- Email: [email protected]
Contact lenses in Saudi Arabia: An overview
Review Article
Contact Lenses in Saudi Arabia: Stella T. Briggs, PhD, and Alabi 0. Oduntan,
Contact lensesare relatively new in SaudiArabia, but interest in the lensesamongthe gopulationis increasingrapidly. In spiteof the short history of the lenses,practice, and practitioner standardsaregood. Refractiveerrorsandcataractstogetherhave a highDrevaIencerate within the kingdomand both could be treatablewith contact lenses.This article is a synopsisof the history, educationalactivities, and practice relating to contact lenses.Future pospectsfor the lensesin the kingdomare high.
Keywords: Contact lenses;Saudi Arabia; education;refractive errors Introduction Increasing numbersof’people in Saudi Arabia are becoming interested in contact lenseseither for the correction of refractive errors or for cosmetic purposes.Saudi Arabia is the largest country in the Arabian Gulf area, with a population of 16.9 million.’ With the oil wealth there have been rapid and quite significant development changesin the last 20 years that have affected the socioeconomicstatusof the country. These changesare reflected in the development of a well-integrated health care systemwith primary and specialist eye care services being delivered by health institutions and hospitals. The emphasison health care together with the wealthy economic statusof the country has attracted many contact lens companiesto the readily available market. This article presentsan insight into the various aspectsof contact lenses in Saudi Arabia, from past to future.
Addressreprint requeststo Dr. Stella T. Briggs,Departmentof Optometry, Collegeof Applied MedicalSciences, King SaudUniversity, P.O. Box 10219,Riyadh 11433,SaudiArabia. Accepted for publicationFebruary10, 1996. ICLC, Vol. 23, March/April, 1996 0 Elsevier Science Inc. 1996 655 Avenue of the Americas, New York, NY 10010
An Overview PhD
Background Eye diseaseshave always been recognized as a serious health problem in the Middle East, and in Saudi Arabia in particular. Previous estimatesby the World Health Organization indicate a 2% blindnessrate.’ A national eye survey in 1984, however, showsthat this hasdeclined to IS%, with another 7.8% visually impaired.3 In the nationwide survey, the main cause of blindness was cataract (55%), with refractive errors at 9%.3 Refractive error and cataract (after surgery) are obviously treatable. Methods of correction for refractive errors available in the Kingdom are spectacles, contact lenses,and refractive surgery.Spectaclesand contact lens modesare most popular. It is not certain when contact lenseswasfirst marketed in Saudi Arabia, but it appearsthis was around 1985. This assumptionis basedon the following: (1) representativesof CIBA Vision claim that they were the first to operate in the Kingdom in 1985; (2) summation of questionnaire replies from major contact lens companies.Most companiesclaim that hard and soft lenseswere introduced in 1985 and disposableswere introduced in 1992; and (3) unpublisheddata (A. Oduntan et al.) from a recent survey of contact lens practices in the Kingdom show that most of the practices were establishedbetween 1985 and 1994. In spite of the recent introduction of contact lensesto the Kingdom, they are quite popular among young adult, (especially in cities) as a meansof refractive error correction. Education and Educational Activities Optometric education started in Saudi Arabia in 1985, when the first classof students was admitted into the optometry program of the Department of Biomedical Technology at the King SaudUniversity. In 1993, the optometry program wasgranted departmental status.The inception of this 4-year baccalaureateprogram has given impetusto op0892-8967/96/$15.00 SSDI 0892-8967(96)00020-l
Contact Lenses in Saudi Arabia: Briggs and Oduntan tometry and contact lens practice in Saudi Arabia. This program is the only source of production of the muchneeded optometric and contact lens manpower for the country, in particular, and the Gulf area, in general. There is additional contact lens manpower provided by the medical schools, because ophthalmologists are involved in prescribing and/or fitting contact lenses. Since 1993, the optometry program has had three separate contact lens courses as opposed to two courses previously. The three courses in contact lenses are spread over three semesters. The first course covers the history of contact lens development; contact lens materials, soft lens design; basic contact lens parameters such as Dk, Dk/L, wetting angle, water content, and tear evaluation; and lens and ocular parameter measurements with emphasis on the fitting consrderation of soft lenses for optimal physiologic function. Criteria for patient selection, training, and lens care regimens are discussed. The second course is devoted mainly to hard contact lenses. Prefitting parameters are reviewed. Other topics include rigid lens design, fitting techniques, and care regimens. Fluorescein pattern, lens fit evaluation, overrefraction, and lacrimal lens calculations are included. The last of the three course series reviews various aspects of contact lens theory. The fitting of special lens designs, such as toric hard and soft lenses, bifocal, aphakic, keratoconic, and extended-wear lenses is taught. Special topics such as prism ballast, truncation, fenestration, and lens carriers are drscussed. In all three courses, special emphases are placed on the practical aspects, and by the end of the courses, students are expected to be able to examine and fit patients with any type of contact lens. Students are further exposed to practical aspects during their l-year internship period (after graduation) at various hospitals in the Kingdom. Practitioners have the opportunity to attend contact lens seminars (contact lens fitting, patient compliance, and practice management) organized by representatives of contact lens companies such as Vistakon, Bausch and Lomb, and Wesley-Jessen. Public enlightenment programs are sometimes undertaken by the Saudi Ophthalmological Society and some contact lens companies by distributing pamphlets on various aspects of contact lenses to patients at primary health care centers, hospitals, and eye care symposia. Other educational activities (of the contact lens companies) within the Kingdom are: Press releases on contact lenses to build awareness and education of the patients. Educational literature for the patients on contact lenses and compliance (available in clinics or hospitals). Training of practitioners in private eye clinics on the uses of the slit-lamp in contact lenses. The management of complications is also reviewed. Production of Contact Lens L&date Magazine for the Middle East by Vistakon (two issues a year); this publi-
l
cation reviews examination techniques, practice management, and complications and presents some updated clinical articles. Production of videos, posters showing complications associated with lens wear, and booklets on fitting techniques and practice management.
Legislature At present, there is no optometric or contact lens associations; hence, no professional law regulating the practice of optometry or contact lenses exists in the Kingdom. There is, however, a unit in the government Ministry of Health involved with monitoring the standard of optometric practice; invariably, this unit monitors the practice of contact lens. In spite of the absence of professional laws, the standard of contact lens practice in the Kingdom is good. This is because most practitioners are either optometrists or ophthalmologists with good clinical experience. The ready availability of contact lenses and solutions is also a contributing factor. Practice
and Practitioner
Profile
The majority of optometrists in the Kingdom practice contact lenses along with general optometric services, but some have specialized in contact lens fitting. All types of lenses are fitted, but 98% of contact lens wearers use soft lenses (unpublished data, S.T. Briggs et al.). All practitioners fit soft lenses, but not all fit hard lenses. The fitting of special contact lenses with advanced techniques is common. For example, such lenses have been used in the treatment of various cornea1 ecstasia such as keratoconus, keratoglobus, and pellucid marginal cornea1 degeneration.4 The level of practice is considered comparable to those in developed countries like America and Britain. The practices are well equipped for general optometric practice but not as well for contact lenses. Less than 35% have contact lens equipment such as radiuscopes, Burton lamps, ultraviolet lamps, measuring magnifiers, and Vgauges (unpublished data, A. Oduntan et al.). Lenses are not manufactured in the Kingdom but are supplied by international companies directly or through local agents. Some of the problems facing contact lens practice in most developing countries have been highlighted.5 These include: Absence of contact lens-manufacturing industries or laboratories with the resultant unavailability of specific lenses. Difficulty or delays in obtaining lenses and solutions because of strict foreign exchange or importation laws. Lenses are expensive to patients. Saudi Arabia is a developing country, but these do not pose serious problems in the Kingdom. Although there are
ICLC, Vol. 23, March/April
1996
47
no man&cturing companies, lenses and solutions are easily
of Contact
Lenses
The use and practice of contact lensesin Saudi Arabia are very promising. A representative of one of the contact lens-manufacturing companies claimed that their salesof lenseshas increasedfrom 2,000 in 1985 to 60,000 in 1995. The present need is quite high, but with greater awareness among the people regarding the importance of contact lensesin eye care, the desire for contact lens use will increasein the future. On a global scale,95% of the world’s blind people live in developing countries and 50% of this vision lossis due to unoperated CatdrdCt and is therefore curable.6 Uncorrected refractive error is also widespreadand is among the three most prevalent visual problems in most developing countries. These international data are quite similar to those of Saudi Arabia7 and emphasizethe need for refractive error correction and the potential need for contact lenses.Cataract and refractive errors together constitute major eye problems in Saudi Arabia. In a nationwide survey on eye conditions most commonly seenat the primary health care level, cataract had a national prevalence averageof 46.1% and refractive error had an average of 26.4%.7 After cataract extraction, the patient will need contact lensesto correct the aphakia or the residual refractive error after intraocular lens implantation. In recent years, there have been many advancesin contact lensesand lens care products that have virtually revolutionalized vision correction. Today’s contact lens technology is so advanced that almost anyone who wearsglasses
48
ICLC, Vol. 23, March/April
1996
can have his or her vision corrected with c:clnt;rit lensea. Disposablelensescan eliminate cleaning and everyday handling and therefore are especially suitable for Zl &st’rt LY\vironment. Contact lensesprovide man) heneflt,s,the IIRN obvious being the cosmetic aspect.With greater ,I\varene+. more people in the Kingdom will prefer contact lrnsrs t;~ refractive error correction. In Saudi Arabia, as thr literaillevel is rapidly increasingand ascontact lens manutiacturer~ are trying new products and improving existing ones the legions of contact lens wearerswill continue to grow. This will have a positive effect on the demand for contact lenses. Ways to increasethe demand for contact lensesare implrmenting improved clinical programs,increasingknowledge of contact lensesto both educators and students, and increasingpublic awarenessof contact lens usage.in the future, we may find more people preferring contact lensesto spectacles,resulting in an increased demand for contact lens practices and companies in Saudi Arabia. References 1.
2. 3. 4. 5. 6. 7.
Al-Mazrou YY: Primary health care in Saudi Arabia. Seminar on common eye disorders: Synopsis of lectures. King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, October 1993. World Health Organization: Report of Prevention of Blindness Profframme. Geneva, WHO, 1979. Report of the National Eye Survey, Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, 1985, pp. 35, 47, 62. Cameron JA, AldRajhi AA, Badr IA: Cornea1 ectasia in vernal keratoconjunctivitis. Ophthalmology 1989;96:1615-1623. Ukwade MT: Contact lens practice in Nigeria. Contact Lens J 1986;14:3-5. Thylefors, B: Worldwide need for vision care. Interoptics 1993;99:5. Al-Tuwaijri A: Resources services, patients and staff perception of Eyecare at the primary health care level in the kingdom of Saudi Arabia. Middle East J Ophthalmol 1994;2:72-83.
Contact Lenses in Saudi Arabia: Brings and Odunran Dr. Stella T. Briggs is an assistant professor of optometry at King Saud University, Riyadh, Saudi Arabia. She undertook her undergraduate studies at Indiana University and continued there for the MSc degree (optometry). She received her PhD degree in optometry from the University of Wales. Her area of specialization and main interest are in contact lens/cornea1 physiology. She has publications on cornea1 metabolism, contact lenses, and other aspects of optometry. She is a member of the British Contact Lens Association and the International Association of Contact Lens Educators.
Dr. Alabi Oduntan is an assistant professor at the Department of Optometry, King Saud University, Saudi Arabia, where he has lectured for 6 years. He received his BSc degree in optometry from the University of Benin, Nigeria, and his PhD degree from the City University, London. His research interest is in ocular anatomy and contact lenses. He is particularly interested in monitoring the progress of optometry and contact lenses in Saudi Arabia. He is a member of the Association of Contact Lens Educators.
ICLC, Vol. 23, March/April
1996
49
Contact Lenses in Saudi Arabia: Stella T. Briggs, PhD, and Alabi 0. Oduntan,
Contact lensesare relatively new in SaudiArabia, but interest in the lensesamongthe gopulationis increasingrapidly. In spiteof the short history of the lenses,practice, and practitioner standardsaregood. Refractiveerrorsandcataractstogetherhave a highDrevaIencerate within the kingdomand both could be treatablewith contact lenses.This article is a synopsisof the history, educationalactivities, and practice relating to contact lenses.Future pospectsfor the lensesin the kingdomare high.
Keywords: Contact lenses;Saudi Arabia; education;refractive errors Introduction Increasing numbersof’people in Saudi Arabia are becoming interested in contact lenseseither for the correction of refractive errors or for cosmetic purposes.Saudi Arabia is the largest country in the Arabian Gulf area, with a population of 16.9 million.’ With the oil wealth there have been rapid and quite significant development changesin the last 20 years that have affected the socioeconomicstatusof the country. These changesare reflected in the development of a well-integrated health care systemwith primary and specialist eye care services being delivered by health institutions and hospitals. The emphasison health care together with the wealthy economic statusof the country has attracted many contact lens companiesto the readily available market. This article presentsan insight into the various aspectsof contact lenses in Saudi Arabia, from past to future.
Addressreprint requeststo Dr. Stella T. Briggs,Departmentof Optometry, Collegeof Applied MedicalSciences, King SaudUniversity, P.O. Box 10219,Riyadh 11433,SaudiArabia. Accepted for publicationFebruary10, 1996. ICLC, Vol. 23, March/April, 1996 0 Elsevier Science Inc. 1996 655 Avenue of the Americas, New York, NY 10010
An Overview PhD
Background Eye diseaseshave always been recognized as a serious health problem in the Middle East, and in Saudi Arabia in particular. Previous estimatesby the World Health Organization indicate a 2% blindnessrate.’ A national eye survey in 1984, however, showsthat this hasdeclined to IS%, with another 7.8% visually impaired.3 In the nationwide survey, the main cause of blindness was cataract (55%), with refractive errors at 9%.3 Refractive error and cataract (after surgery) are obviously treatable. Methods of correction for refractive errors available in the Kingdom are spectacles, contact lenses,and refractive surgery.Spectaclesand contact lens modesare most popular. It is not certain when contact lenseswasfirst marketed in Saudi Arabia, but it appearsthis was around 1985. This assumptionis basedon the following: (1) representativesof CIBA Vision claim that they were the first to operate in the Kingdom in 1985; (2) summation of questionnaire replies from major contact lens companies.Most companiesclaim that hard and soft lenseswere introduced in 1985 and disposableswere introduced in 1992; and (3) unpublisheddata (A. Oduntan et al.) from a recent survey of contact lens practices in the Kingdom show that most of the practices were establishedbetween 1985 and 1994. In spite of the recent introduction of contact lensesto the Kingdom, they are quite popular among young adult, (especially in cities) as a meansof refractive error correction. Education and Educational Activities Optometric education started in Saudi Arabia in 1985, when the first classof students was admitted into the optometry program of the Department of Biomedical Technology at the King SaudUniversity. In 1993, the optometry program wasgranted departmental status.The inception of this 4-year baccalaureateprogram has given impetusto op0892-8967/96/$15.00 SSDI 0892-8967(96)00020-l
Contact Lenses in Saudi Arabia: Briggs and Oduntan tometry and contact lens practice in Saudi Arabia. This program is the only source of production of the muchneeded optometric and contact lens manpower for the country, in particular, and the Gulf area, in general. There is additional contact lens manpower provided by the medical schools, because ophthalmologists are involved in prescribing and/or fitting contact lenses. Since 1993, the optometry program has had three separate contact lens courses as opposed to two courses previously. The three courses in contact lenses are spread over three semesters. The first course covers the history of contact lens development; contact lens materials, soft lens design; basic contact lens parameters such as Dk, Dk/L, wetting angle, water content, and tear evaluation; and lens and ocular parameter measurements with emphasis on the fitting consrderation of soft lenses for optimal physiologic function. Criteria for patient selection, training, and lens care regimens are discussed. The second course is devoted mainly to hard contact lenses. Prefitting parameters are reviewed. Other topics include rigid lens design, fitting techniques, and care regimens. Fluorescein pattern, lens fit evaluation, overrefraction, and lacrimal lens calculations are included. The last of the three course series reviews various aspects of contact lens theory. The fitting of special lens designs, such as toric hard and soft lenses, bifocal, aphakic, keratoconic, and extended-wear lenses is taught. Special topics such as prism ballast, truncation, fenestration, and lens carriers are drscussed. In all three courses, special emphases are placed on the practical aspects, and by the end of the courses, students are expected to be able to examine and fit patients with any type of contact lens. Students are further exposed to practical aspects during their l-year internship period (after graduation) at various hospitals in the Kingdom. Practitioners have the opportunity to attend contact lens seminars (contact lens fitting, patient compliance, and practice management) organized by representatives of contact lens companies such as Vistakon, Bausch and Lomb, and Wesley-Jessen. Public enlightenment programs are sometimes undertaken by the Saudi Ophthalmological Society and some contact lens companies by distributing pamphlets on various aspects of contact lenses to patients at primary health care centers, hospitals, and eye care symposia. Other educational activities (of the contact lens companies) within the Kingdom are: Press releases on contact lenses to build awareness and education of the patients. Educational literature for the patients on contact lenses and compliance (available in clinics or hospitals). Training of practitioners in private eye clinics on the uses of the slit-lamp in contact lenses. The management of complications is also reviewed. Production of Contact Lens L&date Magazine for the Middle East by Vistakon (two issues a year); this publi-
l
cation reviews examination techniques, practice management, and complications and presents some updated clinical articles. Production of videos, posters showing complications associated with lens wear, and booklets on fitting techniques and practice management.
Legislature At present, there is no optometric or contact lens associations; hence, no professional law regulating the practice of optometry or contact lenses exists in the Kingdom. There is, however, a unit in the government Ministry of Health involved with monitoring the standard of optometric practice; invariably, this unit monitors the practice of contact lens. In spite of the absence of professional laws, the standard of contact lens practice in the Kingdom is good. This is because most practitioners are either optometrists or ophthalmologists with good clinical experience. The ready availability of contact lenses and solutions is also a contributing factor. Practice
and Practitioner
Profile
The majority of optometrists in the Kingdom practice contact lenses along with general optometric services, but some have specialized in contact lens fitting. All types of lenses are fitted, but 98% of contact lens wearers use soft lenses (unpublished data, S.T. Briggs et al.). All practitioners fit soft lenses, but not all fit hard lenses. The fitting of special contact lenses with advanced techniques is common. For example, such lenses have been used in the treatment of various cornea1 ecstasia such as keratoconus, keratoglobus, and pellucid marginal cornea1 degeneration.4 The level of practice is considered comparable to those in developed countries like America and Britain. The practices are well equipped for general optometric practice but not as well for contact lenses. Less than 35% have contact lens equipment such as radiuscopes, Burton lamps, ultraviolet lamps, measuring magnifiers, and Vgauges (unpublished data, A. Oduntan et al.). Lenses are not manufactured in the Kingdom but are supplied by international companies directly or through local agents. Some of the problems facing contact lens practice in most developing countries have been highlighted.5 These include: Absence of contact lens-manufacturing industries or laboratories with the resultant unavailability of specific lenses. Difficulty or delays in obtaining lenses and solutions because of strict foreign exchange or importation laws. Lenses are expensive to patients. Saudi Arabia is a developing country, but these do not pose serious problems in the Kingdom. Although there are
ICLC, Vol. 23, March/April
1996
47
no man&cturing companies, lenses and solutions are easily
of Contact
Lenses
The use and practice of contact lensesin Saudi Arabia are very promising. A representative of one of the contact lens-manufacturing companies claimed that their salesof lenseshas increasedfrom 2,000 in 1985 to 60,000 in 1995. The present need is quite high, but with greater awareness among the people regarding the importance of contact lensesin eye care, the desire for contact lens use will increasein the future. On a global scale,95% of the world’s blind people live in developing countries and 50% of this vision lossis due to unoperated CatdrdCt and is therefore curable.6 Uncorrected refractive error is also widespreadand is among the three most prevalent visual problems in most developing countries. These international data are quite similar to those of Saudi Arabia7 and emphasizethe need for refractive error correction and the potential need for contact lenses.Cataract and refractive errors together constitute major eye problems in Saudi Arabia. In a nationwide survey on eye conditions most commonly seenat the primary health care level, cataract had a national prevalence averageof 46.1% and refractive error had an average of 26.4%.7 After cataract extraction, the patient will need contact lensesto correct the aphakia or the residual refractive error after intraocular lens implantation. In recent years, there have been many advancesin contact lensesand lens care products that have virtually revolutionalized vision correction. Today’s contact lens technology is so advanced that almost anyone who wearsglasses
48
ICLC, Vol. 23, March/April
1996
can have his or her vision corrected with c:clnt;rit lensea. Disposablelensescan eliminate cleaning and everyday handling and therefore are especially suitable for Zl &st’rt LY\vironment. Contact lensesprovide man) heneflt,s,the IIRN obvious being the cosmetic aspect.With greater ,I\varene+. more people in the Kingdom will prefer contact lrnsrs t;~ refractive error correction. In Saudi Arabia, as thr literaillevel is rapidly increasingand ascontact lens manutiacturer~ are trying new products and improving existing ones the legions of contact lens wearerswill continue to grow. This will have a positive effect on the demand for contact lenses. Ways to increasethe demand for contact lensesare implrmenting improved clinical programs,increasingknowledge of contact lensesto both educators and students, and increasingpublic awarenessof contact lens usage.in the future, we may find more people preferring contact lensesto spectacles,resulting in an increased demand for contact lens practices and companies in Saudi Arabia. References 1.
2. 3. 4. 5. 6. 7.
Al-Mazrou YY: Primary health care in Saudi Arabia. Seminar on common eye disorders: Synopsis of lectures. King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, October 1993. World Health Organization: Report of Prevention of Blindness Profframme. Geneva, WHO, 1979. Report of the National Eye Survey, Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, 1985, pp. 35, 47, 62. Cameron JA, AldRajhi AA, Badr IA: Cornea1 ectasia in vernal keratoconjunctivitis. Ophthalmology 1989;96:1615-1623. Ukwade MT: Contact lens practice in Nigeria. Contact Lens J 1986;14:3-5. Thylefors, B: Worldwide need for vision care. Interoptics 1993;99:5. Al-Tuwaijri A: Resources services, patients and staff perception of Eyecare at the primary health care level in the kingdom of Saudi Arabia. Middle East J Ophthalmol 1994;2:72-83.
Contact Lenses in Saudi Arabia: Brings and Odunran Dr. Stella T. Briggs is an assistant professor of optometry at King Saud University, Riyadh, Saudi Arabia. She undertook her undergraduate studies at Indiana University and continued there for the MSc degree (optometry). She received her PhD degree in optometry from the University of Wales. Her area of specialization and main interest are in contact lens/cornea1 physiology. She has publications on cornea1 metabolism, contact lenses, and other aspects of optometry. She is a member of the British Contact Lens Association and the International Association of Contact Lens Educators.
Dr. Alabi Oduntan is an assistant professor at the Department of Optometry, King Saud University, Saudi Arabia, where he has lectured for 6 years. He received his BSc degree in optometry from the University of Benin, Nigeria, and his PhD degree from the City University, London. His research interest is in ocular anatomy and contact lenses. He is particularly interested in monitoring the progress of optometry and contact lenses in Saudi Arabia. He is a member of the Association of Contact Lens Educators.
ICLC, Vol. 23, March/April
1996
49