Dear MSO Members,
 
On behalf of the MSO Committee I would like to wish all our members a healthy and happy New Year in this 2019. It has been another fruitful year for the society in 2018 with one of the greatest milestones being the formation of the Malaysian Journal of Ophthalmology (MyJO), a free online quarterly journal published by Kugler Publications. MyJO is the official journal for the MSO and other boards in the Ophthalmology fraternity such as the College of Ophthalmologists and the Malaysian Universities Conjoint Committee for Ophthalmology (MUCCO).

The MSO pays homage to a doyen in Ophthalmology, Jack J. Kanski who died from cancer on January 5th 2019 with his wife Val at his side. Few, if any, wouldn’t be indebted to him for his authorship of numerous textbooks which have helped trainees and Ophthalmologists around the world not just pass exams but also improve on our clinical acumen. Like many of his ilk, he may be sorely missed, but his works and influence will live on; not just in text; but also in the practice of Ophthalmology.

ARTICLES

PARALLEL PATHWAY FOR MALAYSIAN TRAINEES IN OPHTHALMOLOGY

We had the opportunity to speak with Dr Mohd Aziz Husni in detail regarding the FRCOphth examination and the Parallel Pathway in Ophthalmology. Dr Mohd Aziz Husni is currently the Head of Ophthalmology in Hospital Selayang and the chairperson of Ophthalmology Post Graduate Education and Training Subcommittee for the Master’s Programme and Parallel pathway for Ministry of Health candidates.

How many trainees are currently in the programme?

To date, there are currently 4 registered trainees in the parallel pathway programme while another 4 candidates are scheduled for interview in January 2019.

What are the criteria to enroll for the parallel pathway?

The prerequisites for candidates to register with KKM parallel pathway includes:

• Confirmation in service with a permanent post with the Ministry of Health
• Minimum of 85 marks in the Annual assessment 3 years consecutively
• Valid Basic Science Examination (BSE)
• Part I FRCOphth
• FRCOphth Refraction Certificate

Having fulfilled these criteria, the application form (Borang BPAR2019) should be submitted via their respective Heads of Departments and Hospital Director to the ‘Bahagian Perkembangan Perubatan’ in the Ministry of Health. The list of candidates will then be finalized between October and November with the interview being conducted between December and January.

OPTIC NERVE SWELLING: A GUIDE FOR GENERAL OPHTHALMOLOGISTS

“Doctor, I cannot see clearly”

“Doctor, I’m having a headache”

These are the usual complaints of patients who come to seek help. Optic nerve (ON) swelling is either unilateral or bilateral. Papilloedema is a term specifically for bilateral ON swelling. The approach to this condition should be aimed at finding the underlying pathology and delivering the correct treatment. Timely diagnosis may be vision and sometimes even life-saving.

The aetiology of ON swelling varies from infectious, inflammatory, demyelinating, metabolic and infiltrative. The diagnosis is made on clinical grounds, but haematological tests and neuroimaging are is sometimes necessary to identify the cause. The list of differentials is inexhaustible, and includes multiple sclerosis, toxic optic neuropathy, spaceoccupying lesions and vasculitis to name a few.

IDIOPATHIC INTRACRANIAL HYPERTENSION: THE UNWANTED RISE

Idiopathic intracranial hypertension (IIH) is a syndrome caused by raised intracranial pressure (ICP) in the absence of any identifiable intracranial pathology as supported by normal neurological imaging. Previously, several terminologies were used to describe this condition. The most well-known but potentially misleading terms were pseudotumour cerebri and benign intracranial hypertension. The latter is no longer used due to the awareness of potentially severe visual impairment. IIH commonly occurs in young women with a high body mass index. It has also been reported to occur in males and prepubescent age groups.

The exact pathophysiology is unknown, but IIH is associated with several risk factors including obesity, obstructive sleep apnea (OSA), kidney failure, systemic lupus erythematosus and Behcet’s disease. Several medication linked to the development of IIH includes tetracycline, oral contraceptives, cyclosporine, lithium, nalidixic acid, nitrofurantoin, danaxol, vitamin A and tamoxifen. Initiation and discontinuation of corticosteroids also has been indicated as a risk factor.

Prior art suggests several pathogenesis which include imbalance between cerebrospinal fluid (CSF) absorption and production, elevation of cerebral venous pressure and high water composition of the brain.7 Obesity seems to be a strong association of IIH. It has also been suggested that the accumulation of adipose tissue causes increased intra-abdominal and intra-thoracic pressure leading to raised central venous pressure and subsequently, high ICP.

SAVE THE DATE

The 10th MSO Annual Scientific Meeting in conjunction with
The 34th Malaysia-Singapore Joint Ophthalmic Congress

22 - 22 March 2019
SASICC & Zenith Hotel, Kuantan, Pahang