THE BINOCULAR VISION STATUS OF ‘ORANG ASLI’ CHILDREN IN A SAMPLE POPULATION IN KUALA LANGAT, SELANGOR Fairuz Mohd Nordin* 1 , Mohd Azizi Saperi2 , AP Dr Mohd Zaki Awg Isa3 , Siti ‘Aishah Ismail4 , Mohd Ferdaus Sari5 , Amalina Othman6 . Affiliation: Management and Science University 09 Ethical Approval Number: EAL2-01-FHLS-2023-03-001 Conclusion In conclusion, binocular vision anomalies were detected among the sampled population of 'Orang Asli' children, particularly affecting those with hyperopia. It is recommended to conduct binocular vision status screening for 'Orang Asli' children to identify any potential binocular vision abnormalities, particularly the non-strabismic types." Introduction The refractive status of ‘Orang Asli’ children mostly prevalent as hyperopia. Therefore, the risks to have binocular vision anomalies especially non-strabismic types may be suspected. The prevalence of visual impairment among Orang Asli children in this study was 34.5% where the main cause was refractive errors. The main cause of refractive errors found to be hyperopia (28.2%) followed by amblyopia (2.7%), strabismus (1.8%) and ocular abnormalities (1.8%)1 . The aims of this study to identify the binocular vision status of ‘Orang Asli’ children in a sample population in Kuala Langat Selangor. References 1. Omar, R., Wan Abdul, W.M.H., & Knight, V.F. (2019). Status of Visual Impairment among indigenous (Orang Asli) school children in Malaysia. BMC Public Health, 19 (Suppl 14), 543. 2. Fairuz, M.N., Noor Farasuhana, M.F., Mohd Zaki A.I., & Noorsuhaila, S. (2020). The Visual and Refractive Status in One Sample population of ‘Orang Asli’ (Indigenous) Children in Hulu Langat, Selangor. Bangladesh Journal of Medical Science, 19 (4), 609-613. 3. Abdul-Kabir,M., Kumah,D., Koomson, N., & Afari, C. (2015). Prevalence of accommodative insufficiency and accommodative infacility among junior high school students in a Ghanaian town. Journal of Science and Technology (Ghana), 34(2), 60. doi:10.4314/just.v34i2. 4. Jang, J.U. & Park, I.J. (2015). Prevalence of general binocular dysfunctions among rural schoolchildren in South Korea. Taiwan Journal of Ophthalmology, 5, 177-181. Methodology Locations: Mukim Tanjung 12, Kuala Langat Selangor Type of Study: Cross Sectional and Purposive Sampling Discussion 1. The prevalence of binocular vision anomalies among ‘Orang Asli’ children in a sample populations in Kuala Langat Selangor is 52%. This study showed the ‘Orang Asli’ children had binocular vision anomalies and the types of anomalies are under non-strabismic and all the subjects were hyperopic2 . 2. The most types of non-strabismic types of binocular vision anomalies is accommodation insufficiency (47%) followed by divergence excess (4%) and convergence excess (1%)3 . 3. There were an association between types of refractive error and binocular vision anomalies (p<0.05)4 . 4. However, there were no association of gender and age with the binocular vision anomalies (p>0.05)3 . 109 recruited Inclusion criteria Age match between 6-12 years old ‘Orang Asli’ children and ‘Malay-Jawa’ children (control) Understand the instruction from examiner Exclusion criteria History of eye diseases, low vision or blindness will be excluded 103 subjects New model of nonstrabismic binocular vision pathway for ‘Orang Asli’ children (validated) Diagnosis (Min 3 clinical signs related to binocular vision problem ) Type of refractive error Binocular Vision Status P value Binocular Vision Anomalies Without Binocular Vision Anomalies Hyperopia 52.4 (54) 5.8 (6) 0.017 Myopia 0 17.5 (18) Emmetropia 0 24.3 (25) Refer 52% 48% Prevalence of Binocular Anomalies Among 'Orang Asli' Children Binocular Vision Anomalies Without Binocular Vision Anomalies Demography With binocular vision problem % (n) Without binocular vision problem % (n) N - value P – value Gender Male 28.2 (29) 28.2 (29) Female 24.3 (25) 19.3 (20) 103 P =0.18 Age group 4 - 6 year old 15.5 (16) 13.6 (14) 103 P =0.17 7 - 9 year old 17.5 (18) 14.6 (15) 10 – 12 year old 19.4 (20) 19.4 (20) 1% 4% 47% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Convergence Excess Divergence Excess Accommodation Insufficiency Types of Binocular Vision Anomalies
CHANGES IN CORNEAL THICKNESS AND KMAX VALUE BEFORE AND AFTER 6 MONTHS UNDERGOING CXL : CASE REPORT Suzana Ahmad* , Normalisa M.Som , Tengku Zalikha T.Husin , Khurul Ain M.Anas , Dr. Asmah Ahmad Department of Ophthalmology, Hospital Tuanku Ja’afar Seremban Keratoconus is a specific type of corneal ectasia in which the cornea thins and weakens1 . Treatment for keratoconus include glasses, contact lenses and corneal cross linking (CXL). CXL is used to strengthen the cornea and halt the progression of keratoconus2,3 . This case report describes the changes in corneal thickness and maximum-K reading (Kmax) value before and after 6 months undergoing CXL. INTRODUCTION DISCUSSION CONCLUSION REFERENCES 1. Santodomingo-Rubido, J., Carracedo, G., Suzaki, A., Villa-Collar, C., Vincent, S. J., & Wolffsohn, J. S. (2022). Keratoconus: An updated review. Contact Lens and Anterior Eye, 45(3), 101559 2. Xu, K., Chan, T. C. Y., Vajpayee, R. B., & Jhanji, V. (2015). Corneal collagen crosslinking: A review of clinical applications. Asia-Pacific Journal of Ophthalmology. 3. Duncan, J., & Gomes, J. A. (2015). A new Tomographic Method of Staging/Classifying Keratoconus: The ABCD Grading System. International Journal of Keratoconus and Ectatic Corneal Diseases, 4(3), 85–93. 4 .Maier, P., Reinhard, T., & Kohlhaas, M. (2019). Corneal Collagen Cross-Linking in the Stabilization of Keratoconus. Deutsches Arzteblatt International, 116(11), 184–190 5. Saraç, Ö., Kars, M. E., Temel, B., & Çağıl, N. (2019). Clinical evaluation of different types of contact lenses in keratoconus management. Contact Lens and Anterior Eye Corneal Topography Before CXL Corneal Topography After CXL Kmax change after CXL: 1.8D Corneal thickness change after CXL: 7.5% (28µm)
NMRR ID-23-01498-EOS Ocular Manifestation of Lowe Syndrome: A Case Report Arief Fikri Bin Sulaiman*1 , Nurul Hafizah Binti Amil Bangsa1 , Mahani Mohd Salleh1 , Rachel Ray ak Roslan2 , Chieng Lee Ling3 1Hospital Putrajaya, 2Hospital Limbang, 3Hospital Miri NMRR ID-23-01498-EOS Background The oculocerebrorenal (OCRL) syndrome of Lowe is an extremely rare x-linked multisystemic disorder characterized by the triad of congenital cataracts, intellectual disability and proximal tubular dysfunction1 which occur in 1 out of 500 000 individuals2 . This study described the ocular manifestation of Lowe Syndrome in a young patient from Sarawak from primary eye care perspective. Case Presentation This is the first report of ocular manifestation of Lowe syndrome in Malaysia based on our literature searches. A 9-year-old boy came to Eye Clinic Hospital Limbang on 7th February 2019 for recurrent corneal growth, reduced visual acuity (VA) and absence of red reflex on left eye. Previous medical history were unremarkable. Summary of patient examination are shown below. Discussion Dense congenital bilateral cataract, severe glaucoma with buphthalmos and corneal keloids are the hallmark of ocular manifestation in Lowe syndrome. Corneal keloids are rare and can be confused as other types of growth as shown in Table 1 (differential diagnosis). Management of ocular complications that arises from Lowe syndrome are mainly treatment of the underlying symptoms. Feb 2019 RE LE BCVA +0.75, 6/9 6/20 ph : NI Anterior Vascular growth extending from conjunctiva IOP: 19 mmHg Lens : lamellar cataract Elevated vascular growth covering cornea (3-4mm) IOP : 15 mmHg Lens : unable to visualize Fundus NAD Unable to visualize Impression Salzman’s nodular corneal degeneration, congenital cataract and pterygium Management Corneal lesion and lid biopsy Table 1 : Summary of clinical findings References 1Lowe, M. (2005). Structure and function of the Lowe syndrome protein OCRL1. Traffic, 6(9), 711-719. 2Loi, M. (2006). Lowe syndrome. Orphanet journal of rare diseases, 1(1), 1-5. 3Bökenkamp, A., & Ludwig, M. (2016). The oculocerebrorenal syndrome of Lowe: an update. Pediatric nephrology, 31, 2201-2212. 4Sethi, S., Sethi, N., Mehta, S., Kaur, S., Makkar, V., & Sohal, P. M. (2020). Lowe syndrome–Case report with a novel mutation in the oculocerebrorenal gene. Saudi Journal of Kidney Diseases and Transplantation, 31(1), 285-288. Nov 2020 RE LE BCVA 6/6 NPL Anterior Whitish perilimbal growth on cornea (4.5mm x 8 mm) IOP: 19 mmHg Lens : lamellar cataract Pedunculated papillomatous growth. Upper lid granuloma IOP: unable to assess Fundus NAD Unable to visualize HPE - Corneal keloids MRI LE bupthalmos (possible posterior scleritis). Benign fibroepithelial lesion with no intraorbital extension Paediatric investigation Deranged renal profile : distal tubular acidosis (Fanconi Syndrome) and developmental delay Diagnosis OCRL (Lowe syndrome) Management Monitor progression glaucoma & cataract To follow /continue peads treatment plan for nervous & renal symptomatic manifestation July 2020 RE LE BCVA 6/12 (NIPH) NPL Anterior Segment Superficial opacity on cornea (3mm x 7mm) IOP : 17 mmHg Vascularized whitish lesion covering cornea limbal to limbal (10mm x 12.5mm) IOP: unable to assess Fundus Blur disc margin Unable to visualize Impression LE papiloma Management Debulking surgery at HQE Refer to peads Limbang for MRI Discussion Corneal keloids are more tricky to treat and could worsen the visual prognosis. It is important to preserve the visual function of the precious eye as the longest reported survival was 54 year old due to renal failure2 . Lowe Syndrome Salzmann’s nodular degeneration Lipid keratopathy Aetiology Genetic Primary (Idiopathic) Secondary (inflammation) Primary (Idiopathic) Secondary (Infection/trauma) Age manifestation Since birth 50-60 years Any Gender (ratio) Male only Female > male Non-specific Eyes involvement Bilateral Bilateral>unilateral Unilateral/bilateral Corneal appearance White elevated bumps (keloids) White elevated bumps Yellow-white infiltrate Prognosis Poor Good Good Systemic manifestation mental retardation, hypotonia, and kidney dysfunction None None Life expectancy Short ( kidney failure ) long Long Conclusions Early detection of Lowe Syndrome by primary eye care especially on boys with congenital cataract is extremely important as it could save the patients’ life, as the systemic manifestation of Lowe Syndrome can be life threatening. Table 1 : Differential diagnosis Acknowledgement All pictures and patient details are taken with written consent from patients family to be used in this study. The authors would like to thank the family for their cooperation and Dr Suriana Suaibun for permission to publish this poster.
Methodology Acknowledgement References EARLY CHANGES IN QUALITY OF LIFE AFTER MONOVISION LASER REFRACTIVE SURGERY Nurul Maisarah Mohd Taha1* , Azuwan Musa2 , Md Mustafa Md-Muziman-Syah1 , Khairidzan Mohd Kamal2 1Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, 2Department of Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang. ID No: IREC 2022-155 Research and Ethical Approval Prospective Longitudinal Study (n=44) Pass Inclusion & Exclusion Criteria Preoperative visit Monovision Laser Refractive Surgery Postoperative visits Inclusion Criteria ❑ Myopic presbyopes range 35 to 45 years old [1] ❑ Healthy and do not have any active and unstable pathologies [2] Exclusion Criteria ❑ Non-presbyopic individuals ❑ Mentally ill The pre- and presbyopic patients have been treated with photorefractive keratectomy, PRK (n=22) and femtosecond laser in situ keratomileusis, FS-LASIK (n=22). The dominant eye was corrected for distance vision and the non-dominant eye was corrected for near vision by adding +0.50D to +1.50D sphere to the final manifest distance refractive power. Patient satisfaction is the key to vision-correcting surgery; hence apart from objective visual assessments, quality of life (QoL) assessment is an added value that offers a detailed evaluation of patient outcomes. Purpose: To investigate the impact of monovision laser refractive surgery on the quality of life (QoL) of pre- and presbyopic patients during preoperative and three postoperative follow-up visits. • QIRC questionnaires [3] • QIRC questionnaires Within 2-week (Po1) 1-month (Po2) 3-month (Po3) 1. Braun, E. H. P., Lee, J., & Steinert, R. F. (2008). Monovision in LASIK. Ophthalmology, 115(7), 1196–1202. https://doi.org/10.1016/j.ophtha.2007.09.018 2. Kandel, H., Khadka, J., Lundström, M., Goggin, M., & Pesudovs, K. (2017). Questionnaires for measuring refractive surgery outcomes. Journal of Refractive Surgery, 33(6), 416–424. https://doi.org/10.3928/1081597X-20170310-01 3. Garcia-Gonzalez, M., Teus, M. A., & Hernandez-Verdejo, J. L. (2010). Visual outcomes of LASIK-induced monovision in myopic patients with presbyopia. American Journal of Ophthalmology, 150(3), 381–386. https://doi.org/10.1016/j.ajo.2010.03.022 4. Klokova, O. A., Sakhnov, S. N., Geydenrikh, M. S., & Damashauskas, R. O. (2019). Quality of life after refractive surgery: ReLEx smile vs Femto-LASIK. Clinical Ophthalmology, 13, 561–570. https://doi.org/10.2147/OPTH.S170277 Result This study involved 12 males and 32 females with 6 patients from low myopia (<-3.00D), 8 patients from moderate myopia (-3.00D to -5.00D) and 8 patients with high myopia (>-5.00D). The objective visual assessments such as distance visual acuity, contrast sensitivity and stereopsis between pre- and within 2- week postoperative visits were statistically significant with p<0.05. Items Questions Pre vs Po1 Po1 vs Po2 Po2 vs Po3 Q1 Driving* Q2 Tired* Q3 Sunglasses* Q4 Think* Q5 Waking* Q6 Swimming* Q7 Gym* Q8 Cost* Q9 Maintenance* Q10 Rely Q11 Vision* Q12 Complications Q13 UV Q14 Looked best* Q15 Others* Q16 Complimented* Q17 Confident* Q18 Happy* Q19 Able Q20 Eager Table 1: QIRC item scores before and after monovision laser refractive surgery (n=44). Discussion/Conclusion Variable PRK Mean (SD) FS-LASIK Mean (SD) t-statistic (df) p-value Pre 38.57 (4.80) 39.79 (4.08) -0.90 (42) 0.372 Po1 42.78 (7.26) 45.60 (4.84) -1.51 (42) 0.138 Po2 44.17 (5.65) 47.95 (5.88) -2.17 (42) 0.036* Po3 47.31 (8.22) 50.84 (7.57) -1.48 (42) 0.146 Introduction Table 2: The QIRC total scores between PRK (n=22) and FS-LASIK (n=22). Figure 1: The means of QIRC total scores (n=44). p<0.001* p<0.001* p=0.087 p<0.001* p=0.024* p=0.001* Note: *ANOVA: p-value is significant, : Paired t-test, p<0.05 as significant 95% CI Special thanks to the team of laser refractive surgery “ LASIK Team”, IIUM Eye Specialist Clinic for all the support and encouragement during the data collection process. • Every postoperative visit showed an escalation in the overall QIRC score. The higher the total score of Quality of Life Impact of Refractive Correction (QIRC), the lower the level of anxiousness and the better the patient satisfaction as well as QoL after performing the surgery. [4] • Monovision correction by laser refractive surgery improved the patient’s QoL and visual quality in early postoperative visits among pre- and presbyopic patients. • However, there are only two patients (5%) who have a decrement in overall QIRC total scores in 3-month postoperative surgery. Nevertheless, the visual quality remains unchanged, especially within 2-week to 3-month postoperatively.
Malaysian Optical Council, Pejabat Pendidikan Daerah Muar, CRC HPSF, eRAS (Ministry of Education), MREC (Ministry of Health) SPECTACLES WEAR AMONG PRIMARY SCHOOLCHILDREN IN MUAR, JOHOR - ACCESSIBILITY Roziana Sumardi*1 , Ungku Noor Aqilla Ungku Hassan1 , Rasyida Awang1 , Norhuda Md Yusof1 , Shuhada Ahmad Suhaimi1 , Effendy Bin Hashim2 1 Hospital Pakar Sultanah Fatimah, Muar - Johor 2 Ministry of Health Malaysia (Optometry Officer) KPM.600-3/2/3-eras(14628) NMRR ID-23-00109-XEB(IIR) Uncorrected refractive error can impede children's education where spectacle correction is simple and cost-effective. 1,2 Key barriers to obtaining eye glasses are predominately rooted in external factors such as cost and access to vision care 3,4 Introduction Results ⮚ Primary schoolchildren in Muar, Johor have to travel double the distance to get a pair of spectacles from their respective house in comparison to their school ⮚ In this research, 14 out of every 100 students use glasses. ⮚ This highlights the importance of this study for future policy recommendations to improve access to spectacle for school children shall involve the school and education sector ⮚ This study shall be replicated and conducted to encompass more Districts and States to be representative of Malaysia. Discussions/Conclusions Acknowledgement 1.Flaxman SR, Bourne RRA, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(12):e1221-e1234. 2.Barria Von-Bischhoffshausen F, Muñoz B, Riquelme A, Ormeño MJ, Silva JC. Spectacle-wear compliance in school children in Concepción Chile. Ophthalmic Epidemiol. 2014;21(6):362-369. 3.Killeen OJ, Cho J, Newman-Casey PA, Kana L, Woodward MA. Barriers and Facilitators to Obtaining Eyeglasses for Vulnerable Patients in a Michigan Free Clinic. Optom Vis Sci. 2021;98(3):243-249. 4.The Public Health Act of 1848.; 1998. www.bmj.com References Figure 1: Distance of School and House to Optical Stores Items Description Study Design A descriptive cross-sectional study Study Population ✔ Subjects in this study are the primary school administrators (teachers) and parents of schoolchildren wearing spectacles. ✔ Random sampling among primary schools located in Muar, Johor Sample Size School administrators: 64 respondents with consent (Response rate : 19/64 (29.7%), Total number of students:5570) Parents: All parents of schoolchildren wearing glasses from selected 64 schools with consent Study Site Ministry of Education (Public Primary School in Muar, Johor) Study Instrument Data Collection Form ✔ Google Form A (for schools administrator): February to March 2023 ✔ Google Form B (for parents of schoolchildren wearing glasses): March to April 2023 Inclusion Criteria School administrators with consent and parents of schoolchildren wearing spectacle with consent Exclusion Criteria School administrators without consent and parents of schoolchildren wearing spectacle without consent Data Analysis Microsoft Excel 2013 Ethical Approval Medical Research & Ethic Committee(MREC) Methodology 4.49km SD:±7.06 10.21km SD:±23.54 Figure 3: Prevalence of Spectacle Wear Among Schoolchildren According to Gender & Ethnicity SCHOOL OPTICAL STORES HOUSE Specific Objectives To determine the distance between their school and house to the optical shop To determine the prevalence of spectacle wear according to gender and ethnicity General Objective To assess the accessibility to optical correction among primary schoolchildren wearing spectacle for refractive error in Muar, Johor 14 in every 100 students Figure 2: Percentage of Spectacle Wear Among Schoolchildren
KPM.600-3/2/3-eras(14628) NMRR ID-23-00109-XEB (IIR) SPECTACLES WEAR AMONG PRIMARY SCHOOLCHILDREN IN MUAR, JOHOR- AFFORDABILITY Ungku Noor Aqilla Ungku Hassan*1 , Roziana Sumardi1 , Rasyida Awang1 , Norhuda Md Yusof1 , Suhada Ahmad Suhaimi1 , Effendy Bin Hashim2 1 Hospital Pakar Sultanah Fatimah, Muar - Johor 2 Ministry of Health Malaysia (Optometry Officer) Poster ID font size (28) NMRR ID-23-00109-XEB (IIR) 1. Pejabat Pendidikan Daerah Muar. 2. Clinical Research Centre, Hospital Muar. Children with refractive error commonly experience changes in their spectacles prescription because eyes and vision continuously change while growing. For schoolgoing children needing frequent changes of refractive correction with spectacles, this may cause additional economic stress to those who belong to families with lowincome status. 1,2 1. A first random-sampling survey (Google Forms) was conducted among public primary school administrators in Muar, Johor to gain access to the parents of the schoolchildren wearing glasses between February to March 2023. 2. A second convenient-sampling survey (Google Forms) was administered among those parents with contacts between March to April 2023 to maximize responses. 3. To improve the response rate, administrators and parents were approached via WhatsApp, telephone, and e-mail with assistance from the District Education Office. Data analysis was performed using Microsoft Excel 2019. 1. To investigate the price of a pair of spectacles in Muar, Johor. 2. To investigate the frequency of spectacles changes among schoolchildren in Muar, Johor. 3. To describe the family income status of the children wearing spectacles in Muar, Johor. Introduction Objectives Methodology 82.7% (182/220) afford to purchase only pair/year Gross Household Monthly Income RM4,958.41 (SD∓ RM4016.34) NMRR ID-23-00109-XEB (IIR) Total: 220 parents from 19 primary schools were included in this study Results 60.50% 19.10% 20.50% once or more times in 1 year once in 2 years once in 3 or more years SPECTACLES CHANGES FOR SCHOOL CHILDREN Acknowledgement 1. The price of one pair of spectacles for schoolchildren is higher than the expected affordable price for the majority of respondents in Muar. 2. Only one out of five respondents was able to change more than one pair of spectacles per year. 3. The price and frequency of spectacles changes for schoolchildren were highly dependent on their family income. Discussion/Conclusion 1. Malvankar-mehta, Monali S et al. 2018. “Cost and Quality of Life Overlooked Eye Care Needs of Children.” Dove Press Journal 11: 25-33. 2. Zhang, Xinzhi et al. 2012. “Unmet Eye Care Needs among U.S. 5th-Grade Students.” American Journal of Preventive Medicine 43(1): 55-58. References 0 500 1000 1500 0 500 1000 1500 2000 Expected Affordable Spectacles Price (RM) Estimated Spectacles Purchase Price (RM) r= +0.674, p-value =1.9 x 10 -30 0 10000 20000 30000 40000 0 500 1000 1500 2000 Estimated Gross Monthly Income (RM) Estimated Spectacles Purchase Price (RM) r=+0.266, p-value=.000066 VS Estimated Spectacles Purchase Price : RM 375.94 (SD∓RM237.19) Expected Affordable Spectacles Price : RM 210.50 (SD∓RM122.55)
RESEARCH POSTER PRESENTATION DESIGN © 2022 www.PosterPresentations.com Uncorrected refractive error is the predominant cause of reduced vision in children1 . It can affect their daily life, including difficulty in studying and if it is left untreated at an early age, it not only causes amblyopia but also other problems in the future. Based on National Eye Survey (NESSII) that was conducted in 2018, it was reported that Sabah has one of the highest prevalence of visual impairment due to poor access to ophthalmological services3 . Thus, this study is carried out to investigate the common types of refractive error(RE) among students who are referred to HDOK by Health School Service Unit (UPKS). The knowledge of the prevalence refractive error would be helpful in planning of public health strategy. Muhammad Iqbal Basri 1 , Nur Hafizah Mat Jalil 1 , Najwa Munirah Mohd Yussoff 1 , Norina Abd Ghafor 1* 1 Ophthalmology Department, Hospital Duchess of Kent (HDOK) Refractive Error Findings in Students Who Failed School-Based Vision Screenings at Hospital Sandakan (HDOK), Sabah. INTRODUCTION METHODOLOGY CONCLUSIONS OBJECTIVES REFERENCES ACKNOWLEGDEMENT A total of 228 students were analyzed in this study. • Almost 2/3 of the students had clinically significant refractive error and any refractive error with suburban community had higher risk of acquiring myopia. • The detection of refractive error and prescription for glasses provided by the vision program helped a significant percentage of students who might not have accessibility to it. • Thus, this demonstrated that the screening program by UPKS had a significant impact on identifying students with vision problems. • Regular eye screening would also lead to increase awareness of myopia in school age children and may increase the proportion of children seeking care appropriately. • An improved eye care delivery system and public health policies are required in the future. 1. Maul E., Barroso S., Munoz S.R., Sperduto R.D., Ellwein L.B., 2000. Refractive error study in children: results from La Florida, Chile. AM. J. Ophthalmol. 129, 445–454. 2. Guo X, Angeline M.N., Hursuong V, et al (2021). Refractive Error Findings in Students Who Failed School- based Vision Screening. Ophthalmic Epidemiology. https://doi: 10.1080/09286586.2021.1954664. 3. Chew F.L.M, Salowi M.A, Mustari Z, et al. Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII). Plos one. 2018 ;13(6):e0198799. DOI: 10.1371/journal.pone.0198799. PMID: 29944677; PMCID: PMC6019397. • To find out the general types of refractive status among students in Sandakan Division. • To determine the risk factors associated with the refractive error among students in Sandakan Division. We gratefully acknowledge the contributions of the individuals of Health School Service Unit (UPKS). Figure 2: Proportions of students with myopia, hyperopia, astigmatism & anisometropia by age. A student may be classified as having more than one type of refractive error. Clinically Significant Refractive error n (%) Type of Refractive error n (%) Yes No Myopia Hyperopia Astigmatism Aniso Suburban Standard 1 31 (73.8) 11 (26.2) 27 (64.3) 5 (11.9) 30 (71.4) 8 (19.4) Standard 6 57 (85.1) 10 (14.9) 47 (70.1) 6 (9) 26 (38.8) 23 (34.3) Form 3 38 (97.4) 1 (2.6) 36 (92.3) 0 (0) 14 (35.9) 13 (33.3) Total 126 (85.1) 22 (14.9) 110 (74.3) 11 (7.4) 70 (47.2) 44 (29.7) Rural Standard 1 14 (38.9) 22 (61.1) 12 (33.3) 5 (13.9) 14 (38.9) 4 (11.1) Standard 6 22 (50) 22 (50) 20 (45.5) 4 (9.1) 13 (29.5) 6 (13.6) Total 36 (45.0) 44 (55.0) 32 (40) 9 (11.2) 27 (33.8) 10 (12.5) RESULTS Figure 1: Demographic gender and locality of students. Figure 3: Proportions of students with clinically significant refractive error in different localities. Table 1 : Comparison of students in different localities (suburban & rural areas) with clinically significant refractive error & the types of refractive error. 0 10 20 30 40 50 60 70 Male (n) Female (n) Suburban (n) Rural (n) Standard 1 45 33 45 36 Standard 6 57 54 67 44 Form 3 14 25 39 0 Number of students Demographic Gender & Locality of the Students • Clinically significant refractive error and any refractive error were found in 162 (71.1%) and 174 (76.3%) students respectively. • The most prevalent type of refractive error found is myopia; 142 (62.3%) followed by astigmatism; 97 (42.5%), anisometropia; 54 (23.7%) and lastly is hyperopia; 20 (8.8%). • Myopia reported more in Form 3 (89.3%) students compared to the lower age group. • Based on Table 1, suburban district showed a higher incidence of myopia, which is 74 (67.9%) students than rural area which is 32 (40%) students. • Clinically significant refractive error also increased with the increment of age as demonstrated in Figure 3. But the significant increment (p<0.05) only reported for students living in suburban area. • However, students in the same age group in Standard 1 and Standard 6 showed significant differences in clinically significant refractive error in different areas; (p<0.05) & (p<0.001) respectively. • As there had been no screening for Form 3 students in the rural area, there was no comparison between the same age group for Form 3 and the two locations. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% MYOPIA HYPEROPIA ASTIGMATISM ANISOMETROPIA Proportions of students with any refractive error by age. Standard 1 (7 years old) Standard 6 (12 years old) Form 3 (15 years old) Cross-sectional analysis Procedures: 1) Visual Acuity Assessment 2) Refraction 3) BV Assessment Students were divided into : 1) Age : Standard 1 (7 years old), Standard 6 (12 years old), Form 3 (15 years old). 2) Locality: Suburban (Sandakan) & Rural (Kinabatangan, Telupid, Beluran, Tongod). Criteria: Any refractive error was identified when there is at least -0.50 diopter (D) sphere equivalent (SE) myopia, +0.50D SE hyperopia, -1.00D astigmatism or 1.00D anisometropia in the right eye. Clinically significant refractive error is defined as decreased VA; 6/12 or less & myopia ≥-0.75D SE, hyperopia without esodeviation ≥+2.00D SE, hyperopia with esodeviation≥+1.00D or astigmatism≥ 1.50D. The data was analyzed using IBM SPSS Statistics version 28. 73.80% 85.10% 97.40% 38.90% 50% STANDARD 1 STANDARD 6 FORM 3 Proportions of students with clinically significant refractive error in different localites. Suburban Rural
An Analytic Hierarchy Process-Based Clinical Decision-Making for Dry Eye Disease Diagnostic Test Selection Yu Ting Chai1 , Pui Juan Woi1* , Jecksin Ooi2 , Narayanasamy Sumithira 1 1Center for Community Health Studies (ReaCH), Optometry and Vision Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia 2School of Engineering and Physical Sciences, Heriot-Watt University Malaysia,Precinct 5, 62200 Putrajaya, Malaysia 11 UKM PPI/111/8/JEP -2023-292 Ø Schirmer test is the most preferred DED diagnostic test as it measures tear production directly and is readily available. Ø AHP approach can address the uncertainty of practitioners’ clinical decision-making in selecting DED diagnostic tests. Six optometry experts were recruited to rank 4 criteria in deciding DED diagnostic tests and 7 DED diagnostic tests according to their preferences. Pairwise comparison of multiple criteria and alternatives were performed based on AHP Approach. Saaty’s nine-point scale was used to evaluate the relative importance of criteria and alternatives.The geometric average of experts’ response was obtained AND The weight were calculated. DRY EYE DISEASE There are a lot of diagnostic tests used to diagnose DED.To date, there is no single gold standard clinical sign that correlates perfectly with DED1 . In this study, a systematic framework using analytic hierarchy process (AHP), a decision-making technique developed for the multicriteria evaluation of alternatives for DED diagnostic test selection. 0.06 0.09 0.23 0.62 COSTS TIME NEEDED RELIABILITY ACCURACY 0.07 0.13 0.14 0.14 0.15 0.18 0.20 QUSTIONNAIRE MEIBOMIAN GLAND DYSFUNCTION OSMOLARITY TEST NIBUT CORNEAL AND CONJUNCTIVAL STAINING TBUT SCHIRMER TEST Overall, Schirmer test has the highest weightage because: Accuracy = 1 st Reliability = 1 st Cost = 5 th Time needed = 6 th ACKNOWLEDGEMENT The authors are grateful to the experts for their commitment and cooperation. REFERENCES 1.Savini, G., Prabhawasat, P., Kojima, T., Grueterich, M., Espana, E. & Goto, E. 2008. The Challenge of Dry Eye Diagnosis. Clinical ophthalmology 2(1): 31-55. 2.Saaty, T. L. 2004. Decision Making—the Analytic Hierarchy and Network Processes (Ahp/Anp). Journal of systems science and systems engineering 13(1): 1-35. Figure 1: Structure of AHP Goal Criteria Alternatives
RESEARCH POSTER PRESENTATION DESIGN © 2022 www.PosterPresentations.com Acute acquired concomitant esotropia is a special subtype of esotropia characterised by the acute onset of comitant esotropia with diplopia and equal deviation in all gaze direction which more common in older children and adults.(1). The cause of acute acquired concomitant esotropia seems to be associated with an imbalance between the converging and diverging extraocular muscle of the eye (2). With the advent of Covid 19, universal lockdown and introduction of web based online classes for students, including young children and online professional tasks, there has been a higher incidence of AACE which may be attributable to the stress and accommodation load (3) Tengku Aida AA¹ Syarmilla CS¹ Rossaidah M¹ Aznor Azwan AA² Muhammad Afzam Shah ³ Ophthalmology Department Hospital Raja Perempuan Zainab II¹ Ophthalmology Department Hospital Sultan Ismail Petra² Kulliyah Of Allied Health Sciences, International Islamic University Malaysia³ CASE REPORT : ACUTE ACQUIRED COMITANT ESOTROPIA (AACE) – POST COVID-19 HOME CONFINEMENT INTRODUCTION CASE REPORT 1 DISCUSSION OBJECTIVE CONCLUSION ACKNOWLEDGEMENT A 7-year-old boy presented to the Ophthalmology Department , HRPZ II, Kota Bharu with acute onset of diplopia. Two days before presentation, his parents noted crossed eyes when she woke up and dancing eye. He had no history of recent infections or physical or psychological stress. In the past 2 months, he used a tablet approximately 8 hours a day. All test were done and the findings shown in Table.1. Neurologic evaluation and brain magnetic resonance imaging (MRI) under sedation were unremarkable. Full time glasses was prescribed , although other treatment options such as prisms and topical cycloplegics were discussed. We discussed two instances of acute concurrent acquired esotropia (AACE) that took place during COVID-19 home confinement. Case 1 displayed minor hyperopia, while Case 2 featured a myopic patient who voluntarily used spectacles; both had no history of physical or emotional stress. It's interesting to note that both patients used computers, tablets, and smartphones for 8 to 10 hours per day for gaming, accessing coursework, and using social media. According to Aldo Vagge et al (3) , although the cause of acute acquired concurrent esotropia is yet unknown, excessive use of computers, tablets, and smartphones has been linked to continuous nearpoint demands. The authors hypothesized that excessive smartphone usage would cause accommodation and vergence anomalies that would cause the medial rectus muscles to dynamically contract, resulting in the development of manifest esotropia. Home confinement during covid-19 appeared to cause an increasing total hours of screen time and the number of consecutive minutes/hours without visual breaks, should be recommended to prevent AACE. As preventive measures, limiting screen time, taking periodic breaks, and having a larger screen with higher resolution and a correspondingly longer reading distance should all be taken into consideration suggested by YH Lau et al (4). To present a case of Acute Acquired Comitant Esotropia ( AACE ) encountered in the Ministry of Health Hospital, Malaysia. AACE is a relatively rare form of strabismus characterized by a sudden onset of concomitant esotropia with diplopia. The authors would like to thank the Director of Health Malaysia, Datuk Dr Muhammad Radzi Bin Abu Hassan for permission to publish this poster. REFERENCES 1.Yanfang Meng, Xuemin Hu, Xiaoqi Huang,Yiia Zhao, meihong Ye, Beixi Yi & Lianhong Zhou (2022) Clinical Characteristic and aetiology of acute acquired comitant esotropia, Clinical And Experimental Optometry,105:3,293-297, DOI:10.1080/08164622.2021.1914510. 2 Lekskul A, Chotkajornkiat N, Wuthisiri W, Tangtammaruk P. Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management. Clin Ophthalmol. 2021; 15:1567. https://doi.org/10.2147/OPTH.S307951 PMID: 33883873 3 Aldo Vagge., et al. “Acute Acquired Concomitant Esotropia From Excessive Application of Near Vision During the COVID-19 Lockdown”. Journal of Pediatric Ophthalmology and Strabismus 57 (2020): 6. 4. YH Lau et al. “Acute acquired esotropia during the COVID-19 pandemic : four case reports”. Hong Kong Medical Journal , Volume 29 Number 2, April 2023.www.hkmj.org CASE REPORT 2 A 22-year-old girl presented to the Ophthalmology Department , HRPZ II, Kota Bharu with acute onset of diplopia. She is studying on statistic course and spend many hours on computers. She had no history of recent infections or physical or psychological stress. The patient reported an intense use of the computer for more than 8 hours a day. She had worn any glasses yet. Neurologic evaluation and MRI were normal. All test were done and the findings shown in Table.2. Figure 1: Hirschberg test done on patient RE LE Stereopsis (Lang test) Failed Worth 4 Dots see 5 Lights BCVA 6/12 6/18 Ocular motility SAFE Cover Test LE Esotropia with good recovery at distant & near Prism Cover Test Near : 20 PD BO Distant : 20 PD BO Cycloplegic Refraction +0.75/- 1.00 x 20 (6/7.5) +1.50 / -1.00 x 165 (6/7.5) Table.1: Optometric findings RE LE Stereopsis ( TNO ) Failed Worth 4 Dots See 5 Lights BCVA 6/6 6/6 Ocular motility SAFE Cover Test RE Esotropia with good recovery at near and distant Prism Cover Test Near : 25 PD BO Distant : 25 PD BO Cycloplegic Refraction -2.00/-0.25 X 180 (6/6) +1.00/-1.00 X 180 (6/6) Table.2: Optometric findings RSCH ID-23-03909-KCU
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
CLINICAL PROFILE OF PATIENTS ATTENDING LOW VISION CLINIC IN HOSPITAL-BASED MALAYSIA RAZALI NUR ADNIN1*, ABDUL GHANI MUHAMMAD IHSAN2 , MOHAMAD NOOR SURIANI3 , SIDID OMAR MOHD AFIRU4 1 HOSPITAL SULTAN HAJI AHMAD SHAH TEMERLOH 2 HOSPITAL KEPALA BATAS 3 HOSPITAL SULTANAH BAHIYAH ALOR SETAR 4 HOSPITAL SULTANAH NUR ZAHIRAH KUALA TERENGGANU Low vision service was established in Malaysian public hospitals in 1986 and gradually expanded. As in 2023, there are 70 hospitals offer low vision service. To date, limited study has been conducted to review the characteristics of patients attending this clinic in Malaysia. This study aims to review the causes of low vision and rehabilitation services that have been offered at low vision clinic. • Study design: Retrospective crosssectional study • Study period: Jan 2021 until December 2022 • Subject: all new patient attending low vision clinics at public hospital (n=534) • Inclusion criteria : All completed data • Data collection: Data was derived from Low Vision Registry. Each patient was represented by an unique code to protect name and their identities. • Data Analysis: Wilcoxon Signed Rank Test RESULTS • 67% of patient were in the working age group (less than 50 years old) and this is in agreement with previous studies reported in Malaysia1,2 . In contrast different result reported in Australia3 . • Primary causes in our study showed combination of hereditary and age-related disease, similar with studies conducted in Thailand and Australia. However, proportion of ARMD is lower compare to those reported in the studies3,4 . • Median presenting vision, rate of referral to occupational therapist and numbers of patients prescribes with low vision devices are lower compare to study reported in previous studies1,3 . Possible reason are different study population and lack of awareness among health care practitioner. • Limitation of this study is some data may possible interpret inaccurately as this is secondary data analysis. Retinal diseases, glaucoma and diabetic retinopathy were the most common causes of low vision and prescribing low vision aids as well as referral to other professionals was part of the services that have been offered in low vision clinics. This data provide an input for further development of national policies for lowvision patients. 1. Omar et.al. The Causes of Low Vision and Pattern of prescribing at UKM Low Vision Clinic. Jurnal Sains Kesihatan Malaysia. 2008. 6(2): 55-64 2. Mohidin, N and Yusoff,S. Profile of a Low Vision Clinic Population. Clinical and Experimental Optometry. 1998. September-October 3. Chong, MA et al. An Update on the Characteristics of Patients Attending the Kooyong Low Vision Clinic. Clinical and Experimental Optometry. 2016. 99: 555-558 4. Chotikavanich S, Chanvarapha N, Loket S, et al, A 5-year retrospective record review of hospital-based low-vision rehabilitation in Thailand. Clinical Optometry 2018. 10:41-50 INTRODUCTION DISCUSSION CONCLUSION ACKNOWLEDGEMENT All optometrist in Ministry of Health for their provision especially entering data in Low Vision Registry METHODOLOGY REFERENCES 31 Median Presenting Vision (logMAR) Median Best corrected Visual Acuity (logMAR) P value 1.00 (0.78) 0.90 (0.70) p= 0.001 Types of low vision aids n (%) Spectacles 14 (2.6) Optical aids (188, 35.2%) High reading Addition 47 (8.8) Hand Magnifier 69 (12.9) Stand magnifier 32 (6.0) Telescope 40 (7.5) Electronic devices (154, 28.8%) Electronic devices 99 (18.5) Apps in phone 55 (10.3) Referral to other agencies Number (%) Social Welfare 218 (40.8) Occupational Therapist 97 (18.2) NGO 56 (10.5) PERKESO 11 (2.1) 0 20 40 ARMD Corneal disease Diabetic… Glaucoma Macular disease Neurological… Nystagmus Optic nerve… Retinal disease Others Retinitis Pigmentosa 49% Retinal Detachment 14% Retinopathy of prematurity 4% Others 33% Fig 1: Age and gender distribution Fig 2: Primary cause (%) of vision impairment Fig 3: Distribution of causes in retinal disease Table 1: Median Presenting Vision and Best corrected Visual Acuity Table 2: Referral to other agencies Table 3: Prescribed Low vision aids