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Fulltext Correlation between Visual Functions and Retinal Morphology in Eyes with Early and Intermediate Age-Related Macular Degeneration

Ghoshal R, Sharanjeet-Kaur S, Mohamad Fadzil N, Mutalib HA, Ghosh S, Ngah NF, et al.

Int J Environ Res Public Health, 2020 09 02;17(17).
PMID: 32887214 DOI: 10.3390/ijerph17176379

In early and intermediate age related macular degeneration (ARMD), visual acuity alone has failed to explain the complete variation of vision. The aim of the present study was to determine correlation between different visual functions and retinal morphology in eyes with early and intermediate ARMD. In this single center cross sectional study, patients diagnosed as early or intermediate ARMD in at least one eye were recruited. Visual functions measured were best- corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS). Parameters such as thickness (RT) and volume (RV) of the retina, outer retinal layer thickness (ORLT) and volume (ORLV), outer nuclear layer thickness (ONLT) and volume (ONLV), retinal pigment epithelium layer-Bruch's membrane complex thickness (RPET) and volume (RPEV) were assessed employing semi-auto segmentation method of Spectralis optical coherence tomography (OCT). Twenty-six eyes were evaluated. DVA, CS, and RS showed significantly good correlation with RPET, ONLT, and ONLV, whereas NVA showed good correlation with ONLV and RPET. The present study concluded that RS, CS, NVA, and DVA represent the morphological alteration in early stages and should be tested in clinical settings. ONLT, ONLV, and RPET morphological parameters can be employed as important biomarkers in diagnosis of early to intermediate ARMD.
Fulltext Identification of risk factors for myopia questionnaire in the Malay language among primary school children in Malaysia

Nur Liyana I., Sharanjeet-Kaur, Saadah M.A., Mahadir A., Abdul Mutalib O.

International Medical Journal Malaysia, 2018;17(1):127-134.
MyJurnal

This study aimed to develop a questionnaire in Malay language for the identification of risk factors for myopia among primary school children aged 10 to 12 years old in Malaysia. Materials and Methods: The study commenced in October 2012 till Julai 2013 in two main phases. The first phase was a pilot study for the construction of questionnaire items by literature review and discussion with the experts. A total of 103 parents of primary school children were randomly selected to test the comprehensibility of the preliminary questionnaire. The second phase was the actual study which involved parents of 353 primary school children , 132 were parents whose children were myopes and 221 parents whose children were nonmyopes. Results: Discussions with experts in human vision science identified 5 main domains and 71 items for the preliminary questionnaire. A total of 55 items were retained for the actual study phase in view of statistically good correlation (r = 0.4 and above). Predictive validity by chi-square test allowed 28 items to be retained because of significant association with myopia (p
Fulltext Incidence and predictors of postpartum depression among postpartum mothers in Kuala Lumpur, Malaysia: A cross-sectional study

Hairol MI, Ahmad S, Sharanjeet-Kaur S, Hum Wee L, Abdullah F, Ahmad M

PLoS One, 2021;16(11):e0259782.
PMID: 34752486 DOI: 10.1371/journal.pone.0259782

Postpartum depression (PPD) is one of the mental health complications that may arise following childbirth. This cross-sectional study explores the association between socioeconomic factors and PPD literacy with PPD incidence in 350 participants (mean age: 30.58±4.72 years) at one to six months postpartum, who attended the Kuala Lumpur Health Clinic from May to October 2020. PPD incidence and literacy were assessed using the validated Malay versions of the Edinburgh Postpartum Depression Scale (EPDS) and the Postpartum Depression Literacy Scale (PoDLiS), respectively. The participants' socioeconomic characteristics were collected using a self-administered questionnaire. Chi-square tests were performed to determine the association between these factors and PPD incidence. Binary logistic regression models were used to determine the odds ratios (OR). The incidence of postpartum depressive symptoms was 14.29%. Those with low household income were twice likely to have PPD symptoms (OR:2.58, 95% CI:1.23-5.19; p = 0.01) than those with higher incomes. Unemployment (i.e., participants who were housewives/homemakers) was associated with higher PPD incidence (Χ2(2, 350) = 6.97, p = 0.03), but it was not a significant PPD predictor. In conclusion, PPD incidence in the sample of Kuala Lumpur postpartum mothers is significantly associated with low household income. Other socioeconomic characteristics, including PPD literacy, were not significant predictors of PPD incidence.
Fulltext Distribution of Refractive Errors among Healthy Infants and Young Children between the Age of 6 to 36 Months in Kuala Lumpur, Malaysia-A Pilot Study

Yahya AN, Sharanjeet-Kaur S, Akhir SM

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783494 DOI: 10.3390/ijerph16234730

Uncorrected refractive error, especially myopia, in young children can cause permanent visual impairment in later life. However, data on the normative development of refractive error in this age group is limited, especially in Malaysia. The aim of this study was to determine the distribution of refractive error in a sample of infants and young children between the ages of 6 to 36 months in a prospective, cross-sectional study. Cycloplegic retinoscopy was conducted on both eyes of 151 children of mean age 18.09 ± 7.95 months. Mean spherical equivalent refractive error for the right and left eyes was +0.85 ± 0.97D and +0.86 ± 0.98D, respectively. The highest prevalence of refractive error was astigmatism (26%), followed by hyperopia (12.7%), myopia (1.3%) and anisometropia (0.7%). There was a reduction of hyperopic refractive error with increasing age. Myopia was seen to emerge at age 24 months. In conclusion, the prevalence of astigmatism and hyperopia in infants and young children was high, but that of myopia and anisometropia was low. There was a significant reduction in hyperopic refractive error towards emmetropia with increasing age. It is recommended that vision screening be conducted early to correct significant refractive error that may cause disruption to clear vision.
Fulltext Effect of petroleum derivatives and solvents on colour perception

Sharanjeet-Kaur, Mursyid A, Kamaruddin A, Ariffin A

Clin Exp Optom, 2004 Jul;87(4-5):339-43.
PMID: 15312037 DOI: 10.1111/j.1444-0938.2004.tb05064.x

BACKGROUND: Occupational exposure to various neurotoxic chemicals has been shown to be associated with colour vision impairment. It seems that this can occur at low exposure levels, sometimes well below the recommended occupational threshold limits. This study was undertaken to determine the effect of exposure to petroleum derivatives (polyethylene, polystyrene) and solvents (perchloroethylene) on colour perception.
METHODS: Colour vision was assessed using the Ishihara plates, the D-15 test and the Farnsworth Munsell 100 Hue test. Two factories using petroleum derivatives and three dry cleaning premises were chosen at random. A total of 93 apparently healthy employees were recruited from the five workplaces. Two age-matched control groups comprising 56 people, who were support staff of the university with no exposure to petroleum, solvents or their derivatives, were also recruited.
RESULTS: All subjects passed the Ishihara test, showing that none had a congenital red-green defect. Some of the exposed employees failed the D-15 and had abnormally high FM100 Hue scores. All control subjects passed all the colour vision tests. The D-15 test showed that 28 per cent (26 of 93) of exposed employees had a colour vision defect whereas the FM 100 Hue test found that 63 per cent (59 of 93) had a colour vision defect. Most defects were of the blue-yellow type (22.6 per cent) when using the D-15 test. However, with the FM 100 Hue test, most defects were of the non-polar type with no specific axis (50.5 per cent). Mean total error scores calculated from the FM100 Hue test for exposed employees were statistically significantly higher than those of the control subjects.
CONCLUSION: Employees directly exposed to petroleum derivatives and solvents have a higher risk of acquiring colour vision defects compared to subjects who are not.
Study sites: Factories; the control subjects were tested at the Optometry Clinic in Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Fulltext Macular thickness as determined by optical coherence tomography in relation to degree of myopia, axial length and vitreous chamber depth in Malay subjects

Othman SF, Sharanjeet-Kaur, Manan FA, Zulkarnain AI, Mohamad Z, Ariffin AE

Clin Exp Optom, 2012 Sep;95(5):484-91.
PMID: 22716100 DOI: 10.1111/j.1444-0938.2012.00752.x

PURPOSE:This study aimed to determine the relationship between macular thickness and spherical equivalent refraction (SER), axial length (AL) and vitreous chamber depth (VCD) in Malay subjects.
METHODS: Sixty-three subjects (aged 19-24 years) with a mean SER of -1.79 ± 2.24 D, mean axial length of 24.26 ± 1.35 mm and mean vitreous chamber depth of 17.02 ± 1.33 mm were included in this clinical cross-sectional study. Stratus optical coherence tomography (Time Domain optical coherence tomography) was used to determine the thickness of the outer macular (perifovea) and inner macular (parafovea) at four different locations, that is, temporal, superior, nasal and inferior quadrants and also the fovea itself.
RESULTS: Positive correlations were found between the outer macular (perifovea) thickness and SER at the temporal (R = 0.47, p < 0.05), superior (R = 0.36, p < 0.05) and inferior (R = 0.31, p < 0.05) quadrants. Foveal thickness was also positively correlated with AL (R = 0.34, p < 0.05) and VCD (R = 0.32, p < 0.05). Negative correlations were found between outer macular thickness and axial length at the temporal (R = -0.46, p < 0.05), superior (R = -0.27, p < 0.05), nasal (R = -0.25, p < 0.05) and inferior (R = -0.36, p < 0.05) quadrants. Negative correlations were also found between outer macular thickness and VCD at the temporal (R = -0.51, p < 0.05), superior (R = -0.32, p < 0.05), nasal (R = -0.31, p < 0.05) and inferior (R = -0.40, p < 0.05) quadrants.
CONCLUSIONS: This study shows that the degree of myopia and elongation of the globe are associated with thinning of most areas of the perifovea. A trend for foveal thickening in the high myopia group is also inferred, although this does not apply to the low and moderate myopia groups.
Study site: Optometry and ophthalmology clinics, National Institute of Ophthalmic Sciences, Tun Hussein Onn National Eye Hospital (THONEH), Petaling Jaya
Fulltext Patient-Perceived Benefit of Treatment in Polypoidal Choroidal Vasculopathy: A Pilot Study

Ghoshal R, Sharanjeet-Kaur S, Fadzil NM, Ghosh S, Ngah NF, Aziz RAA

Int J Environ Res Public Health, 2020 09 02;17(17).
PMID: 32887213 DOI: 10.3390/ijerph17176378

Polypoidal choroidal vasculopathy (PCV), a subtype of neovascular age-related macular degeneration, requires repeated treatment. The objective of this pilot study was to evaluate and compare vision-targeted quality of life (QOL) at baseline and after 6 months of treatment in patients with PCV. Naive PCV patients were recruited. Visual functions assessed were distance visual acuity (DVA), near visual acuity (NVA), contrast sensitivity (CS), reading speed (RS), and QOL at baseline and after 6 months of treatment. Thirty patients (average age of 67.62 ± 8.05 years) revealed mean DVA and NVA improvements of 0.24 logMAR and 0.30 logMAR, respectively. Mean CS and RS improved by 0.39 log contrast and 25.58 words per minute, respectively. The National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) composite score significantly increased from a baseline of 66.73 ± 13.74 to 73.54 ± 14.26. Twenty-eight of the patients showed overall improvement in QOL score by 5 units or more or remained stable. Subscales of NEI-VFQ-25 significantly improved, with general vision, mental health, and role difficulties improving by 10 or more units. The present pilot study reports a significant improvement of QOL in PCV patients after 6 months of treatment, with mental health, role difficulties, social functioning, and distance vision activities being the most improved subscales.
Fulltext Baseline Optical Coherence Tomography Parameters That May Influence 6 Months Treatment Outcome of Polypoidal Choroidal Vasculopathy Eyes with Combination Therapy: A Short-Term Pilot Study

Ghoshal R, Sharanjeet-Kaur S, Fadzil NM, Ghosh S, Ngah N, Aziz RAA

Int J Environ Res Public Health, 2021 05 18;18(10).
PMID: 34070071 DOI: 10.3390/ijerph18105378

Although optical coherence tomography (OCT) parameters have assisted in the diagnosis of polypoidal choroidal vasculopathy (PCV), its potential to evaluate treatment outcomes has not been established. The purpose of this pilot study was to evaluate baseline OCT parameters that may influence treatment outcome in PCV eyes with combination therapy. In this single-centered, prospective study, patients were recruited with at least one treatment-naïve PCV eye and treated with combination therapy of intravitreal anti-vascular endothelial growth factor and photodynamic therapy. Best-corrected distance and near visual acuity (DVA and NVA), and contrast sensitivity (CS) were recorded at baseline and six months after treatment. OCT parameters were determined. Twenty-six eyes of 26 patients aged between 51 to 83 years were evaluated. In eyes that had disrupted external limiting membrane (ELM), photoreceptors inner and outer segment (IS-OS) junction at 1000 micron of fovea at baseline showed low mean visual functions after 6 months of treatment. Eyes with foveal sub-retinal fluid (SRF) and polyp at central 1000 micron of fovea at baseline showed significantly worse DVA and CS after six months. Thus, the presence of foveal SRF, foveal polyp, disrupted ELM, and IS-OS junction at baseline significantly influenced the six months' visual outcome in PCV eyes treated with combination therapy.
Fulltext Visual Parameters and Retinal Morphology for Polypoidal Choroidal Vasculopathy Pre- and Post-Intravitreal Ranibizumab with or without Photodynamic Therapy: A Short-Term Prospective Study

Ghoshal R, Sharanjeet-Kaur S, Fadzil NM, Ghosh S, Ngah NF, Aziz RABA

Int J Environ Res Public Health, 2021 03 04;18(5).
PMID: 33806713 DOI: 10.3390/ijerph18052581

The objective of this study was to compare visual parameters and retinal layers' morphology pre-treatment (baseline) and 6 months post-treatment in polypoidal choroidal vasculopathy (PCV) eyes. A single centre, longitudinal, prospective study was conducted at a public tertiary hospital of Malaysia. Visual parameters including distance and near visual acuity (DVA and NVA), contrast sensitivity (CS), reading speed (RS), and different qualitative and quantitative optical coherence tomography (OCT) parameters were evaluated pre- and 6 months post-treatment. Thirty-three naïve PCV eyes of 32 patients (mean age of 67.62 years) were evaluated pre- and post-treatment of intravitreal ranibizumab with and without photodynamic therapy. After treatment, sub retinal fluid decreased from 27 eyes (84.35%) at baseline to 7 eyes (21.88%) at 6 months while pigment epithelium detachment decreased from 32 eyes (100%) at base line to 15 eyes (46.87%) at 6 months. Mean pre-treatment quantitative morphological OCT retinal parameters including thickness and volume of central sub field, center thickness, center minimum, and maximum thickness reduced significantly. Similarly, all visual parameters including DVA, NVA, CS, and RS showed statistically significant improvement. While 89% of the eyes showed improvement in CS, 78%, 71%, and 65% of the eyes showed improvement in NVA, RS, and DVA, respectively. Thus, CS was the most treatment responsive visual parameter.
Isolation of chromatic and achromatic mechanisms: a new approach

Sharanjeet-Kaur, Kulikowski JJ, Carden D

Ophthalmic Physiol Opt, 1998 Jan;18(1):49-56.
PMID: 9666910

The purpose of this study was to optimise the testing paradigm for isolating the contributions of chromatic and achromatic mechanisms to the human spectral sensitivity function. Spectral sensitivity was determined for a test spot size of 1.2 deg presented with various spatial and temporal masks on a large, 10 deg background field of moderate intensity (1000 td) and colour temperature, CT = 2700 K. Sinusoidal temporal presentation (1 Hz) and a masking annulus of between 3 and 10 min of arc surrounding the test spot, was found to be most effective in separating chromatic from achromatic mechanisms. Square-wave (1 Hz) temporal presentation combined with the annulus was slightly less selective. The presence of the annulus did not affect the shape of flicker detection at 25 Hz which is a measure of the luminosity (achromatic) spectral sensitivity function.
Fulltext Development of Knowledge, Attitude and Practice Questionnaire for age-related macular degeneration patients

Abd Rahman MH, Amirtharatnam P, Sharanjeet-Kaur S, Narayanasamy S, Mohd Rasdi HF, Catherine Bastion ML

Int J Ophthalmol, 2023;16(4):589-600.
PMID: 37077492 DOI: 10.18240/ijo.2023.04.13

AIM: To develop and validate a questionnaire to evaluate knowledge, attitude and practice of patients diagnosed with age-related macular degeneration (AMD) who have undergone intravitreal injection treatment.
METHODS: This study was conducted among patients diagnosed with AMD in Kuala Lumpur. The generation of the instrument included four phases which included item and domains development, content, face validity and exploratory factor analysis. Content validity and modified Kappa was used for validation of knowledge domain. Exploratory factor analysis was used for validation of both attitude and practice domains. Face validity was conducted in 12 patients, content validity was ascertained in 120 patients and test-retest reliability was determined in 39 patients with AMD.
RESULTS: Content validity index (CVI) and modified kappa showed excellent values for most items in the knowledge domain with CVI for item (I-CVI) values between 0.78-1.0 and Kappa values of >0.74. The Kaiser-Meyer-Olkin (KMO) sampling adequacy showed acceptable scores of 0.70 and 0.75 for both attitude and practice domains respectively and Bartlett's Test of sphericity were significant (χ2 =0.00, P<0.001). Factor analysis resulted in five factors with thirty items for attitude domain and four factors with twenty items for practice domain. The Cronbach's alpha showed acceptable values for all items in knowledge, attitude and practice domain with values >0.70 and good test-retest reliability. The final version of the questionnaire consisted of 93 items from four sections consisting of demographic details, knowledge, attitude and practice.
CONCLUSION: The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring KAP of patients diagnosed with AMD undergoing intravitreal injection treatment.
Special tinted contact lens on colour-defects

Mutilab HA, Sharanjeet-Kaur, Keu LK, Choo PF

Clin Ter, 2012;163(3):199-204.
PMID: 22964691

PURPOSE: The objective of this study was to determine the visual function of colour-deficient subjects when wearing special red tint contact lenses.
MATERIALS AND METHODS: A total of 17 subjects with congenital colour vision deficiency (14 deutans and 3 protans), voluntarily participated in this study. The average age for the subjects was 23.00 ± 4.06 years old. Visual functions tested were visual acuity (LogMAR), contrast sensitivity (FACT Chart) and stereopsis (TNO and Howard Dolman tests). Two types of special red tint lenses were used in this study; Type I (light red) and Type II (dark red).
RESULTS: The protans and deutans showed no significant changes in visual acuity and contrast sensitivity when wearing either type of contact lens. Stereopsis testing using the Horward-Dolman test gave no significant changes but significant differences were seen using the TNO test. Stereopsis using the TNO test was significantly poorer with the red tinted contact lenses compared to without for both protons and deutans. Testing binocularly with Ishihara plates showed that 88% (n=15) of patients passed the test with Type I and Type II contact lenses. When D15 test was done, 3 patients (17.6%) were 'normal' when using the Type I contact lenses and 2 patients (11.8%) were 'normal' when using the Type II contact lenses. However, with FM100Hue test, most patients showed deutan responses. Total error scores (TES) were found to be higher with Type I and Type II contact lenses compared to without.
CONCLUSIONS: The Type I and II special tinted contact lens used in this study did not cause a reduction of visual acuity and contrast sensitivity for the colour defects. Stereopsis was also not reduced with the Type I and Type II contact lenses for the colour defects except when tested with the TNO test. Colour vision defects became difficult to detect using the Ishihara plates but FM100Hue test did not show any improvement with the Type I and Type II contact lenses.
Fulltext The Relationship Between Tear Ferning Patterns and Non-invasive Tear Break-up Time in Normal Asian Population

Sharanjeet-Kaur, Ho CY, Mutalib HA, Ghazali AR

J Optom, 2016 Jul-Sep;9(3):175-81.
PMID: 26652245 DOI: 10.1016/j.optom.2015.10.004

PURPOSE: To investigate the relationship between tear ferning patterns (TFP) and non-invasive tear break-up time (NIBUT) in normal Asian subjects.

METHODS: One hundred and forty-five adults with no ocular surface disorders were recruited. TFP and NIBUT were determined. Tears were collected using a capillary tube and allowed to air dry at room temperature for 10min. TFP was later observed using a light microscope and classified according to Rolando's classification. Measurement for NIBUT was obtained using a Tearscope with the slit lamp magnification.

RESULTS: It was found that there is no significant difference between gender in TFP (Z=-1.77, P>.05) and NIBUT (Z=-1.475, P>.05). There is also no significant difference between Malay, Chinese, Indian, and other races in TFP, (H(3)=4.85, P>.05) and NIBUT (H(3)=2.18, P>.05). However, there is a significant difference between age groups of 20-29, 30-39, 40-49,and 50-60 years old in both TFP (H(3)=28.25, P
Fulltext In vivo slit scanning confocal microscopic observation in a patient with moderate and severe keratoconus: a case report

Mutalib HA, Ghosh S, Sharanjeet-Kaur, Ghoshal R

Clin Optom (Auckl), 2016;8:79-83.
PMID: 30214352 DOI: 10.2147/OPTO.S106421

A 22-year-old Indian female was referred to Sg Buloh hospital with the diagnosis of bilateral keratoconus. On examination, slit lamp biomicroscopy and corneal topography revealed stage 3 keratoconus in the right eye and stage 2 keratoconus in the left eye. Corneal cell morphology in both eyes was evaluated using confocal microscope. In qualitative observation, almost all corneal layers in right eye except endothelium were partially or completely obscured by haze. Additionally, morphological alterations, such as elongation of keratocyte nuclei and cluster of cells, and dark bands in the anterior stroma were observed in right eye. In the left eye, the amount of haze was less, allowing better visibility of the corneal layers compared with the right eye. The dark bands were evident in the posterior stroma. Quantitative analysis showed that anterior and posterior stromal keratocyte density and endothelium cell density were relatively low in the right eye (834.0, 700.5, and 2,133 cells/mm2, respectively) compared with the left eye (934.1, 750.6, and 2,361 cells/mm2, respectively). In this case, the right eye, exhibiting stage 3 keratoconus, showed more morphological alteration, particularly in the anterior stroma compared with the left eye with stage 2 keratoconus. Increased severity of the disease can explain these differences in corneal cell morphology.
Fulltext Double Eyelid Tape Wear Affects Anterior Ocular Health among Young Adult Women with Single Eyelids

Yong PT, Arif N, Sharanjeet-Kaur S, Hairol MI

Int J Environ Res Public Health, 2020 10 22;17(21).
PMID: 33105550 DOI: 10.3390/ijerph17217701

Many East Asians apply double eyelid tape to create the double eyelid effect temporarily as a means of increasing their beauty. This study evaluated the effects of four-week wear of double eyelid tape on anterior ocular health in young adult women with single eyelids. Twenty-nine participants who met the inclusion criteria were recruited. The participants' anterior ocular health was examined including blinking characteristics (blink pattern and blink rate), ocular surface health (presence of corneal abrasion, corneal staining, conjunctival staining, corneal curvatures, meibomian gland dysfunction), tear break up time, intraocular pressure, and subjective comfort level. Participants were required to apply the double eyelid tape for at least eight hours a day and five days a week for four weeks. The parameters were re-measured at the end of each week. There was a significant increase in conjunctival staining, corneal staining, and meibomian gland dysfunction, with a significant reduction in tear break-up time and intraocular pressure. By week 3, all participants had incomplete blinks. There was no significant change in symptoms and subjective comfort level reported. Therefore, patients and eye care practitioners should be aware of the potential implications of double eyelid tape wear on ocular health, with no significant change in subjective comfort.
Fulltext Association between reduced visual-motor integration performance and socioeconomic factors among preschool children in Malaysia: A cross-sectional study

Hairol MI, Nordin N, P'ng J, Sharanjeet-Kaur S, Narayanasamy S, Mohd-Ali M, et al.

PLoS One, 2021;16(3):e0246846.
PMID: 33657109 DOI: 10.1371/journal.pone.0246846

Visual-motor integration (VMI) is related to children's academic performance and school readiness. VMI scores measured using the Beery-Bucktenicka Developmental Test of Visual-Motor Integration (Beery-VMI) can differ due to differences in cultural and socioeconomic backgrounds. This study compared the VMI scores of Malaysian preschoolers with the corresponding US norms and determined the association between their VMI scores and socioeconomic factors. A cross-sectional study was conducted among 435 preschoolers (mean age: 5.95±0.47 years; age range: 5.08-6.83 years) from randomly selected public and private preschools. VMI scores were measured using Beery-VMI in the preschools' classrooms. Information on the socioeconomic characteristics of the preschoolers was obtained using a parent-report questionnaire. One sample t-test was used to compare their VMI scores with the corresponding US norms. Multivariate logistic regression models were used to explore the influence of socioeconomic factors on the preschoolers' VMI scores. Overall, Malaysian preschoolers' VMI performance was similar to the US standardized norms (p>0.05). Children from low-income families were twice likely to obtain lower than average VMI scores than those from higher-income families (OR = 2.47, 95%CI 1.05, 5.86). Children enrolled at public preschools were more likely to obtain a lower than average VMI score than those who enrolled at private preschools (OR = 2.60, 95%CI 1.12, 6.06). Children who started preschool at the age of six were more likely to obtain lower than average VMI scores than those who started at an earlier age (OR = 4.66, 95%CI 1.97, 11.04). Low maternal education level was also associated with lower than average VMI score (OR = 2.60, 95%CI 1.12, 6.06). Malaysian preschoolers' Beery-VMI performance compared well to their US counterparts. Some socioeconomic factors were associated with reduced VMI scores. Those from disadvantaged socioeconomic backgrounds are more likely to have reduced VMI performance, potentially adversely affecting their school readiness, cognitive performance, and future academic achievements.
Fulltext A comparative study on the inter-session and interexaminer reliability of corneal power measurement using various keratometry instruments

Md. Muziman Syah, M. M., Mutalib, H. A., Sharanjeet Kaur, M. S., Khairidzan Khairidzan, M. K.

International Medical Journal Malaysia, 2016;15(1):69-74.
MyJurnal

Introduction: The purpose of this study was to evaluate inter-session repeatability, inter-examiner
reproducibility and inter-device agreement of corneal power measurements from manual keratometer,
autokeratometer, topographer, Pentacam high resolution and IOLMaster. Methods: Two sets of mean
corneal power measurements (n=40) were compared for inter-session repeatability and inter-examiner
reproducibility in each instrument. Repeatability and reproducibility were evaluated by within-subject
standard deviation (Sw), coefficient of variation (COV) and intraclass correlation coefficient (ICC). A oneway
repeated measures analysis of variance was conducted to compare differences in the corneal power
between each instrument pair. The Bland and Altman analysis and Pearson’s correlation were employed to
assess agreement and determine strength of relationship between measurements. Results: There were no
significant differences in mean corneal power measurements between 2 different visits (p > 0.05). The Sw
and COV values between 2 visits were lower than 0.09 D and 0.20 % respectively. The ICCs were stronger
than 0.99 in all instruments. For reproducibility of each instrument, differences of the measurements
between 2 different examiners were also insignificant (p > 0.05). The Sw and COV values between 2
examiners were lower than 0.11 D and 0.23 % respectively. The ICCs were 0.99 and above in all instruments.
The 95% limit of agreement between instruments ranged from -0.29 to 1.13 D and the r-values were stronger
than 0.84. Conclusion: The corneal power measurements using these 5 instruments were repeatable and
reproducible. These instruments can also be used interchangeably, however the topographer should be used
with caution.
Fulltext New modified equation of contact lens method in determining post myopic laser refractive surgery corneal power

Md. Muziman Syah, M.M., Mutalib, H. A., Sharanjeet Kaur, M. S., Khairidzan, M. K.

International Medical Journal Malaysia, 2016;15(1):61-68.
MyJurnal

Introduction: The purpose of this study was to derive a modified equation for contact lens method (CLM) in
calculating post myopic laser refractive surgery corneal power. Methods: A total of 93 subjects who
underwent myopic laser refractive surgery at IIUM Eye Specialist Clinic were recruited. The accuracy of
postoperative corneal power using the standard CLM and newly-derived contact lens modified method
(CLMmod) were compared to the standard comparison method ; the historical method (HM). The CLMmod
equation was derived by adjusting postoperative corneal power of CLM according to amount of refractive
change. Results: The mean postoperative corneal power using standard CLM was significantly higher than
HM (mean difference: -0.24 D, p < 0.001). Fifty seven percent (n = 53 eyes) of the standard CLM results were
within ±0.50 D of HM results. The difference between postoperative corneal power using standard CLM and
HM increased significantly with the amount of refractive change (r = 0.835; p < 0.001). The mean
postoperative corneal power of CLMmod showed that there was no statistical significant difference compared
to the HM results (mean difference: 0.00 D, p= 0.964). Eighty eight percent (n = 82 eyes) of the CLMmod
results were within ±0.50 D of HM results with improvement of 31% from the standard CLM results.
Conclusion: The CLMmod equation provides more accurate calculation in determining post myopic laser
refractive surgery corneal power. In near future, this modified equation can be used as an alternative
equation to calculate postoperative corneal power when the preoperative data is unavailable.
Fulltext Behavioural issues among primary schoolchildren with colour vision deficiency.

Nithiyaananthan PJ, Sharanjeet-Kaur, Anne BT, Eliana AN, Mahadir A

IIUM Medical Journal Malaysia, 2020;19(3):37-45.
MyJurnal

Colour vision deficiencies may raise behavioural changes among children. This study explores the presence of any behavioural issues faced by primary schoolchildren with congenital red-green colour vision deficiency (CRGCVD). Materials and Methods:Male schoolchildren, aged 8-11 years old, from 10 randomly selected schools in Klang Valley were screened using Ishihara plates and Farnsworth D-15 test. Children with CRGCVD (study group) and without CRGCVD (control group) were asked to complete the Strength and Difficulties Questionnaire (SDQ) for children (self-report) while their class teachers completed the SDQ for teachers (teacher-report). Difficulty scores were calculated. The test categorised behaviour into 3 categories based on the difficulty scores into ‘normal’, ‘borderline’ and ‘abnormal’ behaviours. Non-parametric test was used to compare the median of difficulty scores between control group and study group. Spearman correlation was used to determine association between self-report SDQ and teacher-report SDQ. Results:A total of 134 schoolchildren were recruited in this study, of which 44 had CRGCVD and 90 were in the control group. Teacher-reported SDQ for the children were obtained from 134 teachers. No statistically significant differences (p>0.05) were noted between the total SDQ scores of children with and without CRGCVD using self-report SDQ and teacher-report SDQ. The total difficulty scores of self-report SDQ and teacher-report SDQ were poorly but significantly correlated. Teachers rated 9.09% of children with CRGCVD as falling under the ‘abnormal’ category, slightly higher than self-rated of 2.27%. Conclusion:This study found no prominent behavioural issues among schoolchildren with CRGCVD.
Fulltext Risk factors for cataract: a case study at National University of Malaysia Hospital

Sharanjeet-Kaur, Arifah Nur Yahya, Che Muhaya Mohamad, McCarty, C.A.

Jurnal Sains Kesihatan Malaysia, 2006;4(1):85-98.
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The purpose of this study was to identify the most common forms of age-related cataracts and to estimate possible risk factors for age-related cataracts in a sample of cataract patients at the National University of Malaysia Hospital. Thirty five patients (17 males and 18 female) with cataracts were recruited from the ophthalmology ward and clinic at the hospital. The age range of the patients was between 39 to 93 years (mean 64.9 11.5 years). The Lens Opacities Classification System (Locs) III was used to grade nuclear, cortical and posterior subcapsular lens opacities. Grading of the cataract was carried out and the following information was collected: initial visual acuity and best-corrected visual acuity, demographic details, health history, dietary intake of antioxidants and lifetime ocular ultraviolet B exposure. Analyses were conducted using a standard case-control design. T-tests were used to assess the significance of continuous variables and chi-squared tests were used for categorical variables. The overall prevalence of cortical cataract was 34.4% (12 patients), nuclear cataract was 60.0% (21 patients), and posterior subcapsular cataract was 57.1% (20 patients). No significant potential risk factor was found for nuclear cataracts. In the case of posterior subcapsular cataract, hypertension was the only potential significant risk factor (x2 = 4.38, p = 0.036), and in the case of cortical cataract, cigarette smoking was the only significant risk factor. Although lifetime effective ocular UV-B exposure was found to be not a significant potential risk factor, but it was seen that for cortical cataracts, the mean difference of lifetime effective ocular UV-B exposure between those with cortical and those without cortical cataracts was larger compared to others with nuclear and posterior subcapsular cataracts. Hypertension was found to be a potential significant risk factor for posterior subcapsular cataract whereas cigarette smoking was a potentially significant risk factor for cortical cataract. Although not statistically significant, lifetime effective ocular UV-B exposure maybe a potential risk factor for cortical cataract.

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