PONE-D-25-00919Association of lifestyle and behavioral factors with self-reported visual problems among schoolchildren in rural Bangladesh.PLOS ONE

Dear Dr. Islam,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

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Nick Fogt

Academic Editor

PLOS ONE

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When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

Additional Editor Comments (if provided):

Please address in detail the comments from reviewer #2. In particular, please carefully consider the comments related to limitations of the sampling methods, as well as suggestions regarding the statistical analyses. Please clarify the statistical analyses and results.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The article full filled all rules. Appreciate the title, Introduction , Material and method, statistical analysis, Result, discussion and reference. The sample size, study design, table presentation all were appropriately designed.

Reviewer #2: This is a cross-sectional study including a large sample of participants; however, the reduced number of statistical subgroups limits their statements. The authors present the self-reported ocular problems of schoolchildren mainly in grades one to five in the community of Narail, Bangladesh, as well as the lifestyle, behavioral and sociodemographic factors that are associated with these problems. The data presented can inform initiatives to enhance eye health care for school children in Bangladesh by highlighting the current status.

Regarding the study design and data interpretation possible limitations by the self-reported data collection from children, mainly aged 7-11 should be discussed and possible misreporting and inaccuracies should be clearly addressed. Furthermore, the small number of cases within the subgroups should be discussed as possible limitations within the overall large sample size. In some cases the interpretation of results implies causality. Given the study design only associations can be made. Please revise the manuscript accordingly.

Considering the clarity and definitions used throughout the manuscript please ensure to define the term of financial solvency numerically especially by clearly defining its catergories “all/most/some/none of the time”. On page 5 the study aims listed as (i),(ii) and (iii) should be listed correctly and be used throughout the manuscript. Overall sentence structure should be improved, as potentially independent statements should be cleary separated as on Page12: “ Of the total children, 99 (0.7%) reported that they had problems seeing the blackboard or distance people, with a significant difference between urban (2.2%) and rural areas (0.6%), p<0.001, and those who were living in paka houses (1.3%).”.

The statistical reporting within the manuscript should be presented comprehensively and uniform, including the name of the tests used, p-values, and confidence intervals. For example, on page 11, the statement “significantly higher in urban areas (67.1% vs. 58.1%)” requires supporting statistics. Tables should include description for each number featured (table 1), as well as statistical approaches used should be explained for tables presenting statistical calculation results (tables 2-4). The association between mobile phone use and ocular traumas should be presented with caution, given the low number of trauma cases (n=34).

Check the consistency of your reported results in both the text and the tables, as these do not match on page 15. You state “Only five children did not take vitamin A, of whom one (20%) had problems seeing the blackboard, had headaches, had eye examinations, and used spectacles.”, whereas in table 3, you report that no children with headaches took no vitamin A.

To improve specific data interpretation, please clarify your statement on page 18: “Our study reported that for children who watched TV for more than one hour or used a mobile screen for more than one hour, the relative risk was significantly higher than those who did not watch TV or did not spend time on a mobile screen.”.

Furthermore the discussion provides important contextualization of the findings. However, referencing data from 2002 (Murthy et al.) may be outdated. A more recent comparison would strengthen the relevance of the discussion.

Overall the manuscript provides valuable insights into the topic of pediatric eye health in a rural setting; however, it is essential that the text is subjected to several revisions in order to ensure clarity, statistical rigor, and appropriate interpretation of the findings. It is submitted that the aforementioned revisions would result in the manuscript making a meaningful contribution to the field of global eye health.

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Reviewer #1: Yes:  Prof. Khair Ahmed Choudhury

Reviewer #2: No

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PONE-D-25-00919R1Association of lifestyle and behavioral factors with self-reported visual problems among schoolchildren in rural Bangladesh.PLOS ONE

Dear Dr. Islam,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 07 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Nick Fogt

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Thank you for your thoughtful responses to the reviewer comments. One final thing: could you please bold or highlight those findings with significant p values in Tables 2 and 3. There is obviously a substantial amount of information in these tables, and it would be easier to process them with the suggested highlighting.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Association of lifestyle and behavioral factors with self-reported visual problems among schoolchildren in rural Bangladesh.

PONE-D-25-00919R2

Dear Dr. Islam,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Nick Fogt

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for your highlighting the significant findings.

Reviewers' comments: