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  1. Fulltext Optimising technology to measure functional vision, mobility and service outcomes for people with low vision or blindness: protocol for a prospective cohort study in Australia and Malaysia
    Deverell L, Meyer D, Lau BT, Al Mahmud A, Sukunesan S, Bhowmik J, et al.
    BMJ Open, 2017 12 21;7(12):e018140.
    PMID: 29273657 DOI: 10.1136/bmjopen-2017-018140
    INTRODUCTION: Orientation and mobility (O&M) specialists assess the functional vision and O&M skills of people with mobility problems, usually relating to low vision or blindness. There are numerous O&M assessment checklists but no measures that reduce qualitative assessment data to a single comparable score suitable for assessing any O&M client, of any age or ability, in any location. Functional measures are needed internationally to align O&M assessment practices, guide referrals, profile O&M clients, plan appropriate services and evaluate outcomes from O&M programmes (eg, long cane training), assistive technology (eg, hazard sensors) and medical interventions (eg, retinal implants). This study aims to validate two new measures of functional performance vision-related outcomes in orientation and mobility (VROOM) and orientation and mobility outcomes (OMO) in the context of ordinary O&M assessments in Australia, with cultural comparisons in Malaysia, also developing phone apps and online training to streamline professional assessment practices.

    METHODS AND ANALYSIS: This multiphase observational study will employ embedded mixed methods with a qualitative/quantitative priority: corating functional vision and O&M during social inquiry. Australian O&M agencies (n=15) provide the sampling frame. O&M specialists will use quota sampling to generate cross-sectional assessment data (n=400) before investigating selected cohorts in outcome studies. Cultural relevance of the VROOM and OMO tools will be investigated in Malaysia, where the tools will inform the design of assistive devices and evaluate prototypes. Exploratory and confirmatory factor analysis, Rasch modelling, cluster analysis and analysis of variance will be undertaken along with descriptive analysis of measurement data. Qualitative findings will be used to interpret VROOM and OMO scores, filter statistically significant results, warrant their generalisability and identify additional relevant constructs that could also be measured.

    ETHICS AND DISSEMINATION: Ethical approval has been granted by the Human Research Ethics Committee at Swinburne University (SHR Project 2016/316). Dissemination of results will be via agency reports, journal articles and conference presentations.

    Matched MeSH terms: Vision, Low/rehabilitation*
  2. Fulltext Topical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report
    Ismail AS, Taharin R, Embong Z
    Int Med Case Rep J, 2012;5:33-7.
    PMID: 23754920 DOI: 10.2147/IMCRJ.S29960
    Here, a case of vision threatening blepharokeratoconjunctivitis that responded well to topical cyclosporin is reported. A 9-year-old Malay girl with a history of bilateral blepharokeratoconjunctivitis was regularly treated with lid scrubbing using diluted baby shampoo, fusidic acid gel, and topical steroids as well as an intermittent course of oral doxycycline for the past year. She developed acute onset bilateral eye redness associated with poor vision in her right eye. Both eyes showed marked diffuse hyperemic conjunctiva with corneal vascularization. The presence of corneal vascularization obscured the visual axis in the right eye. The condition did not improve with regular intensive lid hygiene using diluted baby shampoo, fusidic acid gel, and topical steroids. She was started on topical cyclosporin A 0.5% every 6 hours. There was a dramatic regression of corneal vascularization after 3 days on topical cyclosporin, with marked improvement in visual acuity. This is a single case in which cyclosporin improved the status of the ocular surface. A large cohort study is required to justify its effectiveness in treating blepharokeratoconjunctivitis and to test its potential as an alternative immunosuppressive agent in comparison to conventional corticosteroids.
    Matched MeSH terms: Vision, Low
  3. Development and validation of a new vision screening test algorithm for public use mobile application- A pilot study
    Siti Nor Aishah AR, Mutalib A, Asma H, Baig AA, Naing NN, Hashim SE, et al.
    Med J Malaysia, 2020 11;75(6):685-690.
    PMID: 33219178
    OBJECTIVES: To design and develop a simple vision test algorithm for mobile application and perform a pilot study to determine its validity and reliability as a tool for vision test in the community.

    METHODS: A simple visual acuity test algorithm in the form of a single letter E display was designed as the optotype for development of a mobile application. The standardised optotype is presented at random to test visual acuity for corresponding level of 3/60, 6/60, 6/18, and 6/12. The final result is auto-generated based on the classification of the WHO for visual impairment and blindness. The Snellen chart was used as the gold standard to determine its validity while five different users were involved to determine its inter-rater reliability. A pilot study was performed between April till November 2019, in the Universiti Sultan Zainal Abidin Medical Centre (UMC) at Kuala Nerus and Mooris Optometrist Centre at Marang, Terengganu. A total of 279 participants aged four years old and above were involved in this study.

    RESULTS: The highest sensitivity was found at the vision level cut-off point of 6/12 with the percentage of 92.7% and 86.8% for the right and left eye, respectively. The specificity was more than 89% for all vision levels in both eyes. The Krippendorff's alpha value for the inter-rater reliability was 0.87 and 0.83.

    CONCLUSION: The relatively high level of validity and reliability obtained indicate the feasibility of using the designed optotype to develop a valid and reliable mobile app for vision test. The app can be used to screen vision by nonmedical persons, at anytime and anywhere to help improve public awareness and capability to correctly determine their visual status.

    Matched MeSH terms: Vision, Low
  4. Fulltext Posterior capsule rupture-causes, associations and outcomes: eight year analysis in a Malaysian General Hospital
    Thevi T, Zin MM
    International Eye Science, 2016;16:600-606.
    AIM: To see the causative factors, associations and outcomes of posterior capsule rupture (PCR). METHODS: A retrospective cohort study was done of all patients with PCR from 2007 to 2014 in Melaka Hospital. Associations between ocular comorbidities, lens related complications, surgeon grade, type of cataract surgery, whether done alone or in combination, with the occurrences of PCR were studied. The final visual outcome of cases with PCR was studied. RESULTS: PCR was the commonest intraoperative complication (n=623, 4.8%) among 12 846 patients. Ocular comorbidities and status of the lens did not cause PCR. Experience and seniority of surgeons were significantly associated with PCR. Medical officers had more PCRs than gazetting specialists (P=0.0000), who inturn had more PCRs than specialists (P=0.000). Each type of cataract surgery done was also significantly associated with PCR-phacoemulsification (phaco), phaco convert to extracapsular cataract extraction (ECCE) and intracapsular cataract extraction (ICCE) (P=0.000), lens aspiration (P=0.020), and ECCE (P=0.003). Specialists got good outcomes compared to trainees without PCR occurring (P=0.001) and also with PCR occurring (P=0.013). However, no difference was observed in the occurrence of PCR in complicated cases between specialists and trainees. Vision was compromised mainly by astigmatism following PCR. Impaired vision (P=0.000) and poor vision (P=0.000) were more than good vision. Poor vision was more in PCR compared to other complications.(P=0.000). CONCLUSION: PCR occurs in all types of cataract surgeries and is the main intraoperative complication causing poor vision. Good outcomes were significantly more when specialists got PCR compared to trainees. Junior surgeons should practice in wet labs and be given more cases. Copyright 2016 by the IJO Press.
    Matched MeSH terms: Vision, Low
  5. Fulltext Prevalence of retinopathy of prematurity and refractive status in premature infants in Sabah Women and Children Hospital (SWACH)
    Linggam, Rachel Clarice, Mohammed Danial A. Razak, Israk Mohd Isa, Hanisah Abdul Hamid, Shuaibah Abdul Ghani
    Borneo Journal of Medical Sciences, 2020;3(101):13-14.
    MyJurnal
    Introduction: Myopia has been regarded as an important cause of blindness and visual impairment by WHO. Due to higher incidence of myopia in a preterm baby with ROP, early detection and visual rehabilitation need to commence as soon as possible to give the children better quality of life and prevent blindness in this population. To determine the prevalence of ROP and refractive status in premature infants in Sabah Women and Children Hospital, Kota Kinabalu in 2018. To establish the relationship between low BW and GA with the presentation of ROP.
    Matched MeSH terms: Vision, Low
  6. Profile of a low vision clinic population
    Mohidin N, Yusoff S
    Clin Exp Optom, 2002 12 17;81(5):198-202.
    PMID: 12482319
    BACKGROUND: Causes of low vision and types of low vision devices (LVDs) prescribed in other low vision clinics have been studied extensively. Similar studies have not been conducted in Malaysia. This paper reports the results of a retrospective study of 573 patients seen at the Universiti Kebangsaan Malaysia-Malaysian Association for the Blind (UKM-MAB) low vision clinic in Kuala Lumpur. METHODS: The record cards of 573 patients seen at the UKM-MAB clinic over 10 years were examined and the following information extracted: date of first consultation, age, sex, cause of visual impairment as diagnosed by an ophthalmologist and types of low vision devices (LVDs) prescribed. RESULTS: The majority of patients were from the younger age groups with 423 (73.8 per cent) less than 50 years of age. Three hundred and ninety-five (68.9 per cent) of the subjects were males and 178 (31.1 per cent) female. The main causes of low vision were congenital structural defects including nystagmus among patients in the zero to 29 years age group, retinitis pigmentosa among the 30 to 59 years age group and age-related macular degeneration (ARM) among those over 60 years of age. CONCLUSIONS: Since the majority of the patients were from the younger age group the main causes of low vision were congenital and hereditary diseases. Three hundred and forty-one (59.5 per cent) patients seen at the low vision clinic accepted the use of LVDs.
    Matched MeSH terms: Vision, Low
  7. Fulltext The importance of ophthalmic signs in the diagnosis of suprasellar meningioma - a case report
    Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G
    Malays Fam Physician, 2009;4(1):26-29.
    PMID: 25606155 MyJurnal
    A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.
    Matched MeSH terms: Vision, Low
  8. Fulltext Vitreous loss-causes, associations, and outcomes: Eight-year analysis in Melaka Hospital
    Thevi T, Abas AL
    Oman J Ophthalmol, 2018 6 23;11(2):113-118.
    PMID: 29930443 DOI: 10.4103/ojo.OJO_220_2016
    BACKGROUND: Cataract surgery is associated with a variety of complications, one of which is vitreous loss. Doctors and policymakers should be aware about the precipitating factors, associations, and expected outcomes of vitreous loss. This study was, therefore, undertaken to set guidelines to improve the visual outcomes of patients.

    MATERIALS AND METHODS: A retrospective 8-year analysis was conducted from 2007 to 2014 using the national eye database. Demographic features, ocular comorbidities, grade of surgeon, type of surgery, and the associations with the occurrence of vitreous loss, and the final visual outcomes of these patients were studied.

    RESULTS: Out of 12,992 eyes, only 3.2% had vitreous loss, mostly aged <40 years. Pseudoexfoliation was the only ocular comorbidity causing vitreous loss. Medical Officers and Gazetting Specialists got more vitreous loss compared to specialists. Intracapsular cataract extraction, phaco convert to extracapsular cataract extraction (ECCE), ECCE, and phaco all had a significant vitreous loss. Vitreous loss was the most significant intraoperative complication causing poor vision and resulted in impaired or poor visual outcome.

    CONCLUSION: Vitreous loss occurred in almost all types of cataract surgeries, especially by junior surgeons, among those aged <40 years and significantly caused poor visual outcome compared to other complications. Pseudoexfoliation had higher occurrence of vitreous loss. Vitreous loss patients had impaired/poor visual outcome due to preexisting comorbidity and astigmatism. Patients at risk and junior surgeons should be closely monitored to improve outcomes. Further studies need to be done to see why and when the vitreous loss occurred.
    Matched MeSH terms: Vision, Low
  9. Fulltext Irreversible visual loss and optic nerve dysfunction associated with central retinal vein occlusion in Waldenstrom Macroglobulinemia
    Fadilah SA, Muhaya M, Azlin I
    Med J Malaysia, 2007 Oct;62(4):349-51.
    PMID: 18551947 MyJurnal
    Irreversible optic nerve dysfunction associated with central retinal vein occlusion (CRVO) is an unusual but important complication of Waldenstrom Macroglobulinemia (WM). Acute visual loss in CRVO is mainly due the severe macular oedema. However, ischaemic optic neuropathy needs to be considered in patients with CRVO when, (i) there is a relative afferent papillary defect and central scotoma, (ii) the visual acuity is not consistent with the retinal pathology, and (iii) the visual defects persisted despite resolution of macular oedema following treatment of the hyperviscosity state. The ischaemic type of CRVO is associated with a poor visual prognosis and the presenting visual acuity has a prognostic role. We report the first description of irreversible unilateral optic nerve damage associated with CRVO in a patient with WM.
    Matched MeSH terms: Vision, Low/etiology*; Vision, Low/therapy
  10. Visual Presentation and Factors Affecting Visual Outcome in Children with Craniopharyngioma in East Coast States of Peninsular Malaysia: A Five-year Review
    Mohd-Ilham IM, Ahmad-Kamal GR, Wan Hitam WH, Shatriah I
    Cureus, 2019 Apr 08;11(4):e4407.
    PMID: 31205829 DOI: 10.7759/cureus.4407
    Purpose To describe the visual presentation and factors affecting visual outcome in pediatric patients treated for craniopharyngioma at a referral center in the East Coast states of Peninsular Malaysia. Methodology A retrospective review of medical records of children aged 17 years and below who had been treated for craniopharyngioma in Hospital Universiti Sains Malaysia from January 2014 to December 2018. The data collected included age, gender, presenting symptoms and duration, visual acuity, visual fields, color vision, light brightness, relative afferent pupillary defects, fundus examination and cranial nerves examination. The best corrected visual acuity during presentation, and after a one-year post-operative period, was documented. Records on investigations, surgical procedures, therapeutic modalities and recurrences were also reviewed. Results A total of 11 pediatric patients (22 eyes) were recruited. Fifty percent presented with optic atrophy. The mean duration of the onset of symptoms before consultation was 22.3 (24.5) months. A final best corrected visual acuity of 6/12 (20/40) or better was observed in 50% of the patients. There was a statistically significant association between presenting visual acuity, optic nerve function and visual field defects, and the final visual outcome. Conclusions Visual presentations in our study were fairly similar to previous reported studies. One-third presented late with permanent visual loss. Almost half had significant visual impairment after one-year post-operative period. Significant associations were observed between presenting visual acuity, duration of symptoms, impairment of optic nerve function tests, and visual field defects during presentation, and final visual acuity at one year after treatment.
    Matched MeSH terms: Vision, Low
  11. Fulltext Oral health status of a group of visually impaired school children in Kuala Lumpur
    Afsary Jahan Khan, Mas Suryalis Ahmad, Ahmad Shuhud Irfani Zakaria, Universiti Kebangsaan Malaysia, Tanti Irawati Rosli
    Malaysian Journal of Medicine and Health Sciences, 2020;16(1):100-105.
    MyJurnal
    Introduction: Children with visual impairment are reported to be at higher risk of poor oral health. They faced dif- ficulties in basic skills including oral care. For this reason, they may develop dental caries and periodontal disease. The aim of this study was to assess the oral health status of a group of visually impaired school children in Kuala Lumpur. Methods: A cross-sectional study was carried out on students from a Special Education School in Kuala Lumpur. Oral examination was conducted to determine caries experience and oral hygiene status. Caries was mea- sured using DMFT index and simplified oral hygiene index (OHI-S) for oral hygiene status. Oral examination was based on modified World Health Organization (WHO) oral health assessment criteria for children. Chi-square test was used to determine associations between demographic variables and oral health status. Results: A total of 91 visually impaired students (41 blind, 50 low vision) within the age group of 13 to 17 years old participated in this study. The mean OHI-S score was 1.68 (SD 0.87) with majority of students had fair oral hygiene (39.6%) and 29.7% with poor and very poor oral hygiene. The mean DMFT score of total students were 0.80 (SD 1.62). Male students demonstrated significantly better oral health status than female in relation to prevalence and mean score of dental caries. Conclusion: Most of the visually impaired children in this study showed fair oral health status. Regular oral health education is recommended to improve the oral hygiene especially in the totally blind group.
    Matched MeSH terms: Vision, Low
  12. Use of technology by orientation and mobility professionals in Australia and Malaysia before COVID-19
    Deverell L, Bhowmik J, Lau BT, Al Mahmud A, Sukunesan S, Islam FMA, et al.
    Disabil Rehabil Assist Technol, 2020 Jul 09.
    PMID: 32643468 DOI: 10.1080/17483107.2020.1785565
    PURPOSE: Orientation and Mobility (O&M) professionals teach people with low vision or blindness to use specialist assistive technologies to support confident travel, but many O&M clients now prefer a smartphone. This study aimed to investigate what technology O&M professionals in Australia and Malaysia have, use, like, and want to support their client work, to inform the development of O&M technologies and build capacity in the international O&M profession.

    MATERIALS AND METHODS: A technology survey was completed by professionals (n = 36) attending O&M workshops in Malaysia. A revised survey was completed online by O&M specialists (n = 31) primarily in Australia. Qualitative data about technology use came from conferences, workshops and interviews with O&M professionals. Descriptive statistics were analysed together with free-text data.

    RESULTS: Limited awareness of apps used by clients, unaffordability of devices, and inadequate technology training discouraged many O&M professionals from employing existing technologies in client programmes or for broader professional purposes. Professionals needed to learn smartphone accessibility features and travel-related apps, and ways to use technology during O&M client programmes, initial professional training, ongoing professional development and research.

    CONCLUSIONS: Smartphones are now integral to travel with low vision or blindness and early-adopter O&M clients are the travel tech-experts. O&M professionals need better initial training and then regular upskilling in mainstream O&M technologies to expand clients' travel choices. COVID-19 has created an imperative for technology laggards to upskill for O&M tele-practice. O&M technology could support comprehensive O&M specialist training and practice in Malaysia, to better serve O&M clients with complex needs.Implications for rehabilitationMost orientation and mobility (O&M) clients are travelling with a smartphone, so O&M specialists need to be abreast of mainstream technologies, accessibility features and apps used by clients for orientation, mobility, visual efficiency and social engagement.O&M specialists who are technology laggards need human-guided support to develop confidence in using travel technologies, and O&M clients are the experts. COVID-19 has created an imperative to learn skills for O&M tele-practice.Affordability is a significant barrier to O&M professionals and clients accessing specialist travel technologies in Malaysia, and to O&M professionals upgrading technology in Australia.Comprehensive training for O&M specialists is needed in Malaysia to meet the travel needs of clients with low vision or blindness who also have physical, cognitive, sensory or mental health complications.

    Matched MeSH terms: Vision, Low
  13. Fulltext Visual status and prevalence of refractive error among preschool children from amblyopia and vision impairment screening (AVIS) programme in Kota Kinabalu [Abstract]
    Linggam, Rachel Clarice, Arifah Nur Bt Yahya, Muhassanah Aliah Bt Baharum
    Borneo Journal of Medical Sciences, 2019;2(101):15-16.
    MyJurnal
    Introduction: Vision is an important requirement for learning and plays a critical role in the development of a child during the first three years of life. Little is known regarding the extent of visual impairment amongst preschool children in Sabah.
    Objective: To determine visual status among preschool children in Kota Kinabalu and to determine prevalence of refractive error among children who were referred by the programme.
    Methodology: A retrospective cohort study of clinical records was conducted at Department of Ophthalmology, Hospital Queen Elizabeth, Kota Kinabalu, Sabah from May to September 2017. Criteria for failed vision were VA 6/12 (0.3 LogMar) or worse. All records of referred children were selected for prevalence of refractive error. Data collected include basic demographic data, visual acuity and refractive error. Myopia was defined as spherical equivalent (SE) ≥−1.00 DS, hyperopia SE ≥+3.00 DS and astigmatism ≥−1.50 DC.
    Results: A total of 192 children age 4 to 6 years old were screened, comprised of 102 (53.1%) male and 90 (46.9%) female (mean age: 5.81 ± 0.41 years). Of the 192 students, 39 (20.3%) of them failed vision screening. Among the 39 children, only 17 children came for further eye assessment. Twelve (70.6%) of them had a binocular visual impairment (VI) while 5 (29.4%) children had monocular VI. Six years old children were found to have VI more compared to other age groups (n= 14, 82.4%) and majority of this age group having binocular VI (n=10, 83.3%). Mean SE was −0.60 ± 0.94. Astigmatism is the commonest type of refractive error found with a prevalence of 41.4% followed by myopia, 27.6%.
    Conclusion: This study was the first attempt to investigate the visual status among preschool in Kota Kinabalu. As most children were found with astigmatism, early detection of significant refractive error could help to minimize the effect of VI.
    Matched MeSH terms: Vision, Low
  14. 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.
    Matched MeSH terms: Vision, Low
  15. Fulltext Extranodal natural killer/T-cell lymphoma presenting as orbital cellulitis
    Zuhaimy H, Aziz HA, Vasudevan S, Hui Hui S
    GMS Ophthalmol Cases, 2017;7:Doc04.
    PMID: 28194321 DOI: 10.3205/oc000055
    Objective: To report an aggressive case of extranodal natural killer/T-cell lymphoma (NKTCL) of the ethmoid sinus presenting as orbital cellulitis Method: Case report Results: A 56-year-old male presented with right eye redness, reduced vision, and periorbital swelling for 5 weeks duration associated with a two-month history of blocked nose. The visual acuity of the right eye was 6/18. The eye was proptosed with periorbital oedema and conjunctival chemosis. The pupil was mid-dilated but there was no relative afferent pupillary defect. The fundus was normal. The extraocular movements were restricted in all directions of gaze. Nasal endoscopy revealed pansinusitis that corresponded with CT scan orbit and paranasal sinuses findings. Despite treatment, he showed no clinical improvement. Ethmoidal sinus biopsies performed revealed extranodal NKTCL. Further imaging showed involvement of the right orbital contents and its adnexa with intracranial extension into the right cavernous sinus and meninges over right temporal fossa. The patient underwent chemotherapy. However he succumbed to his illness two months after the diagnosis. Conclusion: Extranodal NKTCL is a great mimicker. This case demonstrated how an acute initial presentation of extranodal NKTCL can present as orbital cellulitis with pansinusitis.
    Matched MeSH terms: Vision, Low
  16. Visual impairment and amblyopia in Malaysian pre-school children - The SEGPAEDS study
    Chew FLM, Thavaratnam LK, Shukor INC, Ramasamy S, Rahmat J, Reidpath DD, et al.
    Med J Malaysia, 2018 02;73(1):25-30.
    PMID: 29531199 MyJurnal
    INTRODUCTION: Little is known regarding the extent of visual impairment amongst pre-school children in Malaysia.

    OBJECTIVE: To determine the prevalence of visual impairment and amblyopia in Malaysian preschool children.

    METHODOLOGY: A cross-sectional, population-based study was conducted on children aged four to six years from 51 participating kindergartens in the district of Segamat, Johor, Malaysia from 20 March 2016 to 6 April 2016. All subjects had initial eye screening consisting of LogMar visual acuity, orthoptics examination and Spot vision screener assessment. Subjects who failed the initial eye screening were invited for a formal eye assessment consisting of cycloplegic refraction and a comprehensive ocular examination. Definitions of visual impairment and amblyopia were based on the Multi-Ethnic Pediatric Eye Disease Study criteria.

    RESULTS: A total of 1287 children were recruited. Mean subject age was 5.03 (SD:0.77) and males represented 52.3% of subjects. Subjects by ethnicity were Malay (54.8%), Chinese (27.7%), Indian (15.6%) and Orang Asli (1.9%). Formal eye assessment was required for 221 subjects and 88.8% required ophthalmic intervention. Refractive error, representing 95.4% of diagnosed ocular disorders, comprised of astigmatism (84%), myopia (9%) and hypermetropia (6.9%). With-the-rule astigmatism was present in 93.4% of the subjects with astigmatism. Visual impairment was present in 12.5% of our subjects, with 61% having bilateral visual impairment. Of the subjects with visual impairment, 59.1% had moderate visual impairment. The prevalence of amblyopia was 7.53%, and 66% of the amblyopic subjects had bilateral amblyopia.

    CONCLUSION: Our study highlights an urgent need for initiation of preschool vision screening in Malaysia.

    Matched MeSH terms: Vision, Low
  17. Fulltext Arteriovenous malformation in temporal lobe presenting as contralateral ocular symptoms mimicking carotid-cavernous fistula
    Mohd-Tahir F, Siti-Raihan I, Wan Hazabbah WH
    Case Rep Ophthalmol Med, 2013;2013:158961.
    PMID: 23533876 DOI: 10.1155/2013/158961
    Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.
    Matched MeSH terms: Vision, Low
  18. Use of recombinant tissue plasminogen activator for treatment of recalcitrant anterior uveitis: A case series
    Patrick S, Hui-Tze C, Wan-Hazabbah WH, Zunaina E, Azhany Y, Liza-Sharmini AT
    J Taibah Univ Med Sci, 2018 Oct;13(5):483-487.
    PMID: 31435366 DOI: 10.1016/j.jtumed.2018.03.005
    Management of inflammation after surgery for recalcitrant anterior uveitis is challenging. Herein, we report successful treatment using intracameral injection of recombinant tissue plasminogen activator (rtPA) in two patients with recalcitrant anterior uveitis, due to infective uveitis and Vogt-Koyanagi-Harada disease, respectively. A 40-year-old woman presented with bilateral redness and vision reduction that had persisted 2 weeks. She also had bilateral anterior uveitis, vasculitis, retinitis, and optic disc swelling. Serology was positive for Bartonella henselae and Toxoplasma gondii. She was treated using long-term systemic corticosteroids and appropriate antibiotics. Our second case; a healthy 30-year-old man with bilateral eye redness and reduced vision without pain, and associated with headache and tinnitus for 1 weeks. He showed bilateral granulomatous inflammation with vitritis, choroiditis, retinitis, and hyperemic optic disc. The patient was diagnosed with Vogt-Koyanagi-Harada disease and treated with systemic corticosteroids. Both patients developed secondary cataracts and glaucoma that necessitated surgical intervention. Persistent chronic inflammation led to the formation of a thick fibrin membrane anterior to the intraocular lens (IOL) after phacoemulsification surgery with IOL implantation. This membrane was removed surgically, and intracameral injection of rtPA (25 μg) was carried out. The persistent inflammation had resolved and visual acuity had significantly improved within 1 week of intracameral rtPA injection. There were no reported ocular or systemic side effects. Intracameral rtPA is beneficial in patients with recalcitrant anterior uveitis who have undergone intraocular surgery. In most cases, surgical intervention improves the patients' vision. Intracameral rtPA should be considered in cases of persistent inflammation of varying etiology.
    Matched MeSH terms: Vision, Low
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