Background: and Purpose There is increasing evidence that the anterior visual pathways are involved in neurodegenerative diseases including amyotrophic lateral sclerosis (ALS) and Parkinson’s disease (PD). This study investigated longitudinal changes in retinal nerve fiber layer (RNFL) thickness in patients with ALS and PD with the aim of better understanding their roles as biomarkers of disease progression. Methods: This study recruited 21 ALS patients, 19 age-matched PD patients, and 21 agematched healthy controls. Patient demographics and clinical scores relating to the respective diseases were documented. The RNFL thickness was measured using optical coherence tomography at baseline and after 6 months. Results: At baseline, the RNFL in the superior quadrant was significantly thinner in the patients with ALS than in healthy controls (109.90±22.41 µm vs. 127.81±17.05 µm [mean±standard deviation], p=0.008). The RNFL thickness did not differ significantly between the ALS and PD patients or between the PD patients and healthy controls. At 6 months, there was further significant RNFL thinning in patients with ALS, for both the overall thickness (baseline: median=94.5 µm, range=83.0–106.0 µm; follow-up: median=93.5 µm, range=82.5–104.5 µm, p=0.043) and the thickness in the inferior quadrant (median=126 µm, range=109.5–142.5 µm; and median=117.5 µm, range=98.5–136.5 µm; respectively, p=0.032). However, these changes were not correlated with the ALS functional scores. In contrast, the patients with PD did not demonstrate a significant change in RNFL thickness between the two time points. Conclusions The RNFL thickness is a promising biomarker of disease progression in patients with ALS but not in those with PD, which has a slower disease progression.

The importance of complete and valid written consent for medical procedure is indisputable. Written consent forms for ophthalmology related laser procedures and angiography were audited against guidelines regarding validity and adequacy. A full cycle clinical audit was carried out at a tertiary hospital providing ophthalmology service. A preintervention audit was performed in 2018 where consent forms of all ophthalmology related laser procedures and angiography were reviewed. Multiple interventions were taken to improve the adherence in obtaining a valid and adequate written consent prior to the post intervention audit. Standards of practice were compared to ‘Guidelines for Consent for Treatment of Patients by Registered Medical Practitioners’ by Malaysian Medical Council (MMC), and ‘Consent Forms in Ophthalmic Practice’ by Dr. Amit Khosla. A total of 412 consent forms were reviewed in the pre-intervention audit of 2018. Adherence to standard was 37.14%. In the post intervention audit, 256 forms were reviewed, and the adherence improved to 85.94%. Interventions taken include briefing to stakeholders, formulating a standardized risks checklist and multiple checks were done to ensure the interventions were adhered to by the doctors. The significant improvement in adequacy and validity of consent taking for ophthalmology related laser procedures and angiography showed that the interventions taken, were indeed useful. However, continuous effort in maintaining the standard is crucial for patient care and safety.
Clinical Audit