The Great Reset
 
Twenty-twenty has been a year of varied struggles and opportunities. Many of us have had to learn to cope with the far-reaching consequences of problems not thought to be ours, and in the process, have had to master new skills in order to survive, both personally and professionally, in these tumultuous times.

Nobody knows what 2021 will bring, with no panacea yet visible on an ever-changing horizon. As the year comes to an end, there isn’t any need to remind ourselves of the year’s recent events but rather, there is a pressing need for us as a society and profession to ponder over what can be achieved in the coming years. Even the ‘super-powers’ have been shown to be just as vulnerable as other nations not thought of as such. The playing field is changing and so must we. Our consequent decisions and actions will surely have significant repercussions for the coming generations. There have been some positives which we should probably embrace including fresher air, less traffic, zero-miles food with many taking up urban-farming etc.

ARTICLES

PERSONALITY FOCUS: A FAREWELL TRIBUTE

I am privileged and honoured to have known Dr. Zulkifli having trained under him during his last few months of service and am humbled to be writing this tribute article about the first VR surgeon to have served in the East Coast.

EARLY YEARS

Dr Zulkifli bin Ghani was born on 26th October 1960 in Kampung Bunut Payung Kota Bahru Kelantan. He is the 4th child of 10 and pursued his tertiary education at Universiti Malaya where he obtained his medical degree in 1985. He served as a medical officer in Hospital Tengku Ampuan Rahimah, Klang for 2 years before being transferred to Hospital University Sains Malaysia (HUSM) where he served for a further 4 years. He was a medical officer in ENT (Ear, Nose and Throat) before his calling to Ophthalmology.

CAREER IN OPHTHALMOLOGY

His career in Ophthalmology started when he was offered to pursue Masters in Surgery (Ophthalmology) in Universiti Kebangsaan Malaysia in 1990. After successfully completing his Masters, he joined Hospital Raja Perempuan Zainab II (HRPZ) as a gazetting specialist and later move on to successfully lead the department from years 1996 until 2010.

CAREER IN VR

In the early 2000’s, there were no VR services in the East Coast of Malaysia. Due to the high volume of patients requiring this service, Dr Zulkifli was awarded a scholarship to train as a VR surgeon. He did his Fellowship in Princess Alexandra Eye Pavillion, Edinburgh UK from 2000 until 2001. After his return, he became the first VR surgeon to serve the East of Malaysia. He began expanding the service with the help of a dedicated team of staff and doctors. Dr Zulkifli is also very passionate about paediatric VR and has been managing these patients here despite their challenging presentations.

FROM DOCTORS TO EVENT MANAGERS: MALAYSIA’S WORLD SIGHT DAY 2020

This year, on the 8th of October 2020, Malaysia celebrated World Sight Day which was hosted by Sarawak Eye Services in Kuching. The coronavirus pandemic-induced lockdown did not dampen the spirit of the ophthalmologists to continue to fight against preventable blindness. 

For the first time in history, Malaysia’s World Sight Day 2020 was celebrated virtually, given the requisite measures of social-distancing in the ‘new normal’. The entire ophthalmology fraternity, from both East and West Malaysia, ’met’ via Zoom teleconferencing and celebrated World Sight Day together despite being separated by the vast South China Sea.

World Sight Day (WSD) is an annual awareness event that is celebrated every second Thursday of October. It is coordinated by IAPB (International Agency of Prevention of Blindness) to raise public awareness on blindness and vision impairment as a major international public health issue. It provides a platform to encourage governments, corporations, institutions, hospitals, societies, and individuals to actively support universal access to eye health.

TREATMENT OPTIONS IN VKH

VKH is an autoimmune, multi-system, granulomatous inflammatory disease involving the eye, auditory, cutaneous and neurological system. The exact mechanism of VKH is unknown. However, it has been postulated to affect an autoimmune response mediated by T-lymphocytes against an antigen found on, or associated with melanocytes. In the past, VKH was classified into: Vogt-Koyanagi disease and Harada disease. Vogt-Koyanagi was characterised by anterior uveitis, alopecia, poliosis, dysacusis and paralimbal vitiligo. Harada disease manifested with posterior segment changes and pleocytosis of cerebral spinal fluid. With Revised International Diagnostic Criteria (Table 1), VKH is now seen as a single disease entity.

The treatment goal in VKH is to suppress the inflammatory response of the disease. Steroid therapy is the first line of immunosuppressive therapy for VKH. Posterior segment involvement requires Intravenous Methylprednisolone followed by oral steroids. Patients with an ocular manifestation of VKH need maintenance therapy of steroids for at least six months. Lai TY et al reported that patients receiving treatment for less than six months were more likely to have recurrences (58.8%) compared to those treated for six months or more (11.1%). Long duration and slow tapering of systemic steroids shorten the duration of the disease, reduce the incidence of extraocular manifestation of VKH and prevent the chronic stage associated with poor visual outcome. Vision-threatening complications such as cataract, subretinal neovascularisation, subretinal fibrosis and glaucoma have been recognized to occur in recurrent and chronic phases. Recurrence could lead to a chronic phase, “sunset glow” appearance and atrophic lesions at the retinal pigment epithelium (RPE).