Dear MSO members,

December. A month that always brings with it a natural pause. A moment to look back, to ponder, to reflect and to re-evaluate our decisions and actions over the entire year. It is the time of the year, when we quietly ask ourselves how the year has shaped us, both professionally and personally. As Ophthalmologists, we spend our days restoring clarity for others, and December does the same for us.

One of the events that captured public curiosity this year end, was the passing of the 3i/atlas. A brief, brilliant interstellar visitor from deep space. Appearing suddenly and bringing along with it, a million questions. It moved on as swiftly, reminding us how fleeting even the most striking events can be. In many ways, this mirrors our professional journey. Our days are filled with moments of heightened attention, uncertainty or concern that pass through, leaving behind a profound insight. Responding to such moments with calm observation, careful analysis and measured actions is what we strive to do.

For our society, this year has been quite a memorable one. We witnessed a strong sense of unity with the successful organization of the inaugural Malaysian Ophthalmology Scientific Congress (MOSC I). This event brought together, the Malaysian Universities Conjoint Committee of Ophthalmology (MUCCO), Malaysian Society of Ophthalmology (MSO), College of Ophthalmologists, Academy of Medicine of Malaysia (COAMM), the Ophthalmology Services of the Ministry of Health Malaysia (MOH) and the Malaysian Armed Forces. It was a statement of collaboration, shared purpose and mutual respect that reminded us that we are strongest when we come together.

ARTICLES

Eye Street News: What’s Happening in Ophthal City?

A NATIONWIDE COMMITMENT TO SIGHT: MALAYSIAN SOCIETY OF OPHTHALMOLOGY'S ACTIVITIES FOR WORLD SIGHT DAY 2025

World Sight Day, observed annually on the second Thursday of October, serves as a pivotal global platform to focus attention on blindness and vision impairment. The Malaysian Society of Ophthalmology (MSO) spearheaded multiple initiatives that reached diverse communities through both clinical services and innovative public engagement.

In Ipoh, a collaborative effort between MSO and the Ophthalmology Department of Hospital Raja Permaisuri Bainun brought comprehensive eye care services to the Chenderiang community on September 29, 2025, at the Chenderiang Community Hall. The event attracted approximately 250 participants from Chenderiang and surrounding areas, providing essential vision services to underserved populations. The event's significance was underscored by the presence of distinguished leaders including Prof. Dr. Liza Sharmini Ahmad Tajudin, President of MSO, who emphasized the society's commitment to community ophthalmology, and Dr. Ng Hong Kee, Head of Ophthalmology at Hospital Raja Permaisuri Bainun, who highlighted the importance of bringing specialized eye care to rural communities. The ceremony was officially inaugurated by Dr. Gridhari Nath, Director of Tapah Hospital.

The screening program delivered thorough evaluations through multiple specialized stations conducting visual acuity tests, refraction assessments, and anterior and posterior segment examinations. Clinical teams identified numerous cases requiring intervention, including uncorrected refractive errors, cataracts, and diabetic retinopathy, ensuring proper referral pathways for continued care. Beyond clinical services, the event provided free prescription glasses to indigenous children and offered educational sessions in multiple languages, making eye health information accessible to all community members. A children's colouring competition creatively incorporated eye health messages, while registration booths for Peka B40 and MySalam national health schemes successfully enrolled eligible participants into government healthcare programs.

Eye Street News: What’s Happening in Ophthal City?

RETINOBLASTOMA AWARENESS DAY AT HOSPITAL TUNKU AZIZAH - A DAY TO CELEBRATE OUR YOUNG WARRIORS

Hospital Tunku Azizah (HTA) marked an important milestone on 12 September 2025 with the hospital’s and Malaysia’s first ever Retinoblastoma (RB) Awareness Day, a meaningful event dedicated to raising awareness and more importantly celebrating the courage of our young RB survivors and their families.

The event, held at the hospital atrium stemmed from the wish to have a special day dedicated to children affected by retinoblastoma. While day-to-day hospital visits and treatments can be filled with anxiety and uncertainty, this day was envisioned as one where worries could be set aside and a day to celebrate life, strength, and hope for our young RB warriors.

Bringing this vision to life took nearly nine months of planning, coordination, and perseverance. A special mention must be made to the sponsorship committee; Dr Gaythry, Dr Lee Wan Qing and Dr Thasya, who actively approached and engaged sponsors, playing a crucial role in turning an idea into reality. Their dedication and teamwork were instrumental in making the event possible.

Approximately 300 participants attended the event, including retinoblastoma survivors, parents, caregivers, healthcare staff, and members of the public. The programme began at 8.30 am with opening speeches officiated by the Pengarah Hospital, Dr Shamsul Anuar bin Kamarudin, followed by addresses from Dr Sangeetha Tharmathurai, chairperson of the Retinoblastoma Awareness day; National Head of Paediatric Ophthalmology Services, Dr Jamalia Rahmat; and Head of Ophthalmology Department; Hospital Tunku Azizah, Dr Norhafizah Hamzah, highlighting the importance of early detection and comprehensive care.

One of the most impactful segments of the day was the sharing session by parents of RB survivors. The heartfelt experiences shared by them moved the audience and provided insight into the realities of living through an RB diagnosis. Their stories reflected fear, resilience, and ultimately hope.

Behind the lens: A Conversation with the Expert

AN INTERVIEW WITH DR AINAL ADLIN

Subspecialisation is a vital step in the professional growth of every medical practitioner. In ophthalmology, vitreo-retina is often regarded as one of the most demanding and challenging subspecialties. Having a realistic insight into its training pathway can help young ophthalmologists better understand and perhaps be inspired to pursue this rewarding field.

In this issue, we speak with Dr Ainal Adlin Naffi, a vitreoretinal surgeon at Hospital Canselor Tuanku Muhriz. She shares her journey into the world of vitreoretina, filled with persistence, adaptability and passion for learning. Fresh from completing a one-year fellowship training at Sydney Eye Hospital, Australia, she reflects on the transformative training experience that shaped her into the clinician and surgeon she is today.

First of all, thank you, Dr Ainal, for sparing some time for this interview out of your busy schedule. Could you briefly introduce yourself and share your training pathway in vitreoretina?

My name is Ainal Adlin Naffi, currently a vitreoretinal surgeon at Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur. My VR exposure began immediately after completing my gazettement in 2018. I then joined the VR fellowship programme at UKM in 2021. I recently completed a one-year VR fellowship at Sydney Eye Hospital, a highly competitive programme, with its international

What first sparked your interest in vitreoretinal surgery, and were there mentors or experiences that shaped this path?

My interest in vitreoretina began early in my ophthalmology training. My first encounter with a retinal detachment occurred just two weeks into my posting in the ophthalmology clinic at Hospital Raja Permaisuri Bainun, where the diagnosis was made using B-scan ultrasonography due to a dense cataract. Although this was a brief experience, it left a lasting impression.

Subsequently, I joined Hospital Canselor Tuanku Muhriz as a medical officer and was placed in the VR team for my first rotation, during which I had very limited knowledge of vitreoretinal diseases. Throughout my training, I rotated through the VR posting multiple times and gradually developed a strong passion for the subspecialty. It was, as I often describe, a “tough love” that grew over time. Professor Dr Mae-Lynn Catherine Bastion was my first VR mentor and continues to guide me to this day. I would also like to acknowledge Dr Mushawiahti Mustapha and Dr Amin Ahem, who have been consistently supportive and generous in sharing their vitreoretinal experience.

Next in Vision: Ophthalmic Innovations and Updates

LIGHT ADJUSTABLE INTRAOCULAR LENSES (LAL): A TECHNOLOGY ON THE HORIZON

Light adjustable intraocular lenses (LALs) represent a major innovation in refractive cataract surgery, enabling postoperative modification of IOL power through targeted ultraviolet (UV-A) irradiation of photosensitive macromers within the lens optic. This technology minimizes postoperative refractive surprise, particularly in eyes with prior corneal refractive surgery.

Despite improvements in biometry and IOL formulas, refractive unpredictability persists after cataract surgery. LAL technology effectively shifts the paradigm from predicting final refraction to determining and fine-tuning it after pseudophakic stability is achieved.

History and Development

The concept of a light-adjustable polymer optic originated from research at the California Institute of Technology, where Schwartz and colleagues demonstrated that spatially selective UV exposure could induce controlled shape changes in silicone IOLs. This polymer chemistry was translated into a clinical product by Calhoun Vision (Pasadena, CA), which later became RxSight, Inc. Currently, RxSight is the only commercial provider of FDA-approved light-adjustable IOLs (LAL) and the associated Light Delivery Device (LDD), with no competing platforms currently in clinical trials.

Lens Specifications and Mechanism

The RxSight LAL is a three-piece IOL designed for capsular bag placement. It features a 6.0 mm biconvex optic made of photosensitive silicone and C-loop haptics, giving an overall length of 13.0 mm. The lenses are available from +10.0 D to +30.0 D. Its specifications differ from standard monofocal lenses in a key aspect: the lens matrix contains diffusely dispersed, unpolymerized macromers sensitive to 365-nm UV-A light. These macromers are the "fuel" for adjustment; they are distributed evenly at implantation but move and cross-link when stimulated by the Light Delivery Device. The shape change of the LAL occurs through a precise sequence of photopolymerization and macromer diffusion. This process can be visualized in three distinct steps:

1. Activation: The LDD projects a specific pattern of UV light onto the lens optic.
2. Creation of a Gradient: The macromers in the lit area polymerize (link together), while macromers in the unlit area remain free. This creates a concentration gradient.
3. Volume Change (The "Shape Shift"): Over the next 12–24 hours, the remaining free macromers physically diffuse into the polymerized area to restore equilibrium. This migration causes swelling in that specific spot, changing the curvature of the lens.

Mechanism of the Light Adjustable Lens (LAL). (A) Initial state: Photosensitive macromers are evenly distributed. (B) Irradiation: Targeted UV-A light creates a polymerization gradient in the central zone. (C) Diffusion: Unpolymerized macromers diffuse into the treated area to restore equilibrium, causing the lens to swell (refractive adjustment). (D) Lock-in: A final high-intensity UV treatment polymerizes all remaining macromers, stabilizing the lens.