9% reported that they had a problem with doing another correction surgery. Among those who reported having a problem, the majority (96.1%) did not specify the problem, while a small percentage cited medical concerns (1.8%), financial concerns (0.5%), and appearance (1.6%) as the problem. Finally, the majority of participants (88.6%) would recommend correction surgeries to their families, while 11.4% would not.

Table 5 presents the results of an analysis of the association between sociodemographic factors and knowledge of vision correction surgery among participants (n=385). The results indicate that there is a significant association between age and knowledge of vision correction surgery, with participants between the ages of 18 and 30 being more likely to know about vision correction surgery than those between the ages of 30 and 68 (p-value = 0.002). Additionally, there is a significant association between sex and knowledge of vision correction surgery, with male participants being more likely to know about vision correction surgery than female participants (p-value = 0.005).

The results also show that there is a significant association between marital status and knowledge of vision correction surgery, with divorced participants being more likely to know about vision correction surgery than widows (p-value = 0.047). Furthermore, there is a significant association between educational level and knowledge of vision correction surgery, with participants with intermediate education being more likely to know about vision correction surgery than those with primary education (p-value = 0.032).

Additionally, the results show that there is a significant association between wearing optical glasses and knowledge of vision correction surgery, with participants who wear optical glasses being more likely to know about vision correction surgery than those who don't (p-value = 0.000). Similarly, there is a significant association between wearing contact lenses and knowledge of vision correction surgery, with participants who wear contact lenses being more likely to know about vision correction surgery than those who don't (p-value = 0.005).

Table 6 presents the results of the analysis of sociodemographic factors associated with doing vision correction surgery among a sample of 385 individuals. The majority of participants (88.3%) reported not having done correction surgery before, while 11.7% reported having done so. The results show that age, sex, marital status, educational level, working status, and whether or not the individual visited an ophthalmologist in the last year were not significantly associated with having done correction surgery before. However, having been diagnosed with myopia, which eye suffers from myopia/hyperopia, and whether the individual is wearing contact lenses were significantly associated with having done correction surgery before. Overall, these results indicate that individuals who have been diagnosed with myopia, who have myopia/hyperopia in both eyes or who wear contact lenses are more likely to have done correction surgery before.