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The ability to detect and recognise visual deficits among visually impaired patients can improve the management of daily living skills and activities of these patients. In this report, the importance of using objective and subjective... more
The ability to detect and recognise visual deficits among visually impaired patients can improve the management of daily living skills and activities of these patients. In this report, the importance of using objective and subjective visual performance measures by occupational therapists in managing visually impaired patients is discussed. We describe a case of a 17-year-old Malay female who had vision impairment due to a cataract, a secondary complication from diabetes mellitus (DM). The Brain Injury Visual Assessment Battery for Adult (biVABA) can provide occupational therapists with additional visual performance information and a better understanding of managing visually impaired patients. The biVABA was used in conjunction with other activities of daily living skills tools such as Modified Barthel Index (MBI), Lawton Instrumental Activities of Daily Living Scale (IADL) and EVS Orientation and Mobility Screening (EVS-O&M) for a more holistic assessment. This approach provides more relevant and essential information in managing visually impaired patient rehabilitation from the occupational therapy perspective.
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This study looked at the causes of vision loss, levels of distance, near vision and the use of low vision devices (LVDs) in children studying at special schools in Malaysia. A total of 139 children from two special education schools took... more
This study looked at the causes of vision loss, levels of distance, near vision and the use of low vision devices (LVDs) in children studying at special schools in Malaysia. A total of 139 children from two special education schools took part. Visual acuity was measured with and without LVDs. Those who required further assessment were referred to Low Vision Clinic. Near visual acuity in 71 children ranged from N4 to N64. Sixty eight children could not read the N64 chart or they were totally blind. Only eight students were using LVDs before intervention. Seventy one children were referred for low vision assessment and 48 were found to benefit from the LVDs prescribed. The major cause of visual impairment was cataract (17%). Hand held magnifier was the most preferred LVD. Majority of the children attending the blind schools had residual vision but did not have LVDs. LVDs are able to significantly improve near visual acuity and hence there is a need to prescribe and train the children to use the LVDs.
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Research Interests: Psychology and Physics
Research Interests: Physics, Chemistry, Optometry, Ophthalmology, Medicine, and 3 moreSains Malaysiana, Concentric, and Amplitude
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ABSTRACT ABSTRAK Kajian ini bertujuan untuk mengetahui status visual pelajar berpenglihatan terhad dan mengenal pasti pelajar bermasalah penglihatan yang boleh mendapat manfaat melalui penggunaan alat bantuan penglihatan terhad. Seramai... more
ABSTRACT ABSTRAK Kajian ini bertujuan untuk mengetahui status visual pelajar berpenglihatan terhad dan mengenal pasti pelajar bermasalah penglihatan yang boleh mendapat manfaat melalui penggunaan alat bantuan penglihatan terhad. Seramai 113 pelajar berpenglihatan terhad dari sekolah pendidikan khas mengambil bahagian. Akuiti visual jauh dan dekat diukur dengan dan tanpa alat bantuan penglihatan terhad. Pelajar yang memerlukan pemeriksaan lanjutan dirujuk ke Klinik Penglihatan Terhad, Universiti Kebangsaan Malaysia (KPT UKM). 31% pelajar berkategori berpenglihatan terhad dengan penglihatan jauh di antara 6/18 sehingga 6/95, manakala 67% pelajar berkategori buta. 2% pelajar pula mempunyai akuiti yang lebih baik dari 6/18. Akuiti visual dekat bagi pelajar-pelajar ini adalah di antara N4 hingga N64. Alat bantuan penglihatan terhad seperti kanta pembesar berpemegang, kanta pembesar berdiri dan teleskop dimiliki oleh hanya 17% pelajar dari kategori pelajar berpenglihatan terhad. Kajian ini juga menunjukkan bahawa 85% daripada pelajar yang dirujuk ke KPT UKM mendapat menafaat dari penggunaan alat bantuan penglihatan terhad. Capaian kepada perkhidmatan pemeriksaan dan jagaan mata bagi pelajar berpenglihatan terhad perlu diwujudkan agar pelajar-pelajar ini dapat dikesan awal dan alat bantuan penglihatan terhad yang sesuai dapat diberikan. Kajian ini menekankan kepentingan peranan ibu bapa, guru-guru dan optometris dalam memastikan masalah/gangguan penglihatan kanak-kanak ini ditangani dengan berkesan. Kata kunci: Alat bantuan penglihatan terhad; pemeriksaan penglihatan terhad ABSTRACT The purpose of this study is to determine the visual status and effectiveness of low vision devices among visually impaired school children. One hundred and thirteen students from the special education schools took part in this study. Distance and near visual acuity were measured both with and without low vision devices. Students needing further assessment were referred to the Low Vision Clinic (LVC) Universiti Kebangsaan Malaysia. On presentation, 31% of the students were catagorised as low vision with distance acuity between 6/18 and 6/95 whereas 67% were blind. 2% were found to have distance acuity better than 6/18. The range of near visual acuity of these students was between N4 and N64. Low vision devices such as hand held magnifier, stand magnifier and telescope, were owned by only 17% of low vision students. This study showed that 85% of the students that were referred to the LVC benefited from low vision devices. Access to visual examinations and eye care for students with needs to be provided so that these students can be identified early and suitable low vision devices prescribed. This study emphasises the importance of the role played by parents, teachers and optometrists in the management of vision impairment in school children so that their visual impairment can be rehabilitated effectively.
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Objective: Compare the performance of Lea Symbols and Sheridan Gardiner charts against the standard test chart used to determine reduced VA during vision screening among pre-schoolers. Material and method: Seven hundred seventy five... more
Objective: Compare the performance of Lea Symbols and Sheridan Gardiner charts against the standard test chart used to determine reduced VA during vision screening among pre-schoolers. Material and method: Seven hundred seventy five pre-school participated where 389 subjects were boys and 386 subjects were girls were tested using the Lea Symbols chart and the Sheridan Gardiner chart. The mean age of the pre-school children was 5.3 +/- 0.7 years old. Results: The Lea Symbols chart showed a higher sensitivity (97.5%) compared to the Sheridan Gardiner chart (57.1%). While the Sheridan Gardiner chart showed higher specificity (92.0%) compared to the Lea Symbols chart (45.0%). Conclusion: The Lea Symbols chart offers a better pick-up rate of visual impairment during a vision-screening program especially cases of amblyopia among pre-school children compared to the Sheridan Gardiner chart in Malaysia.
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Retinopathy of prematurity (ROP) is a disorder describing an immature vascularisation of a developing retina in low birth weight preterm infants. This condition potentially leads to blindness. ROP developed as a response of hypoxia of the... more
Retinopathy of prematurity (ROP) is a disorder describing an immature vascularisation of a developing retina in low birth weight preterm infants. This condition potentially leads to blindness. ROP developed as a response of hypoxia of the eye due to incomplete development of the retinal vessels. ROP is commonly reported as bilateral disease,a small percentage of infants have asymmetrical changes. We report a case of long-term outcome of a asymmetry ROP changes with peripheral retinal ablation in a single eye. This particular case demonstrates the possible longterm outcome of unilaterally treated ROP which could either be due to the severity of the disease itself or the treatment she received. It is important to highlight the possibility of unequal development of the eye in asymmetrical presentation of ROP.
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The ability to detect and recognise visual deficits among visually impaired patients can improve the management of daily living skills and activities of these patients. In this report, the importance of using objective and subjective... more
The ability to detect and recognise visual deficits among visually impaired patients can improve the management of daily living skills and activities of these patients. In this report, the importance of using objective and subjective visual performance measures by occupational therapists in managing visually impaired patients is discussed. We describe a case of a 17-year-old Malay female who had vision impairment due to a cataract, a secondary complication from diabetes mellitus (DM). The Brain Injury Visual Assessment Battery for Adult (biVABA) can provide occupational therapists with additional visual performance information and a better understanding of managing visually impaired patients. The biVABA was used in conjunction with other activities of daily living skills tools such as Modified Barthel Index (MBI), Lawton Instrumental Activities of Daily Living Scale (IADL) and EVS Orientation and Mobility Screening (EVS-O&M) for a more holistic assessment. This approach provides more relevant and essential information in managing visually impaired patient rehabilitation from the occupational therapy perspective.
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... more
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 method 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 consistent with the based on sample size calculation and who fulfilled the dual sensory impairment criteria out of the 44 children screened. The mean age was 9.3 ± 2.9 years. A majority of the children were of Indian ethnicity. The category of deafblindness seen 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 the 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 was 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.
Certain public service preschool teachers have been trained as vision screeners of children. However, there are no studies that assessed the knowledge and skills retention of these screeners. This study determines the level of knowledge... more
Certain public service preschool teachers have been trained as vision screeners of children. However, there are no studies that assessed the knowledge and skills retention of these screeners. This study determines the level of knowledge retention among preschool teachers who have been trained to perform vision screening on children. In 2013, 180 KEMAS preschool teachers were recruited in a vision screening training which included both theory and practical sessions. Teachers were assessed through a theory test which comprised of 15 questions, firstly a category on the preparations needed for vision screening and secondly on the implementation of vision screening. They were then asked to conduct preschool vision screening annually at their working premises. In 2016, 136 teachers who had been involved in the earlier program were recruited as subjects in this study. All these subjects answered the same set of theory test questions used in 2013. The Student's t-test result indicated that the mean theory test scores obtained by the preschool teachers in 2013 (84.3 ± 7.8) differed significantly with the mean scores obtained in 2016 (67.5 ± 11.3) (p < 0.001). The mean scores in 2013 for questions in the first and second categories were 4.5 and 4.4, decreasing to 4.2 and 3.7 in 2016. The knowledge level of preschool teachers thus decreased with time and this effect was found significant after 3 years. There is therefore a need to conduct re-certification training, so that the screening conducted by these preschool teachers remains effective and in accordance with established standards.
This study aims to evaluate the perceptions of tutors on their readiness of implementing the basic literacy program and the module of M-Litora (basic literacy and digital transformation module for Orang Asli via mobile learning). This is... more
This study aims to evaluate the perceptions of tutors on their readiness of implementing the basic literacy program and the module of M-Litora (basic literacy and digital transformation module for Orang Asli via mobile learning). This is important to ensure for the appropriateness of the literacy program developed by researchers from Faculty of Education and Faculty of Health Sciences, UKM in meeting the problems of reading difficulties among the children of the Orang Asli. The finding revealed that mastery on Bahasa Melayu among tutors, the capability of Orang Asli tutors to receive online training and motivation among tutors and the children were part of elements influencing the tutor's readiness towards this program. Perhaps the initiatives through this program accelerating the government inspiration in strengthening the marginalized community with education. However, there are more effort and initiative that are deemed essential to the implementation of the Bahasa Melayu program for the marginalized community.
Certain public service preschool teachers have been trained as vision screeners of children. However, there are no studies that assessed the knowledge and skills retention of these screeners. This study determines the level of knowledge... more
Certain public service preschool teachers have been trained as vision screeners of children. However, there are no studies that assessed the knowledge and skills retention of these screeners. This study determines the level of knowledge retention among preschool teachers who have been trained to perform vision screening on children. In 2013, 180 KEMAS preschool teachers were recruited in a vision screening training which included both theory and practical sessions. Teachers were assessed through a theory test which comprised of 15 questions, firstly a category on the preparations needed for vision screening and secondly on the implementation of vision screening. They were then asked to conduct preschool vision screening annually at their working premises. In 2016, 136 teachers who had been involved in the earlier program were recruited as subjects in this study. All these subjects answered the same set of theory test questions used in 2013. The Student's t-test result indicated that the mean theory test scores obtained by the preschool teachers in 2013 (84.3 ± 7.8) differed significantly with the mean scores obtained in 2016 (67.5 ± 11.3) (p < 0.001). The mean scores in 2013 for questions in the first and second categories were 4.5 and 4.4, decreasing to 4.2 and 3.7 in 2016. The knowledge level of preschool teachers thus decreased with time and this effect was found significant after 3 years. There is therefore a need to conduct re-certification training, so that the screening conducted by these preschool teachers remains effective and in accordance with established standards.
Empowering lay screeners, such as preschool teachers, on vision screening is a cost-effective way to ensure larger populations of children can be screened. Although the validity of lay screeners in conducting vision screening were... more
Empowering lay screeners, such as preschool teachers, on vision screening is a cost-effective way to ensure larger populations of children can be screened. Although the validity of lay screeners in conducting vision screening were reported in several studies, none showed data concerning improvement of the level of knowledge among lay screeners after completing vision screening training, which could indicate the effectiveness of the training program. This study aimed to determine the level of knowledge of preschool teachers before and after attending a training program. Sixty preschool teachers from Tabika and Taska KEMAS were randomly selected. The Study Group (n = 30) was given theory and practical training on vision screening, whereas the Control Group (n = 30) was only given brief verbal instructions on how to conduct the screening. A theory test containing 15 questions related to the training modules were administered to both groups, before and after their training/briefing respectively. The findings showed that the level of knowledge among preschool teachers in the Study Group (73.24 ± 11.73%) was significantly higher than the Control Group (56.22 ± 13.11%) (p < 0.01). There was also a significant improvement in the level of knowledge among preschool teachers in the Study Group after the training (p<0.001), whereas no improvement was noted among preschool teachers in the Control Group (p = 0.636). This study shows the importance of conducting training for preschool teachers prior to their involvement in conducting vision screening in order to deliver an effective vision screening program to the preschoolers.
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... more
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.
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... more
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.
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 preschool. Vision... more
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 preschool. Vision screening performed using preschool 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 preschool teachers. A total of sixty preschool 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 preschool teachers was asked to conduct vision screening on 15 preschool 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 preschool teachers in the Study Group and the optometrist was high for all tests (AC1 ≥ 0.89). In conclusion, the vision screening program conducted by preschool teachers was effective but needed proper training for the screeners. This program is seen to be able to empower preschool teachers using vison screening techniques to allow them to identify preschool 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 preschool children in Malaysia in the long term.
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... more
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.
Background: Visual impairment (VI) in patients with diabetes mellitus (DM) worsens as the disease progresses. Therefore, quality of life (QOL) may also be affected. Furthermore, in the absence of macular involvement, some patients may... more
Background: Visual impairment (VI) in patients with diabetes mellitus (DM) worsens as the disease progresses. Therefore, quality of life (QOL) may also be affected. Furthermore, in the absence of macular involvement, some patients may benefit from visual intervention. However, not many Malaysians with known DM had their eyes screened or used correctable spectacles. Consequently, the QOL and VI status of patients with DM in Malaysia remain unclear. This study was aimed at determining the impact of optometric intervention on the QOL and VI status of adults with type II DM. Methods: This was a quasi-self-controlled, experimental study involving adults with known type II DM. We conducted face-to-face interviews using the low vision quality-of-life questionnaire (LVQOL). The habitual visual acuity (VA) of all participants was recorded. All participants underwent fundus photography to grade diabetic retinopathy (DR) in both eyes. Correctable VA was determined following subjective refracti...
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Background: Dyslexia is a learning disability associated with reading difficulties in children. Due to the potential of poor school outcomes interventions have been employed to help students with dyslexia read. This study was aimed at... more
Background: Dyslexia is a learning disability associated with reading difficulties in children. Due to the potential of poor school outcomes interventions have been employed to help students with dyslexia read. This study was aimed at identifying the sustainability of the effect of combined Visual Tracking Magnifier (VTM) and Ministry of Education (MOE) interventions and MOE intervention alone on the reading performance of school children with dyslexia after discontinuation of intervention. Methods: This prospective, interventional study was conducted on primary school children with dyslexia aged 8 – 11 years. The participants underwent comprehensive ophthalmic and optometric examinations and were categorized into groups A, B, and C, comprising primary school children at level 1 or 2. Groups A and B received combined VTM and MOE interventions for 12 and 24 weeks, respectively, and group C received MOE intervention alone. The reading performance was assessed at baseline and 12, 24, a...
