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  1. Mutalib HA, Ghosh S, Sharanjeet-Kaur, Ghoshal R
    Clin Optom (Auckl), 2016;8:79-83.
    PMID: 30214352 DOI: 10.2147/OPTO.S106421
    A 22-year-old Indian female was referred to Sg Buloh hospital with the diagnosis of bilateral keratoconus. On examination, slit lamp biomicroscopy and corneal topography revealed stage 3 keratoconus in the right eye and stage 2 keratoconus in the left eye. Corneal cell morphology in both eyes was evaluated using confocal microscope. In qualitative observation, almost all corneal layers in right eye except endothelium were partially or completely obscured by haze. Additionally, morphological alterations, such as elongation of keratocyte nuclei and cluster of cells, and dark bands in the anterior stroma were observed in right eye. In the left eye, the amount of haze was less, allowing better visibility of the corneal layers compared with the right eye. The dark bands were evident in the posterior stroma. Quantitative analysis showed that anterior and posterior stromal keratocyte density and endothelium cell density were relatively low in the right eye (834.0, 700.5, and 2,133 cells/mm2, respectively) compared with the left eye (934.1, 750.6, and 2,361 cells/mm2, respectively). In this case, the right eye, exhibiting stage 3 keratoconus, showed more morphological alteration, particularly in the anterior stroma compared with the left eye with stage 2 keratoconus. Increased severity of the disease can explain these differences in corneal cell morphology.
  2. Ahmad A, Mohd-Ali B, Ishak B
    Clin Optom (Auckl), 2018;10:109-113.
    PMID: 30319302 DOI: 10.2147/OPTO.S172272
    Purpose: Soft contact lens wear is most frequently associated with morphologic changes in corneal endothelial cells, but the data are scarce in Asians. This study aimed to evaluate changes in corneal endothelial cell morphology after 6 months of wearing soft hydrogel contact lenses (SH) in young myopic adults living in Kuala Lumpur.

    Patients and methods: Forty-eight subjects were included in the study, 24 were fitted with SH contact lenses (A) and the rest were prescribed with glasses (B). Refraction was conducted subjectively and standard contact lens fitting protocol was followed. Corneal endothelial cell morphology (endothelial cell density, ECD; coefficient of variation, COV; cells' hexagonality, HEX; and central corneal thickness, CCT) was evaluated using specular microscope. Data were collected at baseline and after 6 months of lens wear.

    Results: Mean age of all subjects was 21.23±1.30 years. All results are shown at baseline and 6 months, respectively. Mean refraction for A was -2.16±0.97 diopter sphere (DS) and -2.05±1.03 DS (P=0.49); for B was -2.72±1.51 DS and -2.73±1.51 DS (P=0.58). Mean ECD (cell/mm2) for A: 3104.19±237.30 and 3107.23±237.51 (P=0.07); for B: 3011.56±227.95 and 2983.83±244.55 (P=0.33). COV (%) for A: 46.52±8.63 and 48.53±10.65 (P=0.06); for B: 46.93±9.31 and 46.14±10.65 (P=0.88). HEX (%) for A: 46.21±10.12 and 45.15±10.01 (P=0.08); for B: 46.21±10.12 and 45.15±10.01 (P=0.12). CCT (µm) for A: 520.33±0.04 and 525.70±0.05 (P=0.41); for B: 532.00±0.04 µm and 530.00±0.05 µm (P=0.40).

    Conclusion: This study found no significant change in corneal endothelial cell morphology after 6 months of wearing SH contact lenses. This is probably due to better oxygen permeability of the contact lens material, good compliance, and short wearing period.
  3. Norazman FNN, Mohd-Ali B, Syed Mohd Dardin SF, Mohamad Shahimin M, Mohamad Fadzil N, Mohd Saman MN, et al.
    Clin Optom (Auckl), 2024;16:45-52.
    PMID: 38405333 DOI: 10.2147/OPTO.S432496
    Myopia control lenses have been shown to modify visual function; however, it is arguable if these changes are short-term or long-term. We investigated the changes in accommodative behaviour and binocular vision functions of Malay myopic children who participated in a myopia control trial utilising spectacle lenses (n = 40). This article presents baseline accommodation and binocular vision measurements. The mean (± SD) age, spherical equivalent measured by cycloplegic autorefraction, and axial length (AL) for the right eyes were 10.00 ± 1.47 years, -3.02 ± 1.20 D, and 24.42 ± 0.93 mm, respectively. All participants had good distance and near visual acuities with high-contrast charts (100%), which were significantly better than low-contrast charts (10%) (p < 0.001). The mean (± SD) accommodative lag at baseline was 1.14 ± 0.35 D, while monocular and binocular accommodative amplitudes were 15.35 ± 2.07 D and 16.82 ± 2.27 D, respectively. Malay schoolchildren in this study were more esophoric at near compared to distance, with an accommodative-convergence over accommodation (AC/A) ratio of 5.64 ± 0.66 ∆/D. A higher degree of myopia was found to be associated with a longer AL (r = -0.49, p < 0.05) and higher esophoria at near (r = -0.46, p < 0.05). These baseline measures are consistent with data from other studies showing that myopic children have a high accommodative lag, an elevated AC/A ratio, a longer AL, and are more esophoric at near. The measures reported herein will serve as a basis for examining changes that occur within 12 months of wearing myopia control spectacle lenses.
  4. Mohd-Ali B, Azmi N
    Clin Optom (Auckl), 2021;13:155-160.
    PMID: 34295203 DOI: 10.2147/OPTO.S277786
    PURPOSE: To investigate the wearing pattern and awareness about contact lens care among secondary school students in Kuala Lumpur.

    PATIENTS AND METHODS: This is a cross-sectional study using self-administered validated questionnaires. A total of 2500 questionnaires were distributed to secondary school students (aged 13 to 18 years) from 5 selected schools in Kuala Lumpur. Descriptive statistics were used to analyze the results.

    RESULTS: A total of 987 completed questionnaires were returned and analyzed. The response rate was 39.5%. Mean age of respondents was 15.5±2.5 years with 54.6% females. Around 9.9% of the respondents were contact lens wearers with female majority (78.6%) and the main reasons for wearing contact lenses were cosmesis (42.8%) and comfort (32.7%). Majority (92.2%) were soft contact lens wearers and daily wear (monthly disposable) is the preferred modality. Nevertheless, 42.4% purchased their lenses from unlicensed vendors and 18.4% rinsed their lenses using tap water. Regarding contact lens care, more than 50% of the respondents were not aware about the correct way of handling contact lenses.

    CONCLUSION: Soft contact lens wear is popular among the secondary school students in Kuala Lumpur but the level of practice and knowledge about CL care are unsatisfactory. Thus, health communication strategies and aggressive public ocular health education that can influence behavior changes in teenagers are needed to overcome these issues.

  5. Low YC, Mohd-Ali B, Shahimin MM, Mohidin N, Abdul-Hamid H, Mokri SS
    Clin Optom (Auckl), 2024;16:35-44.
    PMID: 38351972 DOI: 10.2147/OPTO.S448815
    PURPOSE: To investigate changes in peripheral eye length (PEL) in myopic children undergoing orthokeratology (Ortho-K) treatment for 12 months using MRI. The results were compared to single vision spectacle wearers (SVS).

    PATIENTS AND METHODS: A total of 70 children with myopia (aged 8-9 years old) were recruited. A total of 45 children were fitted with Ortho-K, and 25 were fitted with SVS. The PEL and axial length (AL) were measured by using MRI 3-Tesla, whereas central and peripheral refraction (PR) measurements were conducted at ±30 degrees horizontally with nasal (N) and temporal (T) intervals of 10°, 20°, and 30° and with an open field autorefractometer (WAM-5500 Grand Seiko). All the measurements were conducted at the baseline and 12 months.

    RESULTS: The MRI analysis indicates that at 12 months, the SVS group showed more elongation of the PEL and AL at all eccentricities than the Ortho-K group did (p < 0.05). The Ortho-K group only showed significant PEL elongation beyond 20 degrees at N20, N30, T20, and T30 (p < 0.05); however, a significant reduction in the AL was detected in the center AL, N10, and T10 (p < 0.05). All eccentricities in the relative PR of the Ortho-K group were significantly more myopic than at the baseline (p < 0.05), whereas in the SVS group, all eccentricities in the relative PR were shown to be significantly more hyperopic than at the baseline (p < 0.05). The PEL and PR showed negative correlations at 12 months in the Ortho-K group.

    CONCLUSION: MRI analysis can be utilized to describe changes in PEL in myopic children. It appears that as myopia progressed in Ortho-K lens wearers, the PEL increased by a greater amount than the AL did; thus, the retina was reshaped to become increasingly oblate and to display peripheral myopic defocus.

  6. Syed Mohd Dardin SF, Mohd-Ali B, Mohamad Shahimin M, Mohd Saman MN, Mohidin N
    Clin Optom (Auckl), 2024;16:107-114.
    PMID: 38596476 DOI: 10.2147/OPTO.S431608
    INTRODUCTION: Corneal characteristics are unique to each eye and can vary among different levels of refractive errors. However, minimal data are available in the literature on corneal characteristics in myopic Malay school children including the difference between the low myopic group and the moderate myopic group. Therefore, this study aims to determine the corneal characteristics of myopic Malay school children and their associations with axial length.

    METHODS: A total of eighty-four data samples were extracted from forty-two myopic Malay school children. Measurements of the central corneal thickness (CCT), corneal curvature, corneal diameter, and axial length were measured using Lenstar LS900, a non-contact optical biometer. Data were later stratified by the spherical equivalent refraction (SER) into a low myopic group and a moderate myopic group, and paired t-test were employed to determine the differences in the corneal characteristics between these two groups. Univariate and multivariate linear regressions were performed to identify factors that are significantly associated with axial length.

    RESULTS: There was no significant difference in the CCT, corneal curvature and corneal diameter between the low myopic group and the moderate myopic group (t82=0.015, P=0.99), (t82=-0.802, P=0.43) and (t82=-0.575, P=0.57), respectively. Pearson univariate correlation analysis found that axial length significantly correlated with corneal curvature (r=-0.765, P<0.001) and corneal diameter (r=0.614, P<0.001) but no significant correlation found with CCT (r=0.046, P=0.68). Multiple regression analysis showed that axial length was significantly associated with a flatter corneal curvature (P<0.001), older age (P<0.001) and larger corneal diameter (P=0.02).

    CONCLUSION: This study reported the corneal characteristics in myopic Malay school children and its associations with axial length. Results of this study can serve as a reference value for the myopic Malay schoolchild population.

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