Alsaqr et al.

BMC Public Health (2024) 24:1950 BMC Public Health

https://doi.org/10.1186/s12889-024-19508-4

RESEARCH Open Access

Perception and awareness of the public

about presbyopia and its corrective approaches
in Saudi Arabia: a population‑based survey
Ali M. Alsaqr1*, Abdulrahman M. Alasmi1, Raied Fagehi1 and Abusharha Ali1

Abstract
Background This study investigated patients’ awareness of presbyopia and its management approaches and their
preferred methods for near vision correction.
Methods In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online,
consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It
was designed to record participants’ awareness of and preferences for presbyopia and its refractive corrections. Non-
parametric tests and descriptive analyses were conducted to analyse participants’ responses.
Result Approximately half of the participants had difficulty with near vision activities, such as reading newspapers
or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncor-
rected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of pres-
byopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants).
When asked if they were aware of management approaches other than spectacles, 72% responded with not at all.
Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia cor-
rection (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyo-
pia other than spectacles were noted. Finally, participants’ age, sex, region, education, and income had a statistically
significant impact on essential parts of their responses (p < 0.05).
Conclusion Presbyopia is a highly prevalent age-related ocular disorder, and a significant percentage of cases are
uncorrected due to a lack of awareness or reluctance to wear spectacles. More efficient health education about pres-
byopia and its corrective alternatives is urgently needed.
Keywords Presbyopia, Near vision, Reading spectacles, Visual acuity, Emmetropia

Introduction vision and can be characterized by a gradual decrease

Presbyopia can be defined as the progressive loss of eye’s by the age of 40 years [2, 3]. It is believed that this age-
ability to accommodate a focus on nearby objects [1]. It related change is a result of a gradual loss of viscoelastic-
is an age-related public health concern that impairs near ity of the intraocular lens [3].
The World Report on Vision in 2019 concluded that the
global need for eye-care services is predicted to increase
*Correspondence: significantly in the future, posing a substantial challenge
Ali M. Alsaqr
Aalsaqr@ksu.edu.sa
to health systems; this would also indicate the need for
1
Department of Optometry, College of Applied Medical Sciences, King managing presbyopia [4]. In 2015, the prevalence of
Saud University, Riyadh, Saudi Arabia presbyopia was reported to be approximately 25% of the

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Alsaqr et al. BMC Public Health (2024) 24:1950 Page 2 of 10

global population, among which approximately 45% of correction for all distances [20]. However, it has been
people are living with uncorrected presbyopia [5]. Specif- previously reported that only one participant (out of
ically, it has been estimated that the number of correct- 17) continued wearing multifocal lenses daily after six
able vision impairments due to uncorrected presbyopia months of follow-up [21]. Furthermore, surgical treat-
worldwide is approximately 1.8 billion individuals [5]. ment for presbyopia has taken many forms in recent
Among those, 826 million have no or inadequate vision decades. However, surgical intervention is irreversible,
correction [5]. This prevalence is anticipated to increase and each type of surgical intervention has challenges and
with the growing ageing population [6]. Uncorrected risks that cannot be overlooked, including but not limited
presbyopia would result in a global economic burden, to the risk of infection, reduced contrast sensitivity and
estimated to be approximately US$25 billion, due to pro- optical aberrations [22–26].
ductivity losses [7–9]. Specifically, approximately 90% Recently, it was reported that presbyopic correction
of the burden of vision impairment due to presbyopia using pilocarpine drops could help increase the per-
comes from low- and middle-income countries, where formance of near vision without negatively influencing
the estimated presbyopic correction rate is as low as 10% distance vision [27, 28], which could encourage many
[3, 9, 10]. In particular, the use of digital devices for work patients living with uncorrected presbyopia to use cor-
and leisure has exponentially increased in recent decades rection and improve their quality of life. This possibility
[11]. Individuals may experience additional stress result- is especially attractive for patients who fear social stigma
ing from uncorrected and sometimes under corrected while using reading spectacles or for patients who do not
presbyopia [12]. Additionally, as presbyopia involves like to wear spectacles every time near vision is needed.
challenges in performing simple tasks such as using a However, there are side effects of pilocarpine, including
smartphone or reading a newspaper, it has been found headaches, inferior night driving, dimness, ocular surface
to negatively impact individuals’ daily activities, emo- symptoms and dizziness, and a more serious increased
tional well-being and quality of life [8, 13–15]. It has also risk of retinal detachment and iritis [29–31]. Finally,
been reported that presbyopia correction with specta- new approaches are in the final stage of development or
cles increases the productivity of workers compared with within clinical trials that are directed toward different
uncorrected workers, especially those in jobs that require structures of the eye, including the cornea, sclera, lentic-
intensive near vision performance [8]. Furthermore, it ular lens, pupil, or other structures [32].
has been suggested that some risk factors, such as sex Presbyopia affects individuals differently depending on
(higher in women), increased sunlight exposure, an occu- multiple factors but, most importantly, unaided distance
pation that requires significant hours of near vision work, vision and refraction. For example, in myopic patients,
and the level of hyperopia, could impact the early onset especially those with low myopia (< -3.00 dioptres), living
of presbyopia [16]. with uncorrected near vision is usually sufficient because
they can remove distance-correcting spectacles and see
Presbyopia management clearly. For more myopic patients, reading spectacles may
McDonald et al. suggested that presbyopia can be clas- be needed depending on the scenario and their visual
sified into mild presbyopia, requiring + 1.25 dioptres demand. The challenge arises from the idea of clear near
(D) of added power, moderate presbyopia, requiring vision at a single focal point, which is strongly dependent
between >  + 1.25 D and + 2.00 D, and advanced presbyo- on the degree of myopia. The proposed solution to this
pia, requiring >  + 2.00 D of added power [17]. Presbyopia problem is the use of multifocal near vision spectacles,
can be managed with various highly effective procedures which were found to improve near vision and quality of
that may involve spectacles, contact lenses (CL), surgical life in both low- and high-myopic patients [33].
correction and eye drops [1, 8]. Spectacle correction can In Saudi Arabia, presbyopia correction may depend
be reading, bifocal, or multifocal, and the reading pairs mainly on ready-made reading glasses (+ 1.00 to + 3.00 in
can be bought as ready-made or can be obtained from 0.50D steps), which are available from major retail stores
the optometry clinic. One of the limitations of multifo- and pharmacies. Other management options, including
cal spectacles is impaired depth perception, which may full refraction and CL, require an appointment with an
lead to an increased risk of falls [18, 19]. Correction of optometrist.
presbyopia with CL can assume many forms; for exam- The increased need for presbyopia awareness could,
ple, mono-vision CL corrects one eye for distance vision therefore, be a significant factor in managing this con-
while correcting the other eye for near vision [20]. The dition. To the best of our knowledge, there have been
main limitations of this approach are reduced vision at no prior reports of presbyopia awareness in Saudi Ara-
the intermediate distance and reduced depth perception. bia, which halts the process of deciding the needs of
Therefore, multifocal CL could be a better functional any intervention regarding awareness campaigns or
Alsaqr et al. BMC Public Health (2024) 24:1950 Page 3 of 10

increasing the availability and access to corrective eastern, central, western, and southern regions). In addi-
options. The objectives of this cross-sectional study were tion, the participants were asked if they had any systemic
to investigate (pre)presbyopic patients’ knowledge and or ocular health conditions.
attitudes towards presbyopia and the methods in which The second part of the survey was designed to explore
it could be managed. Patients’ current knowledge of pres- awareness of presbyopia, such as if the subject had heard
byopia was explored, including their current and pre- about the disorder. Additionally, we asked how often the
ferred future methods of management, and the factors participants visited an optometrist, if they have noticed
that influence these preferences were established. any difficulty in near vision tasks such as reading or using
The outcomes of the current study provide a better a mobile phone, and any history of prior refractive sur-
understanding of the awareness of presbyopia in Saudi gery. Additionally, in this section, participants were asked
Arabia and a chance to compare these results with those if they were using any type of vision correction for dis-
of previously reported studies from various regions tance or near vision, from where they received the pre-
worldwide. Additionally, action is needed to increase scription, and their acceptance of this management
public awareness and offer corrective options for affected choice. The last item concerned whether the participant
patients. faced any social stigma while using reading spectacles.
The third and final part of the survey inquired about
Materials and methods currently available management of presbyopia (spec-
Study design tacles, CL and surgical procedures), specifically if the
This was a cross-sectional study. The participants were participants had prior knowledge of those different
recruited between January 2022 and June 2022. The managements. In this section, the participants were
inclusion criteria were people aged ≥ 35 years who were also asked if they were willing to use CL. This part also
currently living in any region of Saudi Arabia, and there explored a new topical treatment for presbyopia consist-
were no other exclusion criteria. Although participants ing of an eye drop (pilocarpine HCI ophthalmic solution
35 year of age are not truly presbyopic, they could be pre- 1.25%), which was recently approved by the FDA. We
presbyopic due to uncorrected hyperope with a reduced asked about prior knowledge of this management, its side
amplitude of accommodation, and they should be pre- effects, and, finally, whether the participants preferred
pared for presbyopia correction and aware of it. this type of management over spectacles or CL despite
daily administration and their reason for choosing it. The
Sample size last item of the survey examined the participants pre-
To calculate the sample size required in this study, we ferred method of management for presbyopia.
used Epi Info, version 7 (Centers for Disease Control,
Atlanta, USA). In the last 2020 population survey, the Distribution, data collection and analysis
number of residents aged ≥ 35 years in Saudi Arabia was This survey (Arabic copy) was created using Google
approximately 14.7 million (General Authority for Statis- forms. It was distributed through emails, colleagues in
tics, Saudi Arabia. Retrieved January 2022, https://​www.​ other regions, and multiple social media platforms (Twit-
stats.​gov.​sa/​en/​43). The sample size was calculated with ter, WhatsApp, Telegram). Paper handouts were also dis-
a confidence interval of 95%, based on previous finding tributed and collected at the same events to allow more
showing an expected frequency set at 33% [34], a design participants to enrol in the study.
effect of 2, and a number of clusters set at 5 (northern, The Statistical Package for the Social Sciences (SPSS)
eastern, central, western and southern regions). The total (IBM Corp., NY, USA) was used for data analyses. Non-
sample size was calculated to be 680 participants. parametric tests and descriptive analyses were conducted
to explore the data. An ordinal regression test (logit
The survey model for ordinal response) was conducted to under-
The survey contained twenty-eight items and aimed to stand the influence of the participants’ age, sex, region,
assess the knowledge of the participants concerning the education and income on their answers. A p value < 0.05
condition and the different management as well as the was considered statistically significant.
new managements (eye drops) strategies available. Most
of the items were close-ended, and few questions were Results
open-ended to allow for further elaboration. Participants’ profile
The first part of the survey focused on demographic A total of 785 participants were enrolled in this study.
information. This information included age, sex, occupa- The respondents’ demographics are listed in Table 1.
tion, income, education, and place of residence, which Furthermore, the respondents’ background character-
were further classified into five clusters (northern region, istics are recorded in Table 2. In terms of respondents’
Alsaqr et al. BMC Public Health (2024) 24:1950 Page 4 of 10

Table 1 Demographic profile of the respondents occupation status, the most common answers were jobs
Variable n, %
in the education field, administrative jobs and retired/not
working. The majority of the study participants were not
Age group specialized in optometry/ophthalmology-related fields
35–39 years 281 (36%) (752 respondents, 95%).
40–45 years 156 (20%) A total of 248 (31%) respondents reported their gen-
46–50 years 96 (12%) eral health history. The most frequently reported issues
51–55 years 124 (16%) were diabetes (40%), hypertension (30%), cholesterol (9%)
56–60 years 60 (7.5%) and thyroid diseases (6%). In terms of ocular health, 491
More than 60 years 68 (8.5%) respondents (62.5%) did not report any diseases, whereas
Sex n, % 294 (37.5%) respondents reported poor vision, dry eyes
Men 321 (41%) (7%), and cataracts (3%). When they were asked about
Women 464 (59%) previous refractive surgery, 651 (83%) respondents did
Region n, % not undergo any refractive surgery.
Central Region 498 (63%) Regarding periodic visits to an eye clinic, approximately
Eastern Region 53 (7%) 226 (34%) respondents indicated they visited regularly.
Southern Region 94 (12%) When asked about the last clinic visit was, the most
Western Region 117 (15%) common answer was 3 months (280 respondents, 36%).
Northern Region 23 (3%) Lastly, 270 (34.4%) respondents used distance spectacles,
Education n, % and 336 (43%) respondents used reading spectacles.
University 442 (56%)
Secondary 121 (15.5%) Presbyopia
Master’s degree 110 (14%) Regarding presbyopia, 407 (52%) respondents reported
PhD 57 (7%) difficulty with near vision activities, such as reading
Intermediate 25 (3%) newspapers or using mobile phones. However, most of
Other 17 (2%) them had not heard or read about the term "presbyo-
Primary 12 (1.4%) pia" (595 respondents (76%)). Uncorrected presbyopia
Left school before any official tests/at the age of 1 (0.1%) was found in 48% of respondents. For those who use
12 years or less spectacles, the source of the prescription was collected
Income n, % from 409 respondents. A total of 147 (36%) respondents
10,000–15,000 SAR 222 (28%) obtained their spectacles from optical shops, 141 (35%)
5000–10,000 SAR 182 (23%) respondents from private hospitals, 83 (20%) respondents
15,000–20,000 SAR 146 (19%) from government hospitals, 35 (9%) respondents bought
Less than 5000 SAR 139 (18%) them off the shelf, and 3 (0.7%) respondents obtained
20,000–30,000 SAR 65 (8%) them from primary health care centres. The vast majority
More than 30,000 SAR 31 (4%) of the respondents reported accepting spectacles as man-
agement for presbyopia (642 (82%) respondents) and did
not face any social stigma from using reading spectacles
(680 (87%) respondents).

Respondents’ perspective on presbyopia management

The respondents were asked about their knowledge and
Table 2 Cross-tabulation of the responses to “What is your attitudes towards other management methods for pres-
preference for near vision correction?” with sex as a factor byopia. A total of 565 (72%) respondents were not aware
Men Women Total
of management approaches other than spectacles. Fur-
thermore, 524 (67%) respondents did not report any
Spectacles 142 141 283 knowledge about using CL for presbyopia management.
Eye drops 76 163 239 When their preferred contact lens was explored, 495
Refractive surgery 58 114 172 (63%) respondents rejected CL as their choice of man-
Contact lenses 8 16 24 agement. The respondents were asked about their use of
Will not use any of them 36 29 65 eye drops to manage presbyopia, but none of them used
I do not need near vision correction 1 1 2 pilocarpine eye drops, as they are not yet approved by
Total 321 464 785 the Saudi FDA; a total of 642 (82%) respondents never
Alsaqr et al. BMC Public Health (2024) 24:1950 Page 5 of 10

heard of such management, and 694 (88%) respondents respectively). Additionally, age was a statistically signifi-
did not know how using eye drops would improve their cant determinant of the participants’ preference for near
near vision. Interestingly, 521 (66%) respondents pre- vision correction (χ2(5) = 11.9, p = 0.03). Younger par-
ferred the use of eye drops, once they became available, ticipant were more open to the use of eye drops (when
as an alternative management for presbyopia in compari- they became available) as an alternative correction for
son to spectacles and CL. The overwhelming majority presbyopia (B = 0.52, SE = 0.26, Wald = 4.2, p = 0.04). Spe-
of respondents had no knowledge of the side effects of cifically, 51% of 35–39-year-olds preferred the use of eye
pilocarpine eye drops (731 [93%] respondents). The most drops as a treatment option for presbyopia.
common reasons for accepting eye drops as an alterna-
tive to other management methods were ease of use, cost, Gender
and other social reasons. Furthermore, respondents were The ordinal regression test revealed that sex was the main
asked about their preference for near vision correction determinant of all participants’ responses. First, women
among spectacles, eye drops, refractive surgery, CL and were relatively more aware of the term "presbyopia" than
“will not use any correction”. The respondents’ preferen- were men (χ2(1) = 5.5, B = 0.4, SE = 0.17, p = 0.0194), with
tial choices were diverse and are illustrated in Fig. 1. The 25% of women compared with 20% of the men being
highlighted finding was that the respondents generally aware of the term. Women were more likely to know
preferred spectacles, eye drops and refractive surgery about using multifocal CL for near vision correction than
over CL. Finally, approximately 10% of the respondents men (χ2(1) = 9.4, B = 0.48, SE = 0.16, p = 0.0024), with
felt they did not require near vision correction or would 38% of women compared with 27% having this knowl-
not use any correction. edge. The respondents’ preferences for using CL also
differed between sexes (χ2(1) = 31, B = 0.86, SE = 0.16,
Impact of respondents’ demographics p < 0.00014), with 45% of women compared with 25% of
An ordinal regression test (logit model for ordinal the men preferring the use of CL to correct near vision.
response) was performed to understand the impact of the Additionally, women were more likely to favour the use
respondents’ age, sex, region, education, and income on of eye drops as a management procedure (χ2(1) = 29,
their responses. B = 0.79, SE = 0.15, p < 0.0001), as expressed by 60% of
women compared with 40% of the men. Furthermore,
Age women were more likely to use eye drops as a manage-
Age was found to impact only the participants’ response ment procedure, as 75% responded that they would use
to the item inquiring about whether they used specta- eye drops if given as an alternative option to spectacles
cles; the older the respondent was, the greater was the and CL, in contrast to 52% of men (χ2(1) = 37.6, B = 0.94,
likelihood of experiencing difficulty in reading and hav- SE = 0.16, p < 0.00014). Finally, the respondents’ prefer-
ing reading spectacles (χ2(4) = 5.12, B = 0.29, SE = 0.13, ence for near vision correction differed between sexes
p = 0.024, χ2(4) = 14.1, B = 0.49, SE = 0.12, p < 0.0001, (χ2(5) = 31.3, B = 0.29, SE = 0.13, p < 0.00014) (Fig. 2). The

Fig. 1 Management preferences of the study respondents

Alsaqr et al. BMC Public Health (2024) 24:1950 Page 6 of 10

Fig. 2 Respondents’ preferences for different managements among men and women

common selection for men respondents was spectacles and northern region (B = 3.6, SE = 0.22, Wald = 263,
(B = 0.93, SE = 0.29, Wald = 10.4, p = 0.001), whereas for p < 0.0001)). Specifically, reading spectacles were used by
women respondents, spectacles were less favourable, 40% of the respondents in the central region, 55% of the
and eye drops were selected more often over specta- respondents in the eastern region, 38% of the respond-
cles and other management options (B = 0.84, SE = 0.3, ents in the southern region, 54% of the respondents in
Wald = 7.75, p = 0.005) (Fig. 2). the western region and 30% of the respondents in the
northern region. Responses to the question about “from
Region where they received their prescription” also differed by
The respondents in different regions also significantly region or residence (χ2(4) = 10.16, p = 0.03, optical shop
differed in their responses to whether they used read- (B = -2.85, SE = 1.13, Wald = 6.32, p = 0.01), private medi-
ing spectacles ((χ2(3) = 9.34, p = 0.025, central region cal complex (B = -2.63, SE = 1.13, Wald = 5.42, p = 0.02),
(B = 0.66, SE = 0.1, Wald = 44.99, p < 0.0001), eastern government hospital (B = -3.15, SE = 1.15, Wald = 7.57,
region (B = 0.97, SE = 0.1, Wald = 90, p < 0.0001), south- p = 0.006) and ready-made glasses (B = -2.64, SE = 1.17,
ern region (B = 1.64, SE = 0.1, Wald = 204, p < 0.0001) Wald = 5.11, p = 0.02)) (Table 3).

Table 3 Distribution of participants’ responses to the source of reading prescription based on residence location
Optical shop Private medical Government Ready-made Primary Health Total
complex hospital glasses Care Centre

Central Region Count 90 80 58 20 0 248

% within region 36.3% 32.3% 23.4% 8.1% 0.0% 100.0%
Eastern Region Count 15 13 3 3 0 34
% within region 44.1% 38.2% 8.8% 8.8% 0.0% 100.0%
Southern Region Count 16 15 8 4 1 44
% within region 36.4% 34.1% 18.2% 9.1% 2.3% 100.0%
Western Region Count 22 31 13 7 1 74
% within region 29.7% 41.9% 17.6% 9.5% 1.4% 100.0%
Northern Region Count 4 2 1 1 1 9
% within region 44.4% 22.2% 11.1% 11.1% 11.1% 100.0%
Alsaqr et al. BMC Public Health (2024) 24:1950 Page 7 of 10

Table 4 Ordinal regression test of variations in participants’ responses regarding education

Variable B.Sc MSc PhD Education of high ordinal regression test
442 110 57 school or less 176

Do you face a difficulty when reading from mobile or paper documents? 53% (235) 33.5% (37) 42% (24) 63% (111) χ2(2) = 21.95, p < 0.001
Do you use reading spectacles? 41% (183) 27% (30) 44% (25) 55% (98) χ2(2) = 23.5, p < 0.001
Have you ever heard of the term "presbyopia"? 21% (95) 35% (39) 23% (40) 18.75% (33) χ2(2) = 9.2, p = 0.01
Did you know about using multifocal contact lenses for near vision? 36% (159) 37% (41) 46% (26) 20% (35) χ2(2) = 21.14, p < 0.001
Do you have information about how eye drops for presbyopia work? 8% (37) 14% (15) 17.50% (10) 26% (27) χ2(2) = 9.13, p = 0.01
Do you have information about the potential side effects of these eye 5% (22) 12% (13) 7% (4) 8.5% (15) χ2(2) = 1.8, p = 0.40
drops?

Table 5 Crosstabulation: What is your preference for near vision fewer education certificates were associated with greater
correction? difficulty in reading, least awareness of the term “pres-
Preference B.Sc MSc PhD High Total byopia” and greater use of reading spectacles. Knowledge
school or about the use of CL was also associated with a higher
less education. Additionally, the respondents’ knowledge of
Spectacles 139 43 28 73 283 eye drops and their side effects was relatively low, even
Eye drops 144 31 20 44 239 among those with higher education levels (Table 4).
Refractive surgery 109 21 8 34 172 Finally, the respondents’ preference for near vision cor-
Contact lenses 34 12 1 18 65
rection also varied on the basis of their level of education
Will not use any of them 15 3 0 6 24
(χ2(5) = 14.18, p = 0.01), although the common choices
No need for near vision correction 1 0 0 1 2
were spectacles and eye drops across the four education
Total 442 110 57 176 785
groups (Fig. 3). The figure also shows that the lower the
respondents’ education was, the more likely they thought
there was no need for near vision correction.
Education
Income
Level of education had a statistically significant impact
It has been hypothesized that income would be a deter-
on participants’ responses (Tables 4 and 5). In general,
minant of participants’ preferences for presbyopia

Fig. 3 Preference for different management practices in accordance with respondents’ education. * PhD, philosophy degree
Alsaqr et al. BMC Public Health (2024) 24:1950 Page 8 of 10

correction, as certain choices are more expensive than Importantly, this is the first study to explore such a sig-
others. Therefore, respondents’ income was found to be nificant age-related health concern.
significant in two responses: their preference to use CL In this study, only one-third of the respondents
(χ2(4) = 17.88, B = -0.11, SE = 0.13, Wald = 0.7, p = 0.001) received regular eye exams, which may suggest a need
and their knowledge of eye drops (χ2(4) = 12.58, to promote ocular health and well-being. Two-thirds of
B = -0.11, SE = 0.16, Wald = 0.45, p = 0.014). Interestingly, the respondents were not aware of presbyopia, which is
35% to 45% of the respondents whose income was less consistent with previous findings [8, 34, 38, 39]. This lack
than twenty thousands were open to CL, whereas only of awareness could be considered a prominent reason for
20% of those whose income was more than twenty thou- the 48% prevalence of uncorrected presbyopia observed
sand preferred CL. The respondents’ knowledge of eye in this study. The prevalence of uncorrected presbyopia in
drops ranged from 20 to 25% across the different income several parts of the world ranges from 28 to 63% among
groups, except for those with incomes of less than 5000 adults aged > 30 years [40, 41]. Uncorrected presbyopia
SR (response rate of 11%). Finally, participants’ prefer- remains a challenging issue for patients over 40 years of
ence for near vision correction varied based on income age as well as eye care professionals [42]. The majority of
(Fig. 4), where the higher the respondents’ income, the the respondents accepted spectacles as a management
more likely they were to choose spectacles over other method and did not suffer from social stigma while using
management procedures, although this difference was them. Thus, promotion of presbyopia correction via
not statistically significant (χ2(4) = 28.25, p = 0.10). spectacles could be an effective way to address the chal-
lenges faced at near distances.
Discussion The respondents overwhelmingly were not aware of
The prevalence of refractive error in adults (between 16 management choices other than spectacles. However,
and 40 years of age) in Saudi Arabia was investigated in when offered other options, 40% and 66% of them agreed
two recent studies [35, 36], which revealed the distribu- with the use of CL and eye drops, respectively. A good
tion of refractive error by age and sex. Specifically, pres- proportion (10%) thought that they did not need correc-
byopia impacts the quality of life of people in addition to tion. These findings highlight the necessity of educating
its impact on the country’s economy [37]. Consequently, patients about presbyopia, its management choices, side
addressing presbyopia is crucial to achieving sustainable effects, and consequences. For example, issues related
advances in promoting health and well-being for all [33]. to the use of CL, including cost, a lack of suitable near
In this study, awareness and attitudes towards presbyo- vision correction, and an increase in dry eye with age,
pia and its management approaches were investigated. should be discussed with potential candidates [43, 44].

Fig. 4 Preference of various management practices in accordance with respondents’ income. The income is listed in thousand Saudi Riyal
Alsaqr et al. BMC Public Health (2024) 24:1950 Page 9 of 10

Not surprisingly, respondents’ age, sex, education, and Conclusion

income were found to determine their needs and pref- Presbyopia is an ocular disorder that can be easily cor-
erences. For example, as patients aged, they were more rected using spectacles. The findings of this study stress
likely to require near vision correction. Therefore, older the need for health education on presbyopia among the
patients should have easy access to eye care services. older population. Eye care practitioners should match the
Furthermore, younger participants tended to be more need to examine and correct presbyopia within the pop-
open to using eye drops for presbyopia management ulation in their mid-thirties as well as the older popula-
(when approved by the Saudi FDA); this finding should tion. Health policy makers should include the detection
encourage optometrists to open discussions with patients and management of presbyopia as a part of any national
in younger age groups. Gender also played a signifi- eye care programmes.
cant role, with women being more aware of presbyopia
and multifocal CL and preferring the use of CL and eye
Authors’ contributions
drops. Therefore, eye care practitioners should consider Ali Alsaqr: Conceptualization; Formal analysis; Funding acquisition; Investiga-
these findings when managing their patients. Addition- tion; Methodology; Supervision; Writing – original draft; Writing – review &
ally, residents in different local areas had different pref- editing. Abdulrahman Alasmi: Data curation; Methodology; Writing – review
& editing. Raied Fagehi: Conceptualization; Formal analysis; Methodology;
erences, the basis behind these discrepancies is not clear Writing – original draft; Writing – review & editing. Ali Abusharha: Conceptual-
yet and might be due to psychosocial factors and future ization; Funding acquisition; Methodology; Project administration; Resources;
studies would be required to investigate this issue. This Writing – review & editing.
finding also could emphasize the need to discuss all man- Funding
agement choices with every patient to understand their The project was funded by the Researchers supporting project number
preferences. It has also been observed that participants (RSPD2024R854), King Saud University, Riyadh, Saudi Arabia.
outside the central region depend heavily on optical Availability of data and materials
shops and private medical complexes rather than govern- All relevant data have been provided in the manuscript. The supplementary
ment hospitals and primary health centres; it should be datasets used and/or analysed during the current study are available from the
corresponding author upon reasonable request.
noted that the patients’ visit at the government hospitals
and primary health centres will be free of charge while
Declarations
in the private practices will be self-paid by the patients.
This finding may encourage policy makers to design Ethics approval and consent to participate
routine eye-health check-up programmes for those resi- The study received institutional ethical approval from King Saud University
(No. E-22–6645). The principles of the Declaration of Helsinki were followed,
dence areas in government hospitals or provide health- and institutional review board ethics approval was obtained. All participants
care vouchers to lower the financial burden on those enrolled in the study provided electronic informed consent. The aim of the
patients living outside the central region. Education was study was fully described to all participants.
Written informed consent was obtained from all participants.
the third factor impacting responses; therefore, people
with fewer education certificates may need more atten- Consent for publication
tion to increase awareness of presbyopia, its management Not applicable.
choices, side effects and consequences. Interestingly, Competing interests
people with higher incomes were more conservative The authors declare no competing interests.
in their management choices, potentially because they
were more lenient toward the use of spectacles, which is Received: 23 September 2023 Accepted: 16 July 2024
an obvious practical choice. This finding contradicts the
expected assumption that people with higher incomes
might be more open to other, more expensive manage-
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