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PURPOSE: To investigate the impact of smart mobile phones utilization and applying Bandura's social learning theory in educating and raising awareness to glaucoma treatment compliance in primary chronic glaucoma Saudi patients, as well as examining the social learning process and determining the type of educational material (video, electronic document "brochure") with the highest efficacy in social learning as assessed by the change in Saudi patients' awareness. Finally to assess the variations contributing to chronic glaucoma patients' social learning. METHODS: A total of 150 Saudi patients with primary chronic glaucoma were recruited in our study. They were divided equally into three main groups: Control, electronic document brochure, and animated video. An electronic questionnaire was sent to them through WhatsApp twice, starting with the pretest and then after 1 week of the intervention the posttest questionnaire was sent. Results were collected for both the pretest and the posttest. The study was done at the outpatient clinic at King AbdulAziz University Hospital in Riyadh, Saudi Arabia. RESULTS: Upon comparison of the preintervention score for all groups, we found no significant difference. However, there was an improvement in the postintervention score among all groups in comparison to the preintervention score, with a statistically significant difference for the video group (P < 0.0001). Comparing the postintervention score for all groups, the video group was better than other two groups. CONCLUSION: Using mobile-based educational interventions may significantly increase patients' awareness. Both interventional methods were found to be effective in educating patients. However, video-based learning has been significantly more effective. Findings revealed that the most important factor is educational level, which enables better response to health education material.

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BACKGROUND Primary angle closure (PAC) is common in hyperopic eyes, but it is rarely observed in highly myopic eyes. Myopic eyes have a longer axial length and a deeper anterior chamber compared with emmetropic eyes and are considered to be protected from angle closure secondary to pupillary block. PAC can lead to irreversible loss of vision if left untreated. Hence, detection of these atypical cases is important to prevent the permanent sequelae associated with PAC. CASE REPORT We present a case of acute attack of PAC in a patient with high axial myopia. A 53-year-old woman with diabetes presented to the Emergency Department with a 1-week history of pain and redness in the right eye. Ophthalmic examination revealed a high intraocular pressure of 40 mm Hg associated with shallowing of the anterior chamber peripherally in the right eye. The patient's spherical equivalent was -11.00 diopters in the right eye. Gonioscopy confirmed the presence of a 360° appositional closure of the iridocorneal angle. An acute attack of PAC was diagnosed, and the intraocular pressure was decreased using topical and systemic antiglaucoma medications. Laser peripheral iridotomy was performed to abort the acute attack. CONCLUSIONS Although PAC is unusual in highly myopic eyes, ophthalmologists should maintain a high level of suspicion when such atypical cases are encountered. Myopic refraction does not exclude the possibility of angle closure, and gonioscopy should therefore be performed on all patients at the initial assessment.

Asunto(s)

Glaucoma de Ángulo Cerrado , Terapia por Láser , Miopía , Femenino , Glaucoma de Ángulo Cerrado/diagnóstico , Glaucoma de Ángulo Cerrado/cirugía , Gonioscopía , Humanos , Presión Intraocular , Iris , Persona de Mediana Edad , Miopía/complicaciones , Miopía/cirugía

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AIM: Primary open angle glaucoma (POAG) is a leading cause of permanent visual loss affecting significant numbers in Saudi Arabia. There is no cure for glaucoma but there is mounting evidence to guide ophthalmologists in diagnosing and managing this disease. The aim of this pilot project was to assess the compliance with evidence-based criteria and to implement an adapted clinical practice guideline (CPG) for the management of patients with POAG at a tertiary eye care center in Riyadh, Saudi Arabia that will lead to improving quality, consistency and optimizing patients' care. METHODS: The project consisted of three phases using audit and feedback strategy. It has utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. Eleven evidence-based audit criteria were developed. A baseline audit was then conducted. Barriers behind areas of noncompliance were identified and a number of strategies were implemented to overcome them. A follow-up postimplementation audit was then conducted. RESULTS: Twenty electronic medical files were randomly selected for baseline audit. The results of the audit have identified a number of possible areas to improve in the diagnosis and management of POAG in compliance with the adapted CPG with compliance rate as low as 20% (4/20) in some criteria. Multifaceted interventions were implemented targeting mainly attitude and lack of knowledge and time and resource barriers. Significant improvement occurred in most criteria audited postimplementation. CONCLUSION: The project demonstrates that audit and feedback is a feasible and effective tool to change glaucoma practice in a teaching hospital in Saudi Arabia. The success was due to multifaceted interventions including clear communication to promote awareness, an easily accessible CPG, and regular reminders to improve knowledge and change behavior. We propose our pilot implementation to be generalized to promote implementing evidence-based ophthalmology.

Asunto(s)

Práctica Clínica Basada en la Evidencia/organización & administración , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/terapia , Registros Electrónicos de Salud , Adhesión a Directriz , Hospitales de Enseñanza , Humanos , Ciencia de la Implementación , Proyectos Piloto , Arabia Saudita

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PURPOSE: The aim of this study is to assess the efficacy and safety of ExPress mini shunt in glaucoma patients of Middle Eastern descent. METHODS: This is a prospective cohort study. Uncontrolled glaucoma patients were subjected to ExPress mini-shunt implant. Pre- and post-operative glaucoma clinical indices were measured and compared. Both intra- and postoperative complications and surgical success rates were assessed. In addition to comparing a group of combined ExPress mini-shunt implant with cataract surgery versus ExPress mini-shunt implant alone. RESULTS: A total of 35 eyes of 31 patients were involved. The most common type of glaucoma was primary open-angle glaucoma in 13 eyes (37.1%). Fourteen eyes (40.0%) were combined ExPress device with cataract surgery. The mean intraocular pressure (IOP) (±standard deviation) at the last visit dropped from 24.6 mmHg (±8.3) to 13.9 mmHg (±4.5). There was a significant reduction in the number of postoperative glaucoma medications from 3.0 ± 0.5 to 1.3 (±0.7). In cases combined with cataract extraction, the patients required fewer anti-glaucoma medications. Complete success was achieved in 22 eyes (63%) and qualified success was achieved in 9 eyes (26%), whereas 4 eyes (11%) were considered a failure. The two most common complications encountered were hypotony (28.6%) and hyphema (11.4%). CONCLUSION: Among the studied population of patients, ExPress offers IOP reduction that is comparable to reported rates following standard trabeculectomy. Postoperative hyphema was encountered at a slightly higher rate.

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Bilateral optic nerve sheath meningioma is rare. A meningioma is a benign neoplastic lesion from meningothelial cells of the meninges. They usually involve the intracanalicular portion of the optic nerve but may extend into the optic canal and through it to occupy the intracranial space. We present a case of 25-year-old Saudi female with bilateral optic nerve sheath meningioma. The diagnosis was delayed more than six years from initial symptoms.