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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 33  |  Issue : 1  |  Page : 61-66

Awareness and practice toward refractive error correction methods among dental undergraduate students in a tertiary care center in Navi Mumbai


1 Department of Ophthalmology, MGM Institute of Medical Sciences, Navi Mumbai, Maharashtra, India
2 Department of Ophthalmology, Melaka Manipal Medical College, Malacca, Malaysia

Date of Submission23-May-2020
Date of Decision29-May-2020
Date of Acceptance01-Jun-2020
Date of Web Publication19-Apr-2021

Correspondence Address:
Dr. Mamta Agrawal
Alaknanda Building, D-3/304, Lokgram, Netivali Road, Kalyan East, Thane, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_66_20

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  Abstract 


Context: Visual impairment is one of the major health-care problems in the world. People pursuing higher education with long hours of studies and excessive near work are more prone to develop refractive error causing visual impairment. Dental students come into this category. In this study, we are trying to evaluate the level of awareness and practices of dental undergraduates toward refractive errors. Aim: The aim of the study was to assess the level of awareness and various practices toward refractive error correction methods among dental undergraduate students of a tertiary care center in Navi Mumbai. Settings and Design: A cross-sectional study was done by recruiting dental undergraduate students as the subjects, after obtaining ethical approval from the institute and informed consent from the students. Subjects and Methods: A random sample of 198 undergraduate dental students were surveyed by a questionnaire. A similar study was conducted in the Goan population, and the questionnaire was taken from that study. Statistical Analysis: Statistical Package for the Social Sciences (SPSS v 21.0, International Business Machines (IBM)) was used for the statistical analysis. Results: Of 198, a total of 165 students, 58 males (35.15%) and 107 females (64.84%), had got their eyes examined. It was found that 135 students (68.2%) knew the difference between ophthalmologist and optometrist. Females have more usage of spectacles. The use of glasses was maximum among the students with family income >180,000/annum. Around 82 (41.4%) students using spectacles noticed that the use of glasses causes limiting effects on their activities. Hundred and four students were aware of the refractive surgeries. There was a statistically significant difference seen about the awareness between students having annual income <30,000 and >180,000/annum (P < 0.05), and 111 students knew about the side effects of refractive surgery. Conclusion: There is a lack of knowledge about refractive errors among dental students. It is important to create awareness among them and thereby in the society.

Keywords: Awareness and practices, dental undergraduates, refractive errors


How to cite this article:
Ramakrishnan R, Agrawal M, Mehta I, Shrivastava S, Choudhary A, Abidi N. Awareness and practice toward refractive error correction methods among dental undergraduate students in a tertiary care center in Navi Mumbai. Kerala J Ophthalmol 2021;33:61-6

How to cite this URL:
Ramakrishnan R, Agrawal M, Mehta I, Shrivastava S, Choudhary A, Abidi N. Awareness and practice toward refractive error correction methods among dental undergraduate students in a tertiary care center in Navi Mumbai. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Jun 18];33:61-6. Available from: http://www.kjophthal.com/text.asp?2021/33/1/61/314103




  Introduction Top


Visual impairment is one of the major health-care problems in the world. The most common visual impairment is caused due to refractive errors. There are different types of refractive errors such as myopia, hypermetropia, and astigmatism. In emmetropia, parallel rays of light coming from infinity are focused on the retina, causing the formation of a sharp image with accommodation at rest. When these rays of light are focused in front of the retina, it is called myopia, and when these rays are focused behind the retina, it is called hypermetropia. Astigmatism is a type of refractive error where refraction varies in different meridians.

Various studies on the prevalence of refractive errors among medical students were done which showed that in Pakistan, the prevalence was 58%, Norway: 50%, Copenhagen: 50.3%, Turkey: 32.9%, Singapore 90%, China 71%, and in Western India, it was 45%.[1]

Uncorrected refractive error is the second most common cause of blindness globally, first being cataract.[2] Uncorrected refractive error gives rise to strabismus, amblyopia, etc., Vision is an important indicator of a person's standard and quality of living. To have a better lifestyle and quality of living, it becomes important to treat the vision-related problems. Hence, a good knowledge about the refractive error is necessary.

Refractive error is more common among the students pursuing higher education due to exhausting hours of studies which causes eye strain.[1] Sometimes, refractive errors are asymptomatic, and sometimes, it presents with asthenopic symptoms of headache, blurring of vision, and watering on long hours of studies or near work. Screening and examination should be done carefully in such cases. Apart from having the knowledge about refractive errors, the dental undergraduates should also know about the consequences of uncorrected refractive error and about their treatment options. Different options such as spectacles, contact lenses, and various refractive surgeries are available according to the need and comfort of the individual.

People pursuing higher education with long hours of studies and excessive near work are more prone to develop the refractive error.[1] Dental students come into this category and have to do exhausting hours of studies and near work on dental casts. Thus, awareness about refractive error among them becomes important. In this study, we are trying to evaluate the level of awareness and practices of dental undergraduates toward refractive errors. This would help to give them a correct and better guidance to deal with their refractive problems.


  Subjects and Methods Top


Aim

The study aims to assess the level of awareness and various practices toward refractive error correction methods among dental undergraduate students of a tertiary care center in Navi Mumbai.

Objectives

  1. To assess the awareness regarding


    1. Difference between an ophthalmologist and an optometrist
    2. Usage and limiting effect of glasses
    3. Use of contact lenses with their associated side effects
    4. Maintenance and hygiene of Contact lens
    5. Awareness of refractive surgery and its side effects.


  2. To assess the relationship between various methods of refractive error correction with.


    1. Gender
    2. Financial status.


Inclusion criteria

Undergraduate dental students learning in a tertiary care center in Navi Mumbai were included in the study.

Exclusion criteria

Undergraduate dental students refusing consent for the study were excluded from the study.

Study period

This study was conducted from January 2020 to March 2020 (duration – 3 months).

Study design

A cross-sectional study was done by recruiting dental undergraduate students of a tertiary care center as the subjects, after obtaining ethical approval from the institute and informed consent from the students.

Study sample

The study sample was calculated using the formula, N = z2 P (1-p)/d2

Study procedure

A random sample of 198 undergraduate dental students who were willing to participate were surveyed by a questionnaire. A similar study was conducted in the Goan population, and the questionnaire was taken from that study.[3] The questionnaire comprised ten questions [Figure 1]. They all were closed-ended questions in the form of Yes/No. All the statistical analyses were done using the IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
Figure 1: Survey questionnaire for dental undergraduates

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  Results Top


A total of 198 dental students were surveyed, all belonging to the age group of 20–22 years. Of which 72 were male students and 126 were female students [Figure 2]. They were divided into five groups according to their annual income of the parents [Figure 3].
Figure 2: Distribution of the study population as per the gender

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Figure 3: Distribution of the study population as per the annual income

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Eye examination and awareness of difference between ophthalmologist and optometrist

Of 198, a total of 165 students have got their eyes examined [Figure 4], in which 58 were male students (35.15%) and 107 female students (64.84%), as shown in [Figure 5]. Females were more cautious and approached the doctor more frequently as compared to males. They came with asthenopic symptoms such as headache, watering, burning sensation, and straining of eyes. It was found that 135 students (68.2%) knew the difference between ophthalmologist and optometrist [Figure 4], of which 90 were female and 45 were male [Figure 5]. It was observed that students with higher annual income were more likely to get their eyes examined at least once in their lifetime. Amongst the students who had got their eyes examined, a statistically significant difference was seen between the students having annual income <30,000 and > 180,000 (P < 0.01, 0.05) as shown in [Figure 6].
Figure 4: Response of the study population to all questions

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Figure 5: Response of the study population as per the gender

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Figure 6: Response of the study population as per the annual income

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It was noted that students got their eyes examined mostly twice a year, and the frequency of examination was more in students with an income above 180,000 [Figure 6].

Usage of glasses and its limiting effects

A total of 104 students were using spectacles to correct their refractive error [Figure 4], included 35 male (33.6%) and 69 female students (66.24%), as shown in [Figure 5]. Besides this, the use of glasses was maximum among the students with family income >180,000/annum [Figure 6]. There was a statistically nonsignificant difference seen for the frequencies between the groups (P > 0.05). Around 82 (41.4%) students using spectacles noticed that the use of glasses causes limiting effects on their activities such as swimming, having a bath, and watching a three-dimensional movie [Figure 4]. It was more common among female students [Figure 5] and those having family annual income >180,000 [Figure 6].

Awareness of the use of contact lenses, its side effects, and its maintenance and hygiene

It was seen that a total of 42 students [Figure 4], 13 male students (30.95%) and 29 female students (69.04%), were aware of the use of contact lenses instead of spectacles [Figure 5]. Knowledge was maximum among the students with family income >180,000/annum [Figure 6]. There was a statistically nonsignificant difference seen for the frequencies between the groups (P > 0.05). All these 42 students aware of contact lenses knew about its side effects and maintenance and hygiene [Figure 4].

Awareness of refractive surgery and its side effects

One hundred and four students were aware of the refractive surgeries being done for correction of various refractive errors [Figure 4], of which 39 (37.5%) were male students and 65 (62.5%) were female students [Figure 5]. Students with parents having family income >180,000 were mostly aware of it [Figure 6]. There was a statistically significant difference seen about the awareness between students having annual income <30,000 and >180,000/annum (P < 0.05), as shown in [Figure 6]. It was observed that 111 students knew about the side effects of refractive surgery [Figure 4], of which 36 were male students and 75 were female students [Figure 5], in which maximum of them had family income >180,000/annum [Figure 6].


  Discussion Top


According to the WHO, visual impairment due to uncorrected refractive error is seen in 200–250 million population.[4] Hyperopia (spherical equivalent of + 2.00 and higher) is the main refractive error seen in children of 4–6 years of age.[5] As the age increases, myopia becomes more common, especially in adolescents and young adults.[4] After the age of 40–45 years, presbyopia comes into the picture. Children fail, adults cannot work efficiently, and the elderly population cannot do their day-to-day activities due to uncorrected refractive errors. Thus, refractive error is seen in all age groups.

In this study, we have tried to know the overall knowledge about the common ophthalmic treatment modalities among the dental students. It is just a survey to create awareness on the whole among dental students and note the areas where it is necessary to educate them more. Dental students being future doctors might be asked by the general public about certain basic questions related to ophthalmology. Hence, it becomes important for them to know about it for themselves and the society. This would help to deal with the common public health issue of uncorrected refractive error. It is a sad to note only 68% of the students know the difference between ophthalmologist and optometrist. We also concluded that knowledge varies with socioeconomic status of the family of dental students. Students belonging to a higher socioeconomic status were more aware about the treatment modalities and were also getting routine checkups done. Thus, the economy plays an important role in the quality of life and standard of living. There are students who consider that glasses have a limiting effect on their daily life. This turns out to be one of the major reasons for noncompliance. Unaware of the consequences of not using it and having zero ideas about the other options available further restrict the use of glasses.

Dental students do a lot of fine work in a small area (oral cavity) with a small amount of light actually reaching in the cavity. Good depth perception and clarity in work make their work easier and give better results. If their own refractive error remains uncorrected, the ease and accuracy in work decrease. Thus, it is important for dental students to have a better awareness of refractive error to not only create awareness in the society but also increase their own efficiency at work.

Agrawal et al. studied 432 dental students and found that the prevalence of refractive error among the dental students was 64.81%, which included 76 (27.14%) male students and 204 (72.85%) female students. Myopia was the most common refractive error seen among them. The incidence of myopia was found to be 70.4% among the dental population surveyed.[1]

It is also seen that parents tend to delay routine ophthalmic checkups of their children as they are not aware of refractive errors and its consequences. Children frequently visit dentists, especially during exfoliation, can serve as a platform to create awareness among the parents and the children about ophthalmic checkup. Along with their dental camps, a small talk on refractive errors, their symptoms, and importance of its correction can help to create awareness. To bring these strategies into action, it is important that dental students have a basic knowledge about the refractive error.

Usgaonkar and Tambe concluded that of 200, 75% of the participants knew about the difference between an “ophthalmologist” and “optometrist.” Fifty-nine percent were unaware of contact lens use, 77.5% about cosmetic contact lenses, and 62% about the side effects of contact lenses. Sixty-four percent of the participants were not aware of the refractive surgeries done for improvement in vision and decreasing spectacle dependency. Twelve percent were aware of the side effects of refractive surgery.[3]

Aldebasi noticed that of 2039, 8% of the study population wore spectacle. Only two-third of the population knew the importance of spectacles. Intellect was the determining factor in how people consider optical correction (21% of basic intellectual background thought that it was important to wear glasses against some 40% of higher intellect). People with higher education are more aware of the visual symptoms that need care (37% against only 26%), presbyopia condition (23% against 11%), an urgency to seek eye care (85% against 29%), and factors aggravating refractive errors in children (45% against 29%). Knowledge about the different forms of optical correction showed a higher preference for spectacles against both contact lenses and refractive surgery.[4]

With this survey, we aim to enlighten dental undergraduates with the knowledge of all the different modalities available for the treatment of uncorrected refractive errors. It also aims to educate them about the advantages and disadvantages of various vision improving methods so that more people can be reached and the health-care system can improve. It is thus crucial to use this statistics for the betterment in future.


  Conclusion Top


We have noticed in this survey that there are a lot of loopholes in the knowledge about refractive errors and its correction options among the dental undergraduate students. It is thus important for the ophthalmologist and optometrist to create more awareness among the dental students about the same by arranging more eye camps and adding new strategies to decrease the burden of uncorrected refractive errors among the dental undergraduates and the society.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agrawal M, Agrawal S, Singh P, Rastogi R, Dutta SD. Prevalence of refractive errors among dental students. Indian J Res Pharm Biotechnol 2014;2:1417.  Back to cited text no. 1
    
2.
Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology 2016;123:1036-42.  Back to cited text no. 2
    
3.
Usgaonkar D, Tambe D. Awareness and attitude toward refractive error correction methods, among goan population. IOSR J Dent Med Sci 2018;17:4-10.  Back to cited text no. 3
    
4.
Aldebasi Y. Young public's awareness to refractive error deficiency. Int J Health Sci 2011;5:9-15.  Back to cited text no. 4
    
5.
Ip JM, Robaei D, Kifley A, Wang JJ, Rose KA, Mitchell P. Prevalence of hyperopia and associations with eye findings in 6- and 12-year-olds. Ophthalmology 2008;115:678-850.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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