A situational analysis of clinical refraction services in the capital city of the Maldives

Background: Uncorrected refractive error is a leading cause of visual impairment globally. This study aimed to determine the current state of clinical refraction services and barriers to service provision in the capital city of the Maldives. Methods: This cross-sectional, descriptive-analytical study used a purposive sampling technique. The list of facilities providing refraction services in the city of Malé was compiled through a desk review and finalized after verification by personnel from the Ministry of Health. The availability of human resources and infrastructure was measured using a pre-coded questionnaire that also listed barriers to service provision, followed by on-site observations and subsequent data analysis. Results: Three clinical ophthalmology departments within hospitals, two ophthalmology hospitals, and nine primary eye care centers were selected for this study. The private sector (n = 12, 85.7%) was the primary provider of refractive error services. All facilities possessed the essential equipment required for refraction. Only optometrists and ophthalmologists conducted refraction. Contact lens assessment and low vision services were not available at any facility. The number of refractions conducted in Malé annually was 145,392. Human resources and management-related factors were the major barriers to the provision of clinical refraction services (n = 21, 44.7%). Conclusions: Accessibility to refractive error management and low vision services is needed in Malé to meet current population needs. Existing resources, including humans and equipment, require augmentation regarding service provision and enhancement. Knowledge of these barriers could lead to the upscaling of refraction services in Malé, Maldives by health policy makers

Sustainability of the effect of optical intervention on the reading performance of children with dyslexia

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, and 36 weeks post-intervention.Results: Both components of the reading performance improved significantly for school children at both levels in all study groups (all P < 0.05). However, the reading performance improvement was only approximately 28% in group C and 38% – 50% in groups A and B. In group A, students at level 1 showed significantly improved reading speed from baseline to 12 weeks post-VTM intervention and reading rate from baseline to 24 weeks post-VTM intervention (both P < 0.05). Students at level 2 showed significantly improved reading speed and rate from baseline to 12 and 24 weeks post-VTM intervention (all P < 0.05). In group B, students at both levels showed significantly improved reading speed and rate from baseline to 24 and 36 weeks post-VTM intervention (all P < 0.05). Students at level 2 showed significantly improved reading speed 12 weeks after cessation of intervention (at 36 weeks post-VTM intervention) compared to 24 weeks post-VTM intervention (P < 0.05). The improvement remaining stable 12 weeks after discontinuation of intervention indicated a sustained effect.Conclusions: Combined or individual intervention improved the reading performance of school children with dyslexia at levels 1 and 2. However, combined intervention showed a better reading improvement effect. Improvement in the reading performance was maintained after discontinuation of the VTM intervention. Further interventional studies with a longer study period after discontinuation of this optical intervention are required to confirm the long-term sustainability of its positive effects on the reading performance of school children with dyslexia

Knowledge retention level among pre-school teachers in conducting pre-school children vision screening

Certain public service pre-school 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 pre-school teachers who have been trained to perform vision screening on children. In 2013, 180 KEMAS pre-school 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 pre-school 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 pre-school 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 pre-school 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 pre-school teachers remains effective and in accordance with established standards

Elektroretinogram Multifokus (mfERG): Data Piawai Makmal bagi Kanak-kanak Berusia 6-12 Tahun

Objektif kajian ini adalah untuk mendapatkan nilai data piawai mfERG bagi Makmal Elektrofisiologi, Program Optometri & Sains Penglihatan, Fakulti Sains Kesihatan, Universiti Kebangsaan Malaysia (UKM). Pengukuran mfERG yang dilakukan adalah min ketumpatan amplitud (nV/deg²) kedua mata dan perbandingan min antara mata kanan (OD) dan kiri (OS); respon ketumpatan amplitud setiap bulatan yang dikaji dan respon keseluruhan ketumpatan amplitud kawasan retina yang dikaji. Kajian ini melibatkan seramai 16 orang kanak-kanak normal berumur antara 6 hingga 12 tahun. Ujian t-berpasangan mendapati tiada perbezaan signifikan min ketumpatan amplitud antara kedua mata (OD=24.27±8.16 nV/deg², OS=24.12±8.57 nV/deg², p=0.937). Nilai min ketumpatan amplitud setiap bulatan untuk OD adalah bulatan 1=56.41±24.85 nV/deg², bulatan 2=28.36±9.31 nV/deg², bulatan 3=17.50±5.33 nV/deg², bulatan 4=10.51±3.17 nV/deg² dan bulatan 5=8.57±2.74 nV/deg². Nilai min ketumpatan amplitud setiap bulatan untuk OS adalah bulatan 1=54.67±25.10 nV/deg², bulatan 2=28.89±10.52 nV/deg², bulatan 3=18.23±5.98 nV/deg², bulatan 4=10.40±3.37 nV/deg² dan bulatan 5=8.30±2.73 nV/deg². Manakala min ketumpatan amplitud keseluruhan kawasan retina ialah OD=24.27±8.16 nV/deg² dan OS=24.12±8.57 nV/deg². Kesimpulannya nilai piawai makmal mfERG telah berjaya dihasilkan untuk usia 6 hingga 12 tahun di Makmal Elektroretinogram Multifokal, Program Optometri dan Sains Penglihatan, UKM. Diharapkan ia akan diguna pakai sebagai panduan dan perbandingan penyelidikan akan datang

Validity of vision screening program conducted by preschool teachers: An interventional study

Background: Clear vision is crucial for effective learning among preschool children. Hence, early detection of vision impairment and prompt treatment are required to improve prognosis. Currently, limited information is available, and no program exists to screen for vision impairment among preschoolers in Bangladesh. This study aimed to validate the KieVision™ Preschool Vision Screening Kit, translated into the Bengali language, to improve vision impairment detection among preschool children. Methods: In this prospective case–control study, 60 preschool teachers from Chittagong were randomly selected. The study group was trained to conduct vision screening among preschool children using the translated kit, whereas the control group was trained using the Chittagong Eye Infirmary and Training Complex (CEITC) School Teachers’ Training Module. Fifteen preschool children aged 4–6 years were screened by each preschool teacher and again by the optometrist. Results: Sixty preschool teachers screened 900 children. The results showed a higher validity of vision screening findings by the preschool teachers in the study group (sensitivity, 68.00%; specificity, 92.75%) than in the control group (sensitivity 47.37%, specificity 70.39%). The level of agreement between the preschool teachers and optometrists was high for all tests (first-order agreement coefficient [AC1] ? 0.80 in the study group). The sensitivity and specificity of the visual acuity test for the study group were 59.65% and 94.15%, respectively, while in the control group it was 13.33% and 62.54%, respectively. A similar trend was noted in the general observation component and Hirschberg’s test. Conclusions: The Bengali Language KieVision™ Preschool Vision Screening Kit can be used effectively by preschool teachers in vision screening programs to improve the identification of vision impairment among preschool children in Bangladesh

Profile and quality of life of children with dual sensory impairment or deafblindness in visually impaired special centres

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

Validity of external observation examination by teachers during vision screening for preschool children

Background: A vision-screening program is effective in prevention of vision impairment. The validity of vision screening conducted by nurses, medical assistants, and teachers has been previously reported. However, the validity of preschool teachers in conducting external eye observations in preschool children has not been widely investigated. This study aimed to determine validity of preschool teachers in conducting external eye observation tests, including the observation of behavior and external eye health, in preschool children.Methods: In this cross-sectional study, preschool teachers from Kemajuan Masyarakat kindergarten in Klang Valley, Malaysia, were randomly allocated to the study (n = 30) or control (n = 30) groups. The study group underwent theory training with an optometrist and practical sessions with preschool children on vision screening, while the control group received only brief verbal instructions on steps to conduct the screening. After the briefing, teachers from both groups conducted vision screening tests at their kindergartens on preschool children aged 4–6 years. The same vision screening procedure was repeated in the same children by optometrists to verify results of the teachers. Results: A total of 700 preschool children were screened by 60 preschool teachers and optometrists. Teachers from the study and control groups displayed high validity in screening for external ocular health, including sensitivity (66.67% versus 66.67%), specificity (95.21% versus 95.54%), and negative predictive value (99.41% versus 99.69%). The positive predictive value was slightly higher in the study group (19.05%) than in the control group (11.76%). Conclusions: Preschool teachers competently observed external eye health in preschool children. A training module for vision screening is important, and a revision of the current training module is needed. Empowering preschool teachers could help in the early detection and intervention necessary in needy children. This could reduce the nationwide prevalence of visual impairments

Empoderando a los educadores de Orang Asli con el aprendizaje móvil para la alfabetización básica

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.Este estudio tiene como objetivo evaluar las percepciones de los tutores sobre su preparación para implementar el programa de alfabetización básica y el módulo de M-Litora (módulo de alfabetización básica y transformación digital para Orang Asli a través del aprendizaje móvil). Esto es importante para garantizar la idoneidad del programa de alfabetización desarrollado por investigadores de la Facultad de Educación y la Facultad de Ciencias de la Salud, UKM, para resolver los problemas de dificultades de lectura entre los niños de Orang Asli. El hallazgo reveló que el dominio de Bahasa Melayu entre los tutores, la capacidad de los tutores de Orang Asli para recibir capacitación en línea y la motivación entre los tutores y los niños fueron parte de los elementos que influyeron en la preparación del tutor para este programa. Quizás las iniciativas a través de este programa aceleran la inspiración del gobierno en el fortalecimiento de la comunidad marginada con educación. Sin embargo, hay más esfuerzo e iniciativa que se consideran esenciales para la implementación del programa Bahasa Melayu para la comunidad marginada

Reliability of a Bahasa Melayu language version of the MOS 36-item short-form health survey (SF-36) in patients with low vision

Background: The MOS 36-Item Short-Form Health Survey (SF-36) Bahasa Melayu language version is widely used to determine the health outcomes in Malaysia. Low vision is a condition where vision cannot be restored and vision rehabilitation is required to overcome the challenges it imposes. The SF-36 Bahasa Melayu language version can be used to measure the health outcomes among low-vision patients. However, little information is available among low-vision patients. This study aimed to assess the reliability of the SF-36 Bahasa Melayu language version among low-vision patients. Methods: Fifty low-vision patients aged 14 to 74 years (mean ± standard deviation: 44.58 ± 18.70 years) were randomly selected. All low-vision patients were interviewed twice by the same interviewer with a 2-weeks interval. Results: The SF-36 Bahasa Melayu language version showed acceptable and good Cronbach’s alpha values of 0.68, 0.67, 0.76, 0.72, 0.73, 0.75, 0.72, 0.73 for physical function, role-physical, body pain, general health, vitality, social functioning, role-emotion, and mental health, respectively, in the first interview. The second interview also revealed similar Cronbach’s alpha values. The SF-36 Bahasa Melayu language version also showed a good repeatability between the first interview and the second interview, with Pearson’s correlation coefficients ranging from 0.6 to 0.9. Conclusions: From this study, it can be concluded that the SF-36 Bahasa Melayu language version is reliable and repeatable. It is a useful tool to measure health outcomes among Malaysian low-vision patients. However, a future study of low-vision patients from the rural population and age groups representing the youth, working adults, and older individuals is necessary to obtain better outcomes of SF-36 in Bahasa Melayu language-based information on the health status of low-vision patients

Effect of crushed clay brick as partial fine aggregate replacement on properties of concrete

The continuous construction activity increases the demand for concrete production. At the same time, the construction and demolition activity also generate solid waste which is disposed of at landfills. The approach of discarding waste such as concrete waste, brick waste, and timber waste pollutes the environment. Thus, the present research investigates the effect of integrating local clay brick waste as a partial fine aggregate replacement on the properties of concrete. Several concrete mixes were prepared by integrating various percentages of crushed clay brick ranging from 0%, 5%, 10%, 15% and 20% as partial sand replacement in concrete. All specimens were subjected to continuous water curing until the testing date which is 7 days and 28 days. The finding shows that the use of up to 10% crushed clay brick successfully enhances the compressive strength of concrete. The water absorption of concrete increase as larger content of crushed clay brick waste is integrated in the mix. Basically, the use of clay brick waste in concrete would help to reduce dependency on river sand supply for concrete manufacturing and promote a cleaner environment