-The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia

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Estimates put the number of children with vision impairment in the world at 19 million, compared to the estimated 1.4 million who are blind. To battle children’s vision issues, studies on children’s eye disorders have highlighted the significance of raising awareness among parents and educators. So, according to various authors, the awareness, perception, and attitudes of parents towards children’s eye diseases in Saudi Arabia need more research. Aims To determines the prevalence of children’s eye diseases among children aged under 18 years old, in Saudi Arabia, as well as assess the awareness, perception, and attitudes of parents towards children’s eye diseases in Saudi Arabia. Methods A cross-sectional web survey with a sample (n = 1276) of parents of children in Saudi Arabia was carried out from November 2023 to August 2024. Results This study highlights significant gaps in parental awareness of Childhood Eye Diseases (CED), with 46.5% of parents demonstrating intermediate awareness and 29.4% exhibiting poor awareness. Refractive errors were the most commonly reported eye issue, affecting 44.23% of children, while congenital glaucoma and cataracts were less common. Factors positively correlating with higher awareness included marital status, gender, age (30-50 years), education level (bachelor’s degree), and employment status. Notably, more than half of the children had never undergone an eye exam. Conclusion This study highlights significant gaps in parental awareness of CED, with 46.5% of parents demonstrating intermediate awareness and 29.4% showing poor awareness. Factors such as marital status, gender, age (30-50 years), education level (bachelor’s degree), and employment status positively correlate with higher awareness. These findings underscore the need for targeted educational interventions to improve knowledge and encourage proactive eye health care among parents. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-620/v1", "name": "-The Prevalence and Parental Awareness, Perception, and Attitudes..." } } ] } Home Browse -The Prevalence and Parental Awareness, Perception, and Attitudes... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Alhemaidi S, Al-Ghamdi. F, Alharbi T et al. -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :620 ( https://doi.org/10.12688/f1000research.160394.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] Seham Alhemaidi https://orcid.org/0000-0002-2334-7600 1 , Faisal Al-Ghamdi. 2 , Talal Alharbi 3 , [...] Aedah Alqrid 4 , Muath Alhamdi 5 , Tamara Hafez 6 , Abdullah Alshehri 7 , Aryam Alzahrani 8 Seham Alhemaidi https://orcid.org/0000-0002-2334-7600 1 , Faisal Al-Ghamdi. 2 , [...] Talal Alharbi 3 , Aedah Alqrid 4 , Muath Alhamdi 5 , Tamara Hafez 6 , Abdullah Alshehri 7 , Aryam Alzahrani 8 PUBLISHED 25 Jun 2025 Author details Author details 1 ophthalmology Division/department of surgery, University of Tabuk, Tabuk, Tabuk Province, Saudi Arabia 2 Department of Ophthalmology, King Fahad Specialist Hospital, Tabuk, Tabuk, Saudi Arabia 3 University of Tabuk, Tabuk, Tabuk Province, Saudi Arabia 4 Department of Opthamology, King Fahad Specialist Hospital, Tabuk, Saudi Arabia 5 Aljowf, aljowf, Saudi Arabia 6 Health Education and Promotion Department, King Fahad Specialist Hospital,, Tabuk, Specialist, Saudi Arabia 7 Medicine, King Fahad Specialist Hospital,, Tabuk, Saudi Arabia 8 University of Tabuk, Tabuk, Tabuk Province, Saudi Arabia Seham Alhemaidi Roles: Methodology, Supervision Faisal Al-Ghamdi. Roles: Conceptualization, Supervision Talal Alharbi Roles: Formal Analysis Aedah Alqrid Roles: Data Curation, Investigation Muath Alhamdi Roles: Data Curation Tamara Hafez Roles: Investigation Abdullah Alshehri Roles: Methodology Aryam Alzahrani Roles: Formal Analysis OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. Abstract Background Identifying and treating visual impairment in young children is crucial because it has a lasting impact on adults. Estimates put the number of children with vision impairment in the world at 19 million, compared to the estimated 1.4 million who are blind. To battle children’s vision issues, studies on children’s eye disorders have highlighted the significance of raising awareness among parents and educators. So, according to various authors, the awareness, perception, and attitudes of parents towards children’s eye diseases in Saudi Arabia need more research. Aims To determines the prevalence of children’s eye diseases among children aged under 18 years old, in Saudi Arabia, as well as assess the awareness, perception, and attitudes of parents towards children’s eye diseases in Saudi Arabia. Methods A cross-sectional web survey with a sample (n = 1276) of parents of children in Saudi Arabia was carried out from November 2023 to August 2024 . Results This study highlights significant gaps in parental awareness of Childhood Eye Diseases (CED), with 46.5% of parents demonstrating intermediate awareness and 29.4% exhibiting poor awareness. Refractive errors were the most commonly reported eye issue, affecting 44.23% of children, while congenital glaucoma and cataracts were less common. Factors positively correlating with higher awareness included marital status, gender, age (30-50 years), education level (bachelor’s degree), and employment status. Notably, more than half of the children had never undergone an eye exam. Conclusion This study highlights significant gaps in parental awareness of CED, with 46.5% of parents demonstrating intermediate awareness and 29.4% showing poor awareness. Factors such as marital status, gender, age (30-50 years), education level (bachelor’s degree), and employment status positively correlate with higher awareness. These findings underscore the need for targeted educational interventions to improve knowledge and encourage proactive eye health care among parents. READ ALL READ LESS Keywords Keywords: Saudi Arabia, Children, Eye diseases, Eye care, Perception, Parents’ Awareness Corresponding Author(s) Seham Alhemaidi ( [email protected] ) Close Corresponding author: Seham Alhemaidi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Alhemaidi S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Alhemaidi S, Al-Ghamdi. F, Alharbi T et al. -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :620 ( https://doi.org/10.12688/f1000research.160394.1 ) First published: 25 Jun 2025, 14 :620 ( https://doi.org/10.12688/f1000research.160394.1 ) Latest published: 25 Jun 2025, 14 :620 ( https://doi.org/10.12688/f1000research.160394.1 ) Introduction Visual impairment in young children can have a persistent impact on their adult lives. 1 The global prevalence of pediatric vision impairment is estimated to be around 19 million, which is significantly higher than the approximate 1.4 million children who are blind. 2 Recent studies have highlighted the importance of raising awareness among parents and educators to address visual impairment in children. 3 – 6 Sociodemographic factors and parents’ medical history of eye diseases may also play a role in determining their level of awareness. Targeted educational programs and interventions are necessary to improve awareness and promote early detection and treatment. Advances in technology and treatment methods offer hope for improved outcomes for children with visual impairments. Enhancing awareness can enable parents and educators to identify the signs of visual impairment in children and seek timely treatment to avert long-term consequences. This research aims to investigate the awareness, perception, and attitudes of parents towards pediatric eye diseases in Saudi Arabia and to identify potential determinants of their knowledge and awareness. The findings of this study can inform the development of targeted educational programs and interventions to improve awareness and promote early detection and treatment of pediatric eye conditions. Literature review The scope of the kingdom of Saudi Arabia In 2023, a study conducted in Makkah, Saudi Arabia revealed that the majority of parents lacked knowledge of pediatric eye conditions, with 72.8% reporting insufficient awareness, 24.5% reporting decent awareness, and only 2.8% reporting exceptional awareness. 7 Among the identified symptoms, eye redness had the highest percentage of symptoms that would prompt parents to bring their children to an eye specialist, with 24.5% of parents indicating that they would seek medical attention for this symptom. Interestingly, the study found that a significant percentage of parents (68.5%) would allow their children to undergo eye surgery if necessary. However, among those who refused (11.3%), fear of the surgical outcome was the most commonly cited reason for their refusal. 7 In 2022, a study was conducted in Madinah, Saudi Arabia, to assess parental awareness and perceptions of pediatric eye diseases. The study found that 3.6% of parents had excellent knowledge of pediatric eye diseases, 18.2% had good awareness, and the majority of parents (78.2%) had poor awareness of these conditions. 8 The study showed that parents had better knowledge of pediatric cataracts, childhood glaucoma, and amblyopia, with 51.7%, 11.7%, and 12.4% of parents having good knowledge of these conditions, respectively. The study also found that the majority of parents had favorable attitudes towards their children wearing glasses (76.9%) and having eye surgery when necessary (85.4%). The preferred sources of information for parents were doctors, campaigns, and social media. More than half of the participants (58.6%) reported having their children’s eyes examined. Parents with a child with an eye condition, those 51 years of age or older, those with a higher income level, those of Saudi origin, and those with a child with an eye ailment had significantly higher knowledge scores. 8 In November 2022, a descriptive cross-sectional study was conducted in the Aseer region of Saudi Arabia, targeting all parents. The study collected data from 899 parents who completed an online questionnaire developed by the study investigators. The study found that 54% of the responding parents were aged 30-50 years, and 51.2% were males. Almost half of the parents (46.2%) had a university-level education, and nearly half (48.5%) accompanied their children for eye examinations. Approximately 65% of parents knew about clinics for eye examinations, and 63.3% of them knew that blind children could learn. The study also found that parents’ awareness levels varied significantly based on factors such as age, education level, family status, and attitudes towards eye surgery for children. For instance, parents aged 50 years and older and those with a university-level education had a higher awareness level than their counterparts. Parents who lived with their families and those who had a blind child in their family also had a higher awareness level. Parents who accompanied their children for eye examinations and those who had a positive attitude towards their children undergoing eye surgery also had a higher awareness level. Overall, more than one-third of parents were aware of pediatric eye care. The study concluded that while parents in the Aseer region were aware of pediatric eye health and sought eye care for their children, there is a need for planned awareness programs to educate parents and assist them in overcoming the fears and barriers that prevent them from seeking eye care for their children. 9 – 12 In a descriptive cross-sectional study conducted in 2019 in Arar city of Northern Border in Saudi Arabia, a stratified sample of Saudi parents from 1986 was interviewed to assess their perception and awareness of pediatric eye diseases. The sample consisted of 1030 (52%) females and 956 (48%) males. The study found that there is a need to further improve parents’ understanding of pediatric eye conditions in Arar. The authors recommended more concentrated educational initiatives to promote early detection and appropriate therapy of pediatric eye diseases. 18 Targeted educational programs focusing on pediatric eye diseases could be a useful approach to improving awareness and promoting early detection and treatment in the region. Outside the scope kingdom of Saudi Arabia In 2018, a cross-sectional study was conducted in Koh-i-Sulaiman, a remote area of Baluchistan in Pakistan, to assess parental awareness of their children’s eye health. The study used a self-made questionnaire to collect data from 150 parents, of which 100 were female and 50 were male. The parents were divided into two groups: literate and illiterate. The study found that parents who were literate reported seeing eye abnormalities in their children more frequently than illiterate parents. Additionally, the majority of literate parents were aware that wearing glasses could correct bad vision. The study also found that illiterate parents learned about eye health primarily through the radio and local sources, while literate parents relied on newspapers, television, and local resources for information. Furthermore, the study found that parents with less education were more interested in information about complications, while parents with more education were interested in information on symptoms, treatments, and prevention. The study concluded that parents’ literacy level played a significant role in how they perceived eye conditions, but overall, most parents lacked sufficient knowledge about eye diseases due to a lack of resources and education in the region. The study highlights the need for targeted educational programs to improve parental awareness and education about pediatric eye diseases in remote areas of Pakistan. 13 Similarly, in 2018, a qualitative study conducted in Benin City, Nigeria, aimed to understand how parents view and perceive eye disorders in their children. The study found that the majority of causes of childhood blindness could be avoided or treated, emphasizing the importance of early detection and treatment of eye conditions. The study highlights the need for increased awareness and education among parents in Nigeria about the importance of regular eye examinations for their children and the availability of treatments for eye disorders. 4 In Benin City, Nigeria, a study was conducted to assess parental awareness of common eye conditions in children. The study recruited 35 parents aged 38 to 54 years, and ten eye care professionals aged 30 to 45 years. The study found that the majority of parents had some awareness of common eye conditions such as blurry vision, cataracts, conjunctivitis, itching and redness, crossed eyes, strabismus, short-sightedness, and stye or hordeolum. However, the study also found that some parents had false ideas about the causes of eye conditions in children. For instance, some parents believed that measles could cause eye problems, while others thought that watching too much television or using a computer could cause eye strain. The study also found that parents commonly used self-medication and local remedies, such as chloramphenicol eyedrops, to treat eye conditions before seeking medical attention. The study highlights the need for public education programs to improve parental awareness of the causes of eye conditions in children and to discourage self-medication, which can be harmful in some cases. 4 In a cross-sectional survey conducted in Riyadh, Saudi Arabia, in 2017, 1070 Saudi adults participated, out of a total of 1500 invited participants. The study found that the majority of individuals scored poorly (91.9%) on a knowledge test about eye health and care. However, the study also found that individuals with a higher level of education, such as those with university degrees, had a higher level of acceptable knowledge (64.4%). Participants who were retired had the highest mean knowledge score (7.25), followed by those working in the medical sector (6.55), while students had the lowest mean knowledge score (2.47). The study also found that community members were the most frequently referred to as sources of information. The highest percentage of participants (82.8%) knew that diabetes can cause eye problems, while the lowest knowledge scores were for eye conditions such as strabismus, visual deprivation, glaucoma, and eye tumors. The study highlights the need for awareness campaigns to concentrate on parents, particularly mothers, to improve their knowledge of common pediatric eye diseases and recommended eye care practices. Additionally, the study emphasizes the importance of education in promoting health consciousness and improving knowledge of eye health and care in the general population in Saudi Arabia. 14 Due to the limited research on the topic in Saudi Arabia, and the fact that most previous studies were conducted on a regional level rather than at the national level, The researchers conducted this study to investigate the awareness, perception, and attitudes of parents towards children’s eye diseases across the Kingdom of Saudi Arabia. The aim of our study was to gain a better understanding of the knowledge levels of Saudi society and to identify the regions where there is a lack of awareness about pediatric eye conditions. Our findings can help inform the development of targeted educational programs to improve awareness and promote early detection and treatment of eye disorders in children. By better understanding parents’ attitudes and beliefs about eye care for their children, healthcare providers can improve communication with parents and ultimately improve the eye health of children in Saudi Arabia. Aim of the study and objective A study on the prevalence of eye diseases in children under the age of eighteen, and measuring the level of parents’ awareness of their children’s eye diseases in the Kingdom of Saudi Arabia. - To measure the prevalence of eye Diseases in Children in Saudi Arabia. - To investigate the potential role of covariates (sociodemographic, parents’ previous medical history of eye diseases) as determinants of their level of awareness towards eye diseases and their care. In our study, we focused on collecting data from parents who have children under the age of 18 to assess both the prevalence of eye diseases in this population and the level of parental awareness regarding these conditions. Since our primary objective was to evaluate awareness among parents directly responsible for children within this age group, we did not include data from individuals who do not have children under 18. Methods Study design The study aimed to assess the prevalence of ophthalmic diseases among children under 18 years of age and determine the level of awareness among parents regarding ophthalmic diseases and eye care. To achieve this, a structured cross-sectional survey was conducted online. The study was conducted between November 2023, and August 2024, with data collected during this period. The study was conducted across all regions of the Kingdom of Saudi Arabia, including the central, northern, eastern, western, and southern regions. This study was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Sampling and sample size According to the Roasoft sample size calculator, a minimum sample size of 377 is required for the study under the specified conditions. These conditions include a response distribution of 50%, a confidence level of 95%, and a margin of error of 5%. Selection criteria Inclusion criteria - Parents who have children under 18 years of age. - And who live in Kingdom of Saudi Arabia. Exclusion criteria - Parents who do not have children under 18 years of age. - Or who do not live in the Kingdom of Saudi Arabia. Study population We collected data from parents of children under 18 to assess the prevalence of eye diseases and parental awareness. Individuals without children in this age group were excluded, as our primary objective was to evaluate awareness among parents directly responsible for children under 18. Before removing participants, who did not meet the study’s inclusion criteria, the total number of respondents who participated in the survey was N = 1326. From this group, a sample of parents with children under 18 years of age in Saudi Arabia was formed, resulting in a final sample size of N = 1276. Preparing the study instrument Participants were provided with a cover letter on the study website, detailing the study’s purpose, procedures, and relevant information. A self-administered questionnaire has been developed for this research, and it consists of four main sections. The estimated time to complete the questionnaire is 5-10 minutes. The cover page of the questionnaire includes general information related to the study and a consent form for participants to confirm. The first section of the questionnaire collects demographic information about the participants, such as their age, nationality, region, gender, marital status, and occupation. Additionally, this section includes questions about the medical history of the parents’ participants related to children’s diseases. The second section of the questionnaire is designed to measure the prevalence of eye diseases in children under eight years of age. This section includes questions related to the occurrence of eye diseases in children, including amblyopia, cataract, and refractive errors. The third section of the questionnaire measures parents’ awareness of children’s eye diseases. This section includes questions related to the parents’ knowledge of the symptoms, causes, and risk factors of various eye diseases that can affect children. The fourth and final section of the questionnaire measures parents’ awareness of children’s eye care. This section includes questions related to the parents’ knowledge of the importance of regular eye exams, and other factors that contribute to maintaining good eye health in children. Additional information Amblyopia (lazy eye): Amblyopia is a condition where the brain and the eye do not work together properly. The main symptom of amblyopia is reduced vision in one eye. Amblyopia can be mild or severe, and the treatment options depend on the severity of the condition. Treatment often involves patching the stronger eye to force the weaker eye to work harder, along with corrective lenses and vision therapy. 15 Strabismus (crossed eyes): Strabismus is a condition where the eyes do not align properly. The main symptom is an eye turn, which can be constant or intermittent. The severity of strabismus can vary, and treatment options depend on the severity and cause of the condition. Treatment may involve eye exercises, corrective lenses, or surgery. 16 Refractive errors (myopia, hyperopia, astigmatism): Refractive errors occur when the shape of the eye prevents light from focusing properly on the retina. The main symptoms of refractive errors are blurred vision and eye strain. The severity of refractive errors can vary, and treatment often involves corrective lenses, such as glasses or contact lenses. 17 Conjunctivitis (pink eye): Conjunctivitis is an inflammation of the conjunctiva, the thin layer of tissue that covers the white part of the eye and the inside of the eyelid. The main symptoms of conjunctivitis are redness, itching, and discharge from the eye. The severity of conjunctivitis can vary, and treatment depends on the cause of the inflammation. Treatment may involve antibiotics, antihistamines, or eye drops. 18 Blocked tear duct: A blocked tear duct occurs when the tear duct, which drains tears from the eye to the nose, is blocked or partially obstructed. The main symptom is excessive tearing, which can lead to eye infections and irritation. The severity of a blocked tear duct can vary, and treatment may involve massage, antibiotics, or surgery. 19 Data reliability and quality To ensure the reliability of the study questionnaires, a pilot test was conducted prior to the actual data collection process. The questionnaire used in the study was adopted and incorporated from previous research that were conducted in the same study community of Saudi Arabia, in the region of Makkah, Medina, Aseer, and Riyadh. 7 , 8 , 20 , 21 The questionnaire was evaluated on a sample of ten randomly selected parents from different age groups, and modifications were made to ensure its simplicity and conciseness. Each respondent received the questionnaire only once. Statistical analyses The statistical analysis for this study was conducted using IBM SPSS version 22. The extracted data were first scanned and coded, and then subjected to descriptive analysis to summarize the demographic information and the elements of parents’ awareness of children’s eye diseases. To evaluate participants’ awareness and knowledge, each correct answer was given a score of one point, and the scores were added up to determine the total score. Participants who scored less than six points out of the possible sum were considered to have poor awareness. In comparison, those who scored 6-11 points were considered to have a medium level of awareness, and those who scored 12 points or higher were considered to have a good level of awareness and knowledge. All variables, including demographic data, awareness items, knowledge, and attitudes, were described using frequency and percentile distributions. Two-tailed tests were used to evaluate the statistical significance of the data, with a p-value of 0.05 defining statistical significance. The results were presented using tables, graphs, and pie charts for clear visualization and interpretation. To investigate the relationships between parents’ awareness levels and demographic factors, the Chi-squared test was utilized, with a P value of 0.05 or less being considered statistically significant. The study’s findings were presented in tables and graphs, which allowed for clear visualization and interpretation of the results Results Demographic characteristics of participants Table 1 presents the general characteristics of the participants, including demographic variables such as age, gender. These baseline data provide context for understanding the sample population and interpreting subsequent findings. The majority of participants, 50.9% (650), were aged between 30 and 50 years, followed by those under 30 years 37.2% (475). A significant proportion were females 63.8% (814), while males represented 36.2% (462). Most participants were Saudi nationals 93.3% (1,186), with a minority being non-Saudi 6.7% (86). Regionally, the largest group came from the Northern region 45.8% (584), followed by the Western region 19.1% (244). A large majority were married 77.3% (986), with unmarried participants making up 22.7% (290). In terms of education, 59.0% (753) held a Bachelor’s degree, while 21.3% (272) had a high school diploma or equivalent. Most participants were employed 58.3% (744), with those not working comprising 18.0% (230). Additionally, 36.8% (470) reported a history of children’s eye diseases. Table 1. General characteristics of the participants. Characteristics N = 1276 % Age (years) Less than 30 years 475 37.2 30 – 50 years 650 50.9 More than 50 years 151 11.8 Gender Male (Father) 462 36.2 Female (Mother) 814 63.8 Nationality Saudi 1190 93.3 Non-Saudi 86 6.7 Region Western region 244 19.1 Central region 210 16.5 Northern region 584 45.8 Southern region 132 10.3 Eastern region 106 8.3 Marital status Married 986 77.3 Unmarried 290 22.7 Educational level Primary school 59 4.6 Middle school 36 2.8 High school/Diploma 272 21.3 Bachelor's degree 753 59.0 Postgraduate 156 12.2 Occupation Employee/works 744 58.3 Retired 95 7.4 Student 207 16.2 Do not work 230 18.0 H/O CED YES 470 36.8 No 806 63.2 Prevalence of eye diseases among children Figure 1 presents the prevalence of current or recent eye disease reported by parents of study participants. A majority of parents (63.60%, n = 800) did not report any eye problems, while 36.40% (n = 460) indicated that they had observed at least one eye issue. This suggests that a significant proportion of parents—over one-third—are aware of an existing eye condition or have noticed recent eye problems in their children. Figure 1. Prevalence of current or recent eye diseases reported by parents of study participants. Table 2 summarizes the types of current or recent eye diseases (CED) reported by the parents of child participants in Saudi Arabia. The study observed the prevalence of various eye diseases among children as reported by their parents. The most commonly reported condition was refractive errors, affecting 44.23% of the children, indicating a high prevalence of vision correction needs such as short- or long-sightedness. Dryness was the next most prevalent condition, reported in 16.55% of cases, followed by strabismus or crossed eyes, affecting 9.58% of the participants. Amblyopia, or lazy eye, was also relatively common, found in 8.89% of the children. Other conditions reported included allergic conjunctivitis (3.66%), retinal diseases (4.18%), and nasolacrimal duct obstruction (2.79%). Less common conditions included congenital cataract (2.44%), congenital glaucoma (1.57%), facial nerve palsy (1.22%), and the least frequent, chalazion, affecting only 0.17% of the children. Notably, color blindness was reported in 4.71% of the cases. Table 2. Types of Current or Recent Eye Diseases (CED) reported by parents of child participants in Saudi Arabia. Current or Recent CED N = 574 % Refractive error (short-/long-sighted) 254 44.23 Amblyopia 51 8.89 Allergic conjunctivitis 21 3.66 Congenital cataract 14 2.44 Dryness 95 16.55 Nasolacrimal duct obstruction 16 2.79 Retinal disease 24 4.18 Strabismus 55 9.58 Facial nerve palsy 7 1.22 Congenital glaucoma 9 1.57 Chalazion 1 0.17 Color blindness 27 4.71 Timing and barriers to eye examinations Figure 2 illustrates the age at which children had their first eye exam. The majority of children, 55.50%, never had an eye exam. Among those who did, 14.30% had their first exam between 1 to 5 years old, while 13.20% had their first exam before they were less than a year old. Additionally, 10% had their first eye exam between 5 to 10 years old, and 7.10% had their first exam between 10 to 15 years old. Figure 2. Age of children at first eye examination and prevalence of prior eye exams. Table 3 highlights the primary barriers identified by parents concerning the scheduling of initial eye examinations for their children. The most common reason, reported by 58.6% of parents, was the belief that their child did not require an examination based on personal assessment. Additionally, 37.6% of parents indicated they did not recognize any signs that would necessitate a visit to an eye care professional. Table 3. Understanding the barriers to first childhood eye examinations. Parental rationale for foregoing first childhood eye examinations N % I didn’t feel my child had a problem (based on my experience and feelings) 748 58.6 I didn’t notice any signs that would prompt me to take them to an eye doctor 480 37.6 I think my child is too young to have an eye test 88 6.9 I don’t know how and/or where to arrange an appointment for an eye test 59 4.6 I am worried that my child may be given glasses that they don’t need 54 4.2 I am worried about the cost of an eye test and glasses 35 2.7 I do not have the money 41 3.2 No public awareness highlighting the importance of eye exams 108 8.5 Fear of my child being exposed to COVID-19 21 1.6 A smaller proportion, specifically 6.9%, believed their child was too young for an eye test. Logistical barriers were also noted, with 4.6% of parents uncertain about how to arrange an appointment, and 4.2% concerned that their child might be prescribed unnecessary glasses. Financial constraints affected 2.7% of respondents, while 3.2% expressed difficulties affording eye care services. Furthermore, 8.5% of parents identified a lack of public awareness regarding the importance of eye examinations as a barrier. Only 1.6% of parents expressed concern related to exposure to COVID-19. Parental awareness and attitudes toward eye care Figure 3 illustrates the varying levels of parental awareness concerning the appropriate timing for routine vision examinations in children. The majority of parents, accounting for 39.9% (509 parents), believe that vision exams are necessary only when a child exhibits signs of a problem. This indicates a reactive approach to eye care rather than a preventive one. Additionally, 31.3% (399 parents) are uncertain about when to schedule routine vision exams, highlighting a lack of awareness regarding recommended eye care practices. In contrast, only 18.2% (232 parents) recognize the importance of annual eye examinations, emphasizing the need for better education on preventive eye health. A smaller proportion, 7.7%, consider biennial vision exams to be sufficient, though the exact number of parents is not specified. Lastly, 3% (38 parents) believe that eye exams should only be conducted every five years, reflecting minimal prioritization of routine eye check-ups. These findings underscore the need for increased awareness and education on the importance of regular pediatric eye examinations. Figure 3. Parental understanding of optimal timing for routine childhood vision exams. As shown in Figure 4 , the primary reason parents seek eye care for their children is eye redness, reported by 61.3% of respondents. Complaints of double vision follow closely, with 44% indicating that visual disturbances are a serious issue for many parents. Frequent eye rubbing, noted by 37.9% of parents, suggests this behavior may signal underlying eye problems, prompting them to seek professional assistance. Figure 4. Symptoms and observations that prompt parents to seek eye care for their children. Additionally, staring eyes were observed in 33.4% of cases, indicating another common symptom leading to eye care, albeit less frequently reported than the previous concerns. Excessive tear production was noted by 27.4% of parents, raising concerns about abnormal tear levels. The behavior of playing with toys at a close distance was reported by 26.7% of parents, often leading to worries about potential vision impairment. Lastly, head tilting to one side, the least common reason at 18.3%, still represents a notable concern for some parents (see Figure 4 ). The analysis of the data collected reveals that a significant majority of parents, totaling 1,151 (90.20%), support their children wearing eyeglasses. Conversely, a minority of 125 parents (9.80%) expressed disapproval regarding their children’s use of eyeglasses (see Figure 5 ). Figure 5. Gauging parental acceptance of eyeglasses for their children. Table 4 shows that 69.5% of parents are willing to allow their child to undergo essential eye surgery. However, various concerns impact their decision-making process. Financial constraints are a significant challenge for 3.9% of parents, while 9.3% express apprehension regarding the potential outcomes of the surgery. Additionally, 3.4% of parents fear that the procedure may cause further damage to their child’s eyes. Furthermore, 13.3% of parents remain uncertain about granting approval for the surgery, and only 0.5% cite cultural or social factors as reasons for their disapproval. Table 4. Gauging parental acceptance of children receiving eye surgery, if necessary. Receiving eye surgery N % Yes, I would allow my child to undergo the necessary eye surgery 887 69.5 No, the cost of the operation is a barrier 50 3.9 No, I have concerns about the potential outcome of the surgery 119 9.3 No, I'm worried the surgery could cause more damage to my child's eyes 43 3.4 No, I'm not sure if I would allow my child to have the surgery 170 13.3 No, there are cultural or social barriers that would prevent me from approving the surgery 7 0.5 The data indicates that a majority of parents, comprising 887 individuals (69.5%), would consent to their children undergoing necessary eye surgery. Conversely, 389 parents (30.4%) expressed reservations regarding this decision. The specific reasons for their hesitance are detailed in the table below ( Table 4 ). Knowledge and sources of information on eye health The assessment of parents’ knowledge and awareness regarding Childhood Eye Diseases (CED) reveals that the proportions of those with good and poor awareness levels are relatively close, with 308 parents (24.1%) demonstrating good awareness and 375 parents (29.4%) exhibiting poor awareness. The majority of parents, however, displayed an intermediate level of awareness concerning CED (see Figure 6 ). Figure 6. Shows the overall participants’ level of knowledge and awareness toward CED. Table 5 presents the association between selected demographic and socioeconomic characteristics of the sample and their levels of knowledge and awareness regarding CED in Saudi Arabia. The analysis of the association between socio-demographic factors and awareness levels among study participants revealed several significant findings. Participants aged 30-50 years demonstrated the highest levels of awareness, with 145 individuals (11.37%) classified in the high awareness category, although this group also included notable percentages in the poor and intermediate awareness levels. Females exhibited significantly higher awareness compared to males, with 178 females (13.95%) showing high awareness versus 130 males (10.19%). Additionally, regional differences indicated that the northern region had the highest proportion of participants with high awareness at 123 (9.64%), while the southern region reported the lowest at 19 (1.49%). Furthermore, married individuals exhibited greater awareness, with 267 participants (20.92%) classified as having good awareness. Table 5. Selected characteristics of the sample, and its association with the knowledge and awareness of CED, in Saudi Arabia. The basic profile of the sample Awareness and knowledge level Characteristics N % Good Intermediate Poor P Age (years) Less than 30 years 475 37.19 121 9.48% 236 18.52% 118 9.26% 0.041 * 30 – 50 years 650 50.94 145 11.37% 291 22.82% 214 16.80% More than 50 years 151 11.83 42 3.29% 66 5.18% 43 3.37% Gender Male 462 36.21 130 10.19% 182 14.27% 150 11.77% <.001 * Female 814 63.79 178 13.95% 411 32.23% 225 17.65% Region Western region 244 19.12 58 4.55% 119 9.33% 67 5.26% <.001 * Central region 210 16.46 82 6.43% 79 6.20% 49 3.84% Northern region 584 45.77 123 9.64% 281 22.04% 180 14.13% Southern region 132 10.34 19 1.49% 60 4.71% 53 4.16% Eastern region 106 8.31 26 2.04% 54 4.23% 26 2.04% Marital status Married 986 77.20 267 20.92% 436 34.18% 283 22.18% <.001 * Unmarried 290 22.80 41 3.22% 157 12.31% 92 7.22% Education Primary school 59 4.62 26 2.04% 22 1.72% 11 0.86% <.001 * Middle school 36 2.82 8 0.63% 12 0.94% 16 1.26% High school/Diploma 272 21.32 54 4.23% 149 11.68% 69 5.41% Bachelor's degree 753 59.01 180 14.11% 345 27.05% 228 17.87% Postgraduate 156 12.22 40 3.13% 65 5.10% 51 4.00% Occupation Employee/works 744 58.33 213 16.69% 309 24.22% 222 17.41% <.001 * Retired 95 7.45 19 1.49% 45 3.53% 31 2.43% Student 207 16.23 36 2.82% 116 9.10% 55 4.32% Do not work 230 18.02 40 3.13% 123 9.64% 67 5.26% H/O CED Yes 470 36.83 163 12.77% 206 16.15% 101 7.93% <.001 * No 806 63.17 145 11.37% 387 30.33% 274 21.50% * : Significant. All associations were examined with χ2 analyses, CED: children’s eye diseases; H/O: history of; N: number. Educational attainment and occupation also played critical roles in awareness levels. Those holding a bachelor’s degree demonstrated the highest knowledge at 180 individuals (14.11%), while employed participants showed superior awareness, with 213 (16.69%) categorized as having high knowledge. In contrast, only 26 (2.04%) of primary school graduates exhibited good awareness. Finally, participants with a personal history of CED demonstrated higher awareness levels, with 163 individuals (12.77%) classified as having good awareness compared to 145 (11.37%) without such a history (see Table 5 ). When examining the common sources of information among the parents participating in the study, it was noted that most of them depend on clinic visits to receive information (54.9%). This was followed by community sources, such as relatives, parents, and friends (40.4%), and the Internet (36.7%). Close proportions were observed for social media (25.5%) and personal experiences (29.6%). Additionally, 18.8% of parents consulted pharmacists for information, while 16.8% relied on awareness campaigns. Sources such as radio, books, medical journals, and brochures accounted for 16.7%. The least common sources of information were television, radio, and newspapers, with only 7.6% of parents utilizing these channels (see Figure 7 ). Figure 7. Parents’ source of knowledge about CED. Table 6 illustrates participants’ knowledge regarding various aspects of children’s eye diseases, categorized into general eye knowledge, amblyopia, cataracts, glaucoma, and overall eye care awareness, with the percentage of correct answers for each question. • General Eye Knowledge: ○ Wearing Glasses for Children Under Seven: 65.5% of participants recognized that wearing glasses can support the normal development of a child’s vision. ○ Eye Turning in Young Children: 38.6% understood that occasional eye turning in children aged one to seven can be normal. • Amblyopia: ○ Definition of Amblyopia: 36.8% accurately identified amblyopia. ○ Causes of Amblyopia: Only 15.9% were aware of the causes. ○ Treatment of Amblyopia: 27.4% recognized treatment options. ○ Consequences of Untreated Amblyopia: 60.2% acknowledged that untreated amblyopia can result in permanent vision loss. ○ Effectiveness of Early Treatment: 31.1% understood that early intervention enhances outcomes. ○ Consequences of Amblyopia: 38.5% were aware of the repercussions of amblyopia. • Cataract: ○ Definition of Cataract: 16.0% correctly identified what a cataract is. ○ Impact on Children: 50.0% recognized that cataracts can affect children. ○ Permanent Blindness: 34.8% understood that cataracts do not always lead to permanent blindness. • Glaucoma: ○ Definition of Glaucoma: 47.6% accurately identified glaucoma. ○ Impact on Children: 56.4% knew that glaucoma can affect children. ○ Congenital Glaucoma and Blindness: 50.6% understood that congenital glaucoma can lead to blindness. • Awareness and Knowledge of Eye Care: ○ Availability of Clinics: 90.6% recognized that clinics are available for eye examinations. ○ Educational Opportunities for Children with Visual Defects: 81.7% knew that children with visual impairments or blindness can pursue education in schools or colleges. ○ Specialized Schools for Blind Children: 74.8% were aware of schools that specialize in educating blind children. Table 6. Participant points earned for correct responses on CED awareness. Questions CED awareness and knowledge (Correct answer) N (%) Questions related to the eye Will wearing glasses if your child needs them when under seven years of age make your child develop your child eyes and vision develop normally? 836 (65.5) Is it normal for a child aged one to seven years to occasionally have an eye turn? 492 (38.6) Amblyopia What is amblyopia? 470 (36.8) What are the causes of amblyopia? 203 (15.9) Treatment of amblyopia 349 (27.4) Can untreated amblyopia (lazy eye) in children lead to permanent vision loss in that eye?? 768 (60,2) Will early treatment lead to better results? 397 (31.1) What are the consequences of amblyopia? 491 (38.5) Cataract What is a cataract? 204 (16.0) Do cataracts affect children? 638 (50.0) Do cataracts cause permanent blindness? 444 (34.8) Glaucoma What is glaucoma? 608 (47.6) Can glaucoma affect children? 720 (56.4) Can congenital glaucoma lead to blindness? 646 (50.6) Are there clinics available for eye examination 1156 (90.6) Can children with visual defects or blindness learn and attend school or college? 1042 (81.7) Are there any schools that specialize in educating blind children? 954 (74.8) Discussion This study aimed to assess the prevalence of eye diseases among children in Saudi Arabia and gauge parental awareness, perceptions, and attitudes toward pediatric eye care. The results revealed notable insights into the state of pediatric eye health in the region, as well as parental understanding of these conditions. The findings demonstrate that refractive errors are the most commonly reported eye issues, affecting 44.23% of children. This is consistent with previous research in Saudi Arabia, such as the study conducted in Madinah in 2022, which identified significant awareness of refractive errors among parents (51.7%). 8 In contrast, less common conditions, such as congenital glaucoma and cataracts, were reported at lower rates (1.57% and 2.44%, respectively). These findings align with the general trend in pediatric eye health, where refractive errors tend to dominate the burden of eye conditions in children. Interestingly, this study highlights that more than half (55.50%) of the children had never undergone an eye exam, and many parents delayed seeking care until a problem arose, with 58.6% stating they didn’t feel their child needed an exam based on their assessment. This finding is consistent with the barriers identified in the Aseer region study conducted in 2022, 21 where parental misconceptions about the need for routine eye exams and a lack of awareness were key barriers. The results underscore the need for national awareness campaigns to educate parents on the importance of early detection, as highlighted in studies both within and outside Saudi Arabia. When comparing parental attitudes toward eye surgery, this study found that 69.5% of parents were open to their children undergoing necessary eye surgery, which is slightly lower than the 85.4% reported in the 2022 Madinah study. 8 However, fear of surgical outcomes was also a common concern, a barrier that needs addressing through targeted educational programs and improved communication between healthcare providers and parents. Parental awareness of CED was found to be suboptimal, with 29.4% of parents demonstrating poor awareness. This is comparable to the 2023 study conducted in Makkah, which reported that 72.8% of parents lacked sufficient awareness of pediatric eye conditions. 7 The moderate to low awareness levels seen across regions in Saudi Arabia suggest that more comprehensive, region-wide educational interventions are required to bridge this gap. Internationally, similar trends in parental awareness have been observed. For example, a 2018 study in Pakistan identified that parental literacy played a crucial role in awareness levels, with literate parents more likely to recognize eye abnormalities. 13 This resonates with our findings, where higher levels of education were associated with better awareness of eye diseases. Moreover, the study in Nigeria emphasized the role of public education in combating misinformation and self-medication, issues that were less prevalent but still notable in the Saudi population. 4 Our study’s assessment of parents’ knowledge and awareness regarding CED reveals that while 46.5% of parents demonstrated an intermediate level of awareness, the proportions of those with good (24.1%) and poor (29.4%) awareness levels were relatively close. This suggests a baseline understanding of CED among parents, yet also highlights significant potential for improvement through educational outreach. In comparison to our findings, other regions demonstrate varied levels of parental awareness, indicating the influence of geographical and demographic factors. For instance, in Makkah, a substantial majority of parents (72.8%) exhibited poor awareness, with only 24.5% showing good awareness and a mere 2.8% achieving excellent awareness. 7 Similarly, in Madinah, awareness levels were notably low, with 78.2% of parents classified as having poor awareness, 18.2% as having good awareness, and only 3.6% demonstrating excellent knowledge. 8 These findings suggest that parents in Makkah and Madinah may have less exposure to eye health information or fewer community resources dedicated to pediatric eye health education. In Riyadh, parental awareness was particularly alarming, with 91.9% of participants scoring poorly, only 7.4% demonstrating good knowledge, and less than 1% achieving an excellent score. 14 Such high levels of poor awareness indicate systemic gaps in educational outreach or public health programs targeting pediatric eye care in the region. This underscores the urgent need for targeted interventions to address this specific lack of knowledge. In contrast, Arar displayed higher levels of awareness than the other cities. Here, 56.7% of participants had sufficient knowledge about CED, with an average knowledge score of 6.67, indicating a stronger foundational understanding. 20 The comparatively higher awareness levels in Arar could be attributed to more robust local educational initiatives or community health programs emphasizing pediatric eye health. The data from Aseer reveal that 38.9% of parents had a good level of awareness, while 61.1% had a poor level. 21 Although Aseer’s awareness levels are higher than those in Riyadh, Makkah, and Madinah, they still indicate a general lack of high awareness. This finding highlights the necessity for further public health education efforts to elevate parental understanding in this region. Notably, the 30-50 years age group exhibited the highest proportion of participants with a good level of awareness (11.37%), suggesting that this cohort may have greater exposure to and understanding of pediatric eye health issues. This finding aligns with previous research conducted in Makkah, which reported superior knowledge among parents aged 18-40 years compared to older counterparts. 7 However, the current study also revealed that the 30-50 years age group included a substantial proportion of individuals with poor and intermediate awareness levels, indicating that age alone may not be a reliable predictor of parental awareness. In contrast, participants under 30 years of age demonstrated a lower percentage of good awareness (9.48%), while only 3.29% of those over 50 years achieved a high level of awareness. These results are somewhat divergent from findings reported in Madinah and Arar, where older participants, particularly those with more life experience and higher educational attainment, exhibited better awareness scores. 8 , 20 Similarly, a study from Aseer found that approximately 48% of parents aged 50 years and older displayed good awareness levels, compared to only 22.3% of those under 20 years. 21 While the present investigation revealed significantly higher levels of awareness among female participants, with 13.95% exhibiting good awareness compared to 10.19% of males (p < 0.001), other studies have reported the opposite trend, where males demonstrated greater knowledge and awareness. 7 , 14 , 21 The current study’s findings indicate that marital status plays a significant role in shaping parental awareness of pediatric eye diseases in Saudi Arabia. Married participants exhibited substantially higher levels of good awareness, with 20.92% (267 individuals) demonstrating this level compared to only 3.22% (41 individuals) of unmarried participants (p < 0.001). These results are consistent with the findings reported in previous studies conducted in Riyadh and Aseer, where married adults were also found to have the highest levels of awareness regarding pediatric eye health issues. 14 , 21 This trend suggests that the marital experience and the responsibilities associated with parenthood may contribute to enhanced exposure, knowledge, and engagement with matters pertaining to child health and development, including pediatric eye diseases. Notably, individuals holding bachelor’s degrees demonstrated the highest proportion of good awareness, with 14.11% (180 participants) achieving this level. In contrast, only 2.04% (26 participants) of those with a primary school education exhibited good awareness (p < 0.001). This trend aligns with the results reported in previous studies conducted in Riyadh and Aseer, where higher educational attainment, particularly postgraduate education, was associated with significantly greater awareness of pediatric eye health issues. 14 , 21 These findings suggest that educational background plays a pivotal role in shaping parental knowledge and understanding of pediatric eye diseases. Individuals with higher levels of education may have greater access to health information, improved health literacy, and enhanced capacity to comprehend and apply relevant knowledge, all of which could contribute to their heightened awareness. The data reveal a stark contrast, where employed individuals exhibited the highest levels of awareness, with 16.69% classified as having good knowledge, compared to only 3.13% of unemployed participants demonstrating this level of awareness (p < 0.001). This disparity suggests that employment status may be a key factor in shaping access to information, educational resources, and awareness initiatives related to pediatric eye health. Employed individuals may have greater opportunities to engage with and benefit from workplace-based programs, community outreach efforts, or other platforms that facilitate the acquisition and dissemination of relevant knowledge. In contrast, the lower awareness levels observed among unemployed participants underscores the importance of ensuring that public health interventions and educational campaigns targeting parents reach beyond the employed population. Implementing strategies to effectively engage with and empower unemployed individuals, such as through community-based initiatives or targeted outreach efforts, could help address the disparities in knowledge and promote more comprehensive parental awareness. The present study’s findings indicate that a personal history of CED is associated with higher levels of parental awareness regarding these conditions in Saudi Arabia. The data show that 12.77% of participants with a history of CED exhibited good awareness, compared to 11.37% of those without such a history (p < 0.001). This observation aligns with the results reported in multiple previous studies conducted across different regions of Saudi Arabia. Consistently, these investigations have highlighted the correlation between personal experience with eye diseases and improved understanding and awareness among parents. For instance, a study in Makkah found that parents of children with a history of eye disease had a better understanding of these conditions. 7 Similarly, research in Madinah indicated significantly better knowledge of eye diseases and their management among parents whose children were affected. 8 In Arar, parents of children with a history of eye diseases scored higher in awareness assessments, 20 and a study in Aseer associated having blind children within families with heightened awareness toward eye diseases. 21 These findings suggest that direct personal experience with childhood eye health issues may foster a deeper understanding and engagement with the relevant knowledge and preventive measures among parents. The challenges and care-related experiences encountered by parents of children with eye diseases may contribute to their enhanced awareness, as they are likely to actively seek out information, resources, and support to manage their child’s condition. Overall, these findings underscore the significant influence of socio-demographic factors—such as age, gender, marital status, education, occupation, and personal history—on parental awareness of pediatric eye diseases, highlighting the need for targeted educational interventions to enhance awareness across diverse groups. The observed variations across different regions in Saudi Arabia may be attributed to a range of factors, including differences in study methodologies, regional socioeconomic and cultural factors, and the accessibility and quality of healthcare services and public health campaigns. Additionally, the information-seeking behaviors, health literacy levels, and personal experiences of parents within each age group may contribute to the heterogeneity in awareness levels. These findings have important implications for the design and targeting of future educational interventions and awareness campaigns related to pediatric eye health. Tailoring such initiatives to address the specific needs and knowledge gaps of different age groups may enhance their effectiveness and reach. Furthermore, exploring the underlying reasons for the observed age-related differences in awareness, such as access to information, health literacy, and personal experiences, could inform more nuanced and impactful public health strategies. Future research should delve deeper into the complex interplay between demographic factors, and parental awareness of pediatric eye diseases. Qualitative investigations, for instance, may provide valuable insights into the contextual and experiential factors that shape knowledge and perceptions within different age cohorts. Additionally, longitudinal studies could elucidate the dynamic nature of awareness levels and how they evolve over time, potentially informing age-appropriate interventions. The present study underscores the need for a multifaceted understanding of the factors influencing parental awareness of pediatric eye diseases in Saudi Arabia. The nuanced findings on age-related differences highlight the importance of considering the heterogeneity within and across age groups when developing targeted health education and awareness programs. Continued research in this area can contribute to the design of more effective and inclusive strategies to promote eye health knowledge and improve healthcare outcomes for children in the Kingdom. This research primarily relied on self-reported data collected through an online questionnaire. This approach may introduce biases, such as recall distortion and social desirability bias, as respondents might struggle to accurately remember their experiences or may present their answers in a manner, they perceive to be socially acceptable. Additionally, the online nature of the survey may have restricted participation to individuals with internet access, potentially limiting the generalizability of the findings to the broader population of parents in Saudi Arabia. To address these limitations, future studies could employ direct interviews or a mixed-methods approach, incorporating both quantitative and qualitative data collection techniques. This would allow for a more comprehensive understanding and inclusion of a more diverse demographic. Conclusion This study highlights significant gaps in parental awareness regarding CED among a sample of parents in Saudi Arabia. While 46.5% of parents demonstrated an intermediate level of awareness, only 24.1% exhibited good awareness, with 29.4% showing poor awareness. Notably, awareness levels were positively correlated with several factors, including marital status, gender, age, educational attainment, and employment status. Married individuals and females were more likely to have higher awareness levels, as were those in the 30-50 age group and those holding a bachelor’s degree or higher. Employed parents also demonstrated greater knowledge compared to their unemployed counterparts. These findings underscore the need for targeted educational interventions to enhance awareness and understanding of pediatric eye health. Addressing the barriers to awareness—particularly among demographics with lower knowledge levels—will be crucial in promoting early detection and treatment of eye conditions in children. Future research should explore additional factors influencing awareness and evaluate the effectiveness of educational programs aimed at improving parental knowledge of CED. Ethical consideration This study has been granted approval by the Scientific Research Ethics Committee at the University of Tabuk under the approval number: UT-346-181-2024, issued on the 15th of February 2024. The study has also received approval from the Local Research Ethics Committee (LREC). Prior to participating in the online survey, participants were provided with a cover letter on the study website that contained all necessary information and details about the study, including the purpose and procedures involved. The informed consent process was emphasized, highlighting the participants’ right to withdraw from the study at any time without being prompted. Since the survey was conducted online, verbal consent was obtained rather than written consent. This approach was approved by the ethics committee, as verbal consent was considered appropriate for the study’s online format. Participants’ voluntary participation in the survey was taken as an indication of their informed consent. Reporting guidelines • Figshare: The prevalence and parental awareness, perception, and attitudes towards eye diseases in children under 18 years old, in Saudi Arabia. https://doi.org/10.6084/m9.figshare.28189550.v3 22 Details of license: CC0 This study was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Data availability statement Figshare: The prevalence and parental awareness, perception, and attitudes towards eye diseases in children under 18 years old, in Saudi Arabia. https://doi.org/10.6084/m9.figshare.28189550.v3 22 Details of license: CC0 This project contains the following underlying data: • English questionnaire (survey questionnaire in English format). • All underlying data gathered in this study (raw and processed data supporting the findings). • Coding of collected data (data categorization and analysis framework). The data supporting this study are openly available in Figshare at the following link given below. The data is available under the Creative Commons CC0 license, allowing unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Extended data • Figshare: The prevalence and parental awareness, perception, and attitudes towards eye diseases in children under 18 years old, in Saudi Arabia. https://doi.org/10.6084/m9.figshare.28189550.v3 22 This project contains the following extended data: • Questionnaire- Parental Awareness-English (DOCX). (Study questionnaire in English) References 1. Khandekar R, Kishore H, Mansu RM, et al. : The status of childhood blindness and functional low vision in the Eastern Mediterranean region in 2012. Middle East Afr. J. Ophthalmol. 2014; 21 (4): 336–343. PubMed Abstract | Publisher Full Text | Free Full Text 2. Gilbert C, Foster A: Childhood blindness in the context of VISION 2020--the right to sight. Bull. World Health Organ. 2001; 79 (3): 227–232. PubMed Abstract 3. Senthilkumar D, Balasubramaniam SM, Kumaran SE, et al. : Parents’ awareness and perception of children’s eye diseases in Chennai, India. Optom Vis Sci. 2013; 90 (12): 1462–1466. PubMed Abstract | Publisher Full Text 4. Ebeigbe JA, Emedike CM: Parents’ awareness and perception of children’s eye diseases in Nigeria. J Optom. 2016; 10 (2): 104–110. PubMed Abstract | Publisher Full Text | Free Full Text 5. Singh A, Rana V, Patyal S, et al. : To assess knowledge and attitude of parents toward children suffering from strabismus in Indian subcontinent. Indian J. Ophthalmol. 2017; 65 (7): 603–606. PubMed Abstract | Publisher Full Text | Free Full Text 6. Nirmalan PK, Sheeladevi S, Tamilselvi V, et al. : Perceptions of eye diseases and eye care needs of children among parents in rural south India: the Kariapatti Pediatric Eye Evaluation Project (KEEP). Indian J. Ophthalmol. 2004; 52 (2): 163–167. PubMed Abstract 7. Almogbel AH, Al Shanbari N, Alibrahim IS, et al. : Parents’ awareness and attitude toward pediatrics eye diseases in Makkah, Saudi Arabia: a cross-sectional study. Cureus. 2023 May 1; 1 : e38366. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 8. Surrati AM, Almuwarraee SM, Mohammad RA, et al. : Parents’ awareness and perception of children’s eye diseases in Madinah, Saudi Arabia: a cross-sectional study. Cureus. 2022 Feb 25; 14 : e22604. PubMed Abstract | Publisher Full Text | Free Full Text 9. Onakpoya OH, Adeoye AO: Childhood eye diseases in southwestern Nigeria: a tertiary hospital study. Clinics (Sao Paulo). 2009; 64 (10): 947–952. PubMed Abstract | Publisher Full Text | Free Full Text 10. Varma R, Deneen J, Cotter S, et al. : The multi-ethnic pediatric eye disease study: design and methods. Ophthalmic Epidemiol. 2006; 13 (4): 253–262. Publisher Full Text 11. Friedman DS, Repka MX, Katz J, et al. : Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months: The Baltimore Pediatric Eye Disease Study. Ophthalmology. 2009; 116 (11): 2128–2134.e2. PubMed Abstract | Publisher Full Text | Free Full Text 12. Murthy G, John N, Gupta SK, et al. : Status of pediatric eye care in India. Indian J. Ophthalmol. 2008; 56 (6): 481–488. PubMed Abstract | Publisher Full Text | Free Full Text 13. Nasir A, Riaz R: Awareness and perception level in parents of children having eye disease in remote area (Koh-i-Sulaiman) of Baluchistan.2018. 14. Mazrou AA, Alsobaie NA, Abdulrahman AKB, et al. : Do Saudi parents have sufficient awareness of pediatric eye diseases in Riyadh? Saudi J Ophthalmol. 2020; 34 (3): 171–176. PubMed Abstract | Publisher Full Text | Free Full Text 15. American Optometric Association: Amblyopia.April 30, 2021. Accessed January 12, 2025. Reference Source 16. American Academy of Ophthalmology: Strabismus.March 1, 2021. Accessed January 12, 2025. Reference Source 17. American Academy of Ophthalmology: Refractive errors in children.January 1, 2021. Accessed January 12, 2025. Reference Source 18. Centers for Disease Control and Prevention: Conjunctivitis (Pink Eye).February 11, 2020. Accessed January 12, 2025. Reference Source 19. American Academy of Ophthalmology: Blocked tear duct.January 1, 2021. Accessed January 12, 2025. Reference Source 20. ResearchGate: Parents’ awareness and perception of children’s eye diseases in Arar City. Accessed January 12, 2025. Reference Source 21. Aldhabaan W, Alkhammash ZM, Al Zomia AS, et al. : Knowledge and practices of child eye healthcare among parents in Aseer Region, Saudi Arabia. Cureus. 2022; 14 (10). Publisher Full Text 22. Alhemaidi S, AlGhamdi F, Alharbi T, et al. : Figshare: The prevalence and parental awareness, perception, and attitudes towards eye diseases in children under 18 years old, in Saudi Arabia.2025. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 ophthalmology Division/department of surgery, University of Tabuk, Tabuk, Tabuk Province, Saudi Arabia 2 Department of Ophthalmology, King Fahad Specialist Hospital, Tabuk, Tabuk, Saudi Arabia 3 University of Tabuk, Tabuk, Tabuk Province, Saudi Arabia 4 Department of Opthamology, King Fahad Specialist Hospital, Tabuk, Saudi Arabia 5 Aljowf, aljowf, Saudi Arabia 6 Health Education and Promotion Department, King Fahad Specialist Hospital,, Tabuk, Specialist, Saudi Arabia 7 Medicine, King Fahad Specialist Hospital,, Tabuk, Saudi Arabia 8 University of Tabuk, Tabuk, Tabuk Province, Saudi Arabia Seham Alhemaidi Roles: Methodology, Supervision Faisal Al-Ghamdi. Roles: Conceptualization, Supervision Talal Alharbi Roles: Formal Analysis Aedah Alqrid Roles: Data Curation, Investigation Muath Alhamdi Roles: Data Curation Tamara Hafez Roles: Investigation Abdullah Alshehri Roles: Methodology Aryam Alzahrani Roles: Formal Analysis Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 25 Jun 2025, 14:620 https://doi.org/10.12688/f1000research.160394.1 Copyright © 2025 Alhemaidi S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Alhemaidi S, Al-Ghamdi. F, Alharbi T et al. -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :620 ( https://doi.org/10.12688/f1000research.160394.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 25 Jun 2025 Views 0 Cite How to cite this report: Kwarteng MA. Reviewer Report For: -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :620 ( https://doi.org/10.5256/f1000research.176285.r431746 ) The direct URL for this report is: https://f1000research.com/articles/14-620/v1#referee-response-431746 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Nov 2025 Michael Agyemang Kwarteng , The University of the West Indies, Trinidad and Tobago, St. Andrew Parish, Taiwan Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176285.r431746 General Comments Thank you for the opportunity to review this manuscript. The study addresses an important topic by examining the prevalence, parental awareness, perceptions, and attitudes toward ophthalmic diseases among children in the Kingdom of Saudi Arabia. While the ... Continue reading READ ALL General Comments Thank you for the opportunity to review this manuscript. The study addresses an important topic by examining the prevalence, parental awareness, perceptions, and attitudes toward ophthalmic diseases among children in the Kingdom of Saudi Arabia. While the topic is relevant and potentially valuable, the manuscript requires revisions to improve clarity, consistency, methodological robustness, and adherence to ethical standards. Title Authors should consider using "parent-reported prevalence" Abstract Background: The opening statement “Identifying and treating visual impairment in young children is crucial because it has a lasting impact on adults” is ambiguous. As currently phrased, it appears repetitive of the Introduction, where the idea is better explained. It is unclear here what “lasting impact on adults” refers to children with visual impairment will spend many years living with it or adults who interact or have with children with visual impairment? Please revise to clearly convey the intended meaning. The conclusion statement simply restates the initial part of the Results section. A conclusion should highlight the implications of the findings rather than repeat earlier statements. Please revise for clarity and impact. Introduction The section describing studies “outside the scope of KSA” includes a study conducted within KSA. This is inconsistent and should be corrected. The literature review reads more like a summary of the studies conducted without justifying why there is a need for this current study, considering there have been similar studies from 2017 to 2023 in KSA. The only justifying statement is the national coverage while regional studies had similar sample size as the current study. The final paragraph of the Introduction reiterates the aim and objective, which have already been clearly stated. This repetition should be removed for conciseness and flow. Methods The manuscript states that the study sought to include participants from all regions of KSA. However, it is unclear how participants were recruited per region. Please provide detailed information on the regional sampling approach. Also, how was the data collection tool disseminated? Was it via social media, email etc? Sample Size Calculation The description of the sample size calculation is insufficient. Please include: The total population figure used. Assumptions such as expected prevalence considering there have been about 5 similar studies in KSA. Why did the authors consider 50% instead of relying on previous studies? Statistical analysis Please specify the maximum possible score participants could obtain for awareness, perception, or attitude. Results The phrase “prevalence of eye diseases among children” should be replaced with “parent-reported prevalence” throughout the manuscript, including the title, to reflect the nature of the data. The questionnaire uses the term “dry eye,” not “dryness.” Please ensure consistent terminology. Timing and barriers to eye examinations Figure 2 presents data for multiple age categories but omits the groups aged 16 and 17. Authors should either include these age groups or provide a justification for their exclusion. The age intervals in Figure 2 are overlapping (e.g., 1–5, 5–10, 10–15). This creates ambiguity. Please revise to non-overlapping intervals such as: 1-5, 6-10 etc Ethical consideration According to the manuscript, data collection began in 2023, while ethics approval was granted on 15 February 2024. This raises significant concerns. Authors should clarify: Why data were collected before ethical approval was issued. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Optometry and Vision Science I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kwarteng MA. Reviewer Report For: -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :620 ( https://doi.org/10.5256/f1000research.176285.r431746 ) The direct URL for this report is: https://f1000research.com/articles/14-620/v1#referee-response-431746 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Jun 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 25 Jun 25 read Michael Agyemang Kwarteng , The University of the West Indies, Trinidad and Tobago, Taiwan Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kwarteng M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Nov 2025 | for Version 1 Michael Agyemang Kwarteng , The University of the West Indies, Trinidad and Tobago, St. Andrew Parish, Taiwan 0 Views copyright © 2025 Kwarteng M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions General Comments Thank you for the opportunity to review this manuscript. The study addresses an important topic by examining the prevalence, parental awareness, perceptions, and attitudes toward ophthalmic diseases among children in the Kingdom of Saudi Arabia. While the topic is relevant and potentially valuable, the manuscript requires revisions to improve clarity, consistency, methodological robustness, and adherence to ethical standards. Title Authors should consider using "parent-reported prevalence" Abstract Background: The opening statement “Identifying and treating visual impairment in young children is crucial because it has a lasting impact on adults” is ambiguous. As currently phrased, it appears repetitive of the Introduction, where the idea is better explained. It is unclear here what “lasting impact on adults” refers to children with visual impairment will spend many years living with it or adults who interact or have with children with visual impairment? Please revise to clearly convey the intended meaning. The conclusion statement simply restates the initial part of the Results section. A conclusion should highlight the implications of the findings rather than repeat earlier statements. Please revise for clarity and impact. Introduction The section describing studies “outside the scope of KSA” includes a study conducted within KSA. This is inconsistent and should be corrected. The literature review reads more like a summary of the studies conducted without justifying why there is a need for this current study, considering there have been similar studies from 2017 to 2023 in KSA. The only justifying statement is the national coverage while regional studies had similar sample size as the current study. The final paragraph of the Introduction reiterates the aim and objective, which have already been clearly stated. This repetition should be removed for conciseness and flow. Methods The manuscript states that the study sought to include participants from all regions of KSA. However, it is unclear how participants were recruited per region. Please provide detailed information on the regional sampling approach. Also, how was the data collection tool disseminated? Was it via social media, email etc? Sample Size Calculation The description of the sample size calculation is insufficient. Please include: The total population figure used. Assumptions such as expected prevalence considering there have been about 5 similar studies in KSA. Why did the authors consider 50% instead of relying on previous studies? Statistical analysis Please specify the maximum possible score participants could obtain for awareness, perception, or attitude. Results The phrase “prevalence of eye diseases among children” should be replaced with “parent-reported prevalence” throughout the manuscript, including the title, to reflect the nature of the data. The questionnaire uses the term “dry eye,” not “dryness.” Please ensure consistent terminology. Timing and barriers to eye examinations Figure 2 presents data for multiple age categories but omits the groups aged 16 and 17. Authors should either include these age groups or provide a justification for their exclusion. The age intervals in Figure 2 are overlapping (e.g., 1–5, 5–10, 10–15). This creates ambiguity. Please revise to non-overlapping intervals such as: 1-5, 6-10 etc Ethical consideration According to the manuscript, data collection began in 2023, while ethics approval was granted on 15 February 2024. This raises significant concerns. Authors should clarify: Why data were collected before ethical approval was issued. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Optometry and Vision Science I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Kwarteng MA. Peer Review Report For: -The Prevalence and Parental Awareness, Perception, and Attitudes towards Eye Diseases in Children Under 18 years old, in Saudi Arabia [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :620 ( https://doi.org/10.5256/f1000research.176285.r431746) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-620/v1#referee-response-431746 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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