Prevalence and determinants of work-related ocular symptoms among dentists of Bangladesh: A cross-sectional study

Taslima Rafique; Fahima Nasrin Eva; Md. Shah Fattehullah Bhuyan; Shourov Barua; Jyotie Malakar; Arpita Biswangree; Dilruba Alam Chowdhury; Tasin Afrose; Parikshit Dutta; Jannatun Nahar; Disha Mony Dey; Sreshtha Chowdhury; Mohammad Azmain Iktidar; Simanta Roy; Mohammad Delwer Hossain Hawlader

doi:10.1371/journal.pone.0336159

Peer Review History

Original SubmissionJuly 4, 2025
5 Aug 2025 Decision Letter - Samira Adnan, Editor Dear Dr. Chowdhury, 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. ============================== Kindly address the comments of the reviewers so the manuscript can be considered for publication ============================== Please submit your revised manuscript by Sep 19 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. 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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, Samira Adnan Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf . 2. In the online submission form, you indicated that [Data will be available upon reasonable request to the study supervisor]. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. 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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: Kindy revise the manuscript according to the comments of the reviewers. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No Reviewer #3: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** Reviewer #1: Dear author In general, the manuscript is well written and organized. No minor or major corrections must be done. However, the author should go through the ''Instructions to author'' section and follow the Journal's instructions regarding the edition, proof reading and references style. Reviewer #2: Very intriguing and well due research on the topic. he study is well-structured, with clear objectives and a comprehensive methodology. Key strengths include the large sample size, relevant findings on high prevalence of ocular symptoms, and identification of associated factors such as gender, age, smoking, and work hours. The use of multivariable regression and interaction terms adds depth to the analysis. However, several limitations affect the manuscript’s rigor. The use of snowball sampling introduces potential selection bias, limiting generalizability. Reliance on self-reported symptoms without clinical validation raises concerns about measurement accuracy. The discussion occasionally overstates causal inferences despite the cross-sectional design. Statistical interpretations, particularly of interaction terms, lack clarity, and some confidence intervals suggest marginal significance. The writing is often repetitive, and figures need improvement. Additionally, the long author list without clarification of contributions should be addressed. Overall, the manuscript presents important findings but requires revisions to improve clarity, avoid overinterpretation, and enhance methodological transparency before it is suitable for publication. Reviewer #3: The study is interesting and generally well executed; however, please (i) include a backward stepwise regression analysis for the overall occurrence of ocular symptoms, (ii) report the model’s accuracy, (iii) add a complete copy of the survey questionnaire to the supplementary file, (iv) examine whether the type of institution (private vs governmental)—given your original 50 : 50 sampling target—affects the outcomes, and (v) clarify whether the reported ocular symptoms were corroborated by medical examination. Check for english erroers ****** 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 #1: Yes: Mohamed Abdulmunem Abdulateef Reviewer #2: No Reviewer #3: No ******** [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 https://doi.org/10.1371/journal.pone.0336159.r001
Revision 1
19 Oct 2025 Author Response Thank you for the overall positive review. We have attached a point-by-point response below: Reviewer #1: Dear author In general, the manuscript is well written and organized. No minor or major corrections must be done. However, the author should go through the ''Instructions to author'' section and follow the Journal's instructions regarding the edition, proof reading and references style. Response: Thank you for your valuable feedback. We have carefully reviewed the revised manuscript and ensured that it aligns with the Journal’s “Instructions to Authors,” including formatting, proofreading, and reference style. Reviewer #2: Very intriguing and well due research on the topic. The study is well-structured, with clear objectives and a comprehensive methodology. Key strengths include the large sample size, relevant findings on high prevalence of ocular symptoms, and identification of associated factors such as gender, age, smoking, and work hours. The use of multivariable regression and interaction terms adds depth to the analysis. However, several limitations affect the manuscript’s rigor. The use of snowball sampling introduces potential selection bias, limiting generalizability. Reliance on self-reported symptoms without clinical validation raises concerns about measurement accuracy. The discussion occasionally overstates causal inferences despite the cross-sectional design. Statistical interpretations, particularly of interaction terms, lack clarity, and some confidence intervals suggest marginal significance. The writing is often repetitive, and figures need improvement. Additionally, the long author list without clarification of contributions should be addressed. Overall, the manuscript presents important findings but requires revisions to improve clarity, avoid overinterpretation, and enhance methodological transparency before it is suitable for publication. Response: We appreciate the reviewer’s comments regarding potential selection bias and reliance on self-reported symptoms. We would like to note that these limitations have already been acknowledged in the manuscript’s “Limitations” section. Specifically, we discussed the potential selection bias from snowball sampling and the recommendation that ocular assessments ideally be performed by ophthalmologists rather than relying solely on self-reports. Additionally, we highlight that, given the study population’s familiarity with medical terminology, we anticipate minimal reporting bias regarding ocular symptoms. Please refer to Lines 322-332 of the revised manuscript for clarification. In the manuscript, the discussion has been refined as needed, and statistical interpretations (including interaction terms) have already been clarified (please refer to lines 239-245). Additionally, we have included a detailed author contribution statement to clarify each author’s role. Reviewer #3: The study is interesting and generally well executed; however, please (i) include a backward stepwise regression analysis for the overall occurrence of ocular symptoms, (ii) report the model’s accuracy, (iii) add a complete copy of the survey questionnaire to the supplementary file, (iv) examine whether the type of institution (private vs governmental)—given your original 50 : 50 sampling target—affects the outcomes, and (v) clarify whether the reported ocular symptoms were corroborated by medical examination. Check for english erroers Response: We thank the reviewer for this thoughtful suggestion. (i) Explanatory variables in this study were chosen through a combination of statistical approaches (including stepwise regression), theoretical relevance, and prior literature. As such, we did not rely exclusively on backward stepwise regression models, since this approach alone may omit variables with strong theoretical or epidemiological importance. Please refer to lines 174- 178, page 7. (ii) To ensure model adequacy, we compared models using the lowest AIC and BIC values. We also assessed multicollinearity with VIF (<5), which confirmed the stability of the final model. Regarding performance, we reported adjusted aORs with 95% CIs, as the primary aim of our analysis was to evaluate the strength and direction of associations rather than to develop a predictive model. We have clarified these points in the manuscript in lines 176- 180, page 7. (iii) A complete copy of the survey questionnaire has been provided in the supplementary material of the revised manuscript. (iv) We appreciate the reviewer’s thoughtful observation. While the 50:50 representation of government and private dentists was applied only in the pilot phase to refine the questionnaire, in the main survey, participants were recruited nationwide through snowball sampling via online platforms (e.g., social media, email, SMS). During analysis, we did include institutional type (government vs. private) in the multivariable model; however, it did not show any statistically significant results and did not materially affect the associations of interest. Given that our primary focus was on individual- and behavior-related predictors of ocular symptoms, we did not retain this variable in the final model. (v) To ensure accuracy, it is recommended that ophthalmologists perform ocular assessments rather than relying on self-reporting. Given the familiarity of the study population (dentists) with medical terminology and symptoms, we anticipate minimal reporting bias regarding ocular symptoms since no clinical diagnosis was involved. (vi) We have carefully revised the manuscript to correct English language errors and improve readability. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0336159.r002
21 Oct 2025 Decision Letter - Samira Adnan, Editor Prevalence and determinants of work-related ocular symptoms among dentists of Bangladesh: a cross-sectional study PONE-D-25-32756R1 Dear Dr. Chowdhury, 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. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . 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, Samira Adnan Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0336159.r003
Formally Accepted
Acceptance Letter - Samira Adnan, Editor PONE-D-25-32756R1 PLOS ONE Dear Dr. Chowdhury, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Samira Adnan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0336159.r004

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