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BackgroundDiabetic retinopathy (DR) is one of the diabetic complications that leads to the loss of vision. Most diabetic patients will have DR that is varying in its severity under the effect of many factors such as type of diabetes, duration of diabetes, and poor glycemic control. This study aimed to assess the level of adherence of diabetic patients to diabetic retinopathy screening (DRS) and to identify the influencing factors of adherence among diabetic patients in Al Ahsa, Saudi Arabia. MethodsA cross-sectional study was conducted via a self-administered questionnaire among diabetic patients who were attending the primary health-care centers in Al Ahsa, Saudi Arabia, from July to August 2021. This questionnaire included five sections: sociodemographic data, diabetic profile, assessment of the knowledge, attitude toward DRS, and barriers to DRS. ResultsA total of 397 diabetic patients were involved in the study. Diabetic ocular complications were reported among 35.3% of the patients. The most commonly reported diabetic eye complication was cataract (37.1%; 52) followed by retinopathy (36.4%). Among the participants, 32.2% had a good awareness level regarding DR. In addition, 46.9% of diabetic patients have DRS. The most reported barriers were having no visual or eye problems, difficulty getting an appointment, and the cost and lack of information about the screening procedure (50.9%, 50.1%, 42.1%, and 39.8%, respectively). ConclusionImprovement of patients' knowledge is a significant step to enhancing adherence to DRS. The availability of screening programs and well-established ophthalmology clinics in primary healthcare centers in addition to trained physicians will help to overcome the barriers of DRS.

IntroductionKeratoconus is a bilateral non-inflammatory ectasia, characterized by well-described histopathological changes such as stromal thinning, epithelial iron deposition, and breaks in Bowman's layer. The success of clinical intervention among patients with keratoconus is widely determined by randomized clinical trials, and despite associated difficulties, such trials may improve vision and quality of life. AimThis study aimed to assess the willingness of patients with keratoconus in Saudi Arabia to undergo clinical trials. We further aimed to identify patients' beliefs and attitudes towards clinical trials and to establish possible barriers to trial recruitment, potentially improving the quality of future clinical trials and research. Materials and methodsThis was a quantitative analytical cross-sectional study conducted between October 2020 and March 2021 among patients with keratoconus in Saudi Arabia. A self-administered questionnaire was distributed among the targeted patients. The questionnaire identified the socio-demographic characteristics of the patients and included questions on willingness, motivation, potential barriers, and helpful resources. All statistical analyses were performed using SPSS version 21 (IBM Corp, Armonk, USA). ResultsA total of 462 patients were recruited. The most common age group was 16-25 years (39.8%). There were slightly more females (51.3%) than males (48.7%). The prevalence of patients with a previous history of keratoconus was 36.8%. Results revealed that 37.2% of the patients had great motivation to take part in clinical research, and 22.3% indicated a high score in potential barriers to participation, whereas nearly 48% showed a high score in helpful resources. Statistical tests revealed that being in an older age group, having children, and possessing a higher monthly income were factors associated with increased barriers to participation in clinical research. ConclusionPatients with keratoconus showed great motivation to participate in clinical research studies and provided helpful resources. The knowledge that participation could benefit others was a primary motivator, while encouragement from other patients who participated in clinical research was the main helpful resource. Possible side effects were shown to be the major concern of the patients.

Obstructive sleep apnea (OSA) is characterized by frequent episodes of partial or complete obstruction of the airway during sleep causing repeated episodes of apnea. OSA is more prevalent in middle-aged and older adults. OSA is associated with numerous ocular manifestations, including retinal manifestations. Literature highlighted the clear association between OSA and numerous ocular conditions including glaucoma and papilledema. This comprehensive and narrative review aims to summarize up-to-date clinical research concerning the association of OSA and vascular conditions that affect the retina. OSA is associated with the central serous chorioretinopathy (CSC), retinal vein occlusion (RVO), hypertensive retinopathy (HTRP) and development of diabetic retinopathy (DR). Sympathetic activation, hypoxia, and hormonal dysregulation all lead to serious retinal vascular conditions that will worsen OSA patients' quality of life. It is important to refer patients with newly diagnosed OSA to an ophthalmology clinic for the appropriate test.

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