AWARENESS AND ATTITUDE TOWARD REFRACTIVE ERROR CORRECTION MODALITIES IN PARAMEDICAL STUDENTS.

Objectives: This study was designed to determine the level of awareness and attitude toward refractive correction methods in a randomly selected population of Paramedical students in Era University, Lucknow, India. Materials and Methods: A random sampling method was applied to choose 500 subjects aged 17 years-28 years, from various paramedical courses. A structured questionnaire with open-ended and closed ended questions was designed to gather the participants' demographic data as well as their awareness and attitude toward refractive correction methods (Spectacles, Contact lenses and Refractive surgery). Results: Overall, 26.2% of the participants had a clear idea of term 'ophthalmologist' and 'optometrist'. 71.4%, 58.8% and 71% of respondents had no information about contact lens application, cosmetic contact lenses and contact lenses side effects, respectively. 68.6% of participants were not of the possibility of refractive the those of suregry; Conclusion: and was moderately the of this study. Although, were the of impairments respondents, one third percentage of were not even aware of obvious differences between an ophthalmologist and an optometrist. study is a population-based survey on refractive correction method amongest the The


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that is worthwhile to patients. Some patients feel, spectacles as the best choice. Contact lenses or refractive surgery are the correction method of choice in other circumstances 4 . Refractive errors not only impose a huge financial burden on the society but if left uncorrected could extensively affect patient's independence, quality of life and wellbeing 7 . There is no study about awareness of refractive error correction method in our region. To our best knowledge, there is no complete and documented survey on the perception and insight of the people about refractive errors correction methods in North India. Therefore, we strong-willed to perform this study for a better understanding about the level of awareness and attitude of the young students toward refractive correction.

II. Materials and methods
The present study was conducted in Era University among Paramedical students, India between March and April 2019. A random sampling method was applied to choose 500 subjects aged 17-28 years. The students were selected for the study were from different paramedical courses of, Bachelor of Radio Imaging, Bachelor of Medical Laboratory Technology and Physiotherapy. In our study we exclude Optometry courses. An informed verbal consent was also obtained from all participants by the researcher.
A structured questionnaire was designed to gather information related to the awareness of the refractive correction ( figure 1). Initially, all questions of the questionnaire used in this study were assessed by a team of the ophthalmologist, optometrist and psychologist for ease of comprehension and psychological aspects of the questionnaire. The questionnaire was standardized and was explained to the students in their own language if they found difficulties. The questionnaire comprised of five sections with 16 brief questions, both closed and open ended. Closed-ended questions were in the form of Yes/No and multiple choice with an option for "other". Open-ended questions were added to double-check the respondent answers to the related closed-ended questions. The first section contained questions according to demographic data such. The second part was set to evaluate the ability of respondents to distinguish between an ophthalmologist and an optometrist. The remaining sections were arranged to assess respondents' attitude toward spectacles, contact lenses and refractive eye surgery.
All interviewees were asked to answer the closed-ended questions by placing a "×" mark over the box next to the response that they have chosen. Also, there was enough space after every open-ended question for respondents' answers. All questionnaires were filled in with the assistance of our trained interviewers. Statistical data analysis was done with proportional test.

Overall awareness
Of the total participants 153 (30.6%) did undergo eye checkup but 69.4% (347) never had any eye check up. Out of 153 (37.2%) got eye examined by ophthalmologist and rest 96 (62.7%) eye examined by optometrist. Those who had visited ophthalmologist for common symptoms like headache, watering, blurring of vision. 131 (26.2%) knew the difference between ophthalmologist and optometrist. 369 (73.8%) did not know difference between ophthalmologist and optometrist. Only some correctly identified an ophthalmologist as the person who is responsible for diagnosing and treating eye-related diseases and an optometrist as the person who tests people's vision and orders glasses for them (table 1 and figure 4).

Attitude awareness and spectacles
Out of 500 subjects 153 reported that they had refractive error. Of 153, 117 (76.4%) were male and 36 (23.5%) were female. The percentage of male was higher than the percentage of female. This indicated that gender biasness is still present in middle and low income society. Out of 153, 56% (86) participants already had a history of wearing spectacles, while 67 (44%) were not using glasses though they had refractive error ( Figure 6 & 7). The subjects who did not get eye examination (347) till the period of survey, after conducting a visual examination 70 individual had a visual acuity less than 6/9 in one or both eye. Out of 70, 57% were aware that they have difficulties in their vision while 43% did not notice that they have any difficulties in binocular seeing (figure 8 &  table 2).    figure 10).

Attitude & awareness towards refractive surgery
Only 157 (31.4%) knew the possibility of refractive surgery being used to improve the eyesight and decrease or eliminate the dependence on spectacles. And mere 74 (14.2%) were aware of  figure  11).

Discussion:-
This study is a population-based survey on refractive correction method awareness amongest the paramedical students. The maximum participants belong to rural area of Lucknow. Awareness in our study did not mean that participants had a complete knowledge about the subject. The obtained results could have a possible significant effect on public health education because it was found that even with the fact that uncorrected refractive errors are a major cause of visual impairment and blindness globally, the level of knowledge about this issue and its correction methods is low even amongest paramedical students. The study participants were randomly selected without any criteria.Majority of the participants were not aware about refractive surgery as a method for correction ; Just 12% of participants were aware of refractive surgery, some of the respondents unexpectedly mentioned fear of refractive surgery and its side effects as the main reason for not undergoing such correction methods. These findings indicated that in people do not get informed about these subjects by the eye care practitioner.This obersvation result may convey the idea that ocular health educational programs promoting awareness about correction methods, targeted should mostly at university level and/or higher educated individuals.Although there are no other surveys which have particularly examined the awareness of the general public on refractive error correction methods, several published original researches have revealed the factors affecting the awareness of a population about under corrected refractive errors and other major eye diseases. A disappointing result of this survey is the fact that 73.8% were not knowing the difference between ophthalmologist and optometrist,23.8% were using glasses and 26 % were thinking glasses as a limiting factor in their daily routine work ,this might provide the clue to the fact that they might not using the glasses. Effective health education in eye care may manipulate the behavior of individuals towards considering regular ocular care. Communicating visual prognosis by primary health care clinicians and primary eye care practitioners would help to increase knowledge and compliance among patients 8 because needless to say, health promotion and communicating risk is a key public health strategy [9][10][11] . These findings emphasize the crucial role of ophthalmologists and optometrists in bringing the general ocular health information to the public consideration. Awareness about eye care facilities in rural population is very pathetic. In this survey we assumed that students

Awareness about different corrective modalities in different groups -comparative
Without RE With RE Using Glasses With RE Not using Glasses 972 came from good socioeconomic condition so they might be aware about the refractive error correction method but when we analyzed the data that was socking for us also, if the this situation is from good family then what about the pure villagers? Students believed that wearing spectacle will further detoriate a vision or they will become dependent to it. Some of the participants did not have ant idea about contact lens and refractive surgery.

Conclusion:-
The results of our study demonstrate major loose ends in the awareness about the role of ophthalmologists as well as refractive error correction modalities creating awareness about such important issues in genral public will be major step in improving proper ophthalmic services and preventing avoidable visual impairments. Thus, it is crucial for eye care management that ophthalmologists, general practitioners and optometrists provide proper information in details to patients about their refractive error condition and the available correction options.