MyMedR

Fulltext Ocular biometric measurements in emmetropic and myopic Malaysian children - a population-based study

Goh PP, Azura R

Med J Malaysia, 2012 Oct;67(5):497-502.

This is the first population based study on ocular biometric measurements (OBMs) conducted in Malaysia. Its objective is to measure and compare among children of different ethnicity who have myopia and emmetropia. Subsets of children aged between 7 and 8 years old who participated in a larger population based refractive error study had their axial length, anterior chamber depth, lens thickness and vitreous depth measured using A scan and vertical and horizontal corneal curvature measured using an autokeratorefractometer. Eighty eight of the 870 children (10.1%) examined had myopia. Boys, Chinese and children with myopia had significantly longer axial length and vitreous depth compared to girls, Malay and Indian and children who were emmetropic respectively. Girls and children with myopia had steeper corneal curvature. The baseline OBMs in Malaysian children of different ethnicity are valuable for studies in myopia progression. Like other studies, children with myopia have longer axial length (P <0.001). and vitreous depth (P <0.001) compared to children who are emmetropia (without myopia).

Fulltext Status of diabetic retinopathy among diabetics registered to the Diabetic Eye Registry, National Eye Database, 2007

Goh PP, National Eye Database Study Group

Med J Malaysia, 2008 Sep;63 Suppl C:24-8.

PMID: 19230243

Diabetic Eye Registry, a web based registry hosted at the National Eye Database (www.acrm.org.my/end) collects data in a systematic and prospective nature on status of diabetic retinopathy (DR) among diabetics seen for the first time at Ministry of Health ophthalmology clinics. The 2007 report on 10,586 diabetics revealed that 63.3% of eyes examined had no DR, 36.8% had any form of DR, of which 7.1% had proliferative diabetic retinopathy. Up to 15.0% of eyes had vision threatening DR requiring laser or surgery at their first visit. Data on diabetic eye registry is useful in monitoring the quality of diabetic management, particularly in eye screening as reflected by the proportion of patients with severe DR needing intervention at the first visit to Ophthalmology clinics.

Fulltext A study of perforating eye injuries at the Ophthalmology Department, National University of Malaysia

Zainal M, Goh PP

Med J Malaysia, 1997 Mar;52(1):12-6.

PMID: 10968048

One hundred and sixty seven (167) perforating eye injuries involving 159 patients were analyzed in a retrospective study over a three-year period. The degree of blindness and their associated factors were determined. Most patients were in the first three decades of life and were males. One hundred and seven (64%) eyes had vision of 3/60 or worse at initial assessment. Of these only 45% of eyes had improved vision to 6/36 or better at six months of follow-up. Fifty-five per cent of eyes were blind. The only significant associated factor identified was the extent of injury. Age, time interval and mechanism of injury were not significant factors.

Fulltext Retinoblastoma Registry report--Hospital Kuala Lumpur experience

Jamalia R, Sunder R, Alagaratnam J, Goh PP

Med J Malaysia, 2010 Jun;65 Suppl A:128-30.

PMID: 21488473

Retinoblastoma is a childhood ocular cancer. The aim of this paper is to describe the clinical and epidemiological characteristics of patients with retinoblastoma in a major paediatric ophthalmology center in the country. Retrospective information was collected through the retinoblastoma registry. Late presentation with advanced staging is a major problem.

Fulltext Introducing a collection of reviews on major diseases in Malaysia

Lim KG, Lim AW, Goh PP

Med J Malaysia, 2014 Aug;69 Suppl A:1-3.

PMID: 25417945

No abstract available.

Fulltext National Eye Database--a web based surveillance system

Goh PP, Elias H, Norfariza N, Mariam I, National Eye Database Steering Committee

Med J Malaysia, 2008 Sep;63 Suppl C:20-3.

PMID: 19227672

National Eye Database (www.acrm.org.my/ned) is a web based surveillance system which collects data on eye diseases and clinical performance in ophthalmology service. It is a prospective study with online data collection, concurrent descriptive data analysis and real time report. It includes cataract surgery registry, diabetic eye registry, glaucoma registry, contact lens related corneal ulcer surveillance and monthly ophthalmology service census. This article presents the methodology and some registries reports. The web based surveillance system has made dissemination of report prompt, easy and without barrier.

A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children

Choong YF, Chen AH, Goh PP

Am J Ophthalmol, 2006 Jul;142(1):68-74.

PMID: 16815252 DOI: 10.1016/j.ajo.2006.01.084

To evaluate the accuracy of autorefraction using three autorefractors comparing to subjective refraction in diagnosing refractive error in children.

Dengue vaccine in regions of endemic disease

Chew CH, Goh PP, Lim TO

N Engl J Med, 2016 04 07;374(14):1388.

PMID: 27050221 DOI: 10.1056/NEJMc1514451

Fulltext Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006

Goh PP, Omar MA, Yusoff AF

Singapore Med J, 2010 Aug;51(8):631-4.

PMID: 20848059

INTRODUCTION: Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown.
METHODS: The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older.
RESULTS: In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations.
CONCLUSION: The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.
Study name: National Health and Morbidity Survey (NHMS-2006)

Opacification of AcriFlex 50CSE hydrophilic acrylic intraocular lenses

Lim AK, Goh PP, Azura R, Mariam I

J Cataract Refract Surg, 2011 Apr;37(4):655-9.

PMID: 21420589 DOI: 10.1016/j.jcrs.2010.10.050

PURPOSE: To determine the prevalence of and risk factors for AcriFlex 50CSE hydrophilic acrylic intraocular lens (IOL) opacification approximately 3 years after implantation.
SETTING: Selayang Hospital, Selangor, Malaysia.
DESIGN: Cross-sectional study.
METHODS: Patients who had AcriFlex 50CSE IOL implantation in 2005 and 2006 were identified from operating logbooks and recalled via telephone and letters. Opaque IOLs were explanted and sent for scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS).
RESULTS: The review showed that 18 patients had died and 67 had declined examination or could not be contacted, leaving 239 eyes for evaluation. The age of the patients ranged from 25 to 85 years. Of the patients, 83 (34.7%) were Malay, 127 (53.1%) Chinese, and 29 (12.1%) East Indian. The male:female ratio was 1:1. Fourteen eyes of 13 patients (5.4%) had IOL opacification; 1 had bilateral opacification. Five eyes had fine deposits, and 9 eyes had dense opaque deposits. Seven opaque IOLs required explantation. There was no correlation between age (P=.645), sex (P=.319), or race (P=.860) and IOL opacification. Pearson chi-square analysis showed a strong association between diabetes mellitus and IOL opacification (P=.019). Nine (69.2%) of the 13 patients with opacification had diabetes. Scanning electron microscopy and EDS showed calcium and phosphate deposits on the optic surface and intralenticularly near the anterior surface of the optic.
CONCLUSIONS: Results indicate that diabetes mellitus is a risk factor for AcriFlex hydrophilic acrylic IOL opacification. In some cases, opacification affected vision, necessitating explantation. The pathophysiology of this complication is unknown.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Fulltext Contact lens--related corneal ulcer: a two-year review

Goh PP, Shamala R, Chandamalar S, Tai XY, National Eye Database Study Group

Med J Malaysia, 2010 Jun;65 Suppl A:120-3.

PMID: 21488471

To create a national registry of contact-lens related corneal ulcers (CLRCU) patients in Malaysia with the aim of detecting outbreaks, identifying pattern of causative organisms, determining patient demography, risk factors, wearing patterns and monitoring outcome of treatment. The CLRCU registry is an ongoing patient registry established in 2007 as a surveillance tool used by Malaysian Ministry of Health ophthalmology departments. Notification of patients clinically suspected of CLRCU was performed online through the National Eye Database (NED). Data collected included patient demography, contact lens type, causative organism and treatment outcome. During 2007-2008, a total of 202 patients were notified to the CLRCU registry with a mean age of 26.7 years (71.8% female). All registered patients wore soft contact lens and monthly disposable lenses were the most popular (83.5%). The majority of patients had bacterial CLRCU and the most common causative organism was Pseudomonas (79.7% of bacterial cases). No epidemics were identified during the period of data examination. Use of contact lenses, which is increasing during modern times, may lead to CLRCU as a severe complication. The CLRCU registry is an effective tool which uses a web-based notification system that allows quick and up to date reports of CLRCU cases. This provides the ability to monitor outbreaks of disease and identify important causative and associated factors of the disease which may be used to reduce future incidence.

Refractive error and visual impairment in school-age children in Gombak District, Malaysia

Goh PP, Abqariyah Y, Pokharel GP, Ellwein LB

Ophthalmology, 2005 Apr;112(4):678-85.

PMID: 15808262 DOI: 10.1016/j.ophtha.2004.10.048

To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.

Prevalence and Factors Associated With Second Eye Cataract Surgery and the Trend in the Time Interval Between the Two Eye Surgeries Based on the Malaysian National Eye Database

Ho SF, Adnan THB, Goh PP

Asia Pac J Ophthalmol (Phila), 2017;6(4):310-317.

PMID: 28585793 DOI: 10.22608/APO.201605

PURPOSE: To study the prevalence of second eye cataract surgery (SECS), trend in time interval between subsequent surgeries over the years, and factors associated with SECS utilization among patients who underwent cataract surgeries in the Ministry of Health (MOH), Malaysia.

DESIGN: Secondary cross-sectional analysis of the Malaysian National Eye Database (NED) data.

METHODS: The Malaysian Cataract Surgery Registry collected data on patients who had cataract surgery from 2002-2004 and 2007-2012. Data collected included demography, operative events, time interval between 2 surgeries, and postoperative visual outcomes. Descriptive analysis was performed.

RESULTS: Total surgeries increased from 11,954 in 2002 to 30,265 in 2012 with a proportionate increase in SECS (30.7% in 2002 to 34.3% in 2012). Poor vision (<6/12) was reduced from 81.1% to 14.2% after surgery. With improved data capturing, missing data reduced from 29.22% to 1.05%. The time interval between surgeries was 10.58 months in 2002 and 14.49 months in 2012. Malays (40.2%) and those aged 61-70 years (38.1%) had the highest number of SECS. Those aged 40-50 years (10.96 months) and with poorer vision (9.97 months) had the shortest time interval between the 2 surgeries. The commonest surgical method was phacoemulsification (72.3%). Negeri Sembilan State had the highest SECS rate (35.91%) and Melaka had the shortest interval between surgeries (10.15 months).

CONCLUSIONS: Despite an increase in the number of SECS, the time interval is still long. Poor presenting second eye vision and disparity among different states warrants the health authority's attention and intervention.

Fulltext Comparison of refractive error and visual impairment between Native Iban and Malay in a formal government school vision loss prevention programme

Bakar NF, Chen AH, Noor AR, Goh PP

Malays J Med Sci, 2012 Apr;19(2):48-55.

PMID: 22973137 MyJurnal

The epidemiological study of vision problems is important for developing national strategies for the prevention of visual impairment. There was a lack of information regarding vision problems among school children in East Malaysia. The purpose of this study was to compare the refractive errors and degrees of visual impairment between Native Iban and Malay school children who participated in a formal government vision loss prevention programme conducted in a rural area of Betong Division, Malaysia.

The changing pattern of cataract surgery indications: a 5-year study of 2 cataract surgery databases

Lundström M, Goh PP, Henry Y, Salowi MA, Barry P, Manning S, et al.

Ophthalmology, 2015 Jan;122(1):31-8.

PMID: 25234011 DOI: 10.1016/j.ophtha.2014.07.047

PURPOSE: The aim of this study was to describe changes over time in the indications and outcomes of cataract surgery and to discuss optimal timing for the surgery.
DESIGN: Database study.
PARTICIPANTS: Patients who had undergone cataract extraction in the Netherlands, Sweden, or Malaysia from 2008 through 2012.
METHODS: We analyzed preoperative, surgical, and postoperative data from 2 databases: the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) and the Malaysian National Cataract Registry. The EUREQUO contains complete data from the national cataract registries in the Netherlands and Sweden.
MAIN OUTCOME MEASURES: Preoperative and postoperative corrected distance visual acuity, preoperative ocular comorbidity in the surgery eye, and capsule complications during surgery.
RESULTS: There were substantial differences in indication for surgery between the 3 national data sets. The percentage of eyes with a preoperative best-corrected visual acuity of 20/200 or worse varied from 7.1% to 72%. In all 3 data sets, the visual thresholds for cataract surgery decreased over time by 6% to 28% of the baseline values. The frequency of capsule complications varied between the 3 data sets, from 1.1% to 3.7% in 2008 and from 0.6% to 2.7% in 2012. An increasing postoperative visual acuity was also seen for all 3 data sets. A high frequency of capsule complication was related significantly to poor preoperative visual acuity, and a high frequency of decreased visual acuity after surgery was related significantly to excellent preoperative visual acuity.
CONCLUSIONS: The 5-year trend in all 3 national data sets showed decreasing visual thresholds for surgery, decreasing surgical complication rates, and increasing visual outcomes regardless of the initial preoperative visual level. Cataract surgery on eyes with poor preoperative visual acuity was related to surgical complications, and cataract surgery on eyes with excellent preoperative visual acuity was related to adverse visual results.

Fulltext Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry

Mallika PS, Aziz S, Goh PP, Lee PY, Cheah WL, Chong MS, et al.

Med J Malaysia, 2012 Aug;67(4):369-74.

PMID: 23082443

This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).

Women's cardiovascular health: perspectives from South-East Asia

Rajadurai J, Lopez EA, Rahajoe AU, Goh PP, Uboldejpracharak Y, Zambahari R

Nat Rev Cardiol, 2012 Aug;9(8):464-77.

PMID: 22525668 DOI: 10.1038/nrcardio.2012.59

Cardiovascular disease (CVD) is an under-recognized major health problem among women in South-East Asia. The prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, physical inactivity, and being overweight or obese has shown a significantly increasing trend among women in the region, with the exception of Singapore. The problem is compounded by low awareness that CVD is a health problem for women as well as for men, by misconceptions about the disease, and by the lack of suitable, locally available health literature. Efforts have been made by the national heart associations and other organizations to increase heart health awareness and promote healthy lifestyles. Singapore initiated these prevention programs in the early 1990s and has been successful in reducing the prevalence of cardiovascular risk factors. The governments of the region, in accordance with the Noncommunicable Disease Alliance, have begun implementing appropriate preventive strategies and improving health-delivery systems. However, psychological, social, and cultural barriers to cardiovascular health awareness in women need to be addressed before these programs can be fully and successfully implemented.

Fulltext Investigator-initiated clinical trials in Malaysia and the role of the Clinical Research Centre of the Ministry of Health

Sivanandam AF, Hon YK, Yuen S, Muninathan P, Goh PP, Lim TO

Med J Malaysia, 2010 Jun;65 Suppl A:138-42.

PMID: 21488475

The objective of this review is to better understand the concept of investigator-initiated trials and its benefits. While investigator-initiated trials can be an invaluable tool, there are several challenges in its initiation and management. However, it is for these reasons that Clinical Research Centre (CRC) had developed the Investigator Initiated Trial (IIT) Programme where financial support and technical assistance are provided to local investigators embarking on their own clinical trials. In the course of preparing the review, we found that the inclination of investigator-initiated trials has yet to be well established in Ministry of Health, Malaysia. Given the potential and impact of such trials, clinicians should be aware of their ability as well as the availability of a supportive network in mobilising their concerted research efforts. Greater research collaboration among investigators could foster more innovative, insightful and constructive research.

The National Stem Cell Therapy Patient Registry of Malaysia--measuring clinical outcomes of stem cell therapy

Loke SC, Chin SP, Sivanandam S, Goh PP, Ng RK, Saw KY, et al.

Stem Cell Rev Rep, 2010 Dec;6(4):507-11.

PMID: 20669056 DOI: 10.1007/s12015-010-9176-8

Very few registries worldwide focus on clinical outcomes of stem cell therapy (SCT) as the large number of applications and rapid development of the field complicates registry design considerably. The National Stem Cell Therapy Patient Registry of Malaysia aims to accommodate this by using a main protocol which covers the overall design and administration of the registry, and condition-specific sub-protocols which deal with outcome measures. The registry will start with a few sub-protocols covering existing modes of SCT in Malaysia, with new sub-protocols released periodically as the need arises.

Fulltext Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia

Foo CY, Lim KK, Sivasampu S, Dahian KB, Goh PP

BMC Health Serv Res, 2015;15:349.

PMID: 26315283 DOI: 10.1186/s12913-015-1011-0

Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance.

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