Coping with dual sensory impairment or deafblindness can be a challenging task for an individual and for the caregiver. Currently limited information is available hence the objective of this study is to determine the profile and quality of life for children with dual sensory impairment or deafblindness. It is hoped that with this information, better rehabilitation programs can be designed for children with deafblindness in Malaysia. A purposive sampling was adopted. Children with dual sensory impairment were invited to participate in the study. Demographic and hearing loss information was extracted from the children’s medical records. Face to face interviews with parents were conducted using the SF-36 quality of life questionnaire. Vision assessment comprising visual acuity, refraction, cover test, external ocular examination and children’s behaviour observations was conducted. Four children were identified based on sample size calculation and fulfilled the dual sensory impairment criteria out of the 44 children screened. The mean age was 9.3 ± 2.9 years old. Majority of the children were of Indian ethnicity. The category of deafblindness was congenital deafblindness with rubella as the main cause. All the children were premature babies but had a normal birth weight. The hearing profile showed the majority of them had bilateral profound hearing loss with mean pure tone average ranging between 50 dBHL and 120 dBHL. The main type of hearing problem was sensorineural and the majority of children owned hearing aids. The visual profile of the deafblindness children revealed either light perception (LP) and categorised as blind or low to moderate myopia. A majority had esotropia. All the children used braille as a visual aids and children with residual vision used closed circuit television (CCTV). Tactile methods were the main means for communication and majority of the children used a white cane. Behaviour and external observation assessments concurred with the hearing and vision impairment manifested. Quality of life in these subjects was lower in 7 out of 8 SF-36 dimensions as compared to normative values. Congenital deafblindness is the main category found among the children in this study and they had profound vision and hearing losses. Tactile methods are the main means of communication for these children. Their quality of life was affected and introducing deafblindness rehabilitation, which includes a combination of hearing and low vision rehabilitation, will be able to assist them in coping with their daily activities.

When medical and surgical intervention cannot alleviate all of the impairments resulting from diseases of the eye, visual rehabilitation can help reduce the disability and increase the quality of life. Data from 169 patients seen at the UKM Low Vision Clinic (UKM LVC) over the past 2 years were examined and analysed. The age ranged from 6 to 87 years of age. The main cause of ocular pathological categories was conduction (63.9%), media (24.9%) and congenital (11.2%) related problems. The main causes of low vision at UKM LVC were congenital cataract, retinitis pigmentosa, glaucoma, cataract and diabetic retinopathy. 84% of these patients received low vision devices to improve their near or/and distance vision. The most common optical devices dispensed at UKM LVC were near high addition spectacle, hand magnifiers and stand magnifiers. Medical, vision care and rehabilitation professionals working together can offer a comprehensive treatment plan for the visually impaired, offering these patients the very best services to increase their quality of life.

Visual impairment among children can be serious without early intervention. This study was conducted to determine prevalence of visual impairment causes among preschool children. Twenty one kindergartens were randomly selected for vision screening. The screening module consist of visual acuity test, cover test, Hirschberg’s test, exsternal ocular asessment and ophthalmoscopy. Preschool children who failed the vision screening were referred for further assessment. Four hundred and seventy nine preschool children with an average age of 5.30 ± 0.69 years old participated in the vision screening program. Of those 43 children who failed the vision screening, 32 (6.7%) children were confirmed to have some form of visual impairment, while 8 children were normal. Three children were excluded from the study because the children did not cooperate for further assessment. The main cause of visual impairment among preschool children was refractive error (5.8%). Other causes were amblyopia (1.3%), strabismus (1.0%) and ocular abnormalities (0.8%). In conclusion early detection of visual impairment through vision screning and early optometric intervention is very important to be conducted among preschool children so that visual impairment can be reduced.

Pattern electroretinogram (pERG) is a recording of retinal response to a phase reversing pattern stimulus. It gives information on the integrity of the inner retina specifically the ganglion cells. The recording of pERG in a laboratory is easily influenced by many factors hence standardization in a laboratory is required to ensure that pERG recorded is repeatable and reproducible. The objective of this study was to determine the factors that could affect pERG recordings at the Electrophysiology Laboratory, Optometry Program, Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). This study involved forty-five subjects, aged between 20 and 25 years. They were divided into three groups. The factors being investigated were effects of 1) Alcaine 0.5%, 2) diurnal variation and 3) different size and shape of fixation target for pERG measurement (amplitude and implicit time). Paired t-test showed no significant differences between the recording before and after instillation of Alcaine 0.5% for amplitude (p = 0.116) and implicit time (p = 0.557). Measurements carried out in the morning and afternoon did not show significant differences for amplitude (p = 0.864) and implicit time (p = 0.174). For different fixation targets, results also showed no significant difference for amplitude (p = 0.125) and implicit time (p = 0.404). In conclusion, use of Alcaine 0.5%, different time of measurements and different type of fixation targets do not influence pERG results at the Electrophysiology Laboratory, FSK, UKM. Results of this study can be used for comparisons in research or in diagnosing diseases of the retina in the future

While the prevalence of visually impaired children constitutes a small portion of the visually impaired population, it is important to determine whether the Jurnal Sains Kesihatan Malaysia 5 (1) 2007: 37-45 38 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.

A Malay Language Related Reading Text Test was developed to assess reading performance among primary school children. One hundred and twenty normally sighted primary school children were randomly selected from year 2 and 3 (mean age 8.5 ± 0.5 years) and year 4 and 5 (mean age 10.5 ± 0.5 years). Subjects were asked to read all fi ve reading text aloud, correctly and according to their usual reading speed in random order. Time to complete each reading paragraph was recorded and any error or guessing was noted. Reading speed and reading rate were measure as word per minute (wpm). The mean reading speed for grade 1 was 88.81 ± 1.95 (SE) wpm and the reading rate was 87.20 ± 1.98 (SE) wpm. For grade 2, reading speed was 108.12 ± 1.66 (SE) wpm while reading rate was 107.22± 1.67 (SE) wpm. Reading speed and reading rate among subjects were not signifi cantly different (p > 0.05) either for grade 1 or 2 with p value 0.91 and 0.57 respectively. Comparison between each text also showed that there was no signifi cant different (p > 0.05). All texts that were developed were statistically homogenous indicating that the reading texts test can be use in random order and will not affect the reading assessment in primary school children.
Reading

This study reports the vision status of a presbyopic patient who has undergone a corneal inlay procedure. The study hopes to provide optometrists more insight on the procedure and the co-management involved in such a patient. The patient, a 48 years-old Chinese woman with presbyopia underwent the corneal inlay procedure three years ago. She had the inlay implanted in the non-dominant eye to aid near vision i.e. her left eye. The pre and post-operative evaluations include distance and near visual acuity, fundoscopy, tonometry, Schirmer’s test, slit lamp evaluation, corneal topography and corneal pachymetry. Near visual acuity for the left eye improved from N14 to N5 immediately after the procedure. Even after 3 years of post-operative followup, the patient was still able to maintain her near vision. In conclusion, the corneal inlay procedure helped to improve near vision of this presbyopic patient. Optometrist plays a very important role in the co-management of such patients alongside with the ophthalmologist in terms of visual functional assessments pre and post-surgery, counseling of the procedure and managing patients’ expectations.
Corneal Injuries

Visual Functions are affected by the aging process and without appropriate intervention eventually will results in diminishing visual acuity. As the situation proceeds difficulty to perform daily life activities ensureand will impact on the quality of life especially in the elderly. The objective of this study was to determine the effect of visual impairment towards daily activities and quality of life among elderly. Measurements that were conducted included visual acuity at distance using the LogMAR Chart to determine the level of visual impairment, quality of life test using the Low Vision Quality of Life (LVQOL) questionnaire and ability to cope with the activities of daily life was measured using the Barthel Index (BI). It was found that visual function progressively worsens with age, as did the BI which declined as visual function worsened. The LVQOL score reduced significantly with worsening visual ability. Thirty five percent of the elderly in this study required some form of optometric and low vision intervention. In conclusion, the deterioration in the functions among elderly can reduce the ability to cope with the daily life activities. Other than that, uncorrected visual acuity will cause reduction in the quality of life among the elderlies

The purpose of this study is to determine the prevalence and causes of visually impairment among children below 4 years old in two public tertiary referral hospitals in Selangor, Malaysia. In this cross-sectional retrospective study, the case files of all children aged below 4 years from the ophthalmology clinics in two separate public hospitals in Selangor, Malaysia were analysed over a 5-year period. The definition of visual impairment was based on the World Health Organization (WHO) classification, i.e. moderate visual impairment: visual acuity <6/18 to 6/60 in the better eye; severe visual impairment: <6/60 to 3/60 in the better eye; and blindness: visual acuity <3/60 in the better eye. Prevalence of visual impairment was based on the presenting visual acuity and then differentiated according to the cause of visual impairment diagnosed. A total of 243 (17.38%) children from a total of 1,398 children were classified as visually impaired. Most of these children (n=119, 49.0%) exhibited moderate visual impairment, 26 (10.7%) had severe visual impairment, while 98 (40.3%) were blind. Refractive errors (n=60, 24.7%) were the most common cause of vision impairment, mostly myopes (n=28, 46.7 %). This was followed by strabismus (n=31, 12.8%) and retinopathy of prematurity (n=29, 11.9%). In conclusion, vision impairment was prevalent in children aged below 4 years old presenting to two ophthalmology clinics in a highly urbanised region in Malaysia. High refractive errors were the major cause of vision impairment seen. Our study highlights the need and utmost importance of an early intervention programme to be implemented for these children since the main cause of vision impairment found in this study is an easily treated problem.
visual impairment ; prevalence ; children ; blindness

Vision impairment when undetected early can affect the social and mental development of a child. Early detection of visual impairment can provide better prognosis and can be conducted through vision screening at pre-school. Vision screening performed using pre-school teachers would allow cost and time savings while providing greater access to perform this screening. The objective of this study was to determine the effectiveness of vision screening conducted by pre-school teachers. A total of sixty pre-school teachers from KEMAS Tabika’s and Taska’s in the Klang Valley were randomly selected and divided into two groups i.e. a Study Group and a Control Group. The Study Group was given participative and handson vision screening training whereas the Control Group was only given brief verbal instructions on conducting the screening. Each of these pre-school teachers was asked to conduct vision screening on 15 pre-school children aged 4 to 6 years old. Trained optometrists then repeated the vision screening on the same children. The results showed that there was a higher validity in the vision screening findings from the Study Group (sensitivity = 79%, specificity = 95%) compared to the Control Group (sensitivity = 26%, specificity = 95%). The level of agreement concurrence between the pre-school teachers in the Study Group and the optometrist was high for all tests (AC1 ≥ 0.89). In conclusion, the vision screening program conducted by pre-school teachers was effective but needed proper training for the screeners. This program is seen to be able to empower pre-school teachers using vison screening techniques to allow them to identify pre-school children with vision impairment who would then require further examination and management by an eye-care professional. This program would be able to reduce the prevalence of vision impairment among pre-school children in Malaysia in the long term.
Pre-schooler ; vision screening ; vision impairment ; early detection ; teachers