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OPTOMETRIST NEWSLETTEROCTOBER - DECEMBER 2016

Table of Contents

NO. CONTENT PAGE

1 President’s Message 1

2 BCLA Asia 2

3 1st Asia Optometric Congress & 6th ASEAN Optometry Conference 2016 5

4 World Sight Day 2016 14

5 National Eye Health Awareness (NEHA) Campaign 2016 18

6 Educating Malaysians on how to properly care for their eyes 20

7 National Eye Health Awareness (NEHA) Survey 2016 26

8 Optometrist’s View on Sunglasses 29

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President’s Message

October had always been an exciting month for the optometrists World Sight Day. And this year, AMO had collaborated with Malaysian Optical Council (MOC) to organize the National Eye Health Awareness (NEHA) Campaign 2016.

It was our greatest honor to have Director of Medical Practice Division from Ministry of Health, Dr Ahmad Razid to initiate the Opening Ceremony of NEHA 2016. Besides, we have launched the “JomJumpaOptometris” campaign which is in line with our association mission, whereby “A” for awareness campaign, “M” membership drives and “O” for optometry upgrade.

We had achieved the success of this event, in which a contact lens practice guidelines had been developed and currently in its final phase of refinement and the level of public awareness been investigated and reported in NEHA Survey.We would like to express heartfelt thanks to MOC, all Optometry schools and industrial partners for their continuous support towards the association throughout the year. See you in year 2017!

Mr Murphy Chan Hian KeePresidentAssociation of Malaysian Optometrists

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BCLA AsiaBy June Den

For the first time, BCLA (British Contact Lens Association) held their conference (they call it meeting) in Asia, i.e in Hong Kong. It is going to be held in Asia every alternate year. Thirteen of us from Malaysia attended.

It was held at Cordis Langham Place Hotel. It was 2 full days meeting on a Tuesday and Wednesday of 13th and 14th of September. Lectures, research papers and workshops all run concurrently. Exhibitors were mostly from contact lens and eye drop companies. There was no posters exhibit.

Lectures consist of the latest contact lens products which are not yet launch in Malaysia egMyDay daily disposable myo-pia control lens by Coopervision, Dailies Total 1 multifocal lensesby Alcon, etc.

Dry eye presenter, Professor Michel Guillon from UK was very detailed. Kate Gifford (Australia) lecture is more clinical in approach for dry eye diagnosis and management.

Professor Lu Fan from China and Professor James Wolffsohn from UK talked about presbyopia issues. Lu Fan is an oph-thalmologist, so touched more on surgeries and multifocal IOL. Contact lenses will be an important option for corrections of presbyopia until bionic intraocular lenses that mimic the functionality of natural young crystalline lens are perfected.

In 2015, the mainland population of China has reached 1.4 billion and life expectancy has extended to 74.8 years old. Delaying retirement age will cause great challenges for the management capability of the public health.

Therapeutic contact lenses (TCL) talk was given by Lynne Speedwell who works in Great Ormond Street Hospital for children. TCL acts as a bandage or mechanical support for a wide range of abnormal ocular conditions and always fit-ted on advice of an ophthalmologist who manage the medical aspect and optometrist the lens.

Dr. Stan Isaacs urges optometrist to fit specialitylenses (Soft, RGP, Scleral, Semiscleral and Hybrid) so that patients get the best comfort and vision.

Global prevalence of myopia lecture, presented by Prof Padmaja showed an alarming increase of myopia among the Asians (80% prevalence) especially in South Korea and Taiwan. For example, in Taiwan, high myopia increased from 26% of all myopia in 1998 to 40% of all myopia in 2005. Impaired vision caused by high myopia is a burden to society and country. Spectacles lenses have been shown to have limited efficacy in slowing myopia compared to contact lenses and pharmaceuticals.

Dr. Janis Orr’sstudies in U.K., have shown that pharmaceutical treatment can significantly and predictably reduce myo-pia progression in susceptible individuals.

Findings of a survey of over 1000 eye care practitioners showed that they are generally aware of various methods of myopia control, especially in Asia. Practitioners correctly identified orthokeratology, pharmaceutical agents and outdoor activity as the most effective methods to slow down myopia progression.

Nevertheless, 2/3 of practitioners would still fit conventional glasses or contact lenses citing increased cost (35.6%), the lack of convincing information (33.3%) and unpredictable outcome (28.2%) as the main setbacks.

All in all, this meeting not only touched on studies done in contact lens but related topics like myopia and presbyopia.

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1st Asia Optometric Congress & 6th ASEAN Optometry Conference 2016By Prema Muthiah, BOptom (Hons), MHSc (Clinical Optom), UKM

The first Asia Optometric Congress and sixth ASEAN Optometry Congress were successfully hosted by The Integrated Philippine Association of Optometrists Inc. (IPAO) on 11-12 November 2016 at Marriott Grand Ballroom at the City of Pasay, Philippines. There were over 500 delegates comprises of optometrists, researchers, educators and scholars from over 10 countries participated and benefited.

This biennial scientific conference was initiated by Association of Malaysian Optometrists (AMO), which expanded to include countries from the Asian Region. This year’s theme embodies “Optometry in the Forefront Of Eye Care And Vision Science Amidst Multi-Cultural Diversity” featured scientific sessions, lectures and workshops delivered by most respected and reputable speakers from United States, Australia, Canada, Japan, India and ASEAN countries. The theme was indeed relevant to the global clamor for the implementation of comprehensive eye and vision care program in Asian community in accordance with the World Health Organization aim to control and prevent increasing incidence of preventable blindness among Asians.

The keynote lectures was presented by Dr. Lynn Hellerstein, Mr Thomas Headline and Dr John Abbondanza. Dr Hellerstein has shared their expertise in treating children and adults with learning and reading problems, visual processing deficits, brain injuries and binocular anomalies. Mr. Thomas Headline presented on the importance of vision therapy and neuro-visual rehabilitation for patient population with reduced visual skill function. He discussed and shared his invaluable expertise in improving patient’s quality of life and visual function addressed by vision therapy and provided resources to help participants to develop professional skills and knowledge in specialty practice. Dr John Abbondanza has completed the course by sharing on how optometrist can recognize patients that are suffering from binocular vision problems, to properly diagnose those patients and to manage their conditions with both optical and non optical means. In a nutshell, the speakers have truly inspired the participants to broaden the specialization of Optometrists beyond refraction.

The two days conference also saw paper and poster presentations loaded with valuable information to benefit educators, officials, eye care practitioners, scientists, researchers, faculty and students delivered by presenters from different parts of the globe including Asia and the ASEAN region including Malaysia. There were four oral and poster presenters from Malaysia sharing their studies, namely Professor Emeritus Dr Norhani Mohidin, Ms Prema Muthiah, Mr Lew Wei Hau and Ms Chia Jho Yan.

A gala dinner was held in the evening of the first day of the conference at Marriot Grand Ballroom. Dr Chung Kah Meng, founder of the ASEAN conference from Malaysia presented the history of the Congress. At the dinner multi-cultural diversity was showcased by beautiful and entertaining performances by the Philippines Ministry of Tourism performers. As conceptualized by the ASEAN optometric organizations headed by Malaysia and the Singapore Optometrists Association (SOA) in 2014, the hosting of this event is rotated to different Asian countries and Indonesia was announced as the host for the 2nd Asia Optometric Congress in 2018.

It is undeniable that the first Asia Optometric Congress has created the platform for optometrists to pursue the advancement in profession by improving the quality and availability of eye and vision care. The unselfish sharing of expertise of speakers will definitely benefit in uplifting the practice of Optometry profession and delivery of quality service and at the same time adhering to standards and ethical practices. As the other participants, I truly enjoyed the fun learning, meet and greet with eye care professionals from different parts of the worlds and made new friends during the conference.

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Oral presenters Ms Prema and Mr Lew from Malaysia

Malaysian delegates Group photo with Dr John Abbondanza and performers from Ministry of Tourism Philippines

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World Sight Day 2016By Ms Karen Yu, member of the Committee for Wellness and Prevention of Blindness under the umbrella of Sarawak Society for the Blind

KOTA SAMARAHAN: With the theme ‘Stronger Together’, World Sight Day 2016 has united the public and private sec-tors of healthcare to deliver a successful collaboration in the form of a free vision screening and health check held on October 2nd 2016 at the Summer Mall, Kuching, Sarawak.

Together, Klinik Mata Hospital Umum Sarawak, Klinik Kesihatan Kota Samarahan, the Sarawak Society for the Blind Kuching Branch (SSBKB) and the Committee on Wellness and Prevention of Blindness (CWPOB) had the involvement of specialist doctors, medical officers, nurses and optometrists to provide visual acuity checks, retinal health examinations and general health assessments which included blood pressure and blood glucose measurements.

Parked near the mall entrance was the iconic Klinik Katarak 1 Malaysia (KK1M) bus which definitely piqued interests of passing traffic. There was also a crowd-gathering performance by the Blind Band on stage. They played an array of songs, impressing mall patrons while massages by the blind were being delivered offstage.

It was encouraging to see a vast spread of ethnicities at the screening as it serves a wonderful reminder of how multi-cultural we are in Sarawak. More than half of those screened were aged 40 and above while 14% of total patients screened were referred on for further management with majority of the cases being cataracts. The health checks defi-nitely raised public awareness regarding their general health as some were tested to have high blood pressure and/or diabetic tendencies.

screening result is summarised as below:

Total Screened: 51 male, 74 female = 125

Age Distribution: 1 to 39 years old = 52; >40 years old = 73

Ratio of Ethnic Groups: majority were Malay, then Chinese, Iban and Bidayuh

Cases for Referral: Cataract= 11 cases, Keratitis=1 case, Pterygium=5, Refractive error=23

Review of the Nidek RS-330 Duo OCT Author: Sara Challinor Published: 18/03/2015

The latest incarnation of the Retina Scan (RS) OCT from Nidek (distributed in the UK by Birmingham Optical) is likely to turn a few heads at the forthcoming Optrafair event in April. I was fortunate enough to have a brief look at a prototype instrument at last year’s SCLOSS conference (Optician 30.01.15) and liked what I saw. When I heard an old colleague of mine had just had delivery of the full version, I invited myself to Dr Sandip Doshi’s practice to try out the machine (Figure 1).

The Duo boasts a number of new features, most prominently as suggested by the name, a near seamless combination of fundus camera (full colour for the first time, and also with autofluorescence capability) and spectral domain OCT. Immediately, you are struck by its compact design and integrated touch screen control pad which, even hooked up to the adjacent computer, offers a reasonable footprint for most busy practice spaces.

Clinical advantage

I am sure most readers are familiar by now with the benefits of having an OCT in primary care practice. It allows accurate assessment of retinal structure, along with options for anterior anatomy assessment, and so helps in the detection and monitoring of a broad range of eye diseases. High resolution scanning allows detailed measurement of retinal layer thickness, visualisation and analysis of individual lesions or anatomical variations, and important functions such as disc assessment, retinal nerve fibre and ganglion cell layer assessment, measurement of anterior chamber angle, corneal pachymetry mapping to name but a few. The accuracy of the instruments means that intra-machine repeatability is very high and serial scans are very sensitive to changes in structure that may signify the very earliest signs of diseases such as glaucoma. I have, for example, using OCT, found a number of suspect (and subsequently confirmed) glaucoma patients who had no detectable field defects even on full threshold assessment. Asymmetry of tissues and changes over time raised enough doubt to trigger a report to secondary care and intervention at an earlier stage of the disease helped limit the damage of glaucoma.

Figure 1 Figure 2 Figure 3

The RS Duo takes all of these functions in its stride (see later article for a gallery selected from our session). The RS Duo also incorporates a 12-megapixel 45-degree non-mydriatic camera capable of excellent quality images of the retina (Figure 2) or, indeed anterior eye if appropriately set. I also like the inclusion of autofluorescence. As a weakly pigmented Celt now hitting a half century and with a history of some exposure to tobacco products, I am interested in the early detection of any evidence of maculopathy. Autofluorescence imaging shows any atrophic or damaged tissues as black against the normal grey coloured retina. However, lipofuscin, as might build up in early maculopathy, often is seen concentrated around areas of atrophy as brightly shining areas. The technique offers a useful clue as to who might benefit by discussion of risk factor avoidance and further, fine-tuned, monitoring (Figure 3).

Ease of use

The RS Duo really shows itself as a major new player, however, when you come to use it. Once programmed to undertake any specific sequence of OCT data capture or imaging, the machine is, in essence, a one-touch operation system. It incorporates an auto setting (which can, obviously, be over-ridden when the view is difficult, such as with pupils of 2mm or with a less than stable patient) which, once aligned even approximately, positions and focuses to provide the optimal capture. When OCT data is taken, a fairly typical colour scale signals a scale from 1 (in red representing poor detail) through to 10 (green, optimal capture). During my brief clinic session, I did not once manage a scoring of less than 7, even when not really trying!

The essence of the one-touch approach is that capture can be delegated to any trained member of staff in a busy clinic, perhaps in pre-screening, and thus free up more time to analyse the data and explain findings to a patient within the consulting room. Data transfer is simple with this system, either through hardware means of memory transfer or via Wi-Fi linkage (exploiting the Navis-Ex software on the adjoined network linked computer).

Figure 4 Figure 5 Figure 6 Setting a combo

Dr Doshi had already pre-configured his machine to run through a pre-set sequence of capture that best suits his clinic. The ‘combo’ setting enables you to select whichever OCT scans you wish, applicable perhaps for macular disease or glaucoma, along with a fundus image (Figure 4). You are still able to individually set up for each patient from the list of scans and imaging options (colour or autofluorescence or anterior, for example), but the combo setting might be best if delegating screening. OCT options are various, such as the high resolution single line scan (Figure 5), a macular cross (Figure 6), a macular map, which would allow a volume scan of the central retina and enable a 3D visualisation, always guaranteed to wow the patient (Figure 7), and so on.

Our combo undertook four tasks; single line, macular cross, macular map and disc scan. Even with fundus image added, the process per eye is a minute or so at most. After each capture you save or repeat on the touch screen to ensure the end result is up to requirements for any one patient. Once saved at the end, analysis of the data can begin. This includes the usual disc analysis, represented as a two-peak retinal nerve fibre layer map, or segmented disc arrangements, along with thickness maps that can all be layered to individual segments (such as ganglion cell layer) and coded to reveal comparison with a normative database. Deviation maps show change from the norm and may also be used for serial monitoring. A follow-up article showing some of these analyses from our session will appear in Optician in the next few weeks.

Anterior options

As somebody with a very low van Herick grading yet a perfectly patent angle when viewed with OCT, I have always been impressed with anterior OCT functions. The Duo has an anterior adaptor lens and head rest allowing excellent quality pachymetry (Figure 8) and angle assessment (Figure 9).

All in all, I would suggest the RS Duo is an excellent new addition to the OCT market and one which anybody should be able to use to great effect with the minimum of technical ability. Of course what you do with this high quality data is down to your professional abilities.

Figure 7 Figure 8 Figure 9

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National Eye Health Awareness (NEHA) Campaign 2016

Every year hundreds of activities are planned and executed globally on World Sight Day, including Malaysia. This year, the Malaysian Optical Council (MOC), a division of Ministry of Health (MOH) had collaborated with Association of Malaysian Optometrists (AMO) to organize the National Eye Health Awareness (NEHA) Campaign on 21st to 23rd October 2016 at South Court, Mid Valley Megamall. In line with the theme, “Jom, JumpaOptometris!”, the objective of this campaign was to create public awareness about “Optometrist” and “Primary Eye Care”.

This campaign highlights essential services in “Primary Eye Care”.Primary eye care is the “provision of appropriate, accessible, and affordable care that meets patients’ eye care needs in a comprehensive and competent manner” (AAO, 2014). Optometrists are healthcare professionals who are licensed to provide primary vision care services ranging from vision testing and correction to the diagnosis, treatment, and management of vision related problems. Being a primary eye care practitioner, optometrist often standing at the frontline to meet patient with eye-vision-related complaints as well as providing continuing care and management. Primary eye care aims to deliver affordable services to all and raising adequate awareness about eye health through health education.

In this 3 days campaign, a full range of primary eye care services were well-displayed and demonstrated to the public with 8 basic booths, namely (1) History Taking, (2) Refraction, (3) Binocular Vision, (4) Colour Vision, (5) Anterior Eye Ex-amination, (6) Intraocular Pressure, (7) Fundus Examination and (8) Consultations for ophthalmic prescription and contact lens prescription. A series of eye health related programme and public talks will be conducted throughout the days.

In conjunction with NEHA, MOC have launched the contact lens practice standard guidelines to the eligible contact lens fitters in Malaysia. This is to standardize the contact fitting and dispensing procedures across the profession by creating a simple protocol on prescription, dispensing, after care and replenishment with collaboration of Vision Care, a division of Johnson & Johnson Sdn Bhd.Also, AMO officially sanctioned a nationwide survey in collaboration with Essilor (M) Sdn Bhd to evaluate public perception towards Optometrist and Primary Eye Care services in Malaysia.

With the efforts from the ministry, universities, practitioners and industrial partners, we hope public awareness level towards the optometry profession can be upgraded! Together we can!

Written by,Tan Xuan LiEditor, AMO Newsletter

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Educating Malaysians on how to properly care for their eyes‘Jom Jumpa Optometris’ roadshow highlights of the optometrists in helping us preserve our sight

Kuala Lumpur, October 22, 2016 – The Association of Malaysian Optometrists (AMO) and Malaysian Optical Council (MOC) jointly organized the ‘Jom Jumpa Optometris’ roadshow, which was held over the weekend in Midvalley Mega-mall. Aimed at driving home the message on the importance of proper eye care among Malaysian, the three-day road-show included a series of education talks and personal tips from optometrists on the right procedures of caring for ones’ sight. The event was officiated by Dr Ahmad Razid bin Salleh, Director of Medical Practice Division from the Ministry of Health Malaysia.

“The AMO and MOC have been working in tandem on a month-long series of activities to highlight the importance of eye care health among Malaysians. Under the umbrella of the National Eye Health Awareness 2016 campaign, we also aim to raise the level of awareness of the significant role of an optometrist in ensuring that the public know and understand that eye care is not just about getting a prescription but a long-term process of caring for their sight,” said Murphy Chan, President, Association of Malaysian Optometrists.

He added that sight is the sense which people fear losing most and yet many Malaysians shy away from visiting an optometrist. “An optometrist is the primary line of contact when it comes to eye health. A simple eye examination can detect problems with ones’ eyes that could lead to possible vision impairment and other underlying general health conditions, such as early diabetes, high cholesterol and high blood pressure, hence, regular visits to the optometrist is an essential part of one’s overall health care.”

The National Eye Survey conducted in 2014 indicated that the major cause of visual impairment and blindness in Ma-laysia is attributed to 68%,cataract, 14% caused by uncorrected refractive error, 6% fromdiabetic retinopathy and 3% caused by glaucoma.

“To date, there are more than 1,711 registered optometrists in Malaysia and they play a pivotal role as front-liners who can detect and prevent eye diseases from worsening,” said Puan Nor Azizah Bt Ismail, Secretary, Malaysian Opti-cal Council.

She added that “the Ministry spends millions of ringgit a year on measures to cure, prevent or restore sight for Malay-sians, hence imagine the amount of money they would save, if the public played their part and visited an optometrist on a regular basis.”

In recent years, Malaysians have been exposed to eye problems related to use of counterfeit contact lenses. In view of this, both AMO and MOC have been working closely with the Ministry of Health to put in place a contact lens practice standard that mandates all qualified lens practitioners to provide high standards of eye examination. This is to ensure that each consumer not only purchases the right type of lenses but will enjoy a clear, comfortable and healthy wear.

“The guidelines are put in place to also protect consumers from substandard lenses that are readily available from ille-gal sources.Consumers are ignorant to the hazards surrounding counterfeit lenses and much education is needed to cre-ate awareness around the dangers of these lenses. Hence, the Ministry will work closely with AMO and MOC to ensure that the public are kept in the know of,” said Dr Ahmad Razid bin Salleh, Director of Medical Practice Division, Ministry of Health Malaysia.

He added, “On a Ministry level, we are working with relevant parties to monitor and act on any malpractices in re-gards to counterfeit contact lens, in order to safeguard Malaysians from further damages to their sight.”

The month-long National Eye Health Awareness campaign also includes a nationwide survey to gauge the public’s per-ception on proper eye care. Results from this survey will be published in November 2016.

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To participate in the survey, click here: https://www.surveymonkey.com/r/C38HXF5

For more information on the ‘NEHA 2016, please check out: http://www.amoptom.org

Social mediaFacebook: https://www.facebook.com/AssociationofMalaysianOptometristsTwitter: @Optometry_Msia

Malaysian Optical Council (MOC)The Malaysian Optical Council (MOC) was established on 1st February 1992. MOC is responsible in the registration of optometrists and opticians in Malaysia. MOC is also given the responsibility of monitoring the optometry services and practices in Malaysia according to the Optical Act 1991 and Optical Regulations 1994.

Association of Malaysian Optometrists (AMO)AMO is the registered professional body in Malaysia, which represents the Optometry and Eye Care profession. The association was formed in February 1984 and consists of more than 450 members throughout Malaysia. AMO em-bodiesa pool of primary eye care professionalswho can recognize eye problems and plan a proper course of therapy related to the eye or carry out the appropriate referrals. Through this association, eye care professionals have banded together to promote and encourage proper eye care health and preservation of sight for all Malaysians. All eye care practitioners in Malaysia must be registered with the Malaysian Optical Council (Optical Act 1991) under the purview of the Ministry of Health, Malaysia.

Media Contact:Geraldine WongMedia Mob Malaysia+6011 1166 5086geraldine@mediamob.my

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Bausch+Lomb Ultra – Breaking the Cycle of DiscomfortProfessional Services Team

It is estimated that there are more than 140 million contact lens wearers worldwide with an estimated sales of approximately USD7.6 billion globally (Nichols 2014). Despite this healthy trend, one of the major issues related to contact lens wear is dropout, largely due to contact lens discomfort (CLD). “Contact lens discomfort is a con¬dition characterized by episodic or persistent adverse ocular sensations related to lens wear, either with or without visual disturbance, resulting from reduced compatibility between the contact lens and the ocular envi¬ronment, which can lead to decreased wearing time and discontinuation of contact lens wear” (Nichols et al, 2013). While the advances in contact lens materials and designs are intended to expand the number of lens wearers, improve the patient wearing experience, and reduce the likelihood of patients dropping out of contact lenses, consumer research indicates that the number of contact lens wearers considering dropping out of contact lenses has been increasing (Gallup, 2013).Studies reported that between 12 percent and 51 percent of contact lens wearers drop out of contact lens wear with CLD the primary reason for discontinuation (Nichols 2013).

Figure 1: Contact lens drop out based on Gallup 2013 study.

According to a report in the United States (US), more than 55% of users were found to utilize some form of

digital devices varying from smart phones, laptop, tablet or computer (Pew Research, 2014). With increased visual concentration when using digital devices, the blink rate decreases from 15 times to 5 times – leading to increased partial blinking and reduced tear break up time (Cardona et al, 2011; Chu et al, 2014; Himbaugh et al, 2009; Jansen et al, 2010; Patel et al, 1991; Portello et al, 2013). This leads to symptomatic contact lens wear.

Figure 2: MoistureSeal technology consists of a two-phase polymerization.

Despite continuous improvement of contact lens manufacturing technology, contact lens dropout due to discomfort persists. Bausch and Lomb Ultra withMoistureSeal technology is created with comfort as a priority. The lens is manufactured through a curing chamber that uses radiant energy to polymerize the lens material in two distinct phases, which is a process unique to the technology. The first phase creates a matrix that has a combination of long- and short-chain silicone molecules. The longer chains are responsible for the lower modulus, while the short chains increase the Dk/t (Kading 2014). The second phase of the polymerization process grows polyvinylpyrrolidone (PVP, a water-loving polymer) around the meshwork of long- and short-chain silicone molecules.

Figure 3: Two-phase polymerization - (1) Formation of silicone backbone; (2) Incorporation of PVP into the monomer of the lens.

PVP is a common wetting agent that is used in contact lenses and eye drops to increase wettability and moisture retention. This process of growing the PVP around the chains is unique; other processes wrap silicone around fully formed PVP. As a result, MoistureSeal technology reportedly has four times more PVP compared to other silicone hydrogels. B+L believes that this process of growing PVP will help to keep moisture on the surfaceof the lens and away from the hydrophobic silicone, which, as we all know, is the major challenge for all silicone hydrogel lenses. B+L reports that the Ultra lens achieves a high level of both overall and end-of-day comfort while exhibiting a very low level of deposition at the end of the monthly wearing cycle.

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Figure 4: Different approaches for PVP entanglement: (A) Fully formed PVP integration with silicone (B) PVP grown around a silicone backbone via MoistureSeal Technology resulting in 4x more PVP.

The water-loving polymer PVP is grown perma¬nently around the silicone matrix in order to “hide” the hydrophobic silicone and to hold water through¬out the bulk and at the surface of the lens. The PVP in Bausch + Lomb Ultra contact lenses brings high water and wettability everywhere on the lens and not just at its surface. MoistureSeal technology also helps Bausch + Lomb Ultra contact lenses retain this high level of water throughout the day (Wygladacz et al 2014).

A wettable contact lens surface is essential to reduce friction and surface deposition and to improve optical quality and comfort. Two common assessments used to evaluate contact lenses at the surface involve mea¬suring wetting angles and coefficients of friction. These assessments provide insights regarding the interactions between the lens, the tears, and the eyelid when the lenses are worn. When silicone’s hydrophobic struc¬ture is more prominent at the surface of the lens, the contact angle and coefficients of friction values are

higher (Read et al, 2011; Jacob, 2013). Polymer chemistry and manu¬facturing processes, such as MoistureSeal technology play an important role in mask¬ing the silicone structure for improved wetting.

Figure 5: B+L Ultra showed significantly lower static coefficient of friction than competitor products.

Other measures of comfort include the surface smoothness.

During contact lens wear, friction and wearing down of the surface are undesirable characteristics that can impact the patient experience. A smooth, du¬rable surface is essential for spreading the tear film, reducing friction, and providing precision optics. MoistureSeal technology delivers a lens that with¬stands the rigors of a planned replacement lens wear schedule. To demonstrate the smoothness and dura¬bility of the Bausch + Lomb Ultra lens surface, Atom¬ic Force Microscopy (AFM) and X-ray Photoelec¬tron Spectroscopy (XPS) were used to evaluate the morphology, roughness, and elemental composition of new (unworn) Bausch + Lomb Ultra, Senofilcon A, Comfilcon A, and Lotrafilcon B contact lenses (Wygladacz et al, 2014).

Comfilcon A-new

Comfilcon A-cycled

Senofilcon A-new

Senofilcon A-cycled

Lotrafilcon B-new

Lotrafilcon B-cycled

Figure 6: B+L Ultra showed significantly smoother surface with the Atomic Force Microscopy.

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A brief study of 341 subjects found that the subjective comfort of subjects among those upgraded from their habitual lens was much more superior (Steffen et al 2014). The study was a prospective, single arm, open-label clini-cal study. Independent eye-care practitioners from 22 investigational sites enrolled patients. Institutional review board approval was obtained for the study, and patients signed an informed consent form included in the study, patients needed to:• Spend at least 3 hours each

workday using a computer or electronic device (i.e. smartphones, tablets, eReaders)

• Subjects were myopic and required lens correc¬tion from -0.25 D to -6.00 D in each eye

• Have worn their current lens brand for a mini¬mum of one year

• Wear their current lenses for a minimum of 12 hours per day at least four days per week

• Be between the ages of 18 and 35 years

• Have <= Grade 1 for corneal and conjunctival assessments (see below)

• Be absent of any corneal infiltrates

Patients were re-fitted to Bausch + Lomb Ultra contact lenses with MoistureSeal technology and Biotrue multi-purpose solution for 2 weeks. After the first seven days of product use, subjects responded to a Web-based subjective assessment. Three hundred forty one silicone hydrogel patients were enrolled: 132 senofilconA patients, 130 Lotrafilcon B wearers, and 79 Comfilcon A wearers. Average age for the study pop¬ulation was 26.8 years with 69.5% being female and 30.5% male. The median refractive sphere and cyl¬inder power was -3.25 D and 0.00 D, respectively. The average daily wear time with habitual lenses was 13.9 hours. During a typical day, the study pop¬ulation spent an average of 4.8 hours using a com¬puter/laptop at the office and an average of 1.9

The presence of four times more PVP enabled better water retention. A study to compare the ability of dehydration blur of different lenses found B+L Ultra to be more effective in prevention of dehydration blur (Hovinga et al 2014).

The increased use of digital devices in today’s society has made it more important than ever to address lens dehydration. This was tested by focusing an optical imaging system to the USAF 1951 target as a representation of the LogMAR chart.

Figure 9: The USAF chart 1951 used as a target to represent the LogMAR chart.

With better moisture retention, visual quality and comfort through the new MoistureSeal technology innovation, B+L Ultra promises greater chance of lens wear success in the current digital activity dominated world.

hours at home, Table 3. In addition, other digital devices (smartphone/tablet/e-Book) were used an average of 3.1 hours. Playing electronic games was reported to have the least amount of activity of those surveyed.

Figure 7: B+L Ultra were preferred for comfort over the habitual lens of subjects.

The same group of subjects also found B+L Ultra to provide better vision than their habitual lenses with incorporation of aspheric optics.

Figure 8: B+L Ultra were preferred for visual quality over the habitual lens of subjects.

Figure 10: B+L Ultra demonstrated superior dehydration resistance in comparison of competitor products within 30 seconds between blinks.

Senofilcon A

Lotrafilcon B

Comfilcon A

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4. Jansen LMC, GispendeWied CC, Wiegant VM, Westenberg HGM, Lahuis B, van Engeland H. Autonimic and neuroendocrine responses to a psychosocial stressor in adults with Autistic Spectrum Disorder. Journal of Autism and Developmental Disorders. 2006; 36:891–899.

5. Patel, S., Henderson, R., Bradley, L., Galloway, B., & Hunter, L. 1991. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci, 68(11), 888-892.

6. Portobello et al .2014. Blink Patterns: Reading from a Computer Screen versus Hard Copy. Optometry and Vision Sciences. Vol 91(3): 297-302.

7. Nichols J. Contact Lenses 2014. Contact Lens Spectrum. 2015 January8. Nichols KK, Redfern RL, Jacob JT, et al. The TFOS Interna¬tional Workshop on Contact Lens Discomfort Report of

the Definition and Classification Subcommittee. Invest Ophthal¬mol Vis Sci. 2013; 54(11): TFOS14-19.9. The 2013 Gallup Study of the U.S. Consumer Contact Lens Market.10. Device Ownership Over Time, Pew Research Center’s Internet & American Life Project. 2/15/2014. Available at:

pewinternet.org/data-trend/mobile/device-ownership/11. Kading D. 2014. New Lens Technology Target improves Vision & Comfort. Contact Lens Spectrum May 2014. Vol.

29.12. Wygladacz K., Hook D., Steffen R., Reindell W. 2014. Breaking The Cycle of Discomfort. Contact Lens Spectrum

Special Edition 2014. Pp. 23-24.13. Read ML, Morgan PB, Kelly JM, Maldonado-Codina C. Dynamic contact angle analysis of silicone hydrogel contact

lenses. J BiomaterAppl 2011;26(1): 85-99.14. Jacob JT. Biocompatibility in the development of silicone-hydrogel lenses. Eye Contact Lens 2013;39(1):13-19.15. Hovinga et al. 2014. Preventing Dehydration Blur. Contact Lens Spectrum Special Edition 2014.16. Steffen et al. 2014. Clinical Performance of Samfilcon A Silicone Hydrogel Contact Lenses. Contact Lens Spectrum

Special Edition 2014.

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National Eye Health Awareness (NEHA) Survey 2016

In conjunction with the World Sight Day 2016, Malaysian Optical Council (MOC) and Association of Malaysian Optom-etrists (AMO) had launched the National Eye Health Awareness (NEHA) Survey 2016 from September to November. This online survey was hosted by AMO and being sponsored by Essilor (M) Sdn Bhd with the objective to understand awareness of Malaysian in terms of “Primary Eye Care’ and “Optometrist”.

A total of 2,033 respondentswere recruited by AMO members, optometry students and industrial partners throughout the 3 months duration.The demographic details including their gender, age, race, education background and state of origin were recorded. Below are the summary of the survey results:

NO. QUESTION RESULTS

1 Do you want someone who is trained and qualified to check your eyes?

2 Do you want optical shops to provide eye health check besides “eye power”?

3 Do you ask for a qualified and licensed person to check your eyes when you go for an eye test?

4 Do you know that the person who checks your eyes must have a professional practicing license issued by the Ministry of Health Malaysia on a yearly basis?

5 Like in any other professional services, are you aware that there are professional fees charged for an optometric examination and consultation by qualified eye care practitioner?

From the survey, we concluded that close to 100% of Malaysian would like to have their eyes taken care by eye care professionals. However, lesser of them have the general knowledge about professionalism and general awareness.

A series of public awareness campaign about eye health and care would help to increase the level of public awareness towards the profession, e.g.: awareness campaign, primary and secondary school eye screening. Also, universities and industrial partners had organize series of continuing development programme to provide trainings, seminar and work-shop in order to producequalified and competent eye care professionals with updated knowledge and skills to serve the community better.

Written by,Tan Xuan LiEditor, AMO Newsletter

YES97%

YES95%

YES80%

YES71%

YES63%

revolutionary new design RGP contact lensrevolutionary new design RGP contact lens

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Oxygen Permeability [ Dk ] 125×10-11

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Refractive Index 1.44

Light Transmittance 88%

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Tel: 03-5120 1000 / HP: 012-3939 384 (Mr. Ng)email: optolab@outlook.my

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Existing lens

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Bevel width of a standard 8.8mm lens= 0.6mm Diameter of optical zone= 7.6mm.

When I came across this brand of contact lens, I let my wife try a pair for a

month. She felt comfortable throughout. I am now fitting this CL regularly to my

patients who wants longer wearing hours as I know the eye health benefits it can

bring in long term.

Ahmad Fuzai (Vice President of AMO and practice owner)

I have a patient, male in his late 20s who wanted CL but warned me that he had

tried many brands of CL but was unsuccessful. I prescribe him with Hoya Airy and

he immediately felt the comfort upon insertion. He is now wearing Hoya Airy regu-

larly and has become my loyal customer. To build a successful practice, I see the

need to differentiate and avoid CL that have been commoditize and Hoya Airy is

able to give me that alternative.

Christina Tan (Secretary of AMO and practice owner)

I have been fitting Hoya Airy ever since I started my practice a few months back.

Patients respond are good and I have 100% success rate with proper fitting evalua-

tion. It is also the best option for a new practice like mine because it does not give

me pricing problems and I am able to differentiate my practice and build customer

loyalty by leveraging on the Hoya brand.

Muhd Syukri (Asst. Secretary of AMO and practice owner)

Tel: 03-5120 1000 / HP: 012-3939 384 (Mr.Ng)email: optolab@outlook.my

Picture for illustration only.

29

Optometrist’s View on SunglassesBy Muhamad Syukri bin Mohamad Rafiuddin, B. Optom. (Hons.) UiTM. Muhamad Syukri is currently pursuing Ph.D by research in Universiti Teknologi MARA Selangor and practicing in MATA by Optometrist, Bandar Puncak Alam, Selangor Darul Ehsan. He is also the Assistant Honorary Secretary for Association of Malaysian Optometrists (AMO).

Malaysians can buy sunglasses from various sources including optical outlets, clothing retailers, fashion boutiques, supermarkets, pharmacies, online stores and “pasar malam”. The existence of these varieties of retailers not only provided consumers with a wide range of products but also exposed them to dangers of defective or illegal products.Apparently, there is no current standard in Malaysia on sunglasses. Sunglasses sold in Malaysia did not have to go through proper certification or standardization prior entering the market. Imported and original sunglasses from established companies had complied with either European [1], Australian [2] or American [3] standard but there are a lot of fake sunglasses out there that may or may not follow the standard.

Standard for SunglassesWhile there are various standards and guidelines on sunglasses issued by different countries, Malaysian authority may want to follow the International Organization for Standardization (ISO) standard on sunglasses: ISO 12312-1:2013[4]. In the ISO document, sunglasses can be divided according to different usage categories including fashion accessory, medical device, sports item and eye protectors. Different usage will lead to different requirement for its users. However, one of its primary requirements is ultraviolet (UV) protection through limiting UV transmittance into the eye. Nonetheless, there are various other requirements for daily use of sunglasses that should not be overlook including its refractive power, robustness, protective requirement, resistance to solar radiation, resistance to ignition and resistance to abrasion. Failure to follow the requirements (not only requirement for UV protection) by this standard may result in harmful conditions for sunglasses’ consumers.

Claims on UV ProtectionBased on my simple search through the internet, various news reports had claimed that even the cheapest sunglasses bought on the street have total or near total UV protection.[5]However, the reports also noted that about 10% of sunglasses in the market may not have appropriate UV protection. Nevertheless, the values of UV transmittance of sunglasses and lenses can now be identified using a simple spectrophotometer that usually available in Optometry practices and optical outlets across Malaysia. Consumers can always insist on purchasing proper sunglasses at these outlets or visit them to check for UV protection of the sunglasses they bought from somewhere else.

Pupil Dilation Due to SunglassesVarious researches had shown that sunglasses caused significant pupil dilation for human eyes.[6,7,8] The pupil dilation had enabled larger amount of UV light to enter the eyes, hence increasing the risk factors for ocular diseases. However, sunglasses with UV protection minimized these risks while those without adequate UV shield are not. In addition, sunglasses with better face wrap characteristics provide better protection against UV radiation. See also Side Note.

Guidelines and Regulation of Sunglasses in MalaysiaFor Malaysia, there are various authorities that may need to sit together with the stakeholders e.g. associations, retailers, practitioners and consumers for discussion on this issue. Among them are Ministry of Health (MOH)’s Medical Device Authority (MDA), Ministry of Science, Technology and Innovation (MOSTI)’s SIRIM, Ministry of Human Resources’ Department of Occupational Safety and Health (DOSH) and Ministry of Domestic Trade, Co-Operatives and Consumerism (KPDNKK). I would like to highlight the importance of each agency towards sunglasses standard in Malaysia as below:

30

Table 1 Agencies’ roles and the reasons for their involvement in sunglasses standards and regulations.AGENCY ROLES REASONS

Medical Device Authority Sunglasses should be included as medical device. Regulation and enforcement of sunglasses as medical device.

Claims by sunglasses manufacturers and retailers that among the benefits of wearing them is “preventing” cataract and slowing the progression of ocular disorders e.g. pterygium. The word “prevent” from causing ocular condition is enough to justify inclusion of sunglasses as medical device. This is because among medical device definition as stated in Section 2 of Act 737 (Medical Device Act 2012) is “any instrument for human beings for the purpose of diagnosis, prevention, monitoring, treatment or alleviation of disease”.

SIRIM Developing a standard or guideline for sunglasses including classification, labelling, usage and minimum requirements e.g. UV transmittance and robustness.

Create a certification and measurement laboratory for spectrum-based science e.g. photometry, spectrophotometry and radiometry.

While ISO standard had already used by many countries, Malaysia should also set its own criteria for its population.

Currently, there is no laboratory in Malaysia including in SIRIM can perform internationally recognized certification in these area of studies.

DOSH Enforcement or guidelines on proper uses of sunglasses for high-risk workers e.g. oil rig workers, workers in aviation and maritime sectors.

DOSH should take proactive steps to ensure the best welfare for the workers.

KPDNKK Regulation of sunglasses retailer including those at night market and online sellers as sunglasses can also be classified as fashion accessories.

Proper regulation on sunglasses will lead to better protection for the consumers.

RecommendationFor my part as an Optometrist, I would like to suggest that Malaysians should check their sunglasses’ UV transmission at local Optometry store, which may have the appropriate testing equipment (simple spectrophotometer) to do so. By doing so, the public will know whether their sunglasses are hazardous or not, in term of excessive UV exposure. Last but not least, Optometrists should advise the public on the followings:1. Look for sunglasses that block 99% or 100% of all UV light. UV absorption up to 400nm is equal to 100% UV

absorption.2. Lens color and degree of darkness provide no indication of UV protection.3. Larger frames, wraparound and closer fitting styles provide better protection from stray light.4. A higher price tag does not guarantee quality. Cheaper sunglasses can offer superior eye protection over

expensive counterparts.5. Polarized lenses help cut glare, but do not add sun protection.6. If your sunglasses are old, ask your Optometrist to test their UV protection.7. Always seek original sunglasses rather than the fake one to avoid unnoticeable harm.

31

ConclusionSunglasses in Malaysia, should at best interest of the public, be regulated or at least a minimum standard or requirements are set for the retailers. The fact is UV radiation caused long term irreversible damage to the eye and will cause the government millions of ringgit to treat these UV-related conditions as the population is aging. In short, prevention in the form of good sunglasses is better than cure.

References:[1] European Sunglass Standard: EN 1836 Personal Eye Equipment – Sunglasses and Sunglare Filters for General Use and Filters for Direct Observation of the Sun. This standard had been replaced by ISO standard. http://www.bureauveritas.com/wps/wcm/connect/d20b706b-e2c5-44ab-80a2-f6b5eceff77c/Bulletin_13B-152.pdf?MOD=AJPERES[2] Australian Sunglass Standard: https://www.productsafety.gov.au/content/index.phtml/itemId/973556[3] US Sunglass Guidelines by FDA: http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm073952.pdf[4] ISO on Sunglasses: https://www.iso.org/obp/ui/#iso:std:iso:12312:-1:ed-1:v1:en[5] News reports on sunglasses effectiveness to protect against UV ray: a) http://www.dailymail.co.uk/health/article-2374185/Are-cheap-sunglasses-safe-We-asked-eye-expert-analyse-cut-price-shades.html, b) https://www.youtube.com/watch?v=yywGRtppRA8 c) http://www.ksat.com/content/pns/ksat/news/2013/07/16/expensive-cheap-sunglasses-put-to-uv-test0.html[6] Hoover, H. L. (1987). Sunglasses, pupil dilation, and solar ultraviolet irradiation of the human lens and retina. Applied optics, 26(4), 689-695.[7] Sliney, D. H. (2001). Photoprotection of the eye–UV radiation and sunglasses.Journal of Photochemistry and Photobiology B: Biology, 64(2), 166-175.[8] Rosenthal, F. S., Bakalian, A. E., Lou, C. Q., & Taylor, H. R. (1988). The effect of sunglasses on ocular exposure to ultraviolet radiation. American journal of public health, 78(1), 72-74.[9] Cruickshanks, K. J., Klein, B. E., & Klein, R. (1992). Ultraviolet light exposure and lens opacities: the Beaver Dam Eye Study. American journal of public health, 82(12), 1658-1662.[10] Parisi, A. V., Green, A., & Kimlin, M. G. (2001). Diffuse Solar UV Radiation and Implications for Preventing Human Eye Damage¶. Photochemistry and photobiology, 73(2), 135-139.[11] Taylor, H. R., West, S. K., Rosenthal, F. S., Muñoz, B., Newland, H. S., Abbey, H., & Emmett, E. A. (1988). Effect of ultraviolet radiation on cataract formation. New England Journal of Medicine, 319(22), 1429-1433.[12] Taylor, H. R. (1989). Ultraviolet radiation and the eye: an epidemiologic study.Transactions of the American Ophthalmological Society, 87, 802.[13] Taylor, H. R., West, S., Muñoz, B., Rosenthal, F. S., Bressler, S. B., & Bressler, N. M. (1992). The long-term effects of visible light on the eye.Archives of Ophthalmology, 110(1), 99-04.

Side Note:

Effects of UV Radiation on Human EyesThe sun supports all life on our planet, but its life-giving rays also pose dangers. The sun’s primary danger is in the form of Ultraviolet (UV) radiation. UV radiation is a component of solar radiation, but it can also be given off by artificial sources like welding machines, tanning beds and lasers. If the eyes are exposed to excessive amounts of UV radiation over a short period of time, they will literally burn. This is called photokeratitis. Like a “sunburn of the eye”, photokeratitis may be painful and include symptoms such as red eyes, a foreign body sensation or gritty feeling in the eyes, extreme sensitivity to light and excessive tearing. Fortunately, this is usually temporary and rarely causes permanent damage to the eyes. Long-term exposure to UV radiation, however, can be more serious. Scientific studies and research have shown that exposure to small amounts of UV radiation over a period of many years increases the chance of developing ocular lens opacity and may cause damage to the scleral conjunctiva, the white part of the frontal eye, and retina, a nerve-rich lining of the eye that is used for seeing.[7,8,9,10,11,12] Among the ocular disorders that were caused by long term exposure to UV radiation are pinguecula, pterygium, cataract, retinal degeneration, retinal cancer and macular degeneration. These conditions at minimum caused irritation and discomfort for entire life while at maximum caused irreversible blindness.