Evaluation of risk factors for ocular morbidities and its impact on the lives of medical students: An academic collateral.

Introduction

At least 2.2 billion people have vision impairment worldwide, and among these, 1 billion vision impairments are preventable.¹ Avoidable ocular morbidities are a significant public health problem in India.² Vision is an important and special sense of living beings. These days, it is common to find an increasing number of younger people and even children complaining about several vision problems apart from the age-onset eye conditions. The prevalence of myopia was attributed to urban lifestyle, family history, longer time spent on near-work activities, and fewer outdoor activities. Few surveys have explored the role of high exposure in developing cell phone vision syndrome among college students.³ Environmental factors, such as dryness, potentially contribute to ocular discomfort and alteration of the tear film.⁴ Ocular morbidities are common among medical students, although many areas in this field require good near and far vision.⁵ Sleep disorders and underlying diseases are also major concerns pertaining to the onset of vision-related tiredness.⁶ There is a need for standard vision testing in the young population to diagnose such problems at the earliest.⁷ The current study aimed to identify the risk factors for various vision problems among medical students that affect their lifestyles.

Medical students are prone to excessive device usage due to recent shifts to online mode during the pandemic, followed by a hybrid mode of study as well as a heavy load of academic involvement. We intend to identify the risk factors for vision problems among such students and their effect on the lifestyle of the students so that the issue of increasing ocular morbidities can be addressed.

Methodology

Results

Out of 312 majority were females (72.4%) and currently living in hostels (84.4%). Around 83.4% belonged to general caste and high socioeconomic status (86.5%).

202 students (64.7%) were suffering from ocular morbidities currently. Rest of the 110 students (35.3%) had ocular morbidities in the past. However, the students were having ocular symptoms (headache, strain in the eyes, itchiness, watery eyes, eye fatigue, dark circles, dry eye, etc.), among which headaches were the predominant symptom (39.1%). The majority revealed that there were no interventional procedures performed for their past ocular morbidities, except a few (4.3%), which were minor interventions such as chalazion cyst removal, Lasik, trauma, and foreign body in the eye, etc.

Out of 202 students who were suffering from one or other forms of ocular morbidity, the majority had myopia (84.3%), followed by astigmatism (6.4%), hypermetropia (3.3%), strabismus (1.9%), and others (4.1%), including glaucoma, color blindness, retinal thinning, granular corneal dystrophy, and the predominant symptom was headache (51.7%).

The age of onset of the ocular morbidity was ≤15 years in 62.8% of students. The most common presentation was headache (56%), followed by blurred vision (32%) where they were not inability to see the blackboard, red, dry, and watery eyes (8.2%), and regular checkup (3.8%). As perceived by the students, ocular morbidities have been managed; however, the conditions had variable outcomes in terms of 38.9% improvement, 37% not change, 22.7% worsened, and 1.4% were unsure of their conditions.

Likewise, (12.8%) few students had claimed the reason for their development of ocular morbidity after joining medical colleges.

Currently, 89.1% students were using spectacles and rest of them were either contact lenses or both. Amongst them, 88.2% were using it regularly and rest who were not using it regularly. The reasons stated were ignorance, not fashionable, not required for other than academics, non compliance due to unawareness, uncomfortable.

The mean power of right eye and left eye were -1.24 with a lowest of -0.5 to highest of – 8.5 & -1.21 with a lowest of -0.5 to the highest of -6.25 respectively. The majority had the last eye check-up for an average 6.8 months back.

Very few had any interventional procedures (3.8%) or had history (2.9%) majority (91.6%) had a family history of ocular morbidities in their family members. There were no associated co morbidities, except for few (8.6%) such as diabetes, hypertension, thyroid disorder, asthma, migraine, PCOS, epilepsy, bronchitis, and tuberculosis. Only 6% students had mentioned the presence of addiction in their families.

94 students were taking vitamin and mineral supplements attributed to doctors (62.4%) or parent’s (37.6%), including various forms such as Multivitamin, Vitamin B complex, Vitamin D, Iron or IFA, Calcium, Biotin, Omega 3, Vitamin B12, Zinc etc. When asked about the intake of vitamin A-rich food, almost all were eating it consciously or unconsciously in various forms; however, the frequency varied, as shown in Table 1.

Out of the 312, the majority, 84.4% preferred physical books to read, although virtual PDF books were available. Likewise, the majority (67.2%) used tables and chairs while reading, followed by other means, such as bed, couch, floor, and others [ Table 2].

Students had various forms of entertainment, either virtually via electronic devices (59.8%) or physically by interacting with friends and family (58%), followed by outdoor/indoor games (38%), video games, and various other social media interactions. The students were using devices for multiple purposes, but for varied periods of time, as per their needs [ Figure 1].

Figure 1. Average screen time of participants (N = 312 Medical Students).

When asked about adequate lighting, the majority (77.3%) said yes. However, the average number of windows and doors in the reading room was 1.5 and one, respectively, indicating that there was a lack of natural light in the room. Similarly, the average study hours during daylight were less than 3 h compared to study hours without daylight (i.e., 5 h). The majority had a mean sleep hour of 7.3 in the night and a total of 8.6 hours during the 24hours of the day and night. The sources of artificial lights were either light bulbs, tube lights, study lamps, or a combination of them [ Figure 2].

Figure 2. Sources of Artificial Light used by Participants (N = 312 Medical Students).

Early age of onset (<15 years of age) and regular eye check-ups (at least once in 6 months) were associated with improved outcomes (P < 0.0001) with respect to ocular morbid conditions. Inappropriate posture, more than five hours of screen time, and device intimacy were significantly associated (P < 0.0001) with ocular morbidities. The association between perceived adequacy of lighting and the occurrence of morbid ocular conditions was found to be insignificant. (P = 0.7705). Female sex and family history were also associated with ocular morbidities (P < 0.0001). Multivitamin supplementation was associated with a lower incidence of any form of ocular morbidity (P < 0.0001) [ Table 3].

18.7% of students confessed that ocular morbidity had restricted them from participating in activities or applying for a post, such as swimming, military/army/air force post, dance, a few sports, basketball, badminton, cricket, driving at night, watching 3D movies, continuous screen use, and seeing through microscopes, etc.

The students mentioned various challenges encountered with ocular morbidity and suggested solutions to overcome them through open-ended questions, which were presented as themes [ Figure 3].

Figure 3. Challenges and suggested solutions for ocular morbidities.

Discussion

The majority (57.4%) had myopia in the current study followed by other conditions. Studies has stated Refractive error is the most common ocular morbid condition among children.⁸ Likewise the most common presentation of ocular symptoms at onset was blurred vision, followed by headache. However, another study found that headache (50%) and dry eyes (45%) were the common ocular complaints, and myopia was common as well among the students.⁹

The students were concerned about the challenges encountered when dealing with ocular morbidities, such as the inability to study long hours and engaging with devices. Likewise, an observational study was conducted among 200 medical students who are using smart phone, laptops, and computers to determine the relationship between eye strain and related risk factors, which showed that most of the students had more than one symptom, such as headache (56.77%), eye strain (50.52%), blurring of vision (40.62%), and redness (23.95%). 85% of patients used electronic devices for longer duration of 4-10 hours, had more asthenopia or eye strain.¹⁰

Although inappropriate posture, more than five hours of screen time, and device intimacy had a significant association, the perceived adequacy of lighting had no statistically significant association with the occurrence of ocular morbid conditions. Another study on the prevalence of eye strain and other ocular morbidities among students inferred that low levels of lighting in the classroom may be an contributing factor for ocular morbidity.¹¹

The current study observed that female students and those with a family history of ocular morbidity were more vulnerable to ocular morbidity. Another study showed similar results, with a higher prevalence of ocular morbidity among females.⁸

The students suggested solutions to the perceived challenges pertaining to ocular morbidities, such as a vitamin A-rich diet, reduced screen time, yoga, hydration, and regular eye check-ups. Similarly, age <17years was found to be another factor responsible for the high prevalence of ocular morbidities, to which the suggested reasonable services were early screening and health education. Another study among medical students observed common ocular morbidities, such as refractive errors, dry eyes, and color blindness, directing frequent eye checkups.^12,13

As discussed in the study, students were predominantly myopic and using spectacles; they also perceived limitations in playing outdoor games and sports due to their ocular morbidity. Studies have found similar findings where myopia was the common ocular morbidity among medical students as a huge portion of their time was spent on near –work and doing indoor activities while very less in doing outdoor activities, which was indicated as a risk factor for myopia.^14,15

Conclusion

The study concluded that the most prevalent ocular morbidity among medical students was refractive error, with myopia being the most prevalent. Evaluation of various risk factors inferred that ocular morbidity in students was associated with familial history, female sex, appropriate posture while reading, screen time, device intimacy, and multivitamin supplementation. Ocular morbid conditions have adversely affected the students’ lifestyles and academics in terms of their inability to participate in sports and games, career aspirations, such as in the Army or Air Force, Navy, etc. Likewise, the inability to study long hours is another negative effect of ocular morbidity as perceived by the students, underscoring the need for early detection, preventive strategies, and health education interventions.