The validity of short Bahasa Melayu sentences of the UKM-Radner Reading Charts for near vision assessment Mohd Izzuddin Hairol1,2 , Syafiqah Aqilah Mohd Shafiee2 , Zainora Mohammed2,3 , Rogayah A Razak3,4, and Sharanjeet Sharanjeet-Kaur2,3 Poster ID font size (28) UKM REC approval: UKM PPI/111/8/JEP-2021-132 Discussion/ Conclusion Results Acknowledgement Introduction / Background References Methodology 1Centre for Community Health Studies (ReaCH), 2Optometry & Vision Science Program 3Centre for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia 4Faculty of Social Sciences and Liberal Arts, UCSI University Fig 1. Sample sentences (S12, S21, and S37) from the 40 sentences used in the study The 24 selected Malay language sentence optotypes are highly comparable in lexical difficulty and reading length with high validity and reliability for measuring reading performance, A Bahasa Melayu reading acuity chart, the Carta Membaca Radner-UKM, is now being developed similar to Fig 6. Reading performance is usually assessed through reading acuity and speed using charts such as the MNRead, a continuous text chart whose sentences consist of 60 characters and ten standard-length words. However, the length and position of words in the chart are inconsistent. Different lexical and syntactic complexity can affect a patient's reading performance (Radner et al. 2016). The standard concept of the Radner Reading is that each sentence is comparable in lexical difficulty, syntactic complexity, word length, number of syllables, and word position (Radner et al. 2002). The sentences are short, so the reading performance assessment is easier to run, saves time, and is comparable to other reading charts. The objectives of this study were to: a) Create short sentence optotypes for a Bahasa Melayu version of the Radner Reading Charts that were similar in word count, word length, difficulty, and syntactical structure; b) Investigate the validity and reliability of these sentence optotypes by evaluating the reading speed and reading time in adults • The construction of the Bahasa Melayu sentences was based on the rules defined by Radner et al. (2002). • Each sentence consisted of a main clause followed by a relative clause. They contained 14 words with a maximum of 3 syllables arranged in 3 lines. The first and second lines contained 5 words and the third line has only 4 words. Each line had 28 to 30 characters including spaces. 40 sentences that followed the rule were created (Fig. 1). • Each sentence, printed on A4 paper (Times New Roman font size 12 point) was read at 40 cm. • Reading speed and reading time were measured in 120 non-presbyopic adults (mean age: 22.09±1.28 years) with normal vision. • Reading time (rt) for each sentence was measured using a stopwatch when the subject read the first word in the text. • Reading speed (rs) (in words per minute, wpm): the time needed to read each sentence (14 words × 60 s divided by reading time). • Reading errors were recorded by marking the text on a separate form. • Sentences were statistically standardized by selecting those within rtmean±0.25×SD and rsmean ±1.25×SD • rs and rt were also compared with the 75-word Teks Bacaan Awal Bahasa Melayu. • For the 40 sentences, the mean rt was 4.85±0.86 sec (Fig 2), and the mean rs was 178.53±31.10 wpm (Fig 3) • 24 sentences were selected: rt between 4.64 and 5.07 sec, and rs between 170.52 to 186.54 wpm Fig. 2 Fig. 3 We thank Prof. Wolfgang Radner from the Austrian Academy of Ophthalmology and Optometry for his insights and contribution to the development of the chart. • For the standard text, the mean rs was 172.89 ± 27.97 wpm, and the mean rt was 26.17±3.23 sec • The rs correlation between the standard text and the 24 sentences was significant (Fig 4) Fig. 4 • The Radner-UKM sentences have a more consistent rs, and shorter rt, compared to the standard text (Fig 5) • Cronbach’s α value for the 24 sentences: 0.98 Fig. 5 Fig. 6 Radner et al., 2002 Graefes Arch. Clin. Exp. Ophthalmol., 240(6), 461-467. Radner et al., 2016 Graefes Arch. Clin. Exp. Ophthalmol., 254(1), 177-184.
INTRODUCTION • Dry eye with unstable tear film has been associated with glare sensitivity and decreased contrast sensitivity1. • Night driving demands a distinct set of skills and awareness compared to daytime travel due to reduced visibility and increased glare from headlights2. • This study aimed to investigate the association between tear film stability and self-reported night driving difficulty in Malaysian adults. METHODOLOGY DISCUSSION/CONCLUSION • This study suggests that an unstable tear film has a measurable impact on the self-reported capability to drive at night, even with a distance VA of 6/6. • Treatments for dry eye specifically targeting unstable tear film should therefore aim to improve safety while driving at night and hence quality of life. REFERENCES 1. Szczotka-Flynn LB, Maguire MG, Ying GS, Lin MC, Bunya VY, Dana R, Asbell PA, & Dry Eye Assessment and Management (DREAM) Study Research Group (2019). Impact of dry eye on visual acuity and contrast sensitivity: dry eye assessment and management study. Optometry and Vision Science, 96(6), 387– 396. 2. Wood JM (2020). Nighttime driving: visual, lighting and visibility challenges. Ophthalmic Physiol Opt, 40, 187–201. 3. Kimlin JA, Black AA, Djaja N, Wood JM (2016). Development and Validation of a Vision and Night Driving Questionnaire. Ophthalmic Physiol. Opt, 36, 465–476. ASSOCIATION BETWEEN TEAR FILM STABILITY AND SELF-REPORTED NIGHT DRIVING DIFFICULTIES IN MALAYSIAN ADULTS Pui Juan Woi1*, Purani Pathmanathan1, Mohd Harimi Abd Rahman2, Haliza Abdul Mutalib1, Madhavendra Bhandari3 1Center for Community Health Studies (ReaCH), Optometry and Vision Science Programme, Universiti Kebangsaan Malaysia, Malaysia 2Center for Rehabilitation & Special Needs Studies (iCaRehab), Optometry and Vision Science Programme, Universiti Kebangsaan Malaysia, Malaysia 3School of Optometry, Faculty of Medicine & Health Sciences, UCSI University, Malaysia Poster ID: 2 Ethical Approval: UKM PPI/111/8/JEP-2022-103 90 Malaysian drivers (aged 18 to 40 yrs, mean=24.78 yrs±4.52) • Habitual Rx with distance VA of 6/6 or better in both eyes • Drove at night at least once a week Vision and Night Driving Questionnaire (VND-Q)3→night driving difficulty score Tearscope Plus→non-invasive tear break-up time (NIBUT) Fig. 1 Tear film with fine grid insert. Fig. 2 Descriptive statistics of the study population. Median NIBUT, 6.02s was used as the cut-off value to categorize the drivers into low and normal NIBUT groups. Table 1 Comparison of NIBUT and VND-Q scores between drivers with low and normal NIBUT. There was a moderate, negative correlation between VND-Q score and NIBUT. This study was supported by the Young Lecturers Incentive Grant (GGPM) under Universiti Kebangsaan Malaysia (Code: GGPM- 2021-034). The authors are grateful to the subjects for their commitment and cooperation. ACKNOWLEDGEMENT Fig. 3 Correlation between VND-Q score and NIBUT. All p > 0.05 RESULTS
ADULT-ONSET VITELLIFORM MACULAR DYSTROPHY (AVMD): A CLINICAL CASE REPORT Irni Suhana MI , Syarmilla CSII, Nur Mizan HII, Ahmad Ziyad SIII, Syahirul Khalis MIV, Muhammad Afzam Shah ARV . Optometry Unit Hospital JeliI , Ophthalmology Department Raja Perempuan Zainab IIII, Optometry Unit Hospital Gua MusangIII, Optometry Unit Hospital Tanah MerahIV, Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University MalaysiaV . DISCUSSION A central circular yellow deposit, a hyper-autofluorescent lesion, late staining on fluorescein angiography, and a subnormal to normal EOG are the usual symptoms of AVMD3 . Many organizations have hypothesized that AVMD is a minor form of BVMD and exhibits the same range of symptoms as BVMD since the clinical characteristics of AVMD are comparable to those of early-stage BVMD and the age of BVMD onset is very varied4 . The authors would like to thank the Director of Health Malaysia, Datuk Dr Muhammad Radzi Bin Abu Hassan for permission to publish this poster. One of the most prevalent types of macular degeneration is the adult-onset vitelliform foveomacular dystrophy(AVMD)1 .This type of subretinal vitelliform lesion is linked with a strong signal on fundus autofluorescence (FAF) imaging and is best identified by optical coherence tomography (OCT)2 . REFERENCES 1. Chowers I, Tiosano L, Audo I, Grunin M, Boon CJ. Adult-onset foveomacular vitelliform dystrophy: A fresh perspective. Prog Retin Eye Res. 2015 Jul;47:64-85. doi: 10.1016/j.preteyeres.2015.02.001. Epub 2015 Feb 11. PMID: 25681578. 2. Michalis Georgiou1,2, Kaoru Fujinami1,2,3, Michel Michaelides1,2 Ann Eye Sci2020;5:25 | http://dx.doi.org/10.21037/Received: 09 March 2020; Accepted: 22 June 2020; Published: 15 September 2020. doi: 10.21037/aes-20-81. 3. Shah SM, Schimmenti LA, Marmorstein AD, Bakri SJ. Adult-onset vitelliform macular dystrophy secondary to a novel IMPG2 Gene variant. Retin Cases Brief Rep. 2021 Jul 1;15(4):356-358. doi: 10.1097/ICB.0000000000000824. PMID: 30300315. 4. Johnson AA, Guziewicz KE, Lee CJ, Kalathur RC, Pulido JS, Marmorstein LY, Marmorstein AD. Bestrophin 1 and retinal disease. Prog Retin Eye Res. 2017 May;58:45-69. doi: 10.1016/j.preteyeres.2017.01.006. Epub 2017 Jan 30. PMID: 28153808; PMCID: PMC5600499. A 39-year-old man came to the Optometry Unit, Hospital Jeli, Kelantan, in 2022 for his eye examination for a new pair of spectacles. He has never been to a proper eye examination. Upon presentation, he complained that both of his eyes had experienced gradual blurring of vision since his early 30s. He also mentioned that his aunt was recently blinded, but the causes were unknown as his aunt did not go for a proper eye examination. In addition, he has type-2 diabetes mellitus, hypertension and hyperlipidaemia His best corrected VA for the right eye (RE) and left eye (LE) was 6/60, respectively. Upon funduscopy, the optometrists noted a small white lesion near the macular area (BE). As such, he was subsequently referred to the Ophthalmology Department, Hospital Raja Perempuan Zainab II, Kelantan. The ophthalmologist diagnosed him with Vitelliform Macular Dystrophy (atrophic stage). He was given a 6-month appointment to monitor the fundus. No treatment was prescribed since there is no causal treatment for this disorder yet. In most cases of AVMD, the VA is typically unaffected for many years; thus, AVMD may not be detected until much later in life. To date, genetic counselling would be beneficial for the affected individuals and their families. INTRODUCTION CASE REPORT CONCLUSION RESULTS DISCUSSION ACKNOWLEDMENT Figure 1 Fundus photographs of the right and left eyes showing central macular atrophy surrounded circumferentially by scattered yellows lesions.
Three Cats Exercise for Decompensated Esophoria: A Case Report. Nurazillah binti Ismail1 *, Sharifah Suzaini binti Syed Kuning2 , Nur Aida Madiha binti Che Rahim3 , Dr Asmah binti Ahmad4 . Department of Ophthalmology, Hospital Tuanku Ja,afar Seremban LOGO Conclusion The three cats exercise was an effective option for treating decompensated esophoria. Case Description 18 years old female with no known medical illness presented with intermittent horizontal binocular diplopia during driving for 6 months. On the first visit, her aided vision in each eye is 6/6. Her refractive error for RE -4.50/-2.50x180 (6/6) and LE -4.75/-1.75x170 (6/6). Her stereopsis, extraocular muscle movement, and amplitude of accommodation were all within normal range. Hirschberg was initially centre and symmetry. However, Worth’s Four Dots test showed diplopia. The cover test revealed RE esotropia at distant and near. Further test with prism cover test showed 18 prism base out at 6m and 14 prism base out at 40cm. The three cats exercise was prescribed to the patient as divergence training. Her second visit 3 months later showed no improvement as the patient having difficulty performing the exercise. Her third visit demonstrated remarkable improvement with no remaining diplopia symptoms. This parallels Worth’s Four Dots test. The cover test showed esophoria to alternating esotropia at 6m and esophoria at 40cm. She could perform the three cats exercise effectively, but her negative fusional vergence at distance and near range remained inadequate. The patient was instructed to continue with three cats exercise until the next appointment. Introduction Decompensated esophoria is a latent binocular misalignment that becomes symptomatic. Symptoms varied from a simple headache to severe asthenopia and diplopia 1 . Most cases can be treated with vision therapy, but the majority of the exercises are difficult to perform2,3 . Three Cats is a stereogram exercise that is usually used as convergence training to improve the symptom of convergence insufficiency. Patient will see two incomplete images which can be joined and appear as a single complete image at the center3 . In this case, we prescribed three cats exercise that were recommended primarily for convergence training, as divergence training. The aim of the training was to increase the divergence vergence range thus will improve the symptoms. References 1. Ali MH, Berry S, Qureshi A, Rattanalert N, Demer JL.(2018) Decompensated Esophoria as a Benign Cause of Acquired Esotropia. Am J Ophthalmol. Oct;194:95-100. doi: 10.1016/j.ajo.2018.07.007. Epub 2018 Jul 24. PMID: 30053478; PMCID: PMC6438619Sallah, 2. Scheiman. M.,Wick, Bruce. (2015) Clinical Management of Binocular Vision, Heterophoric, Accomodative, and Eye Movement Disorders,. Wolter Kluwer, Lippincott Williams & Wilkins. 3. Evans.B.J. (2007) Pickwell’s Binocular Vision Anomalies. Butterworth Heineman Elsevier.. 4. A.,Thompson.K.,Cornell. E., & Moss. N., (2000) Negative Vergence Training and its Effect on the Divergence Range and Heterophoria Size. Australian Orthoptic Journal, 35(13-21) Discussion ∙ Stereoscopic targets give a positive perception of stereopsis, this feedback encourages and assures the patient that exercises are helpful. 3,4 ∙ Patient can be assured to converge or diverge appropriately by checking the direction of the perceived stereopsis. 3,4 ∙ It is important to make sure that the patient not doing the exercise the wrong way 3,4 as it is easier for esophoric to over converging thus not showing any improvement. ∙ Negative vergence training was proven to increase vergence amplitude. However, compared to positive vergence training, the magnitude is smaller and needs a longer treatment duration 4. We believe if the patient was given more time, her negative vergence range will show improvement. ∙ In order to achieve good results, it is important for the patient to be compliant and adhere to exercise instructions4 .
Knowledge and Attitude Towards Refractive Error Among FSK Undergraduate Students and The Contributing Sociodemographic Factors Sumithira Narayanasamy1,2 ,Tan Yong Xuan1 ,Siti Hanisah Mohd Shariffudin3 1Faculty of Health Sciences, 2Centre for Community Health Studies (ReaCH), 3Center for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia 26 REC UKM (Ref. no: UKM PPI/111/8 JEP-2023-281) Knowledge level in other countries: This discrepancy might be due to variations in study population characteristics, educational status, sampling size, accessibility of eye care services, and utilization. 97.2% of participants had a favorable attitude toward refractive error. This finding is higher than a previous study in Ethiopia (Alemayehu et al. 2018). Since undergraduates are within the literate bracket of the general population, this could be a reason for this positive eye care-seeking attitude. Results & Discussion Introduction • Refractive error is the main cause of low vision in the world. • Global estimates show that more than 2.3 billion people worldwide suffer from vision problems due to refractive errors, of which 670 million people face vision impairment because they do not receive corrective treatment 1 . • Lack of knowledge and attitude towards refractive error correction causes a decreased quality of life and difficulty performing tasks such as studying, working, driving and economic status of an individual 2 . • This study aims to determine the level of knowledge and attitude toward refractive error correction among undergraduate students of the FSK, UKM KL and the contributing sociodemographic factors affecting them. References 1. Maha Hussein Mukhaiseer, V. F. 2021. Attitudes and Beliefs of Students to Spectacles Wear for the Correction of Refractive Errors in Dijlah University College. DJSE 2(2): 14-21 2. Ebrahim Khan, N., Mahomedy, M., Mngadi, L., Moola, Z., Moola, Z., Ndwandwe, G. & Ntombela, A. S. M. 2022. Knowledge, Attitudes and Practices Towards Refractive Error Amongst Students. African Vision and Eye Health 81(1): 3. Ebeigbe, J. A. 2018. Factors Influencing Eye-Care Seeking Behaviour of Parents for Their Children in Nigeria. Clin Exp Optom 101(4): 560-564. 4. Alruwaili, W. S., Alruwaili, M. S. & Alkuwaykibi, M. K. 2018. Prevalence and Awareness of Refractive Errors among Aljouf University Medical Students. The Egyptian Journal of Hospital Medicine 70(1): 29-32. 5. Desalegn, A., Tsegaw, A., Shiferaw, D. & Woretaw, H. 2016. Knowledge, Attitude, Practice and Associated Factors Towards Spectacles Use among Adults in Gondar Town, Northwest Ethiopia. BMC Ophthalmol 16(1): 184. 6. Alemayehu, A. M., Belete, G. T. & Adimassu, N. F. 2018. Knowledge, Attitude and Associated Factors among Primary School Teachers Regarding Refractive Error in School Children in Gondar City, Northwest Ethiopia. PLoS One 13(2): e0191199. Methodology Conclusion Awareness around eye care and optometrists has been created and the general student population is well informed regarding the optometry profession. There is a small percentage of non-favorable attitude and further awareness needs to be created to educate this 2.6%. Convenient sampling study • FSK undergraduate students • Self-administered validated questionnaire • Questionnaire consists of 6 sections Information sheet Consent form Social demographics Factors influencing knowledge and attitude toward refractive errors (5 items) Knowledge towards refractive error correction (10 items) Attitude towards refractive error correction (8 items) • Cost, gender, race, history of spectacle wear, family history of spectacle wear Data Analysis • Knowledge classification: Good & Poor (Cut-off: 8.5 points out of 17 points) • Attitude classification: Favourable & Non-favourable (Cut-off: 16 points out of 24 points) • Analysis tests: Descriptive and ChiSquare • Symptoms • Risk factor • Type • Treatment • Effect on academic • Place for treatment • Cause blindness • Distance affected Knowledge of refractive error 66% 34% KNOWLEDGE TOWARDS REFRACTIVE ERROR Good Poor 97% 3% ATTITUDE TOWARDS REFRACTIVE ERROR Favourable Non-favourable Factor Good knowledge P-value X 2 Gender 236 .03 4.71 Favourable attitude P-value X 2 346 .32 1.01 India: 56% 3 Ethiopia: 90.6%5 India: 56% 3 Ethiopia: 90.6%5 Saudi Arabia: 48.8%4
Unilateral Nutritional Optic Neuropathy (Vitamin A Deficiency) : A Case Report Haizan Farah Hamzah1, Nurul Akma Saharuddin1, Majidah Zainal Abidin1 1 Ophthalmology Department, Hospital Selayang 27 23-03349-R1Q Fundus Photography of Right Eye Discussion/ Conclusion Vitamin A deficiency can cause systemic and ocular complications1. The diagnosis of nutritional optic neuropathy was made based on fundus examination, visual impairment, impaired color vision and constricted visual field with severely reduced vitamin A level. In developing countries, vitamin A deficiency is a major cause of preventable childhood blindness. It is uncommon case in Malaysia. Early diagnosis and treatment necessary to preserve the vision thus reduced the risk of permanent loss of vision. Balance diet are essential especially in growing children. A thorough history taking with high suspicion and involvement other specialties are needed especially for those who are at risk of the condition. Table 1: Optometric examination results Acknowledgement We acknowledge the Head of Ophthalmology Department, Head of Optometry Unit and all colleagues for the support and cooperation. Introduction / Background Nutritional optic neuropathy is a rare condition which can cause progressive visual loss. Lack of vitamin A can cause ocular disease, and the leading cause of childhood blindness worldwide; WHO estimates that approximately 228 million children are affected1. References 1. Chiu M, Watson S: Xerophthalmia and vitamin A deficiency in an autistic child with a restricted diet . BMJ Case Rep. 2015, 2015:10.1136/bcr-2015-209413 2. Cheah J, Muhammed J, Tharmathurai S, et al. (February 09, 2022) Optic Neuropathy in an Autistic Child With Vitamin A Deficiency: A Case Report and Literature Review. Cureus 14(2): e22074. DOI 10.7759/cureus.22074 3. Ngah NF, Moktar N, Isa NH, Selvara S, Yusof MS, Sani HA, Hasan ZA, Kadir RA. Ocular manifestation of vitamin A deficiency among Orang asli (Aborigine) children in Malaysia. Asia Pac J Clin Nutr. 2002;11(2):88-91. doi: 10.1046/j.1440- 6047.2002.00268.x. PMID: 12074186. Methodology / Case Report This is a retrospective case of an eleven years old boy, complained of headache on the frontal region and blurred vision of left eye for pass one week. The patient has no known medical illness, never wear glasses and no history of ocular surgery. Left eye showed positive Relative Afferent Pupillary Defect (RAPD). Optometric and ophthalmology examination done and result as shown in the table 1. MRI brain, spine and orbit showed no evidence of optic neuritis. Skin presented with milia over the face and pharynoderma on the knee which may be associated with Vitamin A deficiency. Dietician review revealed that patient become a picky eater at the age of three years old. He only took nuggets, potato fries, biscuits and plain water as routine diet. Laboratory report showed severely low Vitamin A (0.18umol- normal value is 0.90-3.0 umol). The treatment included intravenous corticosteroid and multivitamin including Vitamin A, Vitamin B, Vitamin C, folate and ferrous fumarate. Post treatment, optic disc swelling subsided and vision improved on the right eye. Unfortunately, the vision on the left eye remained the same. Right eye Left eye Vision (Snellen) 6/6 1/60 ph same Refraction (cyclo refraction) +1.25 6/6 +3.75/ 1.50x180 1/60 Axial length (IOLM 500) 23.37mm 21.89mm Color vision (Ishihara) 17/17 7/17 Visual field (Bjerrum) Constricted Constricted Fundus Optic disc swollen 360 degree Optic disc swollen 360 degree Figure 2: Bjerrum test for Right and Left eye Figure 1:Fundus Photography: First presentation
RE LE VA 6/60 PH 6/30 6/60 PH 6/30 Cover test Small LE esotropia with fast recovery to esophoria Cycloplegic refraction +7.50 (6/21) +6.00 (6/30) K-readings 51.53@162 52.64@72 51.92@94 52.33@4 Axial length 17.17mm 17.39mm Cornea BE clear cornea, HVID 9.8mm, VVID 9.6mm Lens Clear Early PSCC RUSSEL-SILVER SYNDROME (RSS) OCULAR MANIFESTATIONS – A CASE REPORT Prominent forehead Triangular small face Small & Short stature Patient H: 127.5cm W: 18.7kg 13 years old/Male/Malay First Twin Diagnosed with RSS & referred for eye assessment, second twin is normal Chief complaint : Blur vision at distance since past 1 year No prior history of glasses wear Pertinent findings Case History Fundus photo shows small disc, mottled macular and normal blood vessels in BE OCT image of RE shows normal retinal layers and dome shaped retina in LE Diagnosis & Management BE microphthalmia and hyperopia due to RSS Glasses was prescribed Yearly eye examination Conclusion Patient with RSS has severe growth retardation and significant ophthalmological findings. This case highlights eye examination is recommended in children with RSS to optimize visual and ocular development. References Varna SN, Varma BR. Clinical spectrum of Silver-Russell Syndrome. Contem Cli Dent 2013;4:363-5 M Andersson Grönlund, J Dahlgren, E Aring, M Kraemer and A Hellström Ophthalmological findings in children and adolescents with Silver-Russell syndrome. Br J Ophthalmol 2011 95: 637-641 Miho Ishida New developments in Silver–Russell syndrome and implications for clinical practice. Epigenomics, 2016 8(4), 563– 580 Mr Nik Musa and family for giving consent to participate in the clinical investigation and preparation of this poster. Acknowledgement NMRR RSCH ID-23-03613-P3U Azalia Razali , Halijaton Abdul Rahim , Khatijah Mustapa Ophthalmology Department, Selayang Hospital, Ophthalmology Department, Cyberjaya Hospital RSS characteristics 1 2 1 1 2
A CASE OF DECOMPENSATED ESOPHORIA WITH DIPLOPIA Siti Faeza Hanim, Sit Jo Anne, Haizan Farah Department Ophthalmology Hospital Selayang NMRR ID-23-02226-PJM. Decompensated Esophoria is a latent inward misalignment that becomes manifest to esotropia and symptomatic.1 Symptoms of Decompensated Esophoria may range from simple headache to severe asthenopia and binocular diplopia.1 The purpose of this case report is to describe the possible treatment for Decompensated Esophoria with diplopia. An 18-year-old male was referred to Orthoptic Clinic due to increasing frequency of double vision over past three months. He was born prematurely at week 28 via Emergency Lower Segment Caesarean Section (EMLSCS). His ocular health was monitored by Ophthalmologist since birth and subsequently discharged normal. Parents noted intermittent right eye squint at the age of 9. However, patient did not complaint of double vision until 3 months ago. Medical history of patient is otherwise unremarkable. RE LE VA (unaided) 6/6 6/6 Worth 4 Dots - Near: - Distance: Uncrossed diplopia Uncrossed diplopia Stereopsis Nil EOM FULL (duction & version) Near Point of Convergence To the nose Amplitude of Accommodation (Exp. Age 12.5 ±2) 7D, 7D, 8D 9D, 9D, 9D Binocular: 10D, 10D, 10D Refraction Plano 6/6 Plano 6/6 Atropine refraction +1.00DS 6/6 +1.00DS 6/6 Hess Test See Picture 1 Cover test/ Prism Cover Test (with and without spectacle) Near: RE Esotropia to Alternating Esotropia (varies from 25PD to 40PD BO) Distance: RE Esotropia to Alternating Esotropia (varies from 25PD to 40PD BO) Post op diplopia test Near: single vision up to 35PD BO Distance: Intermittent single vision up to 40PD BO Introduction Case Description We would like to thank Ophthalmology Department Hospital Selayang and Optometry Unit Hospital Selayang for all the support in this study. Acknowledgement References Intervention 1. Occlude one eye - temporary 2. Prescribed spectacle prescription 3. Prism prescription - for small angle 4. Suggest for squint surgery - for large angle - Squint surgery done – with Bilateral Medial Rectus recession of 4.5mm, aim for 30PD Outcome (Post Operative) Stereopsis (Frisby) 55” of arc EOM FULL Prism Cover Test Near: Orthophoria Far: Esophoria with 12PD BO Discussion Surgical management is proposed for patients with large angle of deviation.2A prolonged alternate prism cover test should be practised to suspend tonic fusional vergence to overcome the variable angle of esodeviation.3 Conclusion Decompensated Esotropia with diplopia is treatable with bilateral medial rectus recession.2 1. Ali MH, Berry S, Qureshi A, Rattanalert N, Demer JL. Decompensated Esophoria as a Benign Cause of Acquired Esotropia. Am J Ophthalmol. 2018 Oct;194:95-100. doi: 10.1016/j.ajo.2018.07.007. Epub 2018 Jul 24. PMID: 30053478; PMCID: PMC6438619 2. Godts D, Mathysen DG. Distance esotropia in the elderly. Br J Ophthalmol 2013;97(11):1415–1419. 3. Bhola R. (2006, January 19). Intermittent Exotropia: A Major Review. Ophthalmology and Visual Sciences. https://webeye.ophth.uiowa.edu/eyeforum/tutorials/intermittent-exotropia.htm Picture 1
WHEN THE LIGHT GO OUT: A Case Report of Retinitis Pigmentosa in 3 years old Girl Nurul Aini Y1 , Faeza Hanim SY1 1Ophthalmology Department, Hospital Selayang NMRR ID-23-02335-AGR Discussion This case highlights the detection of Retinitis Pigmentosa at an early age, which is uncommon but possible. The patient's symptoms, along with the funduscopy findings, led to a referral for an ERG test to confirm the diagnosis. Early intervention is crucial in managing RP, as it allows for appropriate counseling and support for the child and their family. With early diagnosis, parents and healthcare practitioners can initiate interventions to optimize the child's visual functioning and quality of life. Results Acknowledgement Ophthalmology Department, Hospital Selayang Head of Optometry, Hospital Selayang Head of Department, Department Ophthalmology, Hospital Selayang Introduction Retinitis pigmentosa is the most common hereditary dystrophy of fundus. 1 It presents usually within first 30 years of life with complaints of nyctalopia and tubular vision with symmetric visual impairment in both the eyes. 2 This report describes a case of Retinitis Pigmentosa in a 3-year-old girl presenting with visual symptoms and subsequent diagnosis confirmation. References 1. Pagon RA. Retinitis pigmentosa. Surv Ophthalmol, 1988; 33: 137-77 2. Berson EL. Retinitis pigmentosa: the Friedenwald lecture. Invest Ophthalmol Vis Sci., 1993; 34: 1659-1676. Case Report A 2-and-a-half-year-old girl was referred to the Ophthalmology Department at Hospital Selayang for an eye assessment. The child's parents expressed concerns about their daughter squinting and experiencing poor visual acuity. Refraction findings revealed bilateral high myopia with astigmatism, and an orthoptic assessment showed a small exophoria. Prescription glasses were provided to address the refractive errors. During the sixth visit, the mother reported that her child appeared to be wandering and had difficulty seeing in low light conditions or at night. The mother denied any family history of night blindness or other eye diseases. Funduscopy revealed a mid-peripheral salt and pepper appearance, while other parts of the eyes appeared normal. Due to the suspicious findings, the patient was referred for an Electroretinogram (ERG) test to confirm the diagnosis of Retinitis Pigmentosa. Clinical finding: Funduscopy showed midperipheral salt and pepper appearance Image source: Google