Background: There are a few dry eye remedies available in the market. Currently, artificial tears and lubricants are still the most common management for dry eyes. Objective: We proposed a new method in managing dry eyes. Methods: A pre-soaked contact lens in virgin coconut oil (VCOCL) is being used as a vehicle to deliver virgin coconut oil (VCO) in dry eyes. VCOCL was prepared in sterilised conditions where daily soft hydrogel contact lenses were immersed in raw VCO. The efficacy of VCOCL in delivering the VCO to eyes was assessed by measuring the Tear Break-Up Time (TBUT) values, corneal staining of the anterior eye, Schirmer Test values and the measurement of residual VCO volume in tears at baseline and at 15 minutes after insertion on subjects with dry eyes. Pre- and post-data were used to analyse all the measurable variables. Results: This study showed a significant difference in the TBUT, corneal staining, and residual VCO volume for both eyes (p<0.05). However, there were no changes in the Schirmer Test value (p>0.05). VCOCL was proven to improve tear quality in dry eye subjects and was able to maintain its presence in the eye even after 15 minutes. Conclusion This study suggests a new method for dry eye management.
Contact Lenses ; Therapeutics ; Dry Eye Syndromes

Lipoma is a benign, slow growing tumour composed of adipose tissue. In general, it is very unusual for lipoma to form in the head and neck region, let alone achieve a size of more than 10 cm with the involvement of deep neck spaces. We discussed a case of an extremely huge neck lipoma measuring 18 cm x 14 cm with extensive involvement of deep neck spaces, infratemporal fossa and pharynx, closely adherent to submandibular and parotid gland. The diagnostic and therapeutic challenges were discussed, in achieving a surgically complete excision and cosmetically acceptable outcome

Malaysia is expected to become the elder country by the year 2035 and elderly caregiving is the main issue in the old population. Although the elderly are expected to live for a longer period, half of them are in an unhealthy condition, sick and suffering from the disease. Thus, they need to be taken care of for a longer period formally or informally. However, most of the family members have chosen to take care of the elderly informally. Therefore, the purpose of this article is to identify the problems that are faced by the caregivers on long-term caregiving of the elderly. Informal caregivers need to encounter a financial problem, affected health, difficulty in determining the caregiving rotation and lack of knowledge or information pertaining to elderly caregiving. Hence, the roles of caregiving in the long-term period could burden and affect the informal caregivers’ well-being.

An age-related ocular disease such as cataract that causes reduction of visual functions would affect the individual driving performance. The aim of this study was to compare driving difficulties between Malaysian drivers with bilateral cataracts and without cataract. This cross-sectional study involved measurement of visual functions [visual acuity (VA) and contrast sensitivity (CS)] and driving difficulty of 61 subjects who are actively driving with valid driving license. Subjects were divided into bilateral cataract group (n=30) and non-cataracts group as control group (n=31); which age and gender matched. Results showed that the mean±SD for composite driving difficulty score in the bilateral cataract group and in the control group were 72.08±15.95 and 87.50±12.60 respectively. It showed that both groups had lower mean composite score which indicates difficulty in driving. Results also showed significant mean difference composite driving difficulty score between cataract and control group (p<0.001). Drivers with bilateral cataracts were also found to have significant difficulty when driving the rain (p=0.034), at night (p=0.013) and when driving on local or highway (p=0.005) compared to drivers without cataract. Subsequent Spearman’s Rho showed significant moderate positive correlation between driving difficulty and binocular CS (rs =0.404, p=0.027). This study showed that drivers with cataract would experience driving difficulties compared to the drivers without cataract.

Background: Mutations in glucocerebrosidase (GBA) have been associated with the risk of developing Parkinson’s disease (PD) in different ethnic populations. The prevalence of GBA mutations among Malay PD patients is unknown. Thus, the aim of this study was to determine the frequency of GBA mutations among Malay PD patients, focusing on early (EOPD) and late-onset (LOPD) patients. Methods:EOPD (n = 50) and LOPD (n = 50) patients along with 50 ethnically and age-matched control wererecruited. The GBA exons of these patients were sequenced using the Ion Torrent PGMTM System. Results: Five heterozygous mutations exclusive to EOPD patients were identified; c.-203A>G,p.S146L, p.R159Q, p.L483P and p.L483R+c.-145G>A. In LOPD patients, c.543C>T(p.(F181=)), c.28-10C>A and p.R202Q were identified in which this p.R202Q was also present in a control subject. In addition, c.259C>A(p.(R87=)) and c.-145G>A were identified in two control subjects. In summary, we observed GBA mutations in 8% and 6% of Malay PD cases and control subject, respectively. The prevalence of GBA mutations was higher in EOPD (10%) than LOPD (6%). However, these differences were not statistically significant; [PD vs. controls: OR = 1.36, 95%CI 0.35-5.38, p = 0.752] and [EOPD vs. LOPD: OR = 1.74, 95%CI 0.39-7.71, p = 0.715]. Conclusion: We identified five exclusive heterozygous GBA mutations in EOPD patients which might predict the increase susceptibility of Malays to develop PD at young age. These findings could add knowledge into the existing evidences linking genetic alterations in GBA and PD.

algorithm for mobile application and perform a pilot study todetermine its validity and reliability as a tool for vision testin the community.Methods: A simple visual acuity test algorithm in the form ofa single letter E display was designed as the optotype fordevelopment of a mobile application. The standardisedoptotype is presented at random to test visual acuity forcorresponding level of 3/60, 6/60, 6/18, and 6/12. The finalresult is auto-generated based on the classification of theWHO for visual impairment and blindness. The Snellen chartwas used as the gold standard to determine its validity whilefive different users were involved to determine its inter-raterreliability. A pilot study was performed between April tillNovember 2019, in the Universiti Sultan Zainal AbidinMedical Centre (UMC) at Kuala Nerus and MoorisOptometrist Centre at Marang, Terengganu. A total of 279participants aged four years old and above were involved inthis study. Results: The highest sensitivity was found at the vision levelcut-off point of 6/12 with the percentage of 92.7% and 86.8%for the right and left eye, respectively. The specificity wasmore than 89% for all vision levels in both eyes. TheKrippendorff’s alpha value for the inter-rater reliability was0.87 and 0.83.Conclusion: The relatively high level of validity andreliability obtained indicate the feasibility of using thedesigned optotype to develop a valid and reliable mobile appfor vision test. The app can be used to screen vision by non-medical persons, at anytime and anywhere to help improvepublic awareness and capability to correctly determine theirvisual status.

Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.

Objective: Cataract is the leading cause of blindness inMalaysia. There is an alarming backlog of cataractextraction surgery as the majority believes they did notrequire surgery. This study aimed to explore the barriersat the primary care level to cataract surgery from theperspective of patients with severe cataract blindness.Methods: Eleven participants were involved in thisqualitative research which utilised the interpretativephenomenological analysis approach more renowned inhealth psychology research. All interviews conducted attheir home. The interviews were recorded, typedverbatim, and the transcripts were analysed using NVivosoftware version 8.0.Results: The main barriers identified at the primary carelevel were 1) nondisclosure of their visual problemsoriginated from their belated needs for better sight,delayed awareness of their visual status and socialstigma and 2) patient-provider-related issues namelymiscommunication and delayed referral. The first maintheme explains their belief for not requiring surgery. Thishas led to their delayed awareness and impededdisclosure of their visual problems to family members orprimary care providers. The second main theme reflectsthe provider-patient-related issues which retardedcataract detection and referral process required for earliercataract extraction surgery.Conclusion: Thus, the appropriate approach targeting thesespecific barriers at primary care level will be able to detect,motivate and assist patients for early uptake of cataractextraction surgery to improve their vision and prevent severeblindness.

The aim of the present study was to evaluate visual functions and retinal morphology of Polypoidal Choroidal Vasculopathy (PCV) patients seen in an AMD referral centre of Malaysia and to further explore association between visual functions and optical coherence tomography (OCT) parameters in PCV eyes. In this single centre, cross sectional study, best corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS) were measured in naïve PCV eyes. Selective parameters such as integrity of external limiting membrane (ELM), inner segment and outer segment junction (IS-OS), retinal pigment epithelium and Bruch’s membrane (RPE-BM) complex, average retinal thickness (ART) and volume (ARV), central retinal thickness (CT), centre maximum (CTmax) and centre minimum (CTmin) thickness were assessed using spectral-domain OCT. Forty-three new PCV eyes of 42 patients were evaluated. Mean (±SD) DVA, NVA, CS, RS were 0.83 ± 0.35 logMAR, 0.77 ± 0.3 logMAR, 0.69 ±.26 log CS and 59.56 ±14 words per minutes respectively. ART and CT showed good correlation with DVA (r=0.571& 0.546) and CS (r= 0.576 & 0.586). ARV and CTmax showed good correlation with CS (r=0.516 &, 0.513). The mean DVA, NVA and CS between three ELM and IS-OS status were significantly different (p=.002 & .000; p=.012 & .029; p=.005 & .001). In conclusion, present study reports visual functions and OCT characteristics of PCV patients in an AMD referral centre of Malaysia. Many of the quantitative and qualitative OCT parameters showed good association with the visual functions in eyes with PCV.
polypoidal choroidal vasculopathy ; visual functions ; ocular coherence tomography

Purpose: To evaluate corneal cell morphology in patients with keratoconus using an in vivo slit scanning confocal microscope. Methods: A cross-sectional study was conducted to evaluate the corneal cell morphology of 47 keratoconus patients and 32 healthy eyes without any ocular disease. New keratoconus patients with different disease severities and without any other ocular co-morbidity were recruited from the ophthalmology department of a public hospital in Malaysia from June 2013 to May 2014. Corneal cell morphology was evaluated using an in vivo slit-scanning confocal microscope. Qualitative and quantitative data were analysed using a grading scale and the Nidek Advanced Visual Information System software, respectively. Results: The corneal cell morphology of patients with keratoconus was significantly different from that of healthy eyes except in endothelial cell density (P = 0.072). In the keratoconus group, increased level of stromal haze, alterations such as the elongation of keratocyte nuclei and clustering of cells at the anterior stroma, and dark bands in the posterior stroma were observed with increased severity of the disease. The mean anterior and posterior stromal keratocyte densities and cell areas among the different stages of keratoconus were significantly different (P < 0.001 and P = 0.044, respectively). However, the changes observed in the endothelium were not significantly different (P > 0.05) among the three stages of keratoconus. Conclusion: Confocal microscopy observation showed significant changes in corneal cell morphology in keratoconic cornea from normal healthy cornea. Analysis also showed significant changes in different severities of keratoconus. Understanding the corneal cell morphology changes in keratoconus may help in the long-term monitoring and management of keratoconus.