The Perception of Spectacles Use Among the General Population in Ha’il Region, Saudi Arabia: A Cross-Sectional Study

Introduction

Visual impairment and blindness are often caused by refractive errors, a common condition affecting an estimated 2.3 billion individuals worldwide.^1,2 Sadly, 153 million people with uncorrected refractive errors are estimated to suffer from visual impairment.³ The prevalence of refractive errors varies between 20 to 80.5% in different locations worldwide.^4,5 Moreover, it is worth noting that at least 80% of individuals over 50 require spectacle corrections for near vision.⁶ To address uncorrected refractive error, it is necessary to establish a comprehensive and self-sustaining system. This includes the development of human resources to provide eye care services and the provision of spectacles to correct vision.²

Among the available options for correcting refractive errors, spectacles are the most commonly used. They are a straightforward, cost-effective solution with a high success rate regarding visual acuity, quality of life, and cultural acceptance.⁷ Although spectacles have been deemed essential by the World Health Organization, it has been observed that people often do not wear them even when a specialist has prescribed them. This is attributed to the beliefs and attitudes of users, parents (in the case of children), and the community at large.^8,9 To address this issue, Vision 2020 was launched to improve public awareness and generate demand for services through community-based initiatives, primary eye care, and school eye health programs.⁶

It has been observed that a substantial number of individuals who experience visual impairment are situated in developing countries. Additionally, it has been noted that most of these individuals are students, with a significant proportion being women.^10–12 This condition has been recognized as a highly influential factor causing substantial societal socioeconomic setbacks. Its effects can manifest in various ways, including physical impairments, emotional strain, decreased social interaction, and an overall decline in living standards for those affected.

Such consequences can significantly impact the lives of individuals and require careful consideration to address and alleviate.^13–15 A research study was conducted in the Bisha region of Saudi Arabia, which revealed that refractive errors were responsible for causing visual impairments in 68% of the visually impaired population, which accounted for 11% of the total population.¹⁶ Similarly, other studies in the northern region of Saudi Arabia indicated that the prevalence of refractive errors was approximately 13.7% among primary school children aged 6–14 years, and 36% among older adults aged 18 years and above recruited from a primary care center.^17,18 Additionally, a study conducted among medical students aged 19–25 reported a higher prevalence of refractive errors (83%).^19,20

Due to the limited information about the perception of the Ha’il region population, Saudi Arabia, regarding general eye health and the importance of wearing prescribed spectacles, our study was conducted to explore the perspectives and associated factors regarding spectacles use among the population in Ha’il, Saudi Arabia. This study’s results can aid in modifying or reinforcing existing beliefs and attitudes while also serving as a foundation for future research on related subjects.

Materials and Methods

Consent and Ethical Approval

The study complies with the Declaration of Helsinki and has been reviewed and approved by the Research Ethics Committee (REC) of the University of Ha’il, Saudi Arabia. The research project approval number is H-2023-023 and was obtained on 09\01\2023. Participants took part on a voluntary and informed basis. No personal identifiers were collected.

Study Design

This cross-sectional study was conducted on a population sample from the Ha’il community in Saudi Arabia. Participant recruitment was done through a convenience sampling method, wherein an electronic questionnaire was distributed on several social media platforms. The aims and objectives of the study were presented at the start of the questionnaire, enabling the participants to make an informed decision about participation. Participants are people of both genders in the Ha’il region of Saudi Arabia. The sample size for the present study was 407, with different age groups and nationalities included.

Data Collection

From January to March 2023, data was collected through a self-administered online questionnaire composed of two sections measuring several variables. The questionnaire was developed after intensively reviewing the literature. To test for content validity, we consulted a panel of three ophthalmologists, and we modified the questionnaire according to their suggested comments. Then, a random sample of 10 participants was selected to test leading and complex questions, and those participants were then excluded from the final analysis. The tool reliability coefficient (Cronbach’s Alpha) was assessed, and a value of 0.83 was obtained. The first section concerned the participants’ sociodemographic information (age, gender, nationality, place of residence, educational level, etc.). The second section comprised twenty-eight questions about participants’ perceptions of optical glasses use and their correlation with daily life activities. This section included specific questions about the participant’s perception of refractive errors and their correction methods and how it affects their daily life.

Data Analysis

The data were collected, reviewed, and then fed to Statistical Package for Social Sciences version 21 (SPSS: An IBM Company). The statistical method used was two-tailed with an alpha level of 0.05, considering significance if the P value is less than or equal to 0.05. Descriptive analysis was done, and frequency distribution and percentage for study variables were shown, including participants’ personal data, eye vision problems, checkups, prescribed glasses, and contact lenses. Cross tabulation showing differences between the study groups (participants with vision problems and others without) was done using the Pearson Chi-square test and exact probability test for small frequency distributions.

Results

A total of 407 participants completed the study questionnaire. Participants’ ages ranged from 16 to more than 45 years, with a mean age of 31.2 ± 11.9 years old. Male participants were 221 (54.3%), and 245 (60.2%) had a university level of education.

The participants who reported having vision problems in our study were 190 (46.7%). Of those with diagnosed visual problems, refractive errors were the most prominent visual defect (77.4%), followed by amblyopia (20%), squint (3.2%), and retinal disease (1.6%). While 8.9% had other eye complaints, such as eye dryness, redness, and itching (Figure 1).

Figure 1 Types of reported vision problems among study participants in Ha’il, Saudi Arabia.

Out of the 190 participants with vision problems, 175 (92.1%) of them had undergone a vision examination previously, which was less than one year ago among 102 (58.2%) and 1 to 3 years ago among 56 (32%). The most reported diagnosis was myopia (69.2%), followed by astigmatism (22.1%) and hyperopia (20.3%). A total of 178 (93.7%) participants reported that wearing glasses improves their quality of life.

The presence of vision problems was significantly higher among older participants (> 45 years) compared to younger participants (74.3% vs 52.3%, respectively; P=0.003). More than half (54.3%) of female participants had vision problems compared to 40.3% of males (P=0.005). (Table 1)

Table 1 Distribution of Vision Problems by Participants’ Personal Data in Ha’il, Saudi Arabia

Most participants with vision problems (93.6%) were advised to wear prescribed eyeglasses; 88.4% of them wore the prescribed eyeglasses, and 78.3% took care of their glasses. Around 51.3% of them complained that glasses hurt their nose or ears. Also, a total of 33.1% of respondents with vision problems were given prescribed contact lenses, 30.8% of them wore the prescribed lenses, and 86.8% reported taking care of their lenses. (Figure 2).

Figure 2 Eyeglasses and lenses prescription and compliance among participants with vision problems.

About a third of the participants (32.4%) think that the long-term wearing of glasses worsens vision. On the other hand, 43% believe wearing glasses improves vision. A total of 75.2% think that long-term use of glasses will make them dependent on wearing eyeglasses. Additionally, 45.9% believe that long-term wearing of contact lenses worsens vision. On the other hand, 24.1% think that long-term wearing of lenses improves vision. A total of 60% think long-term use of lenses will make them dependent on contact lenses, and 88.9% think wearing lenses without care or concern for their safety could cause eye inflammation, infections, and further complications. (Table 2)

Table 2 Study Participants’ Perspectives on Using Eyeglasses and Contact Lenses

About 26% of participants had annual checkups. Also, 42.8% did not have a vision checkup as part of the school entry medical examination. A total of 42% have undergone ophthalmic interventions or planned to have one. The most reported reasons for planning to have a refractive error correction surgery in total were the fear of being dependent on glasses and/or lenses (72.5%), the following reason was occupation (23.4%), and lastly, they hate their looks in glasses (20.5%). (Table 3)

Table 3 Periodic Checkups and Eye Interventions Among Study Groups

Discussion

The Kingdom of Saudi Arabia has been committed to enhancing public health awareness and promoting the overall health of its citizens. As living standards continue to improve, individuals are becoming increasingly aware of their daily health concerns, particularly among the educated population.²¹

Our study revealed that the number of people with vision problems among participants was 46.7%, with refractive errors being the most common cause at 77.4%. The commonest diagnosis was myopia, with 69.2%, which is consistent with the reported data provided by Almudhaiyan et al.²² Also, there were some misconceptions regarding the use of spectacles and lenses among the participants, which would need further education and knowledge reinforcement, as more than a quarter of the population think that with long-term usage of glasses, their vision will worsen, and 45.9% think that with long-term use of contact lenses would worsen their vision. This perception may cause individuals who require vision aids to avoid obtaining the necessary correction for their eyesight, as they believe wearing glasses will further harm their eyes. Although school eye examination is essential in diagnosing refractive errors and other children’s vision problems, in order to help children increase their quality of life and prevent their vision from deteriorating even further in some conditions,²³ the number of people who got their eye examined during school in our study is 42.8%.

Our results showed that the participants believed their vision would deteriorate by wearing glasses or contact lenses (32% and 45.9%, respectively). Additionally, 75% of our participants’ perception of being compliant in wearing spectacles will make them dependent on them. Additionally, we found that more than half of the participants who wore eyeglasses or contact lenses (51.3%, and 54.7%, respectively) stated that the main barrier preventing them from being compliant with the spectacles is being annoyed and bothered by wearing them. These results differed from the findings in a study conducted in Oman, which showed that some of the barriers to wearing spectacles were losing or breaking the spectacles.²⁴ A different study, in Nigeria, awareness among spectacle wearers was relatively high. However, most participants reported their fear of complications. This concern further supports the need for spreading accurate knowledge through public health education and campaigns.²⁵

The majority of participants of our study stated that wearing eyeglasses improved their quality of life, which is consistent with a study from Oman where Khandekar et al reported a significant impact of correcting refractive errors on vision-related quality of life, especially among those who were compliant with wearing spectacles, who reported having a higher vision-related quality of life compared to those who were not spectacle-wear compliant.²⁶

These findings highlight the urgent need for a public ocular health intervention strategy in the region, especially since the majority of vision loss cases can be prevented or treated cost-effectively. Therefore, it is crucial to raise awareness about the importance of regular eye checkups and to make affordable and accessible treatment options available to the population.

Although the current study has made available important information, it also has some limitations. These include its cross-sectional design, data collection through self-reported measures, and the absence of some variables, such as management and outcomes. Therefore, studies supplemented with clinical assessment will be of value in addition to patient-reported outcomes.

Conclusion

Our study found that there were prevalent misconceptions among the participants regarding the use of prescribed eyeglasses and contact lenses. Thus, we advise the development of public health education programs and campaigns to spread accurate knowledge and information, as it appears that people avoid getting glasses due to them thinking that glasses will decrease their vision with long-term use. Thus, structured educational programs through mass media are necessary to increase knowledge about refractive errors and visual impairment and their corresponding treatment options. This study recommends devising a policy to improve the perception of the community, which could play a crucial role in addressing poor perceptions regarding the use of spectacles in the population.