Purpose: This study aimed to determine the prevalence and status of refractive error among Chinese primary school children in a rural area in Pahang. Methods: This investigation entailed a cross-sectional retrospective study design involving case file analyses. The study site was a Chinese medium primary school in a rural locality within Bentong district. A total of 82 school children met the B40 classification and selection criteria; therefore, universal sampling was done. Analyses were done according to age group: Level 1 included ages 7 to 9 years, while Level 2 comprised 10- to 12-year-olds. Results: The mean age of the 82 Chinese school children was 9.72±1.5 years; the percentage of refractive errors found was 80.48%. A total of 53 (64.63%) children had myopia. Two-way ANOVA showed a significant difference (P=0.038) in the refractive error between age groups Level 1 and 2, but no significant difference (P=0.947) was observed in refractive error between genders. The chi-square test and Fisher’s exact test showed no significant association between the type of refractive error with gender (P>0.05) and age group (P=0.319). Conclusion Myopia was the most common type of refractive error among Chinese school children in a rural area in Pahang. Refractive error severity was influenced by age group but not by gender. Types of refractive error were not associated with age group and gender. Hence, it is recommended that Chinese school children in rural areas seek an annual vision screening or eye test.
Poverty Areas ; Refractive Errors ; Vision Screening

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.

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

An experimental investigation was conducted to explore visual reaction time and visual anticipation time between athletes and non-athletes. These visual perceptual skills form the base for cognitive processes required by the brain to respond instantaneously to a stimulus. A total of 228 adolescents, equally distributed between athletes and non-athletes, aged 13 to 16 years (mean age 14.69 ± 0.99 years) were examined. The visual reaction time and visual anticipation time were measured using a Lafayette Reaction Timer (Model 63035) and Bassin Anticipation Timer (Model 35575) respectively. The visual reaction time results revealed that athletes have faster reaction time scores as compared to non-athletes, whereas with visual anticipation time, athletes had fewer errors and a higher consistency compared to non-athletes. There was, however, no interaction between gender and sports participation noted for both these visual perceptual skills. These research findings indicate that gender was not an obstacle in sports participation, therefore not limiting the potential to excel in sports performance. Knowledge gained from these research findings will benefit the sports industry, specifically in athletic and sports training as well as provide a basis for the identification of an individual’s potential in their sports.
athletes ; non-athletes ; sports ; visual anticipation time ; visual reaction time

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.

The lack of awareness about comprehensive eye examination amongst athletes could impact their eye health, hence it needs to be addressed. The authors hypothesize that a majority of athletes in Malaysia have never undergone a thorough eye examination. The present study aims to determine Malaysian athletes’ awareness of the importance of eye assessment. One hundred and twenty-one junior athletes, aged 13 to 16 years participated in the visual screening programme. A questionnaire consisting of fourteen dichotomous questions was developed in two languages, each being English and Malay language and administered prior to eye examination. The questionnaire was designed to measure self-reported visual function, ocular symptoms, and perceptions towards eye health. Questionnaire analysis showed 67.8% of participants never underwent any eye examination. A majority of participants, 66.9% and 75.2%, complained of visual and ocular symptoms respectively. The critical finding of this study showed that 57.9% of participants had reduced vision which could be visually corrected. Overall 90.9% of the participants agreed that eye examination was important. Almost none of the athletes owned any sports safety eyewear nor had undergone any visual training. The importance of wearing protective eyewear during sports needs to be given emphasis. This study implies that athletes' awareness of eye health, as well as visually related issues, is still at a very low level. Hence, the need for comprehensive eye examination and regular review among athletes’ needs to be emphasized. Athletes should also be educated on the importance of regular eye examinations from a young age.

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

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

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