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Fulltext Reliability analysis of subjectively graded real-image pterygium based on its translucence appearance between two experienced clinicians – preliminary report

Mohd Radzi Hilmi, Khairidzan Mohd Kamal, Mohd Hafidz Ithnin

Journal of Optometry, Eye and Health Research, 2020;1(2):44-48.
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This study aimed compares the reliability of subjectively graded real-image pterygium based on its translucence appearance between experienced clinicians. Thirty (30) primary pterygium images from 30 pterygium patients were captured in a standardized magnification, illumination and formatting setting as previously described. All images were projected using PowerPoint presentation™ on liquid crystal display (LCD) monitor with standard resolution. Two experienced clinicians act as a grader and grade all images based on reference images provided. For reliability testing, intra-grader assessment was repeated twice with different sequence at least a month apart between each session. Both clinicians were given a set of 30 randomized pterygium images for all sessions. Reliability testing were evaluated using paired T-test and independent T-test. Descriptive analysis revealed observer 1 obtained mean grade of 2.33 (SD = 0.758) and 2.30 (SD = 0.837) for session 1 and 2 respectively. Observer 2 obtained 2.30 (SD = 0.702) and 2.17 (SD = 0.791) for session 1 and 2 respectively. Paired T-test results showed the difference for both observers were not statistically significant for both observer 1 and 2 (P = 0.662 and P = 0.293) respectively. Reproducibility testing using Independent T-test results showed the difference between observers was not statistically significant (P = 0.769). Subjectively graded pterygium clinical grading based on its translucence appearance was repeatable and reproducible. These findings could serve as basis for future work on to evaluate performance of pterygium clinical grading based on its morphology with different level of experience and larger number of samples.
Fulltext Reliability analysis of subjectively graded real-image pterygium based on its translucence appearance between two experienced clinicians preliminary report

Mohd Radzi Hilmi, Khairidzan Mohd Kamal, Mohd Hafidz Ithnin

Journal of Optometry, Eye and Health Research, 2019;1(1):13-17.
MyJurnal

This study aimed compares the reliability of subjectively graded real-image pterygium based on its translucence appearance between experienced clinicians. Thirty (30) primary pterygium images from 30 pterygium patients were captured in a standardized magnification, illumination and formatting setting as previously described. All images were projected using PowerPoint presentation™ on liquid crystal display (LCD) monitor with standard resolution. Two experienced clinicians act as a grader and grade all images based on reference images provided. For reliability testing, intra-grader assessment was repeated twice with different sequence at least a month apart between each session. Both clinicians were given a set of 30 randomized pterygium images for all sessions. Reliability testing were evaluated using paired T-test and independent T-test. Descriptive analysis revealed observer 1 obtained mean grade of 2.33 (SD = 0.758) and 2.30 (SD = 0.837) for session 1 and 2 respectively. Observer 2 obtained 2.30 (SD = 0.702) and 2.17 (SD = 0.791) for session 1 and 2 respectively. Paired T-test results showed the difference for both observers were not statistically significant for both observer 1 and 2 (P = 0.662 and P = 0.293) respectively. Reproducibility testing using Independent T-test results showed the difference between observers was not statistically significant (P = 0.769). Subjectively graded pterygium clinical grading based on its translucence appearance was repeatable and reproducible. These findings could serve as basis for future work on to evaluate performance of pterygium clinical grading based on its morphology with different level of experience and larger number of samples.
Fulltext The comparison of measuring tear film break-up time using conventional slit lamp biomicroscopy and anterior segment digital imaging

Noor Afuza Abdullah, Mohd Hafidz Ithnin, Mohd Radzi Hilmi

Journal of Optometry, Eye and Health Research, 2019;1(1):34-38.
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The stability of tear film can be measured by tear film break-up time (TFBUT). To date, the comparison value of TFBUT between slit lamp with stopwatch, which is conventional method and anterior segment digital imaging (ASDI) is under explored. The aim of this study was to compare TFBUT value between the conventional method and the ASDI utilizing iPhone 6s® video recorder. A total of 20 normal and healthy participants with 40 eyes were involved in this study. Right and left eyes from an individual were considered separately. Three measurements of TFBUT were taken from each methods and average were calculated and recorded. Mann Whitney U test was used to analyze the data and it was found that the median of the TFBUT measurement from the conventional method (2.16 seconds) was higher than the median from the ASDI (2.00 seconds). The comparison between two methods was not significant (p > 0.05). In conclusion, this study suggested that both methods could not give different result in the assessment of TFBUT.
Fulltext Comparison of Immediate Effects Oon Usage of Dual Polymer Artificial Tears on Changes in Tear Film Characteristics

Fatin Amalina Che Arif, Mohd Radzi Hilmi, Mohd Hafidz Ithnin, Khairidzan Mohd Kamal

IIUM Medical Journal Malaysia, 2019;18(102):39-0.
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This study aimed to evaluate the short-term efficacy of artificial tears (AT) instillation on tear film quality and quantity utilising two dual polymer artificial tears; Systane Hydration preservative (SH) and non-preservative (SHUD) in 60 minutes observation period compared to normal saline. Materials and methods: One hundred eyes of 50 participants involved in this prospective, double-masked randomised study. Viscosity and pH of both AT were evaluated using Rheometer and digital pH-meter respectively prior to tear film characteristics assessment. Tear break-up time (TBUT) and tear meniscus height (TMH) were measured at baseline, 5, 15 and 60 minutes after instillation. Tear ferning pattern (TFP) were compared between baseline and 60 minutes after instillation. One-way analysis of variance (ANOVA) was used to evaluate the effects of both AT instillation. Independent T-test was employed to compare between the two groups (SH vs SHUD) for each specific time-interval. P-value of 0.05 was set as the level of significance. Results: The viscosity of SH and SHUD was 0.0267Pa.s and 0.03273Pa.s respectively with pH of 7.85 for SH and 7.74 for SHUD. Both AT showed significant increment in TBUT between baseline and 15 minutes (SH: 5.82 ± 1.063, p = 0.01; SHUD: 6.02 ± 0.979, p
Fulltext Reliability Measurement of Corneal Wavefront Aberrations using Corneal Videokeratograph Atlas 9000

Noorshazana Mat Rejab @ Md Rejab, Mohd Radzi Hilmi, Md Muziman Syah Md Mustafa, Khairidzan Mohd Kamal

IIUM Medical Journal Malaysia, 2019;18(102):54-0.
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Accurate corneal wavefront aberration measurements are essential in determining patient’s suitability, vision outcomes and patient satisfaction in laser refractive surgeries. This study aimed to evaluate the reliability measurement of higher-order aberration (HOA) using corneal videokeratograph Atlas 9000. Materials and method: 38 eyes of 19 participants were recruited in this study. Comprehensive eye examination was done to ensure all participants eligibility, and any conditions in which obstruct the central cornea were excluded. Corneal wavefront aberrations were measured based on Zernike polynomials. In assessing repeatability, three repetitive measurements in five minutes in a single session were taken by 2 experience examiners. For reproducibility measurement, similar approach was done with the time-interval between measurements was set at one week. Bland-Altman, limits of agreement (LoA) and intraclass correlation coefficients (ICCs) were used to evaluate the reliability measurement. Results: Bland-Altman and LoA findings revealed no significant differences for both repeatability and reproducibility measurement. For repeatability testing, the mean differences for vertical trefoil, oblique trefoil and spherical aberration were -0.096 ± 0.493, 0.001 ± 0.048, 0.008 ± 0.035, 0.004 ± 0.029, 0.010 ± 0.053 with LoA of 1.930, 0.188, 0.138, 0.114, and 0.208 respectively. Intraclass correlation coefficient (ICC) excellent reliability of 0.841 for all parameters. Likewise, reproducibility testing showed similar findings with the mean difference were -0.018 ± 0.091, 0.016 ± 0.061, -0.0004 ± 0.036, -0.002 ± 0.042, 0.003 ± 0.026, with LoA of 0.356, 0.24, 0.141,0.164, and 0.102 respectively. Intraclass correlation coefficient (ICC) shows excellent reliability of more than 0.9 for all parameters. LoA of less than 1.0 were observed in all measurements (except for repeatability of vertical trefoil) indicates high consistency of the measurements. Conclusions: Corneal videokeratograph Atlas 9000 provides excellent HOA measurement reliability.
Fulltext The measurement of lower tear meniscus height using anterior segment digital imaging and keratography

Nurin Izzati Rosmadi, Nur Hanisah Diyana Yusoff, Mohd Radzi Hilmi, Khairidzan Mohd Kamal, Mohd Hafidz Ithnin

Journal of Optometry, Eye and Health Research, 2019;1(1):49-54.
MyJurnal

The difference of lower tear meniscus height (TMH) value between invasive and non-invasive techniques is under explained. This study aims to compare the value of lower TMH between Oculus keratograph 5M (OK5M) and anterior segment digital imaging (ASDI) using slit lamp with iPhone6 video recorder attached. The totals of twenty participants with 40 eyes were involved in this cross-sectional study. Right and left eyes from an individual were considered separately. Instillation of fluorescein sodium was applied on the ASDI technique only. Three measurements of TMH were taken from each methods and average were calculated and recorded. Independent sample t-test was used to analyze the data and it was found that the mean of the TMH measurement from the ASDI (0.42 ± 0.11 mm) was higher than the mean from the OK5M (0.25 ± 0.06 mm). The comparison between two methods was significant (p < 0.05). In conclusion, this study suggested that the higher TMH in ASDI was resulted by the effect of fluorescein and together with local climate.
Fulltext Intraocular pressure: the effect of short-term fasting and its association with fluid and fat status

Nur Raihan Esa, Nor Azwani Mohd Shukri, Norsham Ahmad, Mohd Radzi Hilmi, Md Muziman Syah Md Mustafa, Nura Syahiera Ibrahim, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):180-186.
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Introduction: Short-term fasting may influence intraocular pressure (IOP) due to alteration of fluid (total body water;
TBW, and water intake) and fat (total body fat; TBF). This study aimed: i) to compare IOP values within and between,
fasting and non-fasting periods; and ii) to assess the association between IOP and, TBW and TBF. Methods: Thirty
healthy participants aged 21.8±1.1 years were assessed on two different periods (fasting vs. non-fasting). During each
period, the IOP, TBW and TBF values were assessed for four times (morning, afternoon, evening, late-evening). The
IOP was measured using AccuPen® tonopen, while TBW and TBF were assessed by using a Tanita body composition
analyser. Results: During fasting, the IOP value in the afternoon (14.53±2.33 mmHg) was significantly higher than in
the evening (12.43±2.73 mmHg, p=0.009) and late-evening (12.60±2.44 mmHg, p=0.003). No significant difference
in IOP was observed during non-fasting period. The mean of IOP in the evening was significantly lower during fasting
compared to non-fasting (12.43±2.73 mmHg vs 13.75±2.53 mmHg, p=0.044). The IOP and TBW were negatively
correlated (r=-0.268; p=0.011) during non-fasting and showed no association during fasting period. There was no
significant correlation between IOP and TBF during both fasting and non-fasting periods. Conclusion: IOP reduction
during short-term fasting, together with the no association with TBF and TBW suggested that IOP is an independent
factor that reduces during fasting in healthy population.
Fulltext Changes in apical corneal curvature in unilateral primary pterygium and normal adults using Simulated-K and corneal irregularity measurement

Mohd Radzi Hilmi, Nur Hidayah Musa, Khairidzan Mohd Kamal, Mohd Zulfaezal Che Azemin, Nur Nabilah Maruziki, Nur Ain Norazmar, et al.

International Journal of Allied Health Sciences, 2019;3(2):588-594.
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This paper aimed to describe variation in apical corneal curvature between unilateral primary pterygium and normal adults utilizing simulated-K and corneal irregularity measurement corneal indices. A total of 100 participants comprise 50 unilateral primary pterygium eyes from 50 patients and 50 normal adults were recruited in this study. Diagnosis and classification of primary pterygium were done by a consultant ophthalmologist (KMK). Standard optometric examinations were performed in all participants. Simulated-K (SimK) and corneal irregularity measurement (CIM) was objectively measured using a corneal topographer. Three measurements based on best image quality for SimK and CIM were taken by single operator in a same visit. Difference for both SimK and CIM parameters between primary pterygium and normal groups were determined via independent T-test. Overall mean and standard deviation (n = 120) of SimK and CIM were found higher in primary pterygium group (9.06 ± 4.49 D and 11.48 ± 3.12) compared to normal (1.63 ± 0.67 D and 0.62 ± 0.24) respectively. Independent T-test results showed significance difference in SimK and CIM values between primary pterygium groups and normal (both P< 0.001). Both SimK and CIM corneal indices can be an important tool in describing and predicting changes on the corneal curvature due to pterygium progression. However, it is worth to note that the detectability of changes in anterior corneal curvature is limited to 5 mm of central corneal curvature.
Fulltext Corneo-pterygium total area measurements utilising image analysis method

Mohd Radzi H, Khairidzan MK, Mohd Zulfaezal CA, Azrin EA

J Optom, 2019 05 13;12(4):272-277.
PMID: 31097348 DOI: 10.1016/j.optom.2019.04.001

PURPOSE: To describe an objective method to accurately quantify corneo-pterygium total area (CPTA) by utilising image analysis method and to evaluate its association with corneal astigmatism (CA).
METHODS: 120 primary pterygium participants were selected from patients who visited an ophthalmology clinic. We adopted image analysis software in calculating the size of invading pterygium to the cornea. The marking of the calculated area was done manually, and the total area size was measured in pixel. The computed area is defined as the area from the apex of pterygium to the limbal-corneal border. Then, from the pixel, it was transformed into a percentage (%), which represents the CPTA relative to the entire corneal surface area. Intra- and inter-observer reliability testing were performed by repeating the tracing process twice with a different sequence of images at least one (1) month apart. Intraclass correlation (ICC) and scatter plot were used to describe the reliability of measurement.
RESULTS: The overall mean (N=120) of CPTA was 45.26±13.51% (CI: 42.38-48.36). Reliability for region of interest (ROI) demarcation of CPTA were excellent with intra and inter-agreement of 0.995 (95% CI, 0.994-0.998; P<0.001) and 0.994 (95% CI, 0.992-0.997; P<0.001) respectively. The new method was positively associated with corneal astigmatism (P<0.01). This method was able to predict 37% of the variance in CA compared to 21% using standard method.
CONCLUSIONS: Image analysis method is useful, reliable and practical in the clinical setting to objectively quantify actual pterygium size, shapes and its effects on the anterior corneal curvature.