Dear MSO Members,
 
As we enter the last quarter of 2020, one cannot help but to look back and wonder how things have changed over such a short period of time. A new norm is in place, with numerous changes to battle against the common enemy - Covid-19. The Ophthalmology fraternity has also proven that we will always strive to overcome adversity; to continue doing what we do best: Save sight. With the need to implement social distancing, most of us have turned to the virtual platform to continue to share and receive knowledge. Numerous young minds had to put a brief halt to their training and career but are now getting prepared to begin again. From tele-consultations to slit lamp and surgical microscope shields, we have been doing everything we can to keep our practice going. Let’s take a moment to celebrate this perseverance that we are blessed with.

Here at MSO, we too had to make the necessary changes to carry on with our duties. Our first ever fully virtual annual general meeting was held on 18th July 2020. We would like to thank members who took the time to attend this meeting.

ARTICLES

AN INSIGHT INTO OPHTHALMOLOGY BASED RESEARCH AND PUBLICATION IN MALAYSIA

Research and publication in the field of Ophthalmology in Malaysia is still far from reaching the pinnacle of excellence. Despite an abundance of resources, we still lag behind neighbouring countries in terms of impactful and meaningful research that can capture a global audience. In this article, we will hear from research experts in our field regarding the reality of research in Ophthalmology and how we can improve to be at par with the global leaders in research.

From your perspective, what is the prospect of Ophthalmology based research and publication in Malaysia?

Mohamad Aziz Salowi, MBBS: In my opinion, the prospect for research here in Malaysia is excellent. For instance, we have a fine clinical database (Cataract Surgery Registry) which has placed itself on par with other international databases through research collaborations with ICHOM and network with Prevention of Blindness programs under WHO/International Agency for the Prevention of Blindness (IAPB). In addition, we also have a strong platform to collect other data (National Eye Database). Sub-specialities in Malaysia are fairly developed and data collected through these programs can potentially generate research questions and results. Besides these, we also have strong and sustainable technical/financial support from local CRC/ICR/NIH and there are many clinicians with research background and interest who can guide other clinicians in research.

Liza Sharmini Ahmad Tajudin, MBBS: There is a huge potential for Ophthalmology research in Malaysia, but we are lacking in collaborative effort, financial support and proper strategic planning in promoting research. We are still at the stage of ‘standing on the shoulders of the giants’ by depending on our closest neighbouring countries to act as our giant. We need to start moving forward. Although our health system is amongst the best in the world, we do take the extra effort to use it for research purposes. We are a small country and thus coordination of collaborative research is easier in Malaysia when compared to countries such as Indonesia and China. We just need to initiate the collaboration between the different regions. The training program in Malaysia includes a research element to nurture young researchers but somehow the interest dissipates after graduation. In addition, research grants are important to ensure good quality research. However, the availability of funds is shrinking.

Goh Pik Pin, MD: I think the prospect is good as ophthalmologists at MOH are exposed to research methodology and most of them have conducted research when they were doing their post graduate masters training. However, when they become specialists, unless they keep up their passion in seeking new knowledge and have an inquisitive mind, they may not be actively involved in conducting research.

THE WATER DRINKING TEST: PRACTICAL TIPS

Intraocular pressure (IOP) is the primary modifiable risk factor that has been linked to glaucoma development and progression. Interestingly, individuals with low IOP also develop glaucomatous optic neuropathy, while some treated patients continue to progress despite having satisfactory IOP control. It has been postulated that IOP independent factors such as altered optic nerve head microcirculation, oxidative stress, immune mechanisms, and increased translaminar stress from low cerebrospinal fluid pressures may play a role in progressive optic neuropathy.^1,2 However, pitfalls in IOP measurements have also been shown to contribute to this phenomenon.

Like any other biological parameter, IOP is not a fixed value but varies considerably during the circadian cycle and in between clinic visits. Twenty-four-hour IOP profile studies have shown that two-thirds of patients experienced peak IOP outside regular clinic hours.³ Diurnal and 24-hour IOP curves have been useful to determine peak IOP. Circadian variations can be best assessed by a noninvasive recording of ambulatory, continuous 24-hour IOP monitoring using a contact lens sensor or other telemetric devices.⁴ However, is not always feasible or cost-effective to implement in routine clinical practice. The water drinking test (WDT) is an apt assessment that can reliably predict peak and average IOP in an office setting.

HoSHAS, TEMERLOH, PAHANG CREATES KLINIK KATARAK KEMENTERIAN KESIHATAN CATARACT SURGICAL CARNIVAL HISTORY

The Sultan Haji Ahmad Shah Hospital, Temerloh (HoSHAS), Pahang created history after successfully performing 108 cataract surgeries over two days from 15th to 16th November 2019.

High cataract load and long operation waiting time triggered the planning of this cataract carnival. The initial framework included an organizing committee which involved hospital administration, the Ophthalmology department, operation theatre team and daycare unit. The cataract carnival was also supported by external surgeons and nursing staff from other hospitals. Equipment and technological support was provided by industrial partners as part of their charitable contribution.

The cataract carnival was officiated by Pahang Health Director, Dato’ Indera Dr Shaari Ngadiman. In his opening speech, he acknowledged that the number of cataract induced blindness in Pahang was on the rise with the increased life expectancy of Malaysians. He further emphasized that the state health department will continue to improve the quality of service to the people, including through ongoing health promotion activities, provision of health facilities and the purchase of new assets in hospitals and health clinics.

A total of 108 cataract operations were performed with 60 cases on the first day and 48 cases on the next. This involved 9 (nine) surgeons assisted by 70 (seventy) staff members from HoSHAS, Hospital Tengku Ampuan Afzan (HTAA) and University of Institute Technology Mara Medical Centre (UiTM).

A TRIBUTE TO A MENTOR BY A PROTÉGÉ

Firstly, I would like to thank the MSO for allowing me to write a special tribute to Dato’ Dr Ahmad Mt Saad, someone that has been more than a mentor to me. Dato’ Dr Ahmad hugely shaped my view on life, work, and many other things since we first met in 2002.

Where do I start, we share so much, however the moment I start drafting this piece, all I get is overwhelmed by the emptiness Dato’ has left behind.

In the name of Allah, The Most Merciful and The Most Gracious

I reported duty to the Ophthalmology Department, Hospital Alor Setar in April 2002 as an Ophthalmology MO.  That was my first encounter with Dato’ who was the HOD. I remember him as a soft spoken leader and I felt very welcomed from the get-go. Being part of the open system masters program in UKM afforded me the flexibility to be based in 2 places at the same time. Fast forward a few years and I returned to Dato’ as my supervisor during my subspecialty training in glaucoma. Completing my subspecialty, I continue to serve in Alor Setar where the legacy of Dato’ Dr Ahmad, continues to radiate in omnipresence. 

I still recall fondly the memories of managing the glaucoma clinic under the supervision of the late Dato’, who at the time was the Glaucoma Consultant. Many share my view, that they have never met someone as impressive, smart and grounded as Dato’.

The story of Dato’ resonates closely with us all. Dato’ is a true-bred “Kedahan”, born in Kubang Pasu at the northern tip of Kedah, at a time when young Malaysia was coming out of a Communist Insurgency.