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Fulltext Comparison of habitual visual acuity and stereoacuity between children attending kemas and urban private preschools

Naufal, N., Narayanasamy S., Ahmad, M., Hairol, M.I., Sharanjeet K., Kadar, M., et al.

Medicine & Health, 2020;15(1):225-236.
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Penilaian status visual kanak-kanak prasekolah adalah penting kerana ia adalah salah satu faktor yang menentukan ketersediaan mereka untuk bersekolah. Walau bagaimanapun, tidak semua kanak-kanak prasekolah mendapat peluang untuk mengikuti program saringan penglihatan. Dalam kajian ini, akuiti visual jauh dan dekat serta tahap stereoakuiti diukur di kalangan kanak-kanak berumur enam tahun (n=385). Parameter tersebut kemudiannya dibandingkan di antara kanak-kanak prasekolah swasta bandar dan prasekolah KEMAS daripada keluarga berpendapatan rendah di luar bandar. Tujuh peratus kanak-kanak prasekolah KEMAS adalah gagal dalam ujian saringan penglihatan jauh berbanding dengan 6% kanak-kanak prasekolah swasta. Untuk ujian penglihatan dekat, kadar kegagalan adalah masing-masing 8.7% dan 4.9% bagi kanak-kanak prasekolah swasta dan KEMAS masing-masing. Untuk ujian stereoakuiti, seramai 3.3% kanak-kanak prasekolah swasta dan 2.5% kanak-kanak prasekolah KEMAS dikategorikan sebagai lemah stereopsis. Semua perbezaan tersebut adalah tidak signifikan secara statistik (semua p>0.05). Peratusan kanak-kanak yang gagal ujian saringan penglihatan adalah serupa untuk kedua-dua jenis prasekolah. Oleh itu, program saringan penglihatan perlu dijalankan di semua jenis prasekolah untuk memastikan sebarang masalah penglihatan dapat dikesan, didiagnos, dirawat dan dicegah.
Heredity factor in myopia development among a sample in Klang Valley, Malaysia

Kaur S, Ramli NI, Narayanasamy S

Chin Med J (Engl), 2012 Oct;125(19):3522-5.
PMID: 23044317

Development of myopia among young children is often contributed to the refractive status of the parents. This study was conducted to determine whether myopia can be inherited across the generation among a sample in the Klang Valley. Three generations involved are: G1 (grandparents), G2 (parents) and G3 (children).
Smartphone use patterns and the impact on accommodation and convergence system of the eyes among Malaysian teenagers

Chellapan T, Mat Daud N, Narayanasamy S

Int J Ophthalmol, 2024;17(11):2093-2099.
PMID: 39559302 DOI: 10.18240/ijo.2024.11.16

AIM: To determine the smartphone use patterns and effects of smartphone use on accommodation and convergence system of the eyes among Malaysian teenagers.
METHODS: A total of 62 participants aged between 13 and 17y were involved. A self-administered questionnaires containing 12 items was used to evaluate the smartphone usage patterns. This was followed by an eye examination, involving a battery of accommodation and convergence assessments before and after the smartphone use. The data analysis comprised descriptive statistics, paired t-test, and correlation coefficients.
RESULTS: The use of smartphones is at a high level and at an optimal distance daily, with more than 6h a day watching video films, games, and completing school projects. Majority of the participants not reported eye strain factors and eye prescription changes with the use of digital devices. The use of a smartphone continuously for 30min was found to significantly decrease amplitude of accommodation, accommodative facility, and positive relative accommodation (P<0.001). Meanwhile, the lag of accommodation parameters and negative relative accommodation increased with the use of smartphones significantly (P<0.001). The near point of convergence (NPC) and distance and near negative fusional vergence decreased significantly (P<0.001). The NPC parameter was found to have a weak negative association with the frequency of smartphone use (R=-0.276, P<0.05).
CONCLUSION: Frequent and continuous use of smartphones have increased visual stress and resulted in weakness of accommodation and vergence functions. Therefore, frequent break is mandatory when using a smartphone and appropriate visual hygiene, the 20-20-20 rule (every 20min, view something 20 feet away for 20s) are required during smartphone use to maintain visual function.
Do reduced visual acuity and refractive error affect classroom performance?

Hopkins S, Narayanasamy S, Vincent SJ, Sampson GP, Wood JM

Clin Exp Optom, 2020 05;103(3):278-289.
PMID: 31441091 DOI: 10.1111/cxo.12953

The role of visual acuity and refractive errors in the academic performance of children is controversial due to the variable quality of the research in this area and the mixed findings reported. This review aims to provide clarity by reviewing and critiquing relevant peer-reviewed publications and also summarises what is known regarding the visual demands of modern classroom environments. The outcomes of this review suggest that while a number of studies have investigated the role of vision in relation to children's academic performances, the veracity of the evidence obtained from the majority of these studies is undermined by methodological limitations. Comparisons between studies are constrained by differences in experimental designs, instrumentation and sample characteristics. Despite these limitations, the weight of evidence suggests there is an association between academic performance and both visual acuity and refractive error in children. However, well-designed experimental studies are necessary to further understand the relationship between these parameters.
Fulltext Visual demands in modern Australian primary school classrooms

Narayanasamy S, Vincent SJ, Sampson GP, Wood JM

Clin Exp Optom, 2016 May;99(3):233-40.
PMID: 26889920 DOI: 10.1111/cxo.12365

BACKGROUND: The visual demands of modern classrooms are poorly understood yet are relevant in determining the levels of visual function required to perform optimally within this environment.

METHODS: Thirty-three Year 5 and 6 classrooms from eight south-east Queensland schools were included. Classroom activities undertaken during a full school day (9 am to 3 pm) were observed and a range of measurements recorded, including classroom environment (physical dimensions, illumination levels), text size and contrast of learning materials, habitual working distances (distance and estimated for near) and time spent performing various classroom tasks. These measures were used to calculate demand-related minimum criteria for distance and near visual acuity, contrast and sustained use of accommodation and vergence.

RESULTS: The visual acuity demands for distance and near were 0.33 ± 0.13 and 0.72 ± 0.09 logMAR, respectively (using habitual viewing distances and smallest target sizes) or 0.33 ± 0.09 logMAR assuming a 2.5 times acuity reserve for sustained near tasks. The mean contrast levels of learning materials at distance and near were greater than 70 per cent. Near tasks (47 per cent) dominated the academic tasks performed in the classroom followed by distance (29 per cent), distance to near (15 per cent) and computer-based (nine per cent). On average, children engaged in continuous near fixation for 23 ± 5 minutes at a time and during distance-near tasks performed fixation changes 10 ± 1 times per minute. The mean estimated habitual near working distance was 23 ± 1 cm (4.38 ± 0.24 D accommodative demand) and the vergence demand was 0.86 ± 0.07(Δ) at distance and 21.94 ± 1.09(Δ) at near assuming an average pupillary distance of 56 mm.

CONCLUSIONS: Relatively high levels of visual acuity, contrast demand and sustained accommodative-convergence responses are required to meet the requirements of modern classroom environments. These findings provide an evidence base to inform prescribing guidelines and develop paediatric vision screening protocols and referral criteria.
Fulltext Association between reduced visual-motor integration performance and socioeconomic factors among preschool children in Malaysia: A cross-sectional study

Hairol MI, Nordin N, P'ng J, Sharanjeet-Kaur S, Narayanasamy S, Mohd-Ali M, et al.

PLoS One, 2021;16(3):e0246846.
PMID: 33657109 DOI: 10.1371/journal.pone.0246846

Visual-motor integration (VMI) is related to children's academic performance and school readiness. VMI scores measured using the Beery-Bucktenicka Developmental Test of Visual-Motor Integration (Beery-VMI) can differ due to differences in cultural and socioeconomic backgrounds. This study compared the VMI scores of Malaysian preschoolers with the corresponding US norms and determined the association between their VMI scores and socioeconomic factors. A cross-sectional study was conducted among 435 preschoolers (mean age: 5.95±0.47 years; age range: 5.08-6.83 years) from randomly selected public and private preschools. VMI scores were measured using Beery-VMI in the preschools' classrooms. Information on the socioeconomic characteristics of the preschoolers was obtained using a parent-report questionnaire. One sample t-test was used to compare their VMI scores with the corresponding US norms. Multivariate logistic regression models were used to explore the influence of socioeconomic factors on the preschoolers' VMI scores. Overall, Malaysian preschoolers' VMI performance was similar to the US standardized norms (p>0.05). Children from low-income families were twice likely to obtain lower than average VMI scores than those from higher-income families (OR = 2.47, 95%CI 1.05, 5.86). Children enrolled at public preschools were more likely to obtain a lower than average VMI score than those who enrolled at private preschools (OR = 2.60, 95%CI 1.12, 6.06). Children who started preschool at the age of six were more likely to obtain lower than average VMI scores than those who started at an earlier age (OR = 4.66, 95%CI 1.97, 11.04). Low maternal education level was also associated with lower than average VMI score (OR = 2.60, 95%CI 1.12, 6.06). Malaysian preschoolers' Beery-VMI performance compared well to their US counterparts. Some socioeconomic factors were associated with reduced VMI scores. Those from disadvantaged socioeconomic backgrounds are more likely to have reduced VMI performance, potentially adversely affecting their school readiness, cognitive performance, and future academic achievements.
Fulltext Development of Knowledge, Attitude and Practice Questionnaire for age-related macular degeneration patients

Abd Rahman MH, Amirtharatnam P, Sharanjeet-Kaur S, Narayanasamy S, Mohd Rasdi HF, Catherine Bastion ML

Int J Ophthalmol, 2023;16(4):589-600.
PMID: 37077492 DOI: 10.18240/ijo.2023.04.13

AIM: To develop and validate a questionnaire to evaluate knowledge, attitude and practice of patients diagnosed with age-related macular degeneration (AMD) who have undergone intravitreal injection treatment.
METHODS: This study was conducted among patients diagnosed with AMD in Kuala Lumpur. The generation of the instrument included four phases which included item and domains development, content, face validity and exploratory factor analysis. Content validity and modified Kappa was used for validation of knowledge domain. Exploratory factor analysis was used for validation of both attitude and practice domains. Face validity was conducted in 12 patients, content validity was ascertained in 120 patients and test-retest reliability was determined in 39 patients with AMD.
RESULTS: Content validity index (CVI) and modified kappa showed excellent values for most items in the knowledge domain with CVI for item (I-CVI) values between 0.78-1.0 and Kappa values of >0.74. The Kaiser-Meyer-Olkin (KMO) sampling adequacy showed acceptable scores of 0.70 and 0.75 for both attitude and practice domains respectively and Bartlett's Test of sphericity were significant (χ2 =0.00, P<0.001). Factor analysis resulted in five factors with thirty items for attitude domain and four factors with twenty items for practice domain. The Cronbach's alpha showed acceptable values for all items in knowledge, attitude and practice domain with values >0.70 and good test-retest reliability. The final version of the questionnaire consisted of 93 items from four sections consisting of demographic details, knowledge, attitude and practice.
CONCLUSION: The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring KAP of patients diagnosed with AMD undergoing intravitreal injection treatment.