AMBLYOPIA WITH RESPECT TO PARENTS’ AWARENESS AND PERCEPTIONS IN AL-JOUF REGION OF SAUDI ARABIA

also known as lazy eye is an abnormal condition which is associated with decrease in an eye vision. Parents can play an important role in the management of amblyopia in their children, if they have correct information regarding the disease. The present study was conducted to check parents’ awareness and perception regarding the treatment, diagnosis, causes and consequences of amblyopia in Al-Jouf region of Saudi Arabia. Methodology: A questionnairebased study was conducted in Al-Jouf region of Saudi Arabia to fulfill the objectives of the study. A total of 429 parents aged between 19-45 years were included in the study. Out of 429 parents, 110 were males and 312 were females. Data obtained was analyzed both qualitatively and in percentages. Results: Majority of

In Saudi Arabia, it has been reported that the prevalence of amblyopia varies across different regions. For example, in Riyadh, the prevalence of amblyopia among preschool children is 2.6% [8]and in Qassim province, its prevalence among school age children is3.9% [2]. Similarly, the prevalence of amblyopia in the Abha region is 1.9% [9] and in the Al-Baha region, the prevalence is 0.6% [10]. Recently, it has been reported that in Dammam region, the prevalence of amblyopia among children aged (1-15 years) is 9.5% [11] and in Jeddah, the prevalence of 1.3% was found among children (kindergarten ones) [12].
Earlier studies had reported that in Saudi Arabia, there is low awareness and incomplete knowledge among people regarding amblyopia. There is an urgent need to spread awareness and knowledge regarding amblyopia, so to detect the disease in an earlier stage and seek possible medical interventions. It has been reported that untreated amblyopia can be associated with permanent visual loss and therefore can affect a child in a number of ways like socially, academically and psychologically [13]. The present study was therefore carried out to check parents' awareness and perception regarding the treatment, diagnosis, causes and consequences of amblyopia in Al-Jouf region of Saudi Arabia.

Methodology:-
The present study is based on cross-sectional questionnaire data analysis.Collection of data was carried out using a questionnaire based approach. The survey questions were designed with reference to earlier published studies [2][4] [10].Two pediatric ophthalmologists helped us for reviewing the questionnaire with respect to content and face validation.
The questionnaire was divided into 6 parts, which includes(a) demographic data, (b) awareness on detection and diagnosis of amblyopia; (c)knowledge about the definition, possible etiologies, treatment options, and the source of knowledge of amblyopia; (d) perception and attitude about complications and treatment of amblyopia; (e) perception and attitude about amblyopia complications and impact; (f) awareness of the role of parents in prevention and early detection, diagnosis, treatment efficacy, compliance with treatment, follow-up, psychological and social support of the affected child.
The Amblyopia knowledge score (AKS) was calculated as:total number of answers (correct ones) for questions with respect to etiology (14 items), definition (10 items) and treatment options of amblyopia (6 items).

Ethical approval:
The study was approved by the Research Ethics Committee of Qurayyat Health Affairs (on 15july2020). In addition, an informed consent was electronically obtained from all participants.The consent clearly explains the purpose of the study and ensures the confidentiality of the survey.

Inclusion criteria:
All parents of children below 14 years of age living in the Al-Jouf region of Saudi Arabia were included.

Exclusion criteria:
Parents of children with multiple disabilities or special needs.

Statistical analysis:
All the statistical analysis wascarried out using SPSS statistics software version 22.Descriptive statistics use used to fill participants' characteristics and answers to the questionnaire parts. Categorical variables were presented as frequency and percentage and continuous variables as mean ± standard deviation (SD). Mann-Whitney and Kruskal-Wallis tests were used for data analysis and a p-value of <0.05 was considered significance. Factors associated with knowledge about amblyopia are discussed in table 4. It was observed that parents occupation and source of knowledge regarding amblyopia is statistically significant with the amblyopia (p-value less than 0.05).

Discussion:-
Amblyopia:a condition that needs an early intervention and therefore should be detected in an early age for better outcome. A child's parents therefore have a crucial role for this purpose and in the treatment compliance. Less awareness and knowledge of this eye condition can affect one's family quality of life [14] [15]. Therefore, the present study aims to determine awareness and knowledgeof amblyopia in the parent population of the Al-Jouf region.
In the current study, it was found that the percentage of knowledge regarding amblyopia among parents was 44.4%. It means that Al-Jouf region population has moderate awareness level about amblyopia, a similar type of data has been observed in earlier studies in Saudi Arabia [16].Another study carried out in Jeddah, evaluated the knowledge among the Saudi population regarding common eye diseases and found that only 10% of the participants had heard of amblyopia [17]. Study carried out in different regions of Saudi Arabia population showedalmost complete lack of awareness about amblyopia [16].Furthermore, earlier studies in different countries had reported a low awareness of amblyopia among the population [18][19] [20]. It should be noted here that poor understanding regarding eye errors and critical care has been reported worldwide [21].
Only 44.4% of the participants were able to identifythe correct definition of the disease although the majority of them, about 90%, had high educational level (university or above). This trend has been reported earlier also [22] [16].
Our study showed that there is good level of awareness in parents (about amblyopia) who have a family history or personal experience witheye problems especially problems that are associated withchildhood regardless of the educational level. These types of results had already been reported in Saudi population [16]. Although amblyopia is treatable at early stage, but the target population was unaware of this fact [23]. As reports by our study, early intervention to amblyopia can lead to better outcome [24].  [25]. Nowadays, use of social media for disease awareness can be used a good opportunity to curb the disease early.Research articles and educational videos can be posted and circulated on popular social media platforms, so to reach out at larger population [24]. The results of our present study will be quite helpful for eye care professionals for planning awareness programs among parents, especially for amblyopia.

Conclusion:-
In conclusion, most of the parents still have low or moderate level of knowledge about amblyopia. A planned strategy is needed in Saudi Arabia to increase the level of awareness and knowledge among the target population. Social media can be used as a useful resource to achieve this goal. It is important to take the educational level of the population into consideration before such program is planned. Awareness programs must be incorporated into school vision-screening programs and makes them popularize via media infotainment programs can lead to better eye care seeking in the community.