Optometry Blog

List 4 advantages of direct and indirect ophthalmoscope.

As mentioned in one of my comments in article “Ptosis Evaluation”, I’d like to share a story written by Umar Muhammad Noor (Imam at Assyafaah Darul Hadith, Singapore) in his article Semua Ilmu Penting which I read in the latest issue of magazine Solusi #16, page 28-29

Here is the story:

There was an “ahli hadith” named al-Hafiz* Abu Bakar Ahmad bin Ibrahim al-Isma’ili from Jurjan (died 371 H),  a great scholar (ulama) who was very knowledgable in fields of Hadith and Fiqh. He was very negative against Ahli Kalam because he hated Ilmu Kalam* and those who studied Ilmu Kalam. Due to this hatred, he’d never interested to study Ilmu Kalam until something happened to him.

One day, when Abu Bakar al-Isma’ili was performing sunat prayer in a mosque, he’d overheard two men discussing about Ilmu Kalam. As he hated it very much, he hastened to finish his prayer in order to leave the place immediately. But there was one point in the discussion that resided in his memory, when one of the two mens said:

“Actually the teaching of Syiah Ismailiyyah is very stupid. Any ulama doesn’t need to give dalil while debating with followers of Syiah Ismailiyyah. We just need to ask them ‘why?’, then they won’t be able to answer anything back.”

Not so long after that, there was a group of Syiah Ismailiyyah followers making an open confession regarding their apostasy (murtad) and told the Sultan about it by letter, saying that they won’t accept Islam unless that Muslims can prove the truth of Islam in a debate. The Sultan had to select one of his citizens as a representative for Muslims to be debating against the representative from the Syiah Ismailiyyah.

The Syiah Ismailiyyah’s representative requested the Sultan to choose Abu Bakar al-Hafiz to be the Muslim’s representative as he knew that Abu Bakar al-Hafiz was only knowledgeble in Hadith but knew nothing about Ilmu Kalam; and unfortunately the Sultan agreed. This selection made other ulamas worried since they knew that Abu Bakar al-Hafiz would lose the debate as he was unknowledgeable in Ilmu Kalam.

For Abu Bakar al-Hafiz, he knew that Ilmu Kalam was not his field of expertise but he couldn’t refuse from being the representative of Muslims because it was a Sultan’s order. This made him regretted himself for not studying anything about Ilmu Kalam. This time only he realized the importance of studying Ilmu Kalam as it can be used as an agrument in such debate to defend our sacred religion of Islam.

But Allah is always by our side. Abu Bakar al-Hafiz suddenly remembered the saying about Syiah Ismailiyyah that he overheard in a mosque the other day, and this gave him strength to face the representative of Syiah Ismailiyyah. During the debate session, the Syiah’s representative enthusiastically and confidently explained the content of Syiah Ismailiyyah teaching. When it was the turn for Abu Bakar al-Hafiz to speak, can u guess what he said?

Yeah, he only said “Why?” but the representative couldn’t answer anything to defend his strayed teaching. So, the Muslims won the debate by the hand of Abu Bakar al-Hafiz and of course, with the help of Allah. Abu Bakar al-Hafiz was very grateful to Allah for helping him in that critical situation and since then, he was so motivated to learn Ilmu Kalam. What I wanna stress here is not the stupidity of Syiah Ismailiyyah but particularly the importance of mastering a wide range of knowledge. You can think of other moral values from this story by yourself.

:: wallahu a’lam ::

* al-Hafiz adalah gelaran terhormat bagi ahli hadis yang telah menghafal hadis pada kuantiti tertentu, manakala mereka yang menghafal al-Quran pula sepatutnya digelar al-Muqri. Tapi di Malaysia, kita dah terbiasa menggunakan gelaran al-Hafiz untuk mereka yang menghafal Quran.

* Ilmu Kalam secara ringkasnya ialah ilmu yang membahas ajaran-ajaran dasar bagi sesuatu agama, termasuk ajaran-ajaran agama lain.

Bismillahirahmanirahim..

Research Title:
Relationship between Visual Skill and Social Skill among Autistic Children in NASOM Kuantan.

before I proceed with the main concern of this reserach, lets have general view on AUTISM..what it is all about….i will explain it in point form, so that, the readers can understand it better rather than full sentence….

What is Autism:
- Autism is one of brain developmental disorders.
- Also known as autistic disorder, childhood autism, infantile autism, early infantile autism or Kanner’s syndrome.
- Literally, the word autism derived from two Greek words which are ‘aut’ meaning self and ’ism’ implying orientation or state. This suggests that autistic children were unusually fascinated in themselves and showed little interest in others (Dodd, 2005).
- Characteristic: Having triad impairment of social interaction, communication and also by the presence of restricted, repetitive and stereotypic patterns of behaviour, interest and activities ( American Psychiatric Association, 2000).

Classification:
Autsim is classified according to
- World Health Organization’s International Classification of Diseases, Version 10 (ICD-10, WHO 1992)
- American Psychiatric Association’s Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR, APA 2000)

Causes:
-the exact cause of autism is still unknown.
-some research suggests physical problem affecting parts of brain that process language and information coming from the senses.
-Another possible cause includes the abnormalities in brains structures and function. Recent research into the anatomy and functioning of the human brain has indicated that there are consistent differences between the brains of autistic and non-autistic individuals (Dodd, 2005).
-Genetic factors may sometimes involved.
-Thus, Autism indeed result from a combination of several causes.

Treatment:
- No specific medical cure are available for autism.
- Yet, medications can treat some of the associated symptoms.
- In general, autism can be diagnosed by a paediatrician, psychiatrist, neurologist, or clinical psychologist.
- Referral to a psychologist for a autistic children developmental assessment will provide information about the degree of severity and appropriate educational interventions.
- An intervention program is one of the most effective ways to enhance communication and socialization abilities among autistic individuals (Dodd, 2005).

okay, that’s all for introduction to Autism, next post i will explain the common symptoms exhibited among autistic individual.

Tq=)

||Cahaya Yang Menerangi||:)

Mind you, the term “ptosis” which means “droopy” does not merely refer to “droopy eyelid” as we can have something else droopy as well, not just our eyelid. As you know, the exact term for “droopy eyelid” is actually “blepharoptosis” (blepharo=eyelid, ptosis=droopy). But in our field of optometry, we are just comfortable to use “ptosis” rather than “blepharoptosis” in referring to “droopy eyelid”… and so will I do in this article as I’m lacking of time to type the whole lengthy word again and again.

Straight to the point requested by Br Muziman (my PBL group instructor), here are some of the popularly used ways in evaluating ptosis, and you can add them up if you have known another way that is not mentioned here. For any of the pictures below, you can get a clearer view simply by clicking it.

1) Levator Function

- Levator function is measured as the extent of eyelid movement on maximum down and up gaze. Method:

i. The thumb of one hand is placed at the eyebrow (don’t press, just gently place) - this is to block the effect of forehead on the elevation of the eyelid.

ii. With another hand, hold a ruler near the patient’s upper eyelid (with zero-point at the central upper lid margin) while the patient is looking downward (Pic. A & C)

iii. Then have the patient look upward as high as possible without any head movement, and take the measurement on the ruler at which the upper lid margin is now positioned (Pic. B & D).

- Classification of levator function: Good (≥8 mm), Fair (5-7 mm), Poor (≤4 mm)
- An accurate measurement of levator function may be used to determine the type of ptosis and also the best surgical approach to repair it. For instance in cases of involutional ptosis, the patient has a quite normal levator function despite the droopy eyelid.

2) Palpebral Fissure (labelled as PF in Pic. XYZ)

- a.k.a PAS (Palpebral Aperture Size) in our CL clinic

- Measured as distance between upper lid margin to lower lid margin passing through the center of pupil in primary gaze.

- Normal measurement: 9-10 mm

3) Crease Height (labelled as VCD in Pic. XYZ)

- a.k.a Margin Crease Distance (MCD) / Vertical Crease Distance (VCD)

- Crease height is the distance from the upper eyelid margin to the upper eyelid crease in downward gaze.

- Normal measurement: 5-10 mm

4) Marginal Reflex Distance #1 (labelled as MRD1 in Pic. XYZ)

- MRD is the distance from the upper eyelid margin to the corneal reflex in primary gaze.

- Normal measurement: 4-5 mm

- MRD 1 +ve: if upper lid margin is higher than the level of corneal reflex.

- MRD 1 -ve: if upper lid margin is lower than the level of corneal reflex.

5) Margin Reflex Distance #2 (labelled as MRD2 in Pic. XYZ)

- MRD 2 is a distance between corneal reflex and lower lid margin in primary gaze.

- Measurement greater than 5 mm is considered normal.

Picture XYZ:

SEVERITY of PTOSIS

- Bilateral ptosis: the amount of ptosis is measured as difference from the normal value (as given above), with larger difference indicates more severe ptosis.

- Unilateral ptosis: the amount of ptosis is taken as difference in PF / VCD / MRD 1 between RE and LE. Classification of ptosis based on difference between the 2 eyes: mild (2 mm), moderate (3 mm), severe (4 mm)

References:

http://www.eophtha.com/ejo13.html

http://emedicine.medscape.com/article/1213228-overview

:: wallahu a’lam ::