Dear MSO members,
 
Welcome to the opening issue of our newsletter for 2021. It has been a year since the world went into lockdown for the first time. After adapting to a full year of virtual events, we have become accustomed to doing this and to a certain extend enjoy attending events from the comfort of our homes. Off goes the travel chaos, in comes the IT glitches. We all have seen the many amusing videos of online seminars and meeting going awry. On the hindsight, with the removal of travel from the equation, we all benefitted by spending more time with family, managed to carve out the “me time” and managed to put to action the things we have always wanted to do. Many discovered their hidden talents like baking, dancing, singing, painting and even learned a new language.

However, no one can deny that we all do miss the face-to-face conferences where we get to mingle with our fellow colleagues and friends; and learn in person about the latest technologies available in our field. We all miss the human touch to bond, particularly important in establishing mentorships between enthusiastic young ophthalmologists and wise experts. With the availability of a multitude of vaccines, the once distant flicker of light at the end of the tunnel, now seems radiant and closer. Let’s hope that the post pandemic world, allows us to amalgamate the ease of virtual connection with the ability to mingle and freely exchange ideas.

Back at home, this year saw our first fully virtual MSO Annual Scientific Meeting held from 25th-28th of March. We are very grateful to have received an overwhelming response from members for the meet this year, driven by the exciting agenda, professional moderating and engaging debates. For that, we thank you. Bravo to Dr. Shelina Oli Mohamed and her team for the impactful meet. In light of the overwhelming request from members, we would like to announce that the Annual Scientific Meeting 2021 microsite will be online and accessible to members till Sunday, 11th April 2021. MSO members will continue to enjoy access to the recorded sessions, e-posters and virtual exhibition booths during this period.

ARTICLES

PERSONALITY FOCUS: A JOURNEY OF AN OCULOPLASTIC SURGEON

A man who had contributed significantly towards the field of oculoplastics in Malaysia, having served the Ministry of Health, Malaysia for 33 years, of which 17 years were as an oculoplastic surgeon. He retired from the government services in November 2020 and is currently enjoying his hard-earned retirement with his family.

Early Life and Background

Dr Radzlian was born in Perlis. Since his father was a police officer, his family was required to move around the country. Thus, most of his childhood was spent in Kepong, Kuala Lumpur. He was the youngest of three siblings. He completed his secondary education at the Victoria Institution, Kuala Lumpur. He then pursued USM matriculation programme and joined the medical faculty of Universiti Sains Malaysia. He graduated with a medical degree in 1987.

What made you choose medicine as a profession?

Becoming a doctor was never my ambition. It was only after my MCE and upon joining the matriculation programme that I decided to try medicine. I like the idea of a non-office-based work, to learn about diseases and the ability to help others.

Career in Ophthalmology

Dr Radzlian did housemanship at the HTAR Klang. When he was a medical officer at the Out Patient Department of Hospital Besar Kuala Lumpur, he befriended a Medical Assistant named Andi who worked in the ophthalmology department. He persuaded Dr Radzlian to go for a post graduate training in Ophthalmology.

THYROID EYE DISEASE: NEW PARADIGM OF DISEASE CLASSIFICATION

Introduction

Thyroid eye disease (TED) is an orbital inflammatory disease that is related to autoimmune thyroid conditions. It causes expansion and fibrosis of orbital fat, striated extraocular muscles and lacrimal gland. This orbital disorder significantly disrupts appearance, vision and quality-of-life, although it is self-limited. Managing TED requires identifying its clinical features and grade its severity and activity, translating into a few classifications. Accurate evaluation of the clinical features of TED is essential for early diagnosis, identification of high-risk disease, planning medical and surgical intervention and assessing response to therapy. This article illustrates and compares several TED classifications together with the new one proposed by Uddin et al.

Activity versus Severity in TED

An impression of the degree to which the body reacts to autoantigen is defined as an activity. Assessment of activity in TED includes an absence or presence of the symptoms and signs related to inflammation.  The degree of activity can be inactive, moderately active or severely active. In contrast, severity signifies physical consequences of activity that persists despite control of activity. 

TED Classification

Few systemic classifications of TED have been described and proposed by several authors. Nunery et al. defined a dichotomous Type I versus Type II classification based on the clinical features and CT scan findings. Type I of lipogenic variant manifests symmetrical proptosis with no signs of orbital inflammation.  Type II is the restrictive myopathy type of orbitopathy and presents with diplopia and asymmetrical proptosis. The following are several classifications that are commonly used for TED classification.

THE COVID-19 PANDEMIC AND MYOPIA IN CHILDREN

Since the beginning of the Covid-19 pandemic, almost everyone including children have been facing a steep increase in screen time in order to continue with work and learning. Does this cause any serious harm to the eyes?

As Asians, even before  the Covid-19 pandemic, we have been in the epicentre of myopia or shortsightedness, due to our genetic factor. A systematic review and meta-analysis done by the Holden’s Institute, predicts that by 2050 there will be 4758 million people with myopia (49.8% of the world population)¹ , and this is before the increase of near work in children, due to “lockdown” and online learning, as a method to curb the Covid-19 spread.

Some optometrists even came up with the term “covidopia”, which is myopia that is induced or worsened by the Covid-19 pandemic. In the eye clinics and optometrist practices, there has been an increase in the number of children complaining of refractive errors. Among adults, digital strain symptoms such as eye tiredness, dry eyes, tired neck and back ache have been increasing during this pandemic.

What are the contributing factors to the rise in cases of myopia in children during this pandemic ?

If I have to pinpoint 3 factors, it would be online learning, increased digital device use both for education and entertainment and reduced outdoor time.²

Many studies over the years have shown an association between near work and myopia³, years of schooling and myopia⁴ and near work behavior and myopia⁵ though some studies failed to show a significant association.⁶ Insufficient outdoor time is also considered a major lifestyle factor that contributes to myopia in children. With the inevitable increase in near work and reduced outdoor time as a result of this pandemic has thus caused heightened concerns about myopia in children.