Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates

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Alsaadi" }, { "@type": "Person", "name": "Mansour S. Aouda" }, { "@type": "Person", "name": "Maha D. Almheiri" }, { "@type": "Person", "name": "Ghaith A. Al Amri" }, { "@type": "Person", "name": "Sara H. Ouda" }, { "@type": "Person", "name": "Ahmed M. Alsaadi" }, { "@type": "Person", "name": "Asem Alqudah" }, { "@type": "Person", "name": "Abdelwahab Aleshawi" }, { "@type": "Person", "name": "Mohammed Z. Allouh" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Refractive errors (REs) remain a leading cause of visual impairment worldwide. Medical students frequently report a high burden of REs, possibly attributable to genetic influences and lifestyle factors like extended near-work activities and limited outdoor exposure. Limited data exist on the prevalence and determinants of REs among medical students in the United Arab Emirates (UAE). This study aimed to determine the prevalence of REs in this population and to identify the key potential risk factors associated with them. Methods A cross-sectional survey was conducted among medical students at the United Arab Emirates University. A validated 14-item questionnaire assessed the presence and type of REs, demographic and physical characteristics, educational level, family history, electronic device usage, and sunlight exposure. The survey was disseminated electronically between November 2023 and February 2024. Proper statistical analysis was employed to determine key predictors of REs. Results Among 328 participants, the overall prevalence of refractive errors was 61.3%, with myopia (with or without astigmatism) accounting for 84.1% of these cases. Female students exhibited more than three-fold higher risk of having REs than males (p = 0.01), and students with a first-degree relative affected had a 7.6-fold greater likelihood of having REs (p < 0.001). Most students with REs (77.1%) used spectacles for correction, and only 11 had laser refractive surgery. Finally, body weight significantly modulated RE type, favoring hyperopia among heavier participants (p < 0.05). Conclusion This study reveals a high prevalence of REs among medical students in UAE, with myopia being the predominant type. The key risk factors associated with this high prevalence were female sex and positive family history. These findings underscore the need for targeted preventative and corrective strategies. 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F1000Research 2025, 14 :954 ( https://doi.org/10.12688/f1000research.170570.1 ) 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 Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] Mansour A. Alsaadi 1 , Mansour S. Aouda 1 , Maha D. Almheiri 1 , [...] Ghaith A. Al Amri 1 , Sara H. Ouda 1 , Ahmed M. Alsaadi 2,3 , Asem Alqudah 4 , Abdelwahab Aleshawi 4 , Mohammed Z. Allouh https://orcid.org/0000-0003-0105-6260 1 Mansour A. Alsaadi 1 , Mansour S. Aouda 1 , [...] Maha D. Almheiri 1 , Ghaith A. Al Amri 1 , Sara H. Ouda 1 , Ahmed M. Alsaadi 2,3 , Asem Alqudah 4 , Abdelwahab Aleshawi 4 , Mohammed Z. Allouh https://orcid.org/0000-0003-0105-6260 1 PUBLISHED 22 Sep 2025 Author details Author details 1 United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, 15551, United Arab Emirates 2 Department of Ophthalmology, Zayed Military Hospital, Abu Dhabi, Abu Dhabi, United Arab Emirates 3 Department of Ophthalmology, Sheikh Khalifa Medical City, Abu Dhabi, Abu Dhabi, United Arab Emirates 4 Department of Special Surgery, Jordan University of Science and Technology Faculty of Medicine, Irbid, Irbid Governorate, 22110, Jordan Mansour A. Alsaadi Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Mansour S. Aouda Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Maha D. Almheiri Roles: Investigation, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ghaith A. Al Amri Roles: Investigation, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Sara H. Ouda Roles: Investigation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ahmed M. Alsaadi Roles: Conceptualization, Project Administration, Supervision, Writing – Review & Editing Asem Alqudah Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Abdelwahab Aleshawi Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Mohammed Z. Allouh Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. Abstract Background Refractive errors (REs) remain a leading cause of visual impairment worldwide. Medical students frequently report a high burden of REs, possibly attributable to genetic influences and lifestyle factors like extended near-work activities and limited outdoor exposure. Limited data exist on the prevalence and determinants of REs among medical students in the United Arab Emirates (UAE). This study aimed to determine the prevalence of REs in this population and to identify the key potential risk factors associated with them. Methods A cross-sectional survey was conducted among medical students at the United Arab Emirates University. A validated 14-item questionnaire assessed the presence and type of REs, demographic and physical characteristics, educational level, family history, electronic device usage, and sunlight exposure. The survey was disseminated electronically between November 2023 and February 2024. Proper statistical analysis was employed to determine key predictors of REs. Results Among 328 participants, the overall prevalence of refractive errors was 61.3%, with myopia (with or without astigmatism) accounting for 84.1% of these cases. Female students exhibited more than three-fold higher risk of having REs than males (p = 0.01), and students with a first-degree relative affected had a 7.6-fold greater likelihood of having REs (p < 0.001). Most students with REs (77.1%) used spectacles for correction, and only 11 had laser refractive surgery. Finally, body weight significantly modulated RE type, favoring hyperopia among heavier participants (p < 0.05). Conclusion This study reveals a high prevalence of REs among medical students in UAE, with myopia being the predominant type. The key risk factors associated with this high prevalence were female sex and positive family history. These findings underscore the need for targeted preventative and corrective strategies. READ ALL READ LESS Keywords Hyperopia, medical students, myopia, refractive errors Corresponding Author(s) Mohammed Z. Allouh ( [email protected] ) Close Corresponding author: Mohammed Z. Allouh Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Alsaadi MA 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: Alsaadi MA, Aouda MS, Almheiri MD et al. Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.12688/f1000research.170570.1 ) First published: 22 Sep 2025, 14 :954 ( https://doi.org/10.12688/f1000research.170570.1 ) Latest published: 22 Sep 2025, 14 :954 ( https://doi.org/10.12688/f1000research.170570.1 ) Introduction Refractive errors (REs) are a major public health problem worldwide and are considered the most common cause of visual impairment. 1 , 2 Previous studies have investigated the prevalence of REs and their associated risk factors in different countries and populations. A wide range of prevalence rates (20–80%) has been reported. 3 – 6 Various factors were associated with an increased risk of REs among different populations. The most common risk factors discovered were increasing educational levels, higher individual income, professional occupation, better housing, reduced sunlight exposure, and positive family history. 7 – 12 Moreover, the types of REs were found to have different prevalence rates in different age groups, with myopia being relatively common in the 10–29-year age group, hyperopia having an increasing prevalence after 40 years, and astigmatism having a decreasing trend with ages from 6 to 90 years. 13 , 14 The prevalence of REs among medical students has been investigated in many countries. In Singapore, the prevalence of myopia among medical students was 89.8%. 15 Nigerian medical students had a prevalence of 79.5%, and Turkish medical students had a prevalence of myopia of about 32.9%. 16 , 17 In Europe, the European Eye Epidemiology (E3) Consortium concluded that the prevalence of REs in 2015 was distributed as follows: 30.6% for myopia, 25.2% for hyperopia, and 23.9% for astigmatism. 18 In Jordan, a 2023 study reported that three-quarters of medical students suffered from REs (75% prevalence). 19 Among these students, 82.6% had myopia or myopia with astigmatism. 19 To the best of our knowledge, no study has investigated the prevalence of REs and their associated risk factors among medical students in the United Arab Emirates (UAE). This lack of research underscores the objective of our work. This study aimed to assess the prevalence of different types of REs among medical students in the UAE and elucidate the possible risk factors associated with these errors. Methods Study design and setting This was a cross-sectional study performed through a survey that involved medical students at the United Arab Emirates University (UAEU), the largest university in the UAE with the only public medical school in the country. According to the 2023/2024 academic year record, the total number of medical students at the UAEU was 602. Ethical approval for the study protocol was obtained from the Research Ethics Committee at the UAEU (approval # ERSC_2023_3755). The committee waived the need for written or verbal consent because the study was based on an anonymous questionnaire, filled out voluntarily and without any personally identifiable information. The questionnaire aimed to assess the incidence of different types of REs (myopia, hyperopia, and astigmatism) among medical students and their associated risk factors. Questionnaire design The survey was based on a questionnaire developed by our Jordanian collaborators, 19 with minor modifications to reflect the study curriculum at the UAEU and certain physical aspects of the students that might be associated with REs (height and weight). The survey questions were reviewed by several experts, including ophthalmologists and statisticians, who deemed the questions to be reasonable. The questionnaire was developed in English. The complete questionnaire comprised 14 systematic, accurate questions. Eight questions inquired about the risk factors associated with REs. Four of these were related to the student’s physical characteristics: sex, age, height, and weight. The other four were related to the student environment: study level, family history, use of electronic devices, and exposure to sunlight. Notably, the medical program at the UAEU is divided into three phases. These are the premedical phase, covering the foundation and basic medical sciences; the preclinical phase, where medical students learn integrated medical sciences in systemic modules; and the clinical phase, where medical students receive proper clinical training through hospital rotations. One of the objectives of this study was to verify if there was an association between the study level (phase) and the development of REs among medical students. Therefore, the frequency of REs was compared among the students in the three different medical phases. One question related to the family history of REs inquired about having a first-degree relative (parent or sibling) with REs. Additionally, two questions related to the student’s behavior inquired about the daily period of using electronic devices and the daily period of sunlight exposure, as it has been established that myopia is significantly associated with reduced sunlight exposure time. 11 The remaining six questions were related to the: presence of an RE, type of RE, dioptric degree, diagnosis age, correction method used, and laser refractive surgery. The REs were classified into five categories: myopia alone, myopia and astigmatism, hyperopia alone, hyperopia and astigmatism, and astigmatism alone. The last question inquired about why the student did not opt to undergo laser refractive surgery because we also aimed to investigate the students’ attitudes toward this ultimate correction method. Sampling A link to the survey, which was developed through Google Forms, was distributed to the medical students at the UAEU through repeated official emails between November 2023 and February 2024. This data collection method was more convenient for the students and researchers, and it was rapid and efficient. The link included a preface that explained the aim of the study; a statement that ensured the optionality, anonymity, and confidentiality of the study; the right to withdraw anytime; and the consent to participate. Statistical analysis Statistical analyses were performed using IBM SPSS Statistics software (standard version 29.0.0.0, IBM, Armonk, NY, USA). The data were extracted into an Excel file and then transferred to an SPSS spreadsheet. Data were expressed as frequency (percentage) for categorical variables and mean ± standard deviation of the mean (SD) for continuous variables. Cases containing contradictory answers were excluded from the analysis. The level of statistical significance was set at p < 0.05. This was determined using Pearson’s chi-squared test for categorical variables and student’s t -test for continuous variables. Multivariate logistic regression was also applied to determine the main predictors of the incidence of REs among medical students. Results Prevalence of REs A total of 336 students completed the survey, producing a response rate of 55.8% (336/602). However, eight participants were excluded because they provided contradictory answers, such as answering that they had no REs and had myopia as an RE or that they had no REs and used spectacles as a correction method. Three of these eight cases were excluded because the students answered that they used spectacles as a correction method and also answered that they had undergone laser refractive surgery as a correction method. Among the 328 participants, there were 201 (61.3%) students with REs and 127 (38.7%) without REs. Regarding sex, there were 239 (72.9%) females and 89 (27.1%) males. Most of the participants were in the age range of 17–25 years. The students who completed the survey were distributed according to the three phases of the medical curriculum at the UAEU as follows: 161 (49.1%) in the premedical phase, 98 (29.9%) in the preclinical phase, and 69 (21.0%) in the clinical phase. Most of the students (282/328, 86.0%) had a first-degree relative with an RE and had exposure to sunlight for less than 3 h per day (275/328, 83.8%). Additionally, most of the students (304/328, 92.7%) used electronic devices for more than 5 h per day. Risk factors associated with REs The independent risk factors that might be associated with the development of REs are summarized in Table 1 . Most of these factors were independently associated with the prevalence of REs among medical students in the UAE. Student sex was significantly associated with REs (p < 0.01), with female students having a higher-than-expected prevalence (67.4%). Older and shorter students were more likely associated with REs (p < 0.05). Moreover, the statistical analysis revealed a significant association between the study level and the prevalence of REs (p < 0.05). Students in the premedical phase had a less-than-expected prevalence rate of REs (54.0%), while students in the clinical phase had a more-than-expected prevalence rate (72.5%) ( Table 1 ). The presence of a first-degree relative with REs was significantly associated with the prevalence of REs (p < 0.001), as most of the students who had a first-degree relative with REs (68.1%) had REs, while most students who did not have a first-degree relative with REs (80.4%) did not have REs. There were no significant associations between the use of electronic devices or the exposure to sunlight and the prevalence of REs among the medical students. Table 1. Risk factors associated with refractive errors among medical students in the UAE. Risk factor No REs REs p-value Sex <0.001 Female 78 (32.6%) 161 (67.4%)↑ Male 49 (55.1%) 40 (44.9%) Age (y) 19.5 ± 1.7 20.0 ± 1.7 0.008 Height (cm) 165.1 ± 8.7 162.5 ± 7.6 0.007 Weight (kg) 63.9 ± 14.4 63.3 ± 16.1 NS BMI NS Underweight 21 (42.0%) 29 (58.0%) Healthy 58 (38.2%) 94 (61.8%) Overweight 39 (41.5) 55 (58.5%) Obese 8 (29.6%) 19 (70.4%) Medical level 0.020 Premedical 74 (46.0%) 87 (54.0%)↓ Preclinical 34 (34.7%) 64 (65.3%) Clinical 19 (27.5%) 50 (72.5%)↑ Presence of a first-degree relative with an RE 8 56 (35.2%) 103 (64.8%) Exposure to sunlight (h/day) NS 5 3 (50%) 3 (50%) Nevertheless, a multivariate regression analysis model was generated to determine the true predictors of REs from the previously described risk factors. The model revealed that sex and the presence of a first-degree relative with an RE were the only two true predictors of the incidence of REs among medical students in the UAE ( Table 2 ). Female students had a more than 3-fold greater risk of developing REs than male students (p = 0.01). Additionally, students who had a first-degree relative with an RE had a 7.6-fold higher risk of developing REs than students who did not have one (p < 0.001). Table 2. Multivariate logistic regression model for the predictors of refractive errors among medical students in the UAE. The predictors p-value Odds ratio 95% CI Lower Upper Sex Female 0.010 3.2 1.316 7.780 Male Ref Ref Ref Ref Age 0.466 - 0.833 1.489 Height 0.708 - 0.953 1.074 Weight 0.346 - 0.976 1.071 BMI Underweight 0.699 - 0.155 16.171 Healthy 0.628 - 0.254 9.691 Overweight 0.930 - 0.280 4.034 Obese Ref Ref Ref Ref Medical Level Premedical 0.709 - 0.224 2.768 Preclinical 0.721 - 0.356 2.045 Clinical Ref Ref Ref Ref Presence of a first-degree relative with an RE Yes 1000 2–5 0.182 - 0.178 1.387 5–8 0.309 - 0.453 1.285 >8 Ref Ref Ref Ref Exposure to sunlight (h/day) 5 Ref Ref Ref Ref Characteristics of the students with REs and distribution of the different types of REs Table 3 presents the characteristics of the students with REs and the distribution of the different types of REs among the students. Most of the students with REs were females (80.1%), corroborating the previous finding that sex is a predictor of REs. Additionally, most of the students with REs (95.5%) had a first-degree relative with an RE, which also corroborates the previous results above. Most of the students with REs (83.1%) had exposure to sunlight for less than 3 h/day ( Table 3 ). However, this is considered a normal situation, taking into consideration the hot environment of the UAE. Similarly, most of the students without REs (108/127, 85.0%) had exposure to sunlight for less than 3 h/day. Table 3. Distribution of the refractive errors among medical students in the UAE. Studied variable Frequency Percentage Sex Female 161 80.1% Male 40 19.9% BMI Underweight 29 14.4% Healthy 94 46.8% Overweight 55 27.4% Obese 19 9.5% Missing cases 4 2.0% Medical level Premedical 87 43.3% Preclinical 64 31.8% Clinical 50 24.9% Presence of a first-degree relative with an RE Yes 192 95.5% No 9 4.5% Use of electronic devices 2–5 h 10 5.0% 5–8 h 88 43.8% >8 h 103 51.2% Exposure to sunlight 5 h 3 1.5% Type of RE Myopia alone 99 49.3% Myopia with astigmatism 70 34.8% Hyperopia alone 11 5.5% Hyperopia with astigmatism 13 6.5% Astigmatism alone 8 4.0% Degree of myopia or hyperopia 6 11 5.5% Missing cases 10 5.0% Diagnosis age of RE (years) 0–5 9 4.5% 5–10 45 22.4% 10–15 72 35.8% 15–20 64 31.8% >20 8 4.0% Missing cases 3 1.5% Correction method Glasses 155 77.1% Contact lenses 28 13.9% Laser surgery 11 5.5% No corrections 7 3.5% Reasons for not performing laser surgery Cost 6 3.0% Not a candidate 26 12.9% Prefer other methods 29 14.4% Thinking later 127 63.2% I did perform a laser surgery 10 5.0% Missing cases * 3 1.5% * One of the missing cases was of a student who answered that he underwent laser refractive surgery as a correction method in the previous question. Regarding the types of REs, myopia, with or without astigmatism, was the most frequent type among the medical students with REs (84.1%). This constitutes a myopia prevalence rate of 51.5% of the total sample (169/328). Twenty-four (12.0%) students had hyperopia with or without astigmatism. Only eight (4.0%) students had astigmatism alone, as most astigmatism cases (83 students, 41.3%) were associated with either myopia or hyperopia. Most students with REs (44.8%) had myopia or hyperopia within the range of 1–3 diopters, 26.9% had >3–6 diopters, 17.9% had 6 diopters. Regarding the age at diagnosis, approximately two-thirds of the students (67.6%) were diagnosed between 10 and 20 years. Only 4.5% of the students were diagnosed before the age of 5 years; 22.4%, between 5 and 10 years; 35.8%, between 10 and 15 years; 31.8%, between 15 and 20 years; and only 4.0%, above 20 years. Most of the students with REs (155/201, 77.1%) used eyeglasses for correction. Out of the 201 medical students who had REs, only seven (3.5%) did not use any correction method. Eleven (5.5%) students underwent laser refractive surgery. A question was asked about why the students chose not to perform laser refractive surgery, and most of them (127/201, 63.2%) stated that they were thinking of doing it later. However, 29 students (14.4%) preferred other methods, while the other 26 (12.9%) were not candidates for laser refractive surgery. Myopia versus hyperopia The factors that might be associated with the type of REs (myopia or hyperopia) among medical students in the UAE are summarized in Table 4 . Only the students’ heights and weights were significantly associated with the type of REs (p < 0.05). Taller students were associated with hyperopia, while shorter ones were more associated with myopia. Additionally, students with a greater body weight were associated with a higher prevalence of hyperopia, while those with a lower body weight were associated with a higher prevalence of myopia. However, the multivariate regression analysis, including all factors reported in Table 4 , revealed that weight was the only predictor of the type of RE. Students with a higher body weight had a 1.175-fold higher prevalence of hyperopia than those with a lower body weight (p < 0.05). None of the remaining factors were significantly associated with the type of RE. Table 4. Risk factors associated with myopia versus hyperopia among medical students in the UAE. Risk factor Myopia Hyperopia p-value Sex NS Female 137 (89.5%) 16 (10.5%) Male 32 (80.0%) 8 (20.0%) Age (y) 20.0 ± 1.7 19.7 ± 1.9 NS Height (cm) 162.0 ± 7.7 166.2 ± 6.9 0.012 Weight (kg) 62.3 ± 16.6 69.3 ± 13.1 0.049 BMI NS Underweight 28 (96.6%) 1 (3.4%) Healthy 77 (86.5%) 12 (13.5%) Overweight 43 (81.1%) 10 (18.9%) Obese 17 (94.4%) 1 (5.6%) Medical level NS Premedical 69 (83.1%) 14 (16.9%) Preclinical 59 (95.2%) 3 (4.8%) Clinical 41 (85.4%) 7 (14.6%) Presence of a first-relative with an RE NS Yes 163 (88.6%) 21 (11.4%) No 6 (66.7%) 3 (33.3%) Use of electronic devices (h/day) NS 0–2 0 (0%) 0 (0%) 2–5 7 (70.0%) 3 (30.0%) 5–8 73 (86.9%) 11 (13.1%) >8 89 (89.9%) 10 (10.1%) Exposure to sunlight (h/day) NS 5 2 (66.7%) 1 (33.3%) Discussion To our knowledge, this is the first study to investigate the prevalence of REs among medical students in the UAE. We found that sex and the presence of a first-degree relative with an RE were the main risk factors associated with the prevalence of REs among these medical students. Female medical students had a higher prevalence of REs than male medical students. Almost all students with REs (95.5%) had a first-degree relative with an RE. The physical characteristics, among the presence of other confounding factors, did not show any association with the presence of REs. However, when tested for the type of RE, weight was significantly associated with the type of RE, as students with a greater body weight tended to have a higher prevalence of hyperopia. The higher prevalence of REs among female students can be explained by the fact that most of the participants were females (~73%). This can be explained by the higher number of females than males who were admitted to the college: 488 females compared to 197 males. Similarly, a study on the prevalence of REs in Jordan revealed that 63% of the participants were females. 19 Additionally, the prevalence of REs was significantly higher among female school students compared to that among male students in Egypt. 12 However, the prevalence rate of myopia did not show a significant difference between female and male Turkish medical students. 16 A study in Singapore also revealed no difference in the prevalence rate of myopia between female and male medical students. 15 These findings collectively indicate that the influence of sex on the prevalence of REs may be associated with the ethnicity of the studied population. Additionally, the prevalence of REs among medical students in the UAE was significantly higher with the presence of a first-degree relative who has an RE. The results showed that 95.5% of medical students who had REs also had a first-degree relative with an RE. A previous study from Egypt showed that the prevalence of REs was significantly higher among school children with a positive family history of REs compared to that in those with no family history; however, consanguinity did not affect the prevalence of REs. 12 Two multicenter, longitudinal studies revealed that the risk of being myopic was increased for children with two versus one or no parents with myopia. 20 , 21 In summary, having a first-degree relative with an RE increases the chance of developing an RE; however, how REs are inherited is not completely understood. 22 There is inconsistency in the literature regarding the association of physical characteristics, including height and weight, with the prevalence of different types of REs. Several previous studies suggested a positive association between height and myopia. Joseph et al. 23 revealed that increased height was a risk factor for myopia in the southern Indian adult population. In contrast, Hashemi et al. 24 found no correlation between height and myopia among Iranian university students, indicating that the relationship between height and REs may vary by ethnicity or age. A gender-specific pattern was noted by Machluf et al., 25 where shorter males exhibited a higher prevalence of bilateral myopia, while no significant relationship was observed in females. In the context of stunting, Sharma et al. 26 found that neither stunting nor height was associated with REs after adjusting for confounding factors such as age and parental education among rural Chinese schoolchildren. Also, the impact of weight on REs is variable, with some studies indicating a protective effect against myopia at higher weight indices. For example, consistent with our findings, Saw et al. 27 observed that children with greater body weights in Singapore were more hyperopic, suggesting that the relationship between weight and REs may differ across populations and involve other factors such as lifestyle and nutrition. Moreover, Shi et al. 28 reported an inverse correlation between the Weight-Adjusted Waist Index (WWI) and myopia severity, indicating that a higher WWI could be protective against severe myopia. In contrast, Hashemi et al. 24 observed a direct correlation between increased weight and higher odds of myopia among Iranian students, highlighting weight as a broader risk factor for REs. The relationship between physical characteristics (height and weight) and REs appears to be multifactorial, shaped by a complex interplay among genetic, environmental, nutritional, and lifestyle determinants. A limitation of this study could be the possibility of selection bias, as students with REs might be more likely to participate. Also, the response rate of 55.8% might be considered inadequate by some researchers. However, there is a general consensus that at least half the survey cohort must complete the survey to be acceptable. 29 To avoid these limitations, many reminder emails were sent to the students to encourage participation regardless of the presence or absence of REs. Additionally, the survey period was extended for four months to recruit as many participants as possible. Conclusion The overall prevalence rate of REs among medical students in the UAE was high (61.3%). Myopia, with or without astigmatism, constituted the most frequent type of RE in these students, with a prevalence rate of 51.5% of the total sample (169/328). Moreover, the two main risk factors associated with this prevalence were sex and the presence of a familial history. Female medical students had a higher prevalence of REs than male students. Almost all students with REs (95.5%) had a first-degree relative with an RE. The physical characteristics, among the presence of other confounding factors, did not show strong associations with the presence of REs. However, when tested for the type of RE, higher body weights were associated with a higher tendency toward hyperopia than myopia. However, the association between physical characteristics and REs is complex and likely influenced by genetic, environmental, and lifestyle factors. Further research is needed to expand this survey to a national level in the UAE to develop targeted prevention strategies for the population. Ethics and consent Ethical approval for the study protocol was obtained from the Research Ethics Committee at the UAEU (approval # ERSC_2023_3755). The committee waived the need for written or verbal consent because the study was based on an anonymous questionnaire, filled out voluntarily and without any personally identifiable information. Grants information This research was supported by grants from the United Arab Emirates University to M. Z. Allouh; a CMHS grant (Grant code: G00004697, Fund number: 12M176), and a SURE Plus grant (Grant code: G00005273, Fund number: 12M280). Data availability Underlying data Figshare: Prevalence of Refractive Errors among Medical Students in United Arab Emirates, https://doi.org/10.6084/m9.figshare.30093157 . 30 This project contains the following underlying data: 1. Original Dataset Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Naidoo KS, Leasher J, Bourne RR, et al. : Global Vision Impairment and Blindness Due to Uncorrected Refractive Error, 1990-2010. Optom. Vis. Sci. 2016 Mar; 93 (3): 227–234. 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Draugalis JR, Coons SJ, Plaza CM: Best Practices for Survey Research Reports: A Synopsis for Authors and Reviewers. Am. J. Pharm. Educ. 2008 Feb 15; 72 (1): 11. PubMed Abstract | Publisher Full Text | Free Full Text 30. Allouh M: Original Dataset. figshare. 2025 [cited 2025 Sep 10]; p. 43760 Bytes. Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 22 Sep 2025 ADD YOUR COMMENT Comment Author details Author details 1 United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, 15551, United Arab Emirates 2 Department of Ophthalmology, Zayed Military Hospital, Abu Dhabi, Abu Dhabi, United Arab Emirates 3 Department of Ophthalmology, Sheikh Khalifa Medical City, Abu Dhabi, Abu Dhabi, United Arab Emirates 4 Department of Special Surgery, Jordan University of Science and Technology Faculty of Medicine, Irbid, Irbid Governorate, 22110, Jordan Mansour A. Alsaadi Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Mansour S. Aouda Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Maha D. Almheiri Roles: Investigation, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ghaith A. Al Amri Roles: Investigation, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Sara H. Ouda Roles: Investigation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ahmed M. Alsaadi Roles: Conceptualization, Project Administration, Supervision, Writing – Review & Editing Asem Alqudah Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Abdelwahab Aleshawi Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Mohammed Z. Allouh Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing 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: 22 Sep 2025, 14:954 https://doi.org/10.12688/f1000research.170570.1 Copyright © 2025 Alsaadi MA 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 Alsaadi MA, Aouda MS, Almheiri MD et al. Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.12688/f1000research.170570.1 ) 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 22 Sep 2025 Views 0 Cite How to cite this report: Sachi Balasubramaniam S. Reviewer Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r420436 ) The direct URL for this report is: https://f1000research.com/articles/14-954/v1#referee-response-420436 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 27 Oct 2025 Saranya Sachi Balasubramaniam , Acchutha Institute of Optometry, Tamil Nadu, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.188041.r420436 There is no mention regarding the ethnicity of the participants. Please look into the ethnicity. Asian, South East Asian populations have more myopia, compared to the rest of the world. The selection bias: the participants are usually those who ... Continue reading READ ALL There is no mention regarding the ethnicity of the participants. Please look into the ethnicity. Asian, South East Asian populations have more myopia, compared to the rest of the world. The selection bias: the participants are usually those who are proactive students, probably those who tend to do more reading and close work too. Consider this factor too. Otherwise the article looks good, with relevant points and appropriate analysis. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes 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, Employability Skills for Optometry Graduates, 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. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sachi Balasubramaniam S. Reviewer Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r420436 ) The direct URL for this report is: https://f1000research.com/articles/14-954/v1#referee-response-420436 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 Views 0 Cite How to cite this report: Aljaberi HA. Reviewer Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r420432 ) The direct URL for this report is: https://f1000research.com/articles/14-954/v1#referee-response-420432 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 07 Oct 2025 Hassan A Aljaberi , Al-Mustaqbal University, Hillah, Iraq Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.188041.r420432 Overall summary This study examines the prevalence and correlates of refractive errors (REs) among medical students at the United Arab Emirates University. The topic is important for public health and ophthalmic practice in the Gulf region, addressing a ... Continue reading READ ALL Overall summary This study examines the prevalence and correlates of refractive errors (REs) among medical students at the United Arab Emirates University. The topic is important for public health and ophthalmic practice in the Gulf region, addressing a local evidence gap. The manuscript is generally well-written and provides useful epidemiological data. However, several methodological and analytical aspects require clarification or extension to strengthen the validity and interpretability of the findings. Major comments 1. Rationale and positioning: The Introduction should more clearly justify the focus on medical students in the UAE and articulate what is unique about this population or context (e.g., educational intensity, digital exposure, climate/outdoor time). Add comparison to related UAE/GCC student populations (non‑medical) to motivate the study’s contribution. 2. Study design, sampling, and potential biases: Because the study is cross‑sectional and based on a self‑administered online survey, please discuss and, where possible, assess selection and recall biases. Consider comparing early versus late responders to evaluate response bias and provide any available information on representativeness relative to the full medical student cohort (sex, phase). 3. Outcome definition and modeling strategy: The binary outcome combining all REs (myopia, hyperopia, astigmatism) obscures heterogeneity. Given that categories are not mutually exclusive, consider using multinomial/ordinal models, or separate models for each RE subtype; at a minimum, justify the chosen approach and discuss its implications. 4. Model specification and diagnostics: Report full model specification with all covariates; provide adjusted odds ratios with 95% CIs in the main text or tables. Assess multicollinearity (e.g., variance inflation factors) and model fit/calibration. Clarify the variable selection process (theory-driven vs. data-driven) and the rationale for including height/weight alongside BMI. 5. Use of age at diagnosis: Age at diagnosis is a strength of the dataset. Consider survival/duration analysis (time‑to‑RE onset) or at least stratified analyses by age‑of‑onset bands to provide additional insight. 6. Interpretation of sex differences: Avoid attributing the higher RE prevalence in females to a larger female subsample; prevalence is a proportion and not driven by subsample size if sampling is representative. Discuss alternative explanations (behavioral, educational load, near‑work patterns) and consider sensitivity analyses. 7. Height/weight associations with RE subtype: Provide physiological or behavioral hypotheses (e.g., body growth, ocular axial length, hormonal factors) to contextualize the observed associations. Indicate whether findings persist after adjusting for potential confounders (e.g., study phase, device use, family history). 8. Limitations: Expand the limitations to include reliance on self‑reported RE status (lack of clinical confirmation), potential misclassification, single‑institution sampling (generalizability), and inability to infer causality from cross‑sectional data. Minor comments • Abstract: replace vague phrasing (e.g., “proper statistical analysis”) with specific methods (chi‑square tests; t‑tests; multivariable logistic regression). • Keywords: add “United Arab Emirates” and include all RE subtypes (myopia, hyperopia, astigmatism). • Introduction: at first mention of REs, explicitly list the three subtypes for clarity. • Tables: Table 1 and Table 3 contain overlapping information; consider combining to reduce redundancy and add clear footnotes on statistical tests. • Figures: include at least one visualization (e.g., distribution of RE subtypes; prevalence by sex/phase). • Methods: specify questionnaire validation details (source, any psychometrics such as Cronbach’s alpha) and whether RE status was self‑reported or clinically confirmed. • Statistical analysis: state how missing data were handled; confirm assumptions for tests; report exact p‑values when appropriate. • Results: present adjusted ORs with 95% CIs directly in the text or a primary table; ensure consistent decimal places and units. • Discussion: expand comparative discussion versus regional/international studies and clarify potential reverse causality for device‑use variables. • Data availability: briefly describe dataset structure (variables, coding) to aid reuse; keep the Figshare link as provided. • Writing/style: reduce repetition between Introduction and Discussion; use past tense for results; ensure consistent use of abbreviations (REs). Suggested text edits (optional) Abstract – Methods: “Statistical analyses included chi‑square tests, t‑tests, and multivariable logistic regression to identify predictors of refractive errors.” Keywords: “United Arab Emirates; refractive errors; myopia; hyperopia; astigmatism; medical students.” Limitations: “This cross‑sectional, self‑reported survey from a single institution may be subject to selection and recall biases; lack of clinical confirmation may lead to outcome misclassification; generalizability beyond UAEU medical students is limited.” Mandatory reviewer questions (to be copied into the online form) Competing interests: I declare that I have no competing interests. Methodological soundness: Partly. The study design is suitable for prevalence estimation; however, the modeling strategy and bias assessment require further clarification. Statistical analysis: Partly appropriate; recommend multinomial modeling or subtype-specific analyses, along with diagnostics for multicollinearity and model fit. Data availability/reproducibility: Yes. Data are available; recommend adding a brief data dictionary/variable description. Ethics: Ethical approval has been obtained, and the design includes appropriate anonymity and consent waivers. Recommendation Approved with reservations (pending clarifications to methodology and expanded analyses as noted above). 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? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Aljaberi H, Ali I, Noori Z: Prevalence of refractive errors among school students in Iraq — A systematic review and meta-analysis. Journal of Optometry . 2025; 18 (1). Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Optometry, Ophthalmology, Visual Sciences, Refractive Surgery, Eye Health, Medical Device Engineering 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 Aljaberi HA. Reviewer Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r420432 ) The direct URL for this report is: https://f1000research.com/articles/14-954/v1#referee-response-420432 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 Views 0 Cite How to cite this report: Chen Q. Reviewer Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r417089 ) The direct URL for this report is: https://f1000research.com/articles/14-954/v1#referee-response-417089 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 06 Oct 2025 Qihui Chen , China Agricultural University, Beijing, China Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.188041.r417089 Reviewer report: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates General comments The paper under review examines factors associated with the prevalence of refractive errors among ... Continue reading READ ALL Reviewer report: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates General comments The paper under review examines factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates (UAE) (all attending the UAE university) using a cross-sectional survey dataset. The study has some original features (such as being the first to look at medical students in the UAE), and the text is, in general, well-written; however, the statistical analysis could have been done in a more in-depth way to detect more granular patterns between the factors examined and the prevalence of refractive errors (REs), as discussed in my comments below. My more specific comments are divided into “major problems” and “minor issues”. Major problems Motivation. The Introduction should explain clearly why the study focuses on medical students in the UAE. Is there anything particular about medical students or about the UAE that motivates the study? What new knowledge can we learn from a study focusing on medical students in the UAE? Related to my previous point, the “literature review” section in the Introduction should include studies on the prevalence of REs among other types of students in the UAE to provide some background information. As acknowledged in the “limitations” part, one major concern is the potential selection bias generated by the participants’ voluntary participation—those who were more interested in the study or those suffering more from REs were more likely to participate. The authors did not address this issue effectively. However, given that repeated emails were sent to the students, the authors can test whether selection bias is indeed a concern by examining whether those who agreed to participate immediately after the first email was sent and those who agreed after multiple emails were sent. Alternatively, the authors could include the number of emails sent (or the time elapsed) before a student accepted the invitation as an additional control variable in the regression models to see if it makes a difference. As mentioned in the text, REs examined in the study include myopia, hyperopia, and astigmatism, which are neither mutually exclusive nor independent (see Table 3, “type of RE”). Thus, a Multinomial logit model is a better modelling device than separate logit models. In any case, pooling three REs together to define the outcome measure seems unreasonable. The dataset used contains unique information on the age at which REs were developed. This provides an opportunity to fit duration/hazard models. I suggest that the authors try this direction. The choice of risk factors is not clearly explained. Why these risk factors? The authors should provide both theoretical reasons and empirical evidence from previous studies to support their choice. For example, a recent paper in China found that out-of-school private tutoring was a factor contributing to myopia among middle school students (Chen et al., 2024). Related to my previous points, one reason why the significance of many factors disappeared in the multivariable regression model is the presence of multicollinearity among some of these factors. Thus, the authors should provide a clear rationale behind the choice of risk factors and perform a correlation analysis before running a regression to avoid putting many highly correlated factors in the model. Interpretations of the findings should be strengthened. First, the interpretation of previous findings in the Introduction (page 3, 1 st paragraph) seems misleading. For example, while higher income has been found to be positively correlated with a higher prevalence of REs, calling higher income a risk factor seems unreasonable—do you suggest that people should give away some of their income to protect their eyes? Income itself won’t cause vision problems. It is something else related to income (e.g., being able to afford a big TV screen or more video games) that causes the problems. Second, some interpretations of the findings of this paper are incorrect. In particular, the authors attributed the gender difference in RE prevalence to the larger number of female participants in the sample. But “prevalence” is a “proportion” measure. If both male and female samples are representative of the UAE University medical student population, the difference in subsample size should not matter. (If it matters, then what about having a first-degree relative with REs?—Your data includes more participants having a first-degree relative with REs than those without; is its bigger sample size driving its significant effect?) An alternative explanation is that female students work harder than male students, which seems more natural. If you have test scores data, this can be easily verified. Third, I suggest that authors further explore their data to aid in interpreting the findings. For example, the authors reviewed some activities (e.g., the use of electronic devices) as risk factors for RE prevalence (Table 4). However, these activities could be the result of REs (e.g., Huang and Chen, 2023). Using them to explain RE prevalence could lead to a reverse causality problem. Finally, the authors did not explain why having a first-degree relative with REs predicts one’s RE prevalence. The authors mentioned “how REs are inherited is not completely understood,” but inheritance may not be the only explanation. If the whole family studied hard when young, then all members could have developed REs, regardless of what their genes look like. In that case, it is family tradition that drives the first-degree relative–REs relationship. Minor issues Abstract: In the “methods” part, the author mentions “proper statistical analysis.” I suggest that the author replace “proper” with a more specific term, such as the names of the models used (e.g., logit models). Keywords: Consider adding “United Arab Emirates.” Also, why only include “myopia” but not these other REs? Introduction. Should mention myopia, hyperopia, and astigmatism the first time you mention REs (i.e., page 3, 1 st sentence). The Introduction includes a paragraph discussing previous studies (page 3, 1st paragraph), but that section is by no means comprehensive. I would suggest that the author add a more detailed literature review section to better position their own study. Much of the content in Table 3 is redundant, as Table 1, column 2, contains the same information. I suggest that the author combine the two tables. References refer to 1, 2 Is the work clearly and accurately presented and does it cite the current literature? Yes 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? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Chen, Q., Huang, J., Pei, C. 2024. A neglected health burden of shadow education?—Effects of private supplementary tutoring on middle school students’ vision in China. Children and Youth Services Review, 148, 107463. 2. Huang, J., Cai, Y., Chen, Q. 2024. Will disease awareness induce healthier behavior?―A regression-discontinuity analysis of effects of myopia diagnosis among Chinese adolescents. Applied Economics 56(59),8991-9013. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health Economics 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 Chen Q. Reviewer Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r417089 ) The direct URL for this report is: https://f1000research.com/articles/14-954/v1#referee-response-417089 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 22 Sep 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 2 3 Version 1 22 Sep 25 read read read Qihui Chen , China Agricultural University, Beijing, China Hassan A Aljaberi , Al-Mustaqbal University, Hillah, Iraq Saranya Sachi Balasubramaniam , Acchutha Institute of Optometry, Tamil Nadu, India 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 Sachi Balasubramaniam S. 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. 27 Oct 2025 | for Version 1 Saranya Sachi Balasubramaniam , Acchutha Institute of Optometry, Tamil Nadu, India 0 Views copyright © 2025 Sachi Balasubramaniam S. 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 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 There is no mention regarding the ethnicity of the participants. Please look into the ethnicity. Asian, South East Asian populations have more myopia, compared to the rest of the world. The selection bias: the participants are usually those who are proactive students, probably those who tend to do more reading and close work too. Consider this factor too. Otherwise the article looks good, with relevant points and appropriate analysis. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes 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, Employability Skills for Optometry Graduates, 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. reply Respond to this report Responses (0) Sachi Balasubramaniam S. Peer Review Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r420436) 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/14-954/v1#referee-response-420436 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Aljaberi H. 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. 07 Oct 2025 | for Version 1 Hassan A Aljaberi , Al-Mustaqbal University, Hillah, Iraq 0 Views copyright © 2025 Aljaberi H. 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 Overall summary This study examines the prevalence and correlates of refractive errors (REs) among medical students at the United Arab Emirates University. The topic is important for public health and ophthalmic practice in the Gulf region, addressing a local evidence gap. The manuscript is generally well-written and provides useful epidemiological data. However, several methodological and analytical aspects require clarification or extension to strengthen the validity and interpretability of the findings. Major comments 1. Rationale and positioning: The Introduction should more clearly justify the focus on medical students in the UAE and articulate what is unique about this population or context (e.g., educational intensity, digital exposure, climate/outdoor time). Add comparison to related UAE/GCC student populations (non‑medical) to motivate the study’s contribution. 2. Study design, sampling, and potential biases: Because the study is cross‑sectional and based on a self‑administered online survey, please discuss and, where possible, assess selection and recall biases. Consider comparing early versus late responders to evaluate response bias and provide any available information on representativeness relative to the full medical student cohort (sex, phase). 3. Outcome definition and modeling strategy: The binary outcome combining all REs (myopia, hyperopia, astigmatism) obscures heterogeneity. Given that categories are not mutually exclusive, consider using multinomial/ordinal models, or separate models for each RE subtype; at a minimum, justify the chosen approach and discuss its implications. 4. Model specification and diagnostics: Report full model specification with all covariates; provide adjusted odds ratios with 95% CIs in the main text or tables. Assess multicollinearity (e.g., variance inflation factors) and model fit/calibration. Clarify the variable selection process (theory-driven vs. data-driven) and the rationale for including height/weight alongside BMI. 5. Use of age at diagnosis: Age at diagnosis is a strength of the dataset. Consider survival/duration analysis (time‑to‑RE onset) or at least stratified analyses by age‑of‑onset bands to provide additional insight. 6. Interpretation of sex differences: Avoid attributing the higher RE prevalence in females to a larger female subsample; prevalence is a proportion and not driven by subsample size if sampling is representative. Discuss alternative explanations (behavioral, educational load, near‑work patterns) and consider sensitivity analyses. 7. Height/weight associations with RE subtype: Provide physiological or behavioral hypotheses (e.g., body growth, ocular axial length, hormonal factors) to contextualize the observed associations. Indicate whether findings persist after adjusting for potential confounders (e.g., study phase, device use, family history). 8. Limitations: Expand the limitations to include reliance on self‑reported RE status (lack of clinical confirmation), potential misclassification, single‑institution sampling (generalizability), and inability to infer causality from cross‑sectional data. Minor comments • Abstract: replace vague phrasing (e.g., “proper statistical analysis”) with specific methods (chi‑square tests; t‑tests; multivariable logistic regression). • Keywords: add “United Arab Emirates” and include all RE subtypes (myopia, hyperopia, astigmatism). • Introduction: at first mention of REs, explicitly list the three subtypes for clarity. • Tables: Table 1 and Table 3 contain overlapping information; consider combining to reduce redundancy and add clear footnotes on statistical tests. • Figures: include at least one visualization (e.g., distribution of RE subtypes; prevalence by sex/phase). • Methods: specify questionnaire validation details (source, any psychometrics such as Cronbach’s alpha) and whether RE status was self‑reported or clinically confirmed. • Statistical analysis: state how missing data were handled; confirm assumptions for tests; report exact p‑values when appropriate. • Results: present adjusted ORs with 95% CIs directly in the text or a primary table; ensure consistent decimal places and units. • Discussion: expand comparative discussion versus regional/international studies and clarify potential reverse causality for device‑use variables. • Data availability: briefly describe dataset structure (variables, coding) to aid reuse; keep the Figshare link as provided. • Writing/style: reduce repetition between Introduction and Discussion; use past tense for results; ensure consistent use of abbreviations (REs). Suggested text edits (optional) Abstract – Methods: “Statistical analyses included chi‑square tests, t‑tests, and multivariable logistic regression to identify predictors of refractive errors.” Keywords: “United Arab Emirates; refractive errors; myopia; hyperopia; astigmatism; medical students.” Limitations: “This cross‑sectional, self‑reported survey from a single institution may be subject to selection and recall biases; lack of clinical confirmation may lead to outcome misclassification; generalizability beyond UAEU medical students is limited.” Mandatory reviewer questions (to be copied into the online form) Competing interests: I declare that I have no competing interests. Methodological soundness: Partly. The study design is suitable for prevalence estimation; however, the modeling strategy and bias assessment require further clarification. Statistical analysis: Partly appropriate; recommend multinomial modeling or subtype-specific analyses, along with diagnostics for multicollinearity and model fit. Data availability/reproducibility: Yes. Data are available; recommend adding a brief data dictionary/variable description. Ethics: Ethical approval has been obtained, and the design includes appropriate anonymity and consent waivers. Recommendation Approved with reservations (pending clarifications to methodology and expanded analyses as noted above). 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? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Aljaberi H, Ali I, Noori Z: Prevalence of refractive errors among school students in Iraq — A systematic review and meta-analysis. Journal of Optometry . 2025; 18 (1). Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Optometry, Ophthalmology, Visual Sciences, Refractive Surgery, Eye Health, Medical Device Engineering 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) Aljaberi HA. Peer Review Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :954 ( https://doi.org/10.5256/f1000research.188041.r420432) 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/14-954/v1#referee-response-420432 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Chen Q. 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. 06 Oct 2025 | for Version 1 Qihui Chen , China Agricultural University, Beijing, China 0 Views copyright © 2025 Chen Q. 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 Reviewer report: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates General comments The paper under review examines factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates (UAE) (all attending the UAE university) using a cross-sectional survey dataset. The study has some original features (such as being the first to look at medical students in the UAE), and the text is, in general, well-written; however, the statistical analysis could have been done in a more in-depth way to detect more granular patterns between the factors examined and the prevalence of refractive errors (REs), as discussed in my comments below. My more specific comments are divided into “major problems” and “minor issues”. Major problems Motivation. The Introduction should explain clearly why the study focuses on medical students in the UAE. Is there anything particular about medical students or about the UAE that motivates the study? What new knowledge can we learn from a study focusing on medical students in the UAE? Related to my previous point, the “literature review” section in the Introduction should include studies on the prevalence of REs among other types of students in the UAE to provide some background information. As acknowledged in the “limitations” part, one major concern is the potential selection bias generated by the participants’ voluntary participation—those who were more interested in the study or those suffering more from REs were more likely to participate. The authors did not address this issue effectively. However, given that repeated emails were sent to the students, the authors can test whether selection bias is indeed a concern by examining whether those who agreed to participate immediately after the first email was sent and those who agreed after multiple emails were sent. Alternatively, the authors could include the number of emails sent (or the time elapsed) before a student accepted the invitation as an additional control variable in the regression models to see if it makes a difference. As mentioned in the text, REs examined in the study include myopia, hyperopia, and astigmatism, which are neither mutually exclusive nor independent (see Table 3, “type of RE”). Thus, a Multinomial logit model is a better modelling device than separate logit models. In any case, pooling three REs together to define the outcome measure seems unreasonable. The dataset used contains unique information on the age at which REs were developed. This provides an opportunity to fit duration/hazard models. I suggest that the authors try this direction. The choice of risk factors is not clearly explained. Why these risk factors? The authors should provide both theoretical reasons and empirical evidence from previous studies to support their choice. For example, a recent paper in China found that out-of-school private tutoring was a factor contributing to myopia among middle school students (Chen et al., 2024). Related to my previous points, one reason why the significance of many factors disappeared in the multivariable regression model is the presence of multicollinearity among some of these factors. Thus, the authors should provide a clear rationale behind the choice of risk factors and perform a correlation analysis before running a regression to avoid putting many highly correlated factors in the model. Interpretations of the findings should be strengthened. First, the interpretation of previous findings in the Introduction (page 3, 1 st paragraph) seems misleading. For example, while higher income has been found to be positively correlated with a higher prevalence of REs, calling higher income a risk factor seems unreasonable—do you suggest that people should give away some of their income to protect their eyes? Income itself won’t cause vision problems. It is something else related to income (e.g., being able to afford a big TV screen or more video games) that causes the problems. Second, some interpretations of the findings of this paper are incorrect. In particular, the authors attributed the gender difference in RE prevalence to the larger number of female participants in the sample. But “prevalence” is a “proportion” measure. If both male and female samples are representative of the UAE University medical student population, the difference in subsample size should not matter. (If it matters, then what about having a first-degree relative with REs?—Your data includes more participants having a first-degree relative with REs than those without; is its bigger sample size driving its significant effect?) An alternative explanation is that female students work harder than male students, which seems more natural. If you have test scores data, this can be easily verified. Third, I suggest that authors further explore their data to aid in interpreting the findings. For example, the authors reviewed some activities (e.g., the use of electronic devices) as risk factors for RE prevalence (Table 4). However, these activities could be the result of REs (e.g., Huang and Chen, 2023). Using them to explain RE prevalence could lead to a reverse causality problem. Finally, the authors did not explain why having a first-degree relative with REs predicts one’s RE prevalence. The authors mentioned “how REs are inherited is not completely understood,” but inheritance may not be the only explanation. If the whole family studied hard when young, then all members could have developed REs, regardless of what their genes look like. In that case, it is family tradition that drives the first-degree relative–REs relationship. Minor issues Abstract: In the “methods” part, the author mentions “proper statistical analysis.” I suggest that the author replace “proper” with a more specific term, such as the names of the models used (e.g., logit models). Keywords: Consider adding “United Arab Emirates.” Also, why only include “myopia” but not these other REs? Introduction. Should mention myopia, hyperopia, and astigmatism the first time you mention REs (i.e., page 3, 1 st sentence). The Introduction includes a paragraph discussing previous studies (page 3, 1st paragraph), but that section is by no means comprehensive. I would suggest that the author add a more detailed literature review section to better position their own study. Much of the content in Table 3 is redundant, as Table 1, column 2, contains the same information. I suggest that the author combine the two tables. References refer to 1, 2 Is the work clearly and accurately presented and does it cite the current literature? Yes 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? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Chen, Q., Huang, J., Pei, C. 2024. A neglected health burden of shadow education?—Effects of private supplementary tutoring on middle school students’ vision in China. Children and Youth Services Review, 148, 107463. 2. Huang, J., Cai, Y., Chen, Q. 2024. Will disease awareness induce healthier behavior?―A regression-discontinuity analysis of effects of myopia diagnosis among Chinese adolescents. Applied Economics 56(59),8991-9013. Competing Interests No competing interests were disclosed. Reviewer Expertise Health Economics 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) Chen Q. Peer Review Report For: Factors associated with the prevalence of refractive errors among medical students in the United Arab Emirates [version 1; peer review: 1 approved, 2 approved with reservations] . 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