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  1. Majumder C, Afnan H
    Korean J Ophthalmol, 2020 06;34(3):219-226.
    PMID: 32495530 DOI: 10.3341/kjo.2019.0138
    PURPOSE: The purpose of the study was to establish baseline data for amplitude of accommodation (AA) measured using both subjective and objective techniques in students at a private Malaysian university.

    METHODS: This cross-sectional study was conducted including 34 healthy participants with a mean age of 22.26 ± 1.88 years. AA was measured using dynamic retinoscopy and the push-up, pull-away, modified push-up, and minus-lens techniques.

    RESULTS: The mean AA scores for the push-up, pull-away, minus-lens, and modified push-up techniques and dynamic retinoscopy were 11.38 ± 2.03, 10.35 ± 1.64, 9.24 ± 1.18, 8.26 ± 1.44, and 7.2 ± 1.0 diopters, respectively. No AA measurements showed significant difference among ethnicities (Chinese, Malay, and Indian). This study suggested that AA obtained using push-up (p = 0.005) and pull-away (p = 0.017) methods and dynamic retinoscopy (p = 0.041) were significantly different according to sex. No significant difference was observed in AA for the minus-lens (p = 0.051) and modified push-up (p = 0.216) techniques by sex. A moderately negative correlation was found between AA and age for the push-up (r = -0.434, p = 0.010), pull-away (r = -0.412, p = 0.016), and minus-lens (r = -0.509, p = 0.002) techniques and dynamic retinoscopy (r = -0.497, p = 0.003). A weak negative correlation was found between age and AA measured using a modified push-up technique (r = -0.393, p = 0.022).

    CONCLUSIONS: Mean AA was highest for the push-up technique, followed by the pull-away technique, the minus-lens technique, the modified push up technique, and dynamic retinoscopy. The push-up and pull-away methods and dynamic retinoscopy showed a significant difference in measurement of AA between sexes.

  2. Mohd-Ilham I, Tai ELM, Suhaimi H, Shatriah I
    Korean J Ophthalmol, 2021 08;35(4):287-294.
    PMID: 34162187 DOI: 10.3341/kjo.2020.0106
    PURPOSE: There are limited data from Asian countries regarding retinal thickness in children with type 1 diabetes mellitus (T1DM). This study aimed to compare the macular and retinal nerve fiber layer (RNFL) parameters between diabetic children without retinopathy and non-diabetic healthy children. We also evaluated the factors associated with RNFL thickness in children with T1DM.

    METHODS: A comparative cross-sectional study was conducted among children with T1DM and healthy children aged 7 to 17 years old in Hospital Universiti Sains Malaysia from 2017 to 2019. Children with retinal disease or glaucoma were excluded. Macular and RNFL thicknesses were measured using spectral-domain optical coherence tomography. Demographic information, duration of diabetes, blood pressure, body mass index, visual acuity, and retinal examination findings were documented. Glycosylated hemoglobin levels, renal function, and blood lipid levels were also collected.

    RESULTS: Forty-one children with T1DM and 80 age- and sex-matched children were enrolled. Both sexes were affected. Mean duration of diabetes mellitus was 3.66 years. The mean glycated hemoglobin levels in the T1DM group was 9.99%. The mean macular and RNFL thicknesses in children with T1DM were 277.56 (15.82) µm and 98.85 (12.05) µm, respectively. Children with T1DM had a significantly thinner average macula, superior outer macula, nasal outer macula, mean RNFL, and inferior RNFL thickness compared to controls (p < 0.05). There was a significant association between nephropathy and the mean RNFL thickness.

    CONCLUSIONS: Children with T1DM had significantly decreased mean macular and RNFL thicknesses. Nephropathy is associated with an increased RNFL thickness.

  3. Ngoo QZ, A NF, A B, Wh WH
    Korean J Ophthalmol, 2021 06;35(3):223-230.
    PMID: 34120421 DOI: 10.3341/kjo.2020.0019
    PURPOSE: To study the retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters in obstructive sleep apnoea (OSA) patients and their relationship with severity of the disease.

    METHODS: A cross-sectional, hospital-based study. Fifty-four OSA subjects and 54 controls were recruited. Candidate that fulfil the criteria with normal ocular examinations then proceed with spectrum domain Cirrus optical coherence tomography examinations. ONH parameters and RNFL thickness were evaluated. Apnoea-hypopnoea index (AHI) of the OSA group were obtained from the medical record.

    RESULTS: In OSA, mean of average RNFL thickness was 93.87 µm, standard deviation (SD) = 9.17, p = 0.008 (p < 0.05) while superior RNFL thickness was 113.59 µm, SD = 16.29, p ≤ 0.001 (p < 0.05). RNFL thickness fairly correlate with severity of the disease (AHI), superior RNFL with R = 0.293, R2 = 0.087, p = 0.030 (p < 0.05), and nasal RNFL R = 0.292, R2 = 0.085, p = 0.032. No significant difference and correlation observed on ONH parameters. In control group, mean of average RNFL thickness was 98.96 µm, SD = 10.50, p = 0.008 (p < 0.05) while superior RNFL thickness was 125.76 µm, SD = 14.93, p ≤ 0.001 (p < 0.05).

    CONCLUSIONS: The mean of the average and superior RNFL thickness were significantly lower in the OSA group compare to control. Regression analysis showed RNFL thickness having significantly linear relationship with the AHI, specifically involving the superior and nasal quadrant.

  4. Wern-Yih C, Fazilawati Q, Rahmat J, Shatriah I
    Korean J Ophthalmol, 2022 Jan 24.
    PMID: 35067016 DOI: 10.3341/kjo.2021.0116
    Purpose: The prevalence of retinopathy of prematurity (ROP) is higher in developing countries compared to developed countries. There is limited data on vision-related quality of life (VRQoL) among children with severe type of ROP in developing countries. This study evaluated the influence of threshold and pre-threshold ROP on VRQoL in Malaysian children.

    Methods: Multicenter prospective cross-sectional study conducted in three tertiary hospitals in 2018 to 2019. Children less than seven years old with previous ROP diagnosis were recruited and divided into threshold, high-risk and low-risk pre-threshold subgroups. Patients with systemic comorbidities that affected vision or daily activities were excluded. A parent/guardian completed the Children's Visual Function Questionnaire (CVFQ) for the assessment of child's general health, general vision, competence, personality, family impact and treatment difficulty.

    Results: Eight were categorized with threshold ROP, 16 with high-risk pre-threshold ROP, and 26 with low-risk pre-threshold ROP. 50 age-matched controls were also included. Mean visual acuity in logMAR was 0.46 in the threshold, 0.08 in high risk pre-threshold and 0.01 in low-risk pre-threshold subgroups. Threshold ROP was associated with myopia and strabismus, and associated with poor visual acuity compared to pre-threshold ROP. Mean total CVFQ score was significantly lower in the ROP group (p<0.001) compared to the control group. Mean score and all mean subscale scores were significantly lower in the threshold subgroup compared to high-risk and low-risk pre-threshold subgroups, with lowest subscale scores on general vision and general health. There was significant association between gestational age, visual acuity of the better eye and family income and VRQoL (p<0.05).

    Conclusion: ROP was associated with lower VRQoL in children born prematurely in Malaysia. The threshold ROP group is the most affected. General vision and health domains are their main difficulties encountered. Gestational age, visual acuity of the better eye and family income affects the VRQoL.

  5. Syed NH, Zunaina E, Wan-Nazatul Shima S, Sharma M, Shatriah I
    Korean J Ophthalmol, 2022 Oct;36(5):452-462.
    PMID: 35989077 DOI: 10.3341/kjo.2022.0010
    MicroRNAs (miRNAs) are the small noncoding RNA molecules which regulate target gene expression posttranscriptionally. They are known to regulate key cellular processes like inflammation, cell differentiation, cell proliferation, and cell apoptosis across various ocular diseases. Due to their easier access, recent focus has been laid on the investigation of miRNA expression and their involvement in several conjunctival diseases. The aim of this narrative review is to provide understanding of the miRNAs and describe the current role of miRNAs as the mediators of the various conjunctival diseases. A literature search was made using PubMed, Scopus, and Web of Science databases for studies involving miRNAs in the conjunctival pathological conditions. Original articles in the last 10 years involving both human and animal models were included. Literature search retrieved 27 studies matching our criteria. Pertaining to the numerous literatures, there is a strong correlation between miRNA and the various pathological conditions that occur in the conjunctiva. miRNAs are involved in various physiological processes such as cell differentiation, proliferation, apoptosis, development, and inflammation by regulating various signaling pathways, genes, proteins, and mediators. Pterygium was the most studied conjunctival disease for miRNA involvement, whereas miRNA research in allergic conjunctivitis is still in its early stages. Our review provides deep insights into the various miRNAs playing an important role in the various conjunctival diseases. miRNAs do have the potential to serve as noninvasive biomarkers with diagnostic, prognostic, and therapeutic implications. However, multitudinous studies are required to validate miRNAs as the reliable biomarkers in conjunctival pathologies and its targeted therapy.
  6. Mun-Wei L, Aiman-Mardhiyyah MY, Hayati AA, Ikram IM, Tai ELM, Shatriah I
    Korean J Ophthalmol, 2023 Feb;37(1):42-48.
    PMID: 36549302 DOI: 10.3341/kjo.2021.0131
    PURPOSE: Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria.

    METHODS: The comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map.

    RESULTS: The mean foveal thickness was 238.15 ± 22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = -0.41, p = 0.019), the nasal outer macula (r = -0.41, p = 0.019), and the inferior outer macula (r = -0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness.

    CONCLUSIONS: The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.

  7. Zulhisham M, Suhaimi H, Shatriah I
    Korean J Ophthalmol, 2023 Dec;37(6):462-467.
    PMID: 37899288 DOI: 10.3341/kjo.2023.0040
    PURPOSE: The aim of this study is to determine the mean central corneal thickness (CCT) and mean intraocular pressure (IOP) in children with type 1 diabetes mellitus (T1DM) and to determine the relationship between CCT and IOP on the one hand and age, sex, retinopathy hemoglobin A1c (HbA1c), and duration of diabetes on the other.

    METHODS: This is a case-control, hospital-based study conducted at Hospital Universiti Sains Malaysia between January and November 2022. Thirty-eight children with T1DM were recruited as cases, and 38 healthy children were recruited as controls. The cases and controls then underwent ophthalmic examination, IOP measurement, and CCT measurement using optical coherence tomography (OCT) of the right eye. The IOP measurements were adjusted for CCT for further analysis.

    RESULTS: The means of CCT and IOP values were significantly higher in the T1DM group than in the control group (all p = 0.02). The mean CCT was 542.18 ± 20.40 μm in the T1DM group, and 529.52 ± 26.17 μm in the control group. The mean IOP was 14.68 ± 1.98 mmHg in the T1DM group, and 13.52 ± 1.66 mmHg in the control group. The mean HbA1c was 10.68% ± 2.49% in the T1DM group. Age and duration of DM were found to have a significant association with CCT in children with T1DM. The duration of DM was also found to be significantly associated with the IOP. Sex and HbA1c levels were found to have no significant relationship with either CCT or IOP.

    CONCLUSIONS: Children with T1DM have significantly higher CCT and IOP than the average child. The duration of DM is a significant factor that impacts both CCT and IOP. In addition, age is another factor that affects CCT in children with T1DM.

  8. Khairil-Ridzwan KK, Lai YS, Fiona CLM, Shatriah I
    Korean J Ophthalmol, 2024 Oct;38(5):364-374.
    PMID: 39155135 DOI: 10.3341/kjo.2024.0048
    PURPOSE: There has been a lack of data on health-related quality of life (HRQoL) in children with vernal keratoconjunctivitis (VKC) from Southeast Asia. This study evaluated the levels (mean total score and subscales score) of HRQoL, comparing the VKC and normal children groups, and within the VKC severity groups.

    METHODS: A cross-sectional study was conducted in two tertiary hospitals, specifically the pediatric ophthalmology services at Hospital Selayang and Universiti Sains Malaysia, spanning from 2019 to 2020. Participants aged between 8 and 15 years were categorized into two groups: those diagnosed with VKC and healthy children serving as the control group. Each participant completed the Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire, consisting of 16 questions, divided into two subscales: 12 questions focusing on symptoms and four questions for daily activities.

    RESULTS: A total of 240 children took part in the study, with 120 children diagnosed with VKC and another 120 in the control group. The mean age of participants with VKC was 11.21 ± 1.91 years, with a male predominance of 4:1 compared to female. Tearing (98.4%) and itchiness (98.3%) emerged as the most prevalent symptoms affecting HRQoL, while the most challenging activities were outdoor play (36.6%) and participation in recreational water activities (34.2%). The mean total score was significantly higher in the VKC group compared to the control group. Additionally, both the mean total score and all subscale scores were significantly higher in the severe type compared to the mild-moderate type.

    CONCLUSIONS: VKC significantly reduce the HRQoL among Malaysian children, and the negative impact increases with the disease severity.

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