Studets of Color Perception of Safety on College Campuses Peer Reviewed
J Family Customs Med. 2021 Sep-December; 28(3): 196–201.
Prevalence of colour vision deficiency in medical students at a Saudi University
Naela B. Alamoudi
College of Medicine, Imam Abdulrahman Bin Faisal Academy, Dammam, Saudi arabia
Razan Z. AlShammari
College of Medicine, Imam Abdulrahman Bin Faisal Academy, Dammam, Saudi arabia
Reem South. AlOmar
1 Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of saudi arabia
Nouf A. AlShamlan
1 Section of Family and Customs Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of saudi arabia
Abdullah A. Alqahtani
2 Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi arabia
Naheel A. AlAmer
ane Department of Family unit and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of saudi arabia
Received 2021 Jun 10; Revised 2021 Jul 15; Accustomed 2021 Aug 2.
Abstruse
BACKGROUND:
Color vision deficiency (CVD) affects approximately one in 12 men and one in 200 women in the world. It is considered a problem in the medical field since the color is oftentimes used equally a sign in the practice of medicine, in observational assessment, diagnosis, and follow-upward. These weather condition make the appreciation of color essential in doctors' lives, thus we aimed at finding the prevalence and predictors of CVD in medical students.
MATERIALS AND METHODS:
This cantankerous-sectional written report included 1115 medical students. A pretested questionnaire consisting of personal data, history of vision issues, familial color vision defect, centre surgery, bad trauma on the head or optics, drugs taken or chemicals exposed to, other wellness problems, and whether sufficient amount of Vitamin A is taken was used. This was followed by the screening of the participants for CVD using the Ishihara fifteen-plates test.
RESULTS:
A total of 1115 students participated in the study; 52.2% were females and the mean age of the participants was 21.7 years (±1.4). The prevalence of definitive CVD was constitute to exist 2.1%; all of which comprised males. Eighty-seven percent of the affected participants were not aware of their color vision problem. A highly statistically significant clan was found between history of vision issues and CVD condition (P < 0.008). No clan were found for nationality, marital status, family history of CVD, history of eye surgery, and centre trauma.
CONCLUSION:
The percentage of CVD in the present study is lower than that reported by previous studies washed in other countries. Many medical students with CVD remain unaware of their status. Therefore, nosotros recommend early screening of all school-age children, and proper counseling of medical students with definite CVD to have care of their own health and wellbeing.
Keywords: Colour blindness, color vision deficiency, Ishihara plates, medical students, Saudi arabia, screening, 10-linked recessive
Introduction
Color vision deficiency (CVD), representing a group of conditions that disturbs perception of color, affects approximately one in 12 men and one in 200 women in the world.[i] The most common crusade of CVD is the inheritance of the X-linked chromosome. It can also exist acquired through such chronic illnesses that harm the retina, optic nerve, and the brain as diabetes mellitus, sickle cell anemia, and retinitis pigmentosa, or the use of some medications such as sildenafil, digoxin, ethambutol, furosemide, metronidazole, and some antimalarials.[1,2] CVD occurs when light-sensitive cells in the retina neglect to respond appropriately to variations in wavelengths of low-cal that enable people to see an assortment of colors.[iii]
Several tools used to assess CVD in clinical practice are suitable for primary care physicians. Ishihara plates test, which detects protan and deutan defects, used for all new patients, also as Richmond Hardy–Rand–Rittler (HRR) exam, detects tritan defects is the platonic confirmatory examination for the Ishihara test. Richmond HRR exam is used to classify the severity into balmy, medium, and strong. Other tests such as Medmont C-100 and the Farnsworth D15 test may be used if patients neglect the Ishihara test as color vision is normal. They are all quickly performed and easily interpreted.[four]
The prevalence of CVD has been studied in different population groups around the earth.[5,6,7] In Saudi Arabia, the CVD rate in females is reported as 0.4%.[8] In European Caucasian populations, it has been reported as 8% in male and 0.iv% in female individuals and is between iv% and half dozen.five% in male subjects of Chinese and Japanese ethnicity.[9] Hence, CVD varies by race. Yet, few studies have calculated the prevalence of CVD in medical students even though information technology is an of import problem that seems to be going unnoticed in the medical field.[ten,11,12]
In general, people with CVD might encounter many challenges in their daily activities as well as in education. Certain subjects are problematic, which makes them less effective in their work than their color-normal peers. Medical doctors, in particular, may have difficulty in interpreting diverse physical signs during examination, and in identifying color slides and specimens.[13] CVD is still comparatively explored. It is important for all health-intendance practitioners with CVD to be aware of their status. Lack of sensation of one'south condition could put the patient'south safety at take chances. Our aim was, therefore, to investigate the prevalence of CVD in Dammam medical students. This study is of import and should be borne in mind when medical students and doctors with known CVD make decisions on their time to come specialties.
Materials and Methods
A quantitative cross-sectional report was conducted at Imam Abdulrahman bin Faisal University, Saudi Arabia. The data were collected between January and March 2020, prior to the COVID-nineteen lockdown. Ethical approval was obtained from the Institutional Review Board (IRB) vide alphabetic character No. IRB-UGS-2018-01-213 dated x/04/2019, and informed written consent was taken from all participants after they were reassured that all information will be kept confidential.
The study had male and female medical students of all levels (from iind to vith year). Those with glaucoma, retinal/optic nerve disease, significant cataract, diabetes, any other ocular or systemic disease which may lead to CVD, and those who took concomitant medications known to touch on color perception were excluded from the study. The total number of both male and female medical students at the university was 1242. Of these, 1129 students completed the questionnaire, 14 were excluded leaving a total of 1115 students, and a response rate of 89.8%.
Students were asked to fill up the questionnaire, and read the 15-plates on the Ishihara's chart. A self-administered precoded questionnaire of 15 questions in two sections had been designed on a pretested survey taken from a previous study conducted past Alharfi et al., 2016.[ten] Part 1: the personal data included age, gender, academic year, nationality, marital status, and whatever data on CVD. Part two: data on history including vision bug (refractive errors, nyctalopia, cataract, glaucoma, congenital colour vision abnormalities, and others), familial color vision defect, eye surgery, bad trauma on the head or eyes, prescribed drugs (specifically digoxin, barbiturate, sildenafil, ethambutol, and chloroquine), other health problems (diabetes mellitus, sickle cell anemia, hypertension, and others), and whether or not sufficient amounts of Vitamin-A are taken. Regarding the Ishihara examination, the participant was requested by a trained data collector to read 15 plates held 75 cm away from the participant at heart level under natural daylight weather condition.
The Ishihara fifteen-plate examination results are categorized into three groups. Students who scored 13 or more than were considered normal, students scoring betwixt eleven and 12 were considered to take CVD with slight changes (two%) or misdiagnosis, and a score of 10 or less was considered as deficient.[four,14,xv] Descriptive analyses were obtained by counts and percentages, and potential associations were tested through the Pearson Chi-squared test. The 0.05 cutoff indicate for the P value was used to appraise significance. Analyses were performed in Stata version 15.[16]
Results
Of a full of 1115 students who participated in this written report, the prevalence of definitive CVD was ii.one%, as shown in Figure 1, 87% of who were unaware of their colour vision problem. Females deemed for 52.two% of the full sample and the mean age of the participants was 21.7 years (±1.iv standard deviation). Sociodemographic variables past CVD status are presented in Table 1. All 23 students definitively diagnosed with CVD were males and a highly statistically pregnant association (P < 0.000) was found between sexual practice and CVD status, as well as yr of education and CVD (P < 0.000). More than half of the students with scarce CVD were in their preclinical years, and 43.5% of students with deficient CVD were in their clinical years. No statistically significant associations were found of nationality or marital status with CVD status.
Colour vision deficiency status of medical students according to Ishihara test
Table 1
Sociodemographic characteristics of medical students co-ordinate to their colour vision deficiency condition (n=1115)
| Factors | CVD status* | P-value | ||
|---|---|---|---|---|
| | ||||
| Deficienta (n=23; 2.0%) North (%) | Pocket-size modify (2%)/misdiagnosedb (n=31; 2.viii%) Due north (%) | Normalc (n=1061; 95.2%) North (%) | ||
| Age (Hateful±SD) | 21.0±iv.0 | 20.0±1.0 | 22.0±6.0 | 0.28 |
| Sex | ||||
| Males | 23 (100) | 29 (93.6) | 481 (45.3) | <0.000 |
| Females | 0 | 2 (6.5) | 580 (54.7) | |
| Twelvemonth of education | ||||
| Preclinical | thirteen (56.5) | 28 (90.3) | 432 (xl.seven) | <0.000 |
| Clinical | 10 (43.five) | 3 (nine.7) | 629 (59.3) | |
| Nationality | ||||
| Saudi | 23 (100) | 30 (96.8) | 1049 (98.9) | 0.49 |
| Non-Saudi | 0 | 1 (three.2) | 12 (1.i) | |
| Marital status | ||||
| Single | 21 (91.three) | 30 (96.8) | 943 (88.9) | 0.63 |
| Married | 2 (8.7) | 1 (3.2) | 112 (10.6) | |
| Divorced | 0 | 0 | 5 (0.five) | |
| Widowed | 0 | 0 | 1 (0.1) | |
Tabular array 2 presents personal and family history by CVD status. A highly statistically pregnant association was found betwixt history of vision problems and CVD status (P < 0.008), with 65.2% reporting vision problems, while 34.viii% did not. Only 21.7% of deficient students reported a family history of CVD, while of the scarce or misdiagnosed group, but ix.7% reported a family history of CVD. Family history of CVD was non statistically significantly associated with personal CVD status. Neither history of heart surgery nor middle trauma was statistically significantly associated with CVD. Of the students who had CVD, viii.7% had current health problems, compared to 9.vii% of the deficient or misdiagnosed group and 15.one% of the normal group. No statistically pregnant clan was found betwixt current health problems and CVD in spite of 7.9% reporting sickle cell anemia. Yet, consumption of a Vitamin-A-rich diet was borderline meaning (P = 0.05) with CVD status, as 69.6% of the students in the deficient category and 68.iii% of the normal category had a history of Vitamin-A-rich nutrition.
Table ii
Personal and family history of medical students according to their color vision deficiency status (n=1115)
| History | CVD status* | P-value | ||
|---|---|---|---|---|
| | ||||
| Deficienta (n=23; two.0%) N (%) | Small alter (ii%)/misdiagnosedb (n=31; 2.8%) N (%) | Normalc (n=1061; 95.ii%) N (%) | ||
| Vision trouble | ||||
| Yep | 15 (65.ii) | 8 (25.8) | 543 (51.2) | 0.008 |
| No | 8 (34.8) | 23 (74.2) | 518 (48.8) | |
| Family unit history of CVD | ||||
| Yes | 5 (21.seven) | three (09.7) | 94 (08.ix) | 0.09 |
| No | 18 (78.iii) | 28 (90.3) | 967 (91.ane) | |
| History of centre surgery | ||||
| Yes | 1 (four.4) | 1 (03.two) | 78 (7.3) | 0.63 |
| No | 22 (95.7) | 30 (96.8) | 983 (92.6) | |
| History of eye trauma | ||||
| Aye | 4 (17.4) | 1 (03.2) | 80 (07.5) | 0.14 |
| No | 19 (82.6) | xxx (96.eight) | 981 (92.5) | |
| Exposure to chemicals | ||||
| Yes | ii (08.7) | 0 | 37 (03.5) | 0.21 |
| No | 21 (91.3) | 31 (100) | 1024 (96.5) | |
| Current health bug | ||||
| Yes | two (08.7) | 3 (09.seven) | 160 (15.1) | 0.64 |
| No | 21 (91.3) | 28 (90.iii) | 901 (84.9) | |
| Consume Vitamin-A-rich nutrition | ||||
| Yes | 16 (69.6) | 15 (48.four) | 725 (68.3) | 0.05 |
| No | 7 (xxx.4) | 16 (51.6) | 336 (31.7) | |
Figure 2 shows that dissimilar chemical students had been exposed to according to CVD status. Effectually 4% of scarce students were exposed to digoxin, and a like per centum (0.1%) was found for students inside the normal CVD status for digoxin, barbiturate, and chloroquine. Effigy iii shows different vision problems co-ordinate to CVD status. The most common problem of the color vision scarce students was refractive errors (one.4%).
Exposure of medical students to chemicals co-ordinate to color deficiency condition
Vision problems of medical students according to color vision deficiency status
Discussion
This study investigated the prevalence and predictors of CVD in medical students. The current study showed that the prevalence of definitive CVD was 2.one%. This effect is in accord with a cross-sectional study done by Alharfi et al., 2016 of medical students in Al-Ahsa, Saudi Arabia (2.7%) as well as in Cameroon (ii%)[10,17] Notwithstanding, our prevalence was lower than like studies conducted on medical students in Malaysia,[eighteen] Bangladesh,[xix] Pakistan,[12] two studies in Nepal,[xx,21] and India[xi] where the prevalence of CVD was iii.2%, 3.iv%, 3.vii%, 5.vi%, 5.eight%, and 6.ii%, respectively. Further, the electric current prevalence was somewhat higher than another study done in India (i.eight%).[22] Consanguineous marriages are very common in the Saudi population; even so, contrary to our expectations, the prevalence was not every bit high as found in a previous report conducted on Southward Asian populations.[23]
All the afflicted participants with CVD in our study population were males and equally was reported in Republic of india and Cameroon, no case of CVD was observed in females[11,17] Despite the absence of affected females, other studies on medical students have plant cases in females, though the incidence is lower than in their male counterparts.[17,18,22,23,24] Still, Mughal et al., 2013.[12] reported the opposite (4.5% and 2.four%, females and males, respectively) in the report conducted in Pakistan. Even so, this could be due to the fact that their study population had a very high number of females (n = 1250) in comparison to their male person counterparts (n = 750). They concluded that more enquiry was needed to explore this problem. Therefore, information technology is more often than not idea that these results indicate that males are at a greater risk of being affected more than females considering of the X-linked mode of inheritance of red–greenish CVD.
Even though a number of affected participants (21.7%) reported familial CVD, there was no statistically meaning clan. The same percentage was reported in another study of Saudi medical students in Al-Ahsa (22%), which was too non statistically pregnant.[10] This may be mostly because both populations are from the same region of Saudi Arabia (Eastern Province).
CVD can exist either inherited or acquired. Students with a family history of CVD were classified as having hereditary CVD (21.7%), and those who had no family unit history were classified under the acquired category (78.3%). Besides, Alharfi et al., 2016.[10] reported that the number of Saudi medical students who had acquired CVD was greater than those with inherited CVD (2.two% and 0.6%, respectively). In Iran, a study showed that of the 2157 participants, 9.3% had hereditary CVD and xx.2% had acquired.[25] The loftier percentage of acquired CVD in various studies could be due to changes associated with historic period, differences in race and surround, electric current health problems, and ocular conditions such as vision issues which were significantly associated with CVD in our study. However, considering CVD is an unrecognized problem, the number of acquired CVD might include those with familial defects because of their lack of awareness of their condition.[26]
Colour-deficient people may confront many difficulties in their daily activities. This is particularly important for physicians owing to the nature of their work.[27] Dhingra et al., in 2017 reported difficulties physicians faced. These bug brainstorm in medical school for medical students with CVD since they tend to make more errors than their color-normal peers. The nature of their errors suggested that the students had issues in learning specific subjects and specialties.[xiii] At that place is notable evidence that some medical professionals with CVD perform less finer than others in other occupations. Withal, medical doctors with mild CVD reported fewer problems in their practice than those with severe forms. It has been mentioned that the about common bug experienced because of CVD include: misinterpretation of the widespread trunk colour changes of pallor, cyanosis, jaundice, rashes, and erythema of skin.[26] Similarly, the study by Campbell et al., in 2005, showed that physicians with CVD had difficulty in identifying ten clinical photographs, in comparison with their color-normal peers who did so easily.[28]
Our study showed that the bulk of the affected participants were not aware of their color vision bug. This is not uncommon. In Cameroon, no medical student was aware of their deficiency.[17] Moreover, many doctors do not know the severity of their condition and tend to assume information technology is slight, and a few do not even know they have a disability.[27] Therefore, it is recommended that medical students be screened before the kickoff of their medical school training, as obtained in Republic of india, to make them aware of their CVD status and understand their limitations, in order to ensure safe exercise.[13]
As color recognition is essential in life, the importance of screening may be extended to schoolhouse-age children since CVD has been reported in several studies conducted on schoolhouse-age students with a prevalence ranging from 1.7% to 8.ii% in boys and from 0.two% to 2.9% in girls[5,6,29,30,31,32,33,34,35,36] to avert the run a risk to patients during a doctor's clinical practice. Early detection allows parents to give proper support to their children, and teachers to adjust their teaching methods to make them more beneficial to their students.
Although the tool used was a screening tool for protan and deutan defects with loftier sensitivity and specificity,[4,fourteen,15] it is recommended that a further confirmatory tool (Richmond HRR examination) exist used to detect tritan defects. Differentiating protan from deutan defects is also recommended for the affected participants using Medmont C100 Test, and Farnsworth–Munsell 100 Hue Examination to assess severity and dissimilar patterns. Furthermore, the cross-exclusive nature of this study and the sample used limit the generalization to merely a similar age group. Nosotros recommend further explanation on different age groups, i.eastward., children, adolescents, adults, and geriatrics for an in-depth exploration of the nature of the affliction whether acquired or inherited, and its touch on their lives.
Determination
The current pct is lower than many previous studies done in other countries. All definitively diagnosed CVD were males and a highly statistically significant association was institute betwixt sex activity and CVD. Yet, many medical students with CVD remain unaware of their condition and consequently may take a lot of issues in their medical education, particularly in identifying color slides, specimens, and in examining certain physical signs. We recommend early screening of all school-age children, and proper counseling for medical students with definitive CVD to take care of their own health and wellbeing, and be mindful of their condition when choosing their specialties for time to come. This will ensure avoidance of mistakes and any consequent medicolegal litigations in their professional life.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acquittance
We owe our gratitude to Dr. Abdulrahman Alsaedi at Al Imam Mohammad Ibn Saud Islamic University, Dr. Adi Al Owaifeer, Kinesthesia of Ophthalmology, College of Medicine of Male monarch Faisal University, Al-Ahsa, and Dr. Nazih Alzaidi, vitreoretinal specialist at Prince Mansour Armed forces Hospital, Taif, for their valuable fourth dimension and guidance in validating the questionnaire before distributing it to the participants.
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