-The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia

The scope of the kingdom of Saudi Arabia

In 2023, a study conducted in Makkah, Saudi Arabia revealed that the majority of parents lacked knowledge of pediatric eye conditions, with 72.8% reporting insufficient awareness, 24.5% reporting decent awareness, and only 2.8% reporting exceptional awareness.⁷ Among the identified symptoms, eye redness had the highest percentage of symptoms that would prompt parents to bring their children to an eye specialist, with 24.5% of parents indicating that they would seek medical attention for this symptom. Interestingly, the study found that a significant percentage of parents (68.5%) would allow their children to undergo eye surgery if necessary. However, among those who refused (11.3%), fear of the surgical outcome was the most commonly cited reason for their refusal.⁷

In 2022, a study was conducted in Madinah, Saudi Arabia, to assess parental awareness and perceptions of pediatric eye diseases. The study found that 3.6% of parents had excellent knowledge of pediatric eye diseases, 18.2% had good awareness, and the majority of parents (78.2%) had poor awareness of these conditions.⁸ The study showed that parents had better knowledge of pediatric cataracts, childhood glaucoma, and amblyopia, with 51.7%, 11.7%, and 12.4% of parents having good knowledge of these conditions, respectively. The study also found that the majority of parents had favorable attitudes towards their children wearing glasses (76.9%) and having eye surgery when necessary (85.4%). The preferred sources of information for parents were doctors, campaigns, and social media. More than half of the participants (58.6%) reported having their children’s eyes examined. Parents with a child with an eye condition, those 51 years of age or older, those with a higher income level, those of Saudi origin, and those with a child with an eye ailment had significantly higher knowledge scores.⁸

In November 2022, a descriptive cross-sectional study was conducted in the Aseer region of Saudi Arabia, targeting all parents. The study collected data from 899 parents who completed an online questionnaire developed by the study investigators. The study found that 54% of the responding parents were aged 30-50 years, and 51.2% were males. Almost half of the parents (46.2%) had a university-level education, and nearly half (48.5%) accompanied their children for eye examinations. Approximately 65% of parents knew about clinics for eye examinations, and 63.3% of them knew that blind children could learn. The study also found that parents’ awareness levels varied significantly based on factors such as age, education level, family status, and attitudes towards eye surgery for children. For instance, parents aged 50 years and older and those with a university-level education had a higher awareness level than their counterparts. Parents who lived with their families and those who had a blind child in their family also had a higher awareness level. Parents who accompanied their children for eye examinations and those who had a positive attitude towards their children undergoing eye surgery also had a higher awareness level. Overall, more than one-third of parents were aware of pediatric eye care. The study concluded that while parents in the Aseer region were aware of pediatric eye health and sought eye care for their children, there is a need for planned awareness programs to educate parents and assist them in overcoming the fears and barriers that prevent them from seeking eye care for their children.^9–12

In a descriptive cross-sectional study conducted in 2019 in Arar city of Northern Border in Saudi Arabia, a stratified sample of Saudi parents from 1986 was interviewed to assess their perception and awareness of pediatric eye diseases. The sample consisted of 1030 (52%) females and 956 (48%) males. The study found that there is a need to further improve parents’ understanding of pediatric eye conditions in Arar. The authors recommended more concentrated educational initiatives to promote early detection and appropriate therapy of pediatric eye diseases.¹⁸ Targeted educational programs focusing on pediatric eye diseases could be a useful approach to improving awareness and promoting early detection and treatment in the region.

Outside the scope kingdom of Saudi Arabia

In 2018, a cross-sectional study was conducted in Koh-i-Sulaiman, a remote area of Baluchistan in Pakistan, to assess parental awareness of their children’s eye health. The study used a self-made questionnaire to collect data from 150 parents, of which 100 were female and 50 were male. The parents were divided into two groups: literate and illiterate. The study found that parents who were literate reported seeing eye abnormalities in their children more frequently than illiterate parents. Additionally, the majority of literate parents were aware that wearing glasses could correct bad vision. The study also found that illiterate parents learned about eye health primarily through the radio and local sources, while literate parents relied on newspapers, television, and local resources for information. Furthermore, the study found that parents with less education were more interested in information about complications, while parents with more education were interested in information on symptoms, treatments, and prevention. The study concluded that parents’ literacy level played a significant role in how they perceived eye conditions, but overall, most parents lacked sufficient knowledge about eye diseases due to a lack of resources and education in the region. The study highlights the need for targeted educational programs to improve parental awareness and education about pediatric eye diseases in remote areas of Pakistan.¹³

Similarly, in 2018, a qualitative study conducted in Benin City, Nigeria, aimed to understand how parents view and perceive eye disorders in their children. The study found that the majority of causes of childhood blindness could be avoided or treated, emphasizing the importance of early detection and treatment of eye conditions. The study highlights the need for increased awareness and education among parents in Nigeria about the importance of regular eye examinations for their children and the availability of treatments for eye disorders.⁴ In Benin City, Nigeria, a study was conducted to assess parental awareness of common eye conditions in children. The study recruited 35 parents aged 38 to 54 years, and ten eye care professionals aged 30 to 45 years. The study found that the majority of parents had some awareness of common eye conditions such as blurry vision, cataracts, conjunctivitis, itching and redness, crossed eyes, strabismus, short-sightedness, and stye or hordeolum. However, the study also found that some parents had false ideas about the causes of eye conditions in children. For instance, some parents believed that measles could cause eye problems, while others thought that watching too much television or using a computer could cause eye strain. The study also found that parents commonly used self-medication and local remedies, such as chloramphenicol eyedrops, to treat eye conditions before seeking medical attention. The study highlights the need for public education programs to improve parental awareness of the causes of eye conditions in children and to discourage self-medication, which can be harmful in some cases.⁴

In a cross-sectional survey conducted in Riyadh, Saudi Arabia, in 2017, 1070 Saudi adults participated, out of a total of 1500 invited participants. The study found that the majority of individuals scored poorly (91.9%) on a knowledge test about eye health and care. However, the study also found that individuals with a higher level of education, such as those with university degrees, had a higher level of acceptable knowledge (64.4%). Participants who were retired had the highest mean knowledge score (7.25), followed by those working in the medical sector (6.55), while students had the lowest mean knowledge score (2.47). The study also found that community members were the most frequently referred to as sources of information. The highest percentage of participants (82.8%) knew that diabetes can cause eye problems, while the lowest knowledge scores were for eye conditions such as strabismus, visual deprivation, glaucoma, and eye tumors. The study highlights the need for awareness campaigns to concentrate on parents, particularly mothers, to improve their knowledge of common pediatric eye diseases and recommended eye care practices. Additionally, the study emphasizes the importance of education in promoting health consciousness and improving knowledge of eye health and care in the general population in Saudi Arabia.¹⁴

Due to the limited research on the topic in Saudi Arabia, and the fact that most previous studies were conducted on a regional level rather than at the national level, The researchers conducted this study to investigate the awareness, perception, and attitudes of parents towards children’s eye diseases across the Kingdom of Saudi Arabia. The aim of our study was to gain a better understanding of the knowledge levels of Saudi society and to identify the regions where there is a lack of awareness about pediatric eye conditions. Our findings can help inform the development of targeted educational programs to improve awareness and promote early detection and treatment of eye disorders in children. By better understanding parents’ attitudes and beliefs about eye care for their children, healthcare providers can improve communication with parents and ultimately improve the eye health of children in Saudi Arabia.

Aim of the study and objective

A study on the prevalence of eye diseases in children under the age of eighteen, and measuring the level of parents’ awareness of their children’s eye diseases in the Kingdom of Saudi Arabia.

In our study, we focused on collecting data from parents who have children under the age of 18 to assess both the prevalence of eye diseases in this population and the level of parental awareness regarding these conditions. Since our primary objective was to evaluate awareness among parents directly responsible for children within this age group, we did not include data from individuals who do not have children under 18.

Study design

The study aimed to assess the prevalence of ophthalmic diseases among children under 18 years of age and determine the level of awareness among parents regarding ophthalmic diseases and eye care. To achieve this, a structured cross-sectional survey was conducted online. The study was conducted between November 2023, and August 2024, with data collected during this period. The study was conducted across all regions of the Kingdom of Saudi Arabia, including the central, northern, eastern, western, and southern regions.

This study was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.

Sampling and sample size

According to the Roasoft sample size calculator, a minimum sample size of 377 is required for the study under the specified conditions. These conditions include a response distribution of 50%, a confidence level of 95%, and a margin of error of 5%.

Selection criteria

Inclusion criteria

Exclusion criteria

Study population

We collected data from parents of children under 18 to assess the prevalence of eye diseases and parental awareness. Individuals without children in this age group were excluded, as our primary objective was to evaluate awareness among parents directly responsible for children under 18. Before removing participants, who did not meet the study’s inclusion criteria, the total number of respondents who participated in the survey was N = 1326. From this group, a sample of parents with children under 18 years of age in Saudi Arabia was formed, resulting in a final sample size of N = 1276.

Preparing the study instrument

Participants were provided with a cover letter on the study website, detailing the study’s purpose, procedures, and relevant information. A self-administered questionnaire has been developed for this research, and it consists of four main sections. The estimated time to complete the questionnaire is 5-10 minutes. The cover page of the questionnaire includes general information related to the study and a consent form for participants to confirm.

The first section of the questionnaire collects demographic information about the participants, such as their age, nationality, region, gender, marital status, and occupation. Additionally, this section includes questions about the medical history of the parents’ participants related to children’s diseases. The second section of the questionnaire is designed to measure the prevalence of eye diseases in children under eight years of age. This section includes questions related to the occurrence of eye diseases in children, including amblyopia, cataract, and refractive errors.

The third section of the questionnaire measures parents’ awareness of children’s eye diseases. This section includes questions related to the parents’ knowledge of the symptoms, causes, and risk factors of various eye diseases that can affect children. The fourth and final section of the questionnaire measures parents’ awareness of children’s eye care. This section includes questions related to the parents’ knowledge of the importance of regular eye exams, and other factors that contribute to maintaining good eye health in children.

Additional information

Amblyopia (lazy eye): Amblyopia is a condition where the brain and the eye do not work together properly. The main symptom of amblyopia is reduced vision in one eye. Amblyopia can be mild or severe, and the treatment options depend on the severity of the condition. Treatment often involves patching the stronger eye to force the weaker eye to work harder, along with corrective lenses and vision therapy.¹⁵

Strabismus (crossed eyes): Strabismus is a condition where the eyes do not align properly. The main symptom is an eye turn, which can be constant or intermittent. The severity of strabismus can vary, and treatment options depend on the severity and cause of the condition. Treatment may involve eye exercises, corrective lenses, or surgery.¹⁶

Refractive errors (myopia, hyperopia, astigmatism): Refractive errors occur when the shape of the eye prevents light from focusing properly on the retina. The main symptoms of refractive errors are blurred vision and eye strain. The severity of refractive errors can vary, and treatment often involves corrective lenses, such as glasses or contact lenses.¹⁷

Conjunctivitis (pink eye): Conjunctivitis is an inflammation of the conjunctiva, the thin layer of tissue that covers the white part of the eye and the inside of the eyelid. The main symptoms of conjunctivitis are redness, itching, and discharge from the eye. The severity of conjunctivitis can vary, and treatment depends on the cause of the inflammation. Treatment may involve antibiotics, antihistamines, or eye drops.¹⁸

Blocked tear duct: A blocked tear duct occurs when the tear duct, which drains tears from the eye to the nose, is blocked or partially obstructed. The main symptom is excessive tearing, which can lead to eye infections and irritation. The severity of a blocked tear duct can vary, and treatment may involve massage, antibiotics, or surgery.¹⁹

Data reliability and quality

To ensure the reliability of the study questionnaires, a pilot test was conducted prior to the actual data collection process. The questionnaire used in the study was adopted and incorporated from previous research that were conducted in the same study community of Saudi Arabia, in the region of Makkah, Medina, Aseer, and Riyadh.^7,8,20,21 The questionnaire was evaluated on a sample of ten randomly selected parents from different age groups, and modifications were made to ensure its simplicity and conciseness. Each respondent received the questionnaire only once.

Statistical analyses

The statistical analysis for this study was conducted using IBM SPSS version 22. The extracted data were first scanned and coded, and then subjected to descriptive analysis to summarize the demographic information and the elements of parents’ awareness of children’s eye diseases. To evaluate participants’ awareness and knowledge, each correct answer was given a score of one point, and the scores were added up to determine the total score. Participants who scored less than six points out of the possible sum were considered to have poor awareness. In comparison, those who scored 6-11 points were considered to have a medium level of awareness, and those who scored 12 points or higher were considered to have a good level of awareness and knowledge. All variables, including demographic data, awareness items, knowledge, and attitudes, were described using frequency and percentile distributions. Two-tailed tests were used to evaluate the statistical significance of the data, with a p-value of 0.05 defining statistical significance. The results were presented using tables, graphs, and pie charts for clear visualization and interpretation. To investigate the relationships between parents’ awareness levels and demographic factors, the Chi-squared test was utilized, with a P value of 0.05 or less being considered statistically significant. The study’s findings were presented in tables and graphs, which allowed for clear visualization and interpretation of the results

Demographic characteristics of participants

Table 1 presents the general characteristics of the participants, including demographic variables such as age, gender. These baseline data provide context for understanding the sample population and interpreting subsequent findings. The majority of participants, 50.9% (650), were aged between 30 and 50 years, followed by those under 30 years 37.2% (475). A significant proportion were females 63.8% (814), while males represented 36.2% (462). Most participants were Saudi nationals 93.3% (1,186), with a minority being non-Saudi 6.7% (86). Regionally, the largest group came from the Northern region 45.8% (584), followed by the Western region 19.1% (244). A large majority were married 77.3% (986), with unmarried participants making up 22.7% (290). In terms of education, 59.0% (753) held a Bachelor’s degree, while 21.3% (272) had a high school diploma or equivalent. Most participants were employed 58.3% (744), with those not working comprising 18.0% (230). Additionally, 36.8% (470) reported a history of children’s eye diseases.

Prevalence of eye diseases among children

Figure 1 presents the prevalence of current or recent eye disease reported by parents of study participants. A majority of parents (63.60%, n = 800) did not report any eye problems, while 36.40% (n = 460) indicated that they had observed at least one eye issue. This suggests that a significant proportion of parents—over one-third—are aware of an existing eye condition or have noticed recent eye problems in their children.

Figure 1. Prevalence of current or recent eye diseases reported by parents of study participants.

Table 2 summarizes the types of current or recent eye diseases (CED) reported by the parents of child participants in Saudi Arabia. The study observed the prevalence of various eye diseases among children as reported by their parents. The most commonly reported condition was refractive errors, affecting 44.23% of the children, indicating a high prevalence of vision correction needs such as short- or long-sightedness. Dryness was the next most prevalent condition, reported in 16.55% of cases, followed by strabismus or crossed eyes, affecting 9.58% of the participants. Amblyopia, or lazy eye, was also relatively common, found in 8.89% of the children. Other conditions reported included allergic conjunctivitis (3.66%), retinal diseases (4.18%), and nasolacrimal duct obstruction (2.79%). Less common conditions included congenital cataract (2.44%), congenital glaucoma (1.57%), facial nerve palsy (1.22%), and the least frequent, chalazion, affecting only 0.17% of the children. Notably, color blindness was reported in 4.71% of the cases.

Timing and barriers to eye examinations

Figure 2 illustrates the age at which children had their first eye exam. The majority of children, 55.50%, never had an eye exam. Among those who did, 14.30% had their first exam between 1 to 5 years old, while 13.20% had their first exam before they were less than a year old. Additionally, 10% had their first eye exam between 5 to 10 years old, and 7.10% had their first exam between 10 to 15 years old.

Figure 2. Age of children at first eye examination and prevalence of prior eye exams.

Table 3 highlights the primary barriers identified by parents concerning the scheduling of initial eye examinations for their children. The most common reason, reported by 58.6% of parents, was the belief that their child did not require an examination based on personal assessment. Additionally, 37.6% of parents indicated they did not recognize any signs that would necessitate a visit to an eye care professional.

A smaller proportion, specifically 6.9%, believed their child was too young for an eye test. Logistical barriers were also noted, with 4.6% of parents uncertain about how to arrange an appointment, and 4.2% concerned that their child might be prescribed unnecessary glasses. Financial constraints affected 2.7% of respondents, while 3.2% expressed difficulties affording eye care services. Furthermore, 8.5% of parents identified a lack of public awareness regarding the importance of eye examinations as a barrier. Only 1.6% of parents expressed concern related to exposure to COVID-19.

Parental awareness and attitudes toward eye care

Figure 3 illustrates the varying levels of parental awareness concerning the appropriate timing for routine vision examinations in children. The majority of parents, accounting for 39.9% (509 parents), believe that vision exams are necessary only when a child exhibits signs of a problem. This indicates a reactive approach to eye care rather than a preventive one. Additionally, 31.3% (399 parents) are uncertain about when to schedule routine vision exams, highlighting a lack of awareness regarding recommended eye care practices. In contrast, only 18.2% (232 parents) recognize the importance of annual eye examinations, emphasizing the need for better education on preventive eye health. A smaller proportion, 7.7%, consider biennial vision exams to be sufficient, though the exact number of parents is not specified. Lastly, 3% (38 parents) believe that eye exams should only be conducted every five years, reflecting minimal prioritization of routine eye check-ups. These findings underscore the need for increased awareness and education on the importance of regular pediatric eye examinations.

Figure 3. Parental understanding of optimal timing for routine childhood vision exams.

As shown in Figure 4, the primary reason parents seek eye care for their children is eye redness, reported by 61.3% of respondents. Complaints of double vision follow closely, with 44% indicating that visual disturbances are a serious issue for many parents. Frequent eye rubbing, noted by 37.9% of parents, suggests this behavior may signal underlying eye problems, prompting them to seek professional assistance.

Figure 4. Symptoms and observations that prompt parents to seek eye care for their children.

Additionally, staring eyes were observed in 33.4% of cases, indicating another common symptom leading to eye care, albeit less frequently reported than the previous concerns. Excessive tear production was noted by 27.4% of parents, raising concerns about abnormal tear levels. The behavior of playing with toys at a close distance was reported by 26.7% of parents, often leading to worries about potential vision impairment. Lastly, head tilting to one side, the least common reason at 18.3%, still represents a notable concern for some parents (see Figure 4).

The analysis of the data collected reveals that a significant majority of parents, totaling 1,151 (90.20%), support their children wearing eyeglasses. Conversely, a minority of 125 parents (9.80%) expressed disapproval regarding their children’s use of eyeglasses (see Figure 5).

Figure 5. Gauging parental acceptance of eyeglasses for their children.

Table 4 shows that 69.5% of parents are willing to allow their child to undergo essential eye surgery. However, various concerns impact their decision-making process. Financial constraints are a significant challenge for 3.9% of parents, while 9.3% express apprehension regarding the potential outcomes of the surgery. Additionally, 3.4% of parents fear that the procedure may cause further damage to their child’s eyes. Furthermore, 13.3% of parents remain uncertain about granting approval for the surgery, and only 0.5% cite cultural or social factors as reasons for their disapproval.

The data indicates that a majority of parents, comprising 887 individuals (69.5%), would consent to their children undergoing necessary eye surgery. Conversely, 389 parents (30.4%) expressed reservations regarding this decision. The specific reasons for their hesitance are detailed in the table below ( Table 4).

Knowledge and sources of information on eye health

The assessment of parents’ knowledge and awareness regarding Childhood Eye Diseases (CED) reveals that the proportions of those with good and poor awareness levels are relatively close, with 308 parents (24.1%) demonstrating good awareness and 375 parents (29.4%) exhibiting poor awareness. The majority of parents, however, displayed an intermediate level of awareness concerning CED (see Figure 6).

Figure 6. Shows the overall participants’ level of knowledge and awareness toward CED.

Table 5 presents the association between selected demographic and socioeconomic characteristics of the sample and their levels of knowledge and awareness regarding CED in Saudi Arabia. The analysis of the association between socio-demographic factors and awareness levels among study participants revealed several significant findings. Participants aged 30-50 years demonstrated the highest levels of awareness, with 145 individuals (11.37%) classified in the high awareness category, although this group also included notable percentages in the poor and intermediate awareness levels. Females exhibited significantly higher awareness compared to males, with 178 females (13.95%) showing high awareness versus 130 males (10.19%). Additionally, regional differences indicated that the northern region had the highest proportion of participants with high awareness at 123 (9.64%), while the southern region reported the lowest at 19 (1.49%). Furthermore, married individuals exhibited greater awareness, with 267 participants (20.92%) classified as having good awareness.

Educational attainment and occupation also played critical roles in awareness levels. Those holding a bachelor’s degree demonstrated the highest knowledge at 180 individuals (14.11%), while employed participants showed superior awareness, with 213 (16.69%) categorized as having high knowledge. In contrast, only 26 (2.04%) of primary school graduates exhibited good awareness. Finally, participants with a personal history of CED demonstrated higher awareness levels, with 163 individuals (12.77%) classified as having good awareness compared to 145 (11.37%) without such a history (see Table 5).

When examining the common sources of information among the parents participating in the study, it was noted that most of them depend on clinic visits to receive information (54.9%). This was followed by community sources, such as relatives, parents, and friends (40.4%), and the Internet (36.7%). Close proportions were observed for social media (25.5%) and personal experiences (29.6%). Additionally, 18.8% of parents consulted pharmacists for information, while 16.8% relied on awareness campaigns. Sources such as radio, books, medical journals, and brochures accounted for 16.7%. The least common sources of information were television, radio, and newspapers, with only 7.6% of parents utilizing these channels (see Figure 7).

Figure 7. Parents’ source of knowledge about CED.

Table 6 illustrates participants’ knowledge regarding various aspects of children’s eye diseases, categorized into general eye knowledge, amblyopia, cataracts, glaucoma, and overall eye care awareness, with the percentage of correct answers for each question.