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A New Perspective on Dry Eye Classification: Proposal by the Asia Dry Eye Society

Tsubota K, Yokoi N, Watanabe H, Dogru M, Kojima T, Yamada M, et al.

Eye Contact Lens, 2020 Jan;46 Suppl 1:S2-S13.
PMID: 31425351 DOI: 10.1097/ICL.0000000000000643

The 2017 consensus report of the Asia Dry Eye Society (ADES) on the definition and diagnosis of dry eyes described dry eye disease as "Dry eye is a multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage." The report emphasized the instability of tear film and the importance of visual dysfunction in association with dry eyes, highlighting the importance of the evaluation of tear film stability. This report also discussed the concept of tear film-oriented therapy, which stemmed from the definition, and which is centered on provision of insufficient components in each tear film layer and ocular surface epithelium. The current ADES report proposes a simple classification of dry eyes based on the concept of tear film-oriented diagnosis and suggests that there are three types of dry eye: aqueous-deficient, decreased wettability, and increased evaporation. It is suggested that these three types respectively coincide with the problems of each layer: aqueous, membrane-associated mucins, and lipid/secretory mucin. Although each component cannot be quantitatively evaluated with the current technology, a practical diagnosis based on the patterns of fluorescein breakup is recommended. The Asia Dry Eye Society classification report suggests that for a practical use of the definition, diagnostic criteria and classification system should be integrated and be simple to use. The classification system proposed by ADES is a straightforward tool and simple to use, only through use of fluorescein, which is available even to non-dry eye specialists, and which is believed to contribute to an effective diagnosis and treatment of dry eyes.

Matched MeSH terms: Vision Disorders
A negative waveform in the scotopic response in a patient with phosphoglycerate kinase deficiency: a visual electrophysiology report

Mohd Khialdin S, Grigg J, Rowe N, Crofts S, Wilson M, Troedson C

Documenta ophthalmologica. Advances in ophthalmology, 2015 Dec;131(3):215-20.
PMID: 26396085 DOI: 10.1007/s10633-015-9511-0

Phosphoglycerate kinase (PGK) deficiency is an X-linked neurometabolic genetic disorder with variable systemic manifestations. So far, only one patient with retinal anomalies has been reported, but no visual electrophysiology findings were described. We report the first description of visual electrophysiology in a child with PGK deficiency. This provides further information for the site of involvement in the eye.

Matched MeSH terms: Vision Disorders/diagnosis; Vision Disorders/physiopathology*
Fulltext A pilot school health survey to study the incidence of common disorders in primary school children and the role of teachers in the school health service

Ayyamani UD

Med J Malaysia, 1986 Mar;41(1):4-11.
PMID: 3796347

Selected students were subjected to a general health appraisal including vision and hearing tests by teachers, nurses and finally a medical officer. The findings of all three examiners were then compared taking the results of the medical officer as the indicator of accuracy. The findings of the survey indicated that the problems of school children were similar to those reported by other workers and by MCH Division of the Ministry of Health namely dental caries, head lice, malnutrition, skin infections and visual disability. Other problems like skeletal deformity and abnormalities of heart, lung, speech and behaviour were extremely uncommon and formed only 1.5% of the total. Teachers and nurses performed extremely well in relation to the doctor with 93% and 95.8% concurrence respectively in detecting these abnormalities. Teachers were also requested to give a feedback on their view of and role in the SHS as well as problems faced in following the school health card. The majority perceived the SHS as a joint effort between the Ministry of Health and Education and agreed that they had a role to play in the SHS. Many teachers also indicated a willingness to carry out the various tasks in the SHS. The main problem in filling the school health card seemed to be in getting relevant details from parents though over 50% of teachers complained that there were too many details to fill. The role of teachers in the SHS is discussed in the light of the findings of the study and recommendations are made.

Matched MeSH terms: Vision Disorders
Fulltext Age related visual impairment in the elderly

Loh KY, Ogle J

Med J Malaysia, 2004 Oct;59(4):562-8, quiz 569.
PMID: 15779599

Visual impairment among the elderly is a major health problem. With advancing age, the normal function of eye tissues decreases and there is an increased incidence of ocular pathology. Demographic studies have shown that age is the best predictor of blindness and visual impairment. The most common causes of age related visual impairment in the elderly are presbyopia, cataracts, age related macular degeneration, primary open angle glaucoma and diabetic retinopathy. Untreated visual impairment leads to physical handicap, increased incidence of fall, depression, social isolation and dependency. Active screening for visual loss in the elderly should be part of the health examination. The elderly should be encouraged to come for formal 1-2 yearly eye assessment for early detection of visual impairment and to treat all associated problems in order to prevent permanent visual loss.

Matched MeSH terms: Vision Disorders/diagnosis; Vision Disorders/etiology*
Fulltext An analysis of ranibizumab treatment and visual outcomes in real-world settings: the UNCOVER study

Eldem B, Lai TYY, Ngah NF, Vote B, Yu HG, Fabre A, et al.

Graefes Arch Clin Exp Ophthalmol, 2018 May;256(5):963-973.
PMID: 29502232 DOI: 10.1007/s00417-017-3890-8

PURPOSE: To describe intravitreal ranibizumab treatment frequency, clinical monitoring, and visual outcomes (including mean central retinal thickness [CRT] and visual acuity [VA] changes from baseline) in neovascular age-related macular degeneration (nAMD) in real-world settings across three ranibizumab reimbursement scenarios in the Middle East, North Africa, and the Asia-Pacific region.
METHODS: Non-interventional multicenter historical cohort study of intravitreal ranibizumab use for nAMD in routine clinical practice between April 2010 and April 2013. Eligible patients were diagnosed with nAMD, received at least one intravitreal ranibizumab injection during the study period, and had been observed for a minimum of 1 year (up to 3 years). Reimbursement scenarios were defined as self-paid, partially-reimbursed, and fully-reimbursed.
RESULTS: More than three-fourths (n = 2521) of the analysis population was partially-reimbursed for ranibizumab, while 16.4% (n = 532) was fully-reimbursed, and 5.8% was self-paid (n = 188). The average annual ranibizumab injection frequency was 4.1 injections in the partially-reimbursed, 4.7 in the fully-reimbursed and 2.6 in the self-paid populations. The average clinical monitoring frequency was estimated to be 6.7 visits/year, with similar frequencies observed across reimbursement categories. On average, patients experienced VA reduction of -0.7 letters and a decrease in CRT of -44.4 μm. The greatest mean CRT change was observed in the self-paid group, with -92.6 μm.
CONCLUSIONS: UNCOVER included a large, heterogeneous ranibizumab-treated nAMD population in real-world settings. Patients in all reimbursement scenarios attained vision stability on average, indicating control of disease activity.

Matched MeSH terms: Vision Disorders/diagnosis; Vision Disorders/drug therapy*; Vision Disorders/physiopathology
Fulltext An elderly lady with blurring of vision

Azhany Y, Nani D, Zunaina E

Malays Fam Physician, 2012;7(1):43-4.
PMID: 25606247 MyJurnal
Matched MeSH terms: Vision Disorders
Assessment of Visual Acuity in Children Using Crowded Lea Symbol Charts

Sailoganathan A, Rou LX, Buja KA, Siderov J

Optom Vis Sci, 2018 08;95(8):643-647.
PMID: 30063661 DOI: 10.1097/OPX.0000000000001253

SIGNIFICANCE: Vision charts comprising single Lea symbols surrounded by either flanking bars or flanking Lea symbols are available for measurement of visual acuity in children. However, the results obtained with such charts may not be interchangeable owing to potential differences in the crowding effect.
PURPOSE: The purpose of this study was to compare habitual visual acuity in a sample of young children using two versions of the single Lea symbols charts with different crowding features.
METHODS: Monocular habitual visual acuity was measured in a sample of 77 young children aged between 4 and 6 years using crowded Lea symbols charts with either flanking bars separated from the central symbol by 0.5 optotype width or flanking Lea optotypes separated from the central symbol by 1.0 optotype width.
RESULTS: Mean visual acuity was higher (i.e., lower logarithm of the minimum angle of resolution) with the Lea symbols crowded using flanking optotypes, equivalent to about 1.5 optotype difference. Visual acuity measured with the two charts was significantly correlated; however, the 95% limits of agreement were larger than expected from repeatability studies using Lea symbols.
CONCLUSIONS: Lea symbols with flanking optotypes resulted in higher visual acuity than the Lea symbols with flanking bars, probably as a result of differences in the crowding effect. The two charts showed insufficient agreement, and we do not recommend their use interchangeably. We recommend using the Lea symbols with flanking bars because of the closer flanker-target separation.

Matched MeSH terms: Vision Disorders/diagnosis
Fulltext BMI, BP, visual acuity and hearing status of Special Olympics athletes in Sarawak

Toh, Teck Hock, Nurhilda Abdullah, Chua, Soh Yian, Muhamad Rais Abdullah, Islia Nahazatul, Chieng, Lee Ling

Int J Public Health Res, 2011;1(2):66-71.
MyJurnal

Introduction Special Olympics (SO) Inc. is an organization for people with intellectual disability (ID) to actively engaging in Olympic-type sport and participating in competition. Special Olympic Inc. provides Healthy Athletes Programme (HAP®) in screening and providing health education to Special Olympic Athletes. Objective To study the body mass index (BMI), blood pressure (BP), visual acuity and hearing status of children and young adult with ID in Special Olympics Sarawak. Methods Health data were collected by trained health professionals under HAP®held in conjunction with Special Olympics Sarawak State Games on 17th and 18th April 2010 in Sibu. Health data collected were athletes' weight, BMI, BP, ear canal screen and hearing status (oto-acoustic emission, pure tone audiometry), as well as eye health and visual acuity, using guidelines set by HAP®. Results 195 athletes attended the State Games in 2010 of which 138 were screened. Significant number of athletes was considered overweight / obese (31.5% for children and 36.9% for adult). More than 20% of the adult athletes were hypertensive or at risk of hypertension. Sixteen percent of the adult athletes had hearing loss. More than half of the adult and children athletes never had eye checks, and a significant numbers of them had abnormal eye tests results. Conclusions Health screening conducted during the HAP® is a useful screening program in this population. Health data collected can bring awareness to athletes and their family, and corrective measures in hearing and visual impairment can be taken immediately.

Matched MeSH terms: Vision Disorders
Baseline Central Visual Field Defect as a Risk Factor For NTG Progression: A 5-Year Prospective Study

Raman P, Suliman NB, Zahari M, Mohamad NF, Kook MS, Ramli N

J Glaucoma, 2019 11;28(11):952-957.
PMID: 31688446 DOI: 10.1097/IJG.0000000000001359

PRECIS: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.
PURPOSE: The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.
DESIGN: This was a prospective, longitudinal study.
METHODS: A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.
RESULTS: There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.
CONCLUSION: NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

Matched MeSH terms: Vision Disorders/diagnosis*; Vision Disorders/physiopathology
Fulltext Bilateral Inferior Altitudinal Visual Field Defect in Recurrent Intracranial Meningioma: A Case Report

Ghanimi Zamli AK, Chew-Ean T, Wan Hitam WH

Cureus, 2019 Apr 11;11(4):e4436.
PMID: 31245223 DOI: 10.7759/cureus.4436

Altitudinal visual field defect is a rare presentation of retrochiasmal lesion especially when bilateral visual fields were affected. In fact, bilateral inferior altitudinal visual field defect (BIAVFD) usually occurred in patients who survived a gunshot injury to the occipital lobe or as a direct trauma to the brain. We report a rare case of BIAVFD secondary to occipital meningioma. A high index of suspicion enables timely investigation and diagnosis when dealing with atypical presentation of intracranial meningioma.

Matched MeSH terms: Vision Disorders
Bilateral asymmetrical mucoceles of the paranasal sinuses with unilateral orbital complications

Chong AW, Prepageran N, Rahmat O, Subrayan V, Jalaludin MA

Ear Nose Throat J, 2011 Feb;90(2):E13.
PMID: 21328215

We report the rare occurrence of bilateral asymmetrical mucoceles of the paranasal sinuses that resulted in a unilateral orbital complication. The patient was a 47-year-old woman who presented with complaints of diplopia, blurred vision, and protrusion of her right eye that had progressed over a period of several months following an upper respiratory tract infection. Computed tomography detected the presence of two large, asymmetrical mucoceles. The lesion on the right involved the frontal and ethmoid sinuses, and the one on the left involved the ethmoid sinus. The mucoceles were locally expansile and had eroded the surrounding bony structures on the right. The expansile nature of the right-sided mass had displaced the right orbit, which was the cause of the vision deterioration. Transnasal endoscopic surgery was performed to excise and marsupialize the mucoceles. This modality was preferred over conventional open surgery because it affords good visualization, it is safe, and it is a less morbid procedure. The patient's recovery was uneventful, and she was discharged home on the third postoperative day. On continuing follow-up, her vision had improved, her intraocular pressure had returned to normal, and her orbits were in their normal position. Based on our literature search, no case of bilateral frontal and ethmoid sinus mucoceles has been previously reported.

Matched MeSH terms: Vision Disorders/etiology*
Fulltext Blindness and visual impairment amongst rural Malays in Kuala Selangor, Selangor

Zainal M, Masran L, Ropilah AR

Med J Malaysia, 1998 Mar;53(1):46-50.
PMID: 10968137

A population-based cross-sectional study was carried out to determine the prevalence of visual impairment and blindness and its causes amongst the adult rural Malay population in the district of Kuala Selangor, Selangor. By simple random sampling 330 samples were selected for the study. All samples underwent complete ophthalmological examination. The crude prevalence of visual impairment and blindness were 0.7% and 5.6% respectively. Age was the most important factor associated with the prevalence; gender, level of education and level of income was not significantly related. Cataract was the commonest cause of visual impairment and blindness while diabetic retinopathy was the second important cause.

Matched MeSH terms: Vision Disorders/epidemiology*
Fulltext Bromocriptine for visual field defects in prolactinomas

Embong M, Satgunasingam N, Rejab SM, Singh H

Med J Malaysia, 1981 Mar;36(1):29-36.
PMID: 7321934
Matched MeSH terms: Vision Disorders/drug therapy*
Fulltext Caecocentral Scotoma: A Rare Presentation of Optic Perineuritis

Mohamad SA, Zunaina E, Wan Hitam WH

Cureus, 2019 Nov 08;11(11):e6101.
PMID: 31886042 DOI: 10.7759/cureus.6101

Optic perineuritis (OPN) is a subtype of optic neuritis (ON) in which the inflammatory process involves meningeal sheath surrounding the optic nerve. Clinically, OPN simulates ON. However, in contrast to ON, patient with OPN shows sparing of central vision, improves dramatically with high-dose corticosteroid, are more likely to experience recurrence after stopping treatment. We report a rare case of caecocentral scotoma observed in a female with typical ON symptoms. Her magnetic resonance imaging showed features in line with OPN. She was treated with intravenous methylprednisolone 1 g/day for five days followed by slow tapering dose of oral prednisolone for one month. Her vision improved dramatically with a resolution of visual field defect. No relapses seen within two years of follow-up.

Matched MeSH terms: Vision Disorders
Central serous retinopathy: a preliminary report of 33 cases

Eu-sen VO

Med J Malaya, 1969 Sep;24(1):18-20.
PMID: 4243836
Matched MeSH terms: Vision Disorders/etiology
Cerebral arteriovenous malformation--an unusual site

Rathakrishnan V, Mohd TH, Kandiah R

Neuroradiology, 1989;31(1):107.
PMID: 2716995
Matched MeSH terms: Vision Disorders/etiology
Fulltext Characteristics of visually impaired children in Low Vision Clinic in UKM. [Ciri kanak-kanak berpenglihatan terhad di Klinik Penglihatan Terhad UKM]

Omar R, Knight VF, Mohammed Z, Tholasee GM

Jurnal Sains Kesihatan Malaysia, 2007;5(1):37-45.
MyJurnal

While the prevalence of visually impaired children constitutes a small portion of the visually impaired population, it is important to determine whether the low vision services available are utilised by these children. This is important as previous studies have shown that children have a very high rate of successful low vision device use compared to adults. This was a cross sectional retrospective study. Fifty nine low vision clinic children records were evaluated. The results showed that 25.4% of the children were categorised as with moderate low vision, 30.5% with severe low vision and 40.7% were categorised as blind. The major causes of low vision were congenital cataract, congenital nystagmus, congenital glaucoma, macular degeneration and retinitis pigmentosa. Low vision rehabilitation for near work using magnifiers improved the vision of 30.5% of the low vision children. This finding suggests that 1/3 of low vision children could benefit from low vision rehabilitation. The low vision devices most commonly prescribed to the children in this study were stand magnifiers, hand-held magnifiers and spectacles. This study illustrates the key role of optometrists in the management of visual impairment in Malaysian children. It would appear that the establishment of low vision services in government hospitals using trained optometrists is a cost effective method of service delivery. Therefore more low vision children would have access to proper low vision rehabilitation and through that rehabilitation, their quality of life can be improved.
Key words: children, low vision
Study site: Klinik Penglihatan Terhad Pusat Perubatana, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Matched MeSH terms: Vision Disorders
Fulltext Charles Bonnet syndrome: a precursor to Alzheimer disease

Janaki, V., Rosdinom, R., Hatta, S.

Medicine & Health, 2015;10(2):146-150.
MyJurnal

This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Vision Disorders
Fulltext Chemotherapy related optic neuritis

Nur, A.S., Jemaima, C.H., Fuad Ismail, Safinaz, M.K.

International Medical Journal Malaysia, 2017;16(2):133-136.
MyJurnal

In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.

Matched MeSH terms: Vision Disorders
Colloid cyst of third ventricle mimicking normal tension glaucoma

Patel DK, Ali NA, Iqbal T, Subrayan V

Ann Ophthalmol (Skokie), 2008;40(3-4):177-9.
PMID: 19230359

Colloid cysts are rare intracranial tumors most commonly found in the third ventricle. We present a case of colloid cyst of the third ventricle that manifested as bilateral advance optic disc cupping, superior hemifield defects in the visual fields and normal intraocular pressure.

Matched MeSH terms: Vision Disorders/diagnosis

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