Development of Knowledge,Attitude and Practice Questionnaire for age-related macular degeneration patients

AIM:To develop and validate a questionnaire to evaluate knowledge,attitude and practice of patients diagnosed with age-related macular degeneration(AMD)who have undergone intravitreal injection treatment.METHODS:This study was conducted among patients diagnosed with AMD in Kuala Lumpur.The generation of the instrument included four phases which included item and domains development,content,face validity and exploratory factor analysis.Content validity and modified Kappa was used for validation of knowledge domain.Exploratory factor analysis was used for validation of both attitude and practice domains.Face validity was conducted in 12 patients,content validity was ascertained in 120 patients and test-retest reliability was determined in 39 patients with AMD.RESULTS:Content validity index(CVI)and modified kappa showed excellent values for most items in the knowledge domain with CVI for item(I-CVI)values between 0.78-1.0 and Kappa values of>0.74.The Kaiser-MeyerOlkin(KMO)sampling adequacy showed acceptable scores of 0.70 and 0.75 for both attitude and practice domains respectively and Bartlett’s Test of sphericity were significant(χ^(2)=0.00,P<0.001).Factor analysis resulted in five factors with thirty items for attitude domain and four factors with twenty items for practice domain.The Cronbach’s alpha showed acceptable values for all items in knowledge,attitude and practice domain with values>0.70 and good test-retest reliability.The final version of the questionnaire consisted of 93 items from four sections consisting of demographic details,knowledge,attitude and practice.CONCLUSION:The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring KAP of patients diagnosed with AMD undergoing intravitreal injection treatment.

Usage of topical insulin for the treatment of diabetic keratopathy,including corneal epithelial defects

BACKGROUND Diabetic keratopathy(DK)occurs in 46%-64%of patients with diabetes and requires serious attention.In patients with diabetes,the healing of corneal epithelial defects or ulcers takes longer than in patients without diabetes.Insulin is an effective factor in wound healing.The ability of systemic insulin to rapidly heal burn wounds has been reported for nearly a century,but only a few studies have been performed on the effects of topical insulin(TI)on the eye.Treatment with TI is effective in treating DK.AIM To review clinical and experimental animal studies providing evidence for the efficacy of TI to heal corneal wounds.METHODS National and international databases,including PubMed and Scopus,were searched using relevant keywords,and additional manual searches were conducted to assess the effectiveness of TI application on corneal wound healing.Journal articles published from January 1,2000 to December 1,2022 were examined.The relevancy of the identified citations was checked against predetermined eligibility standards,and relevant articles were extracted and reviewed.RESULTS A total of eight articles were found relevant to be discussed in this review,including four animal studies and four clinical studies.According to the studies conducted,TI is effective for corneal re-epithelialization in patients with diabetes based on corneal wound size and healing rate.CONCLUSION Available animal and clinical studies have shown that TI promotes corneal wound healing by several mechanisms.The use of TI was not associated with adverse effects in any of the published cases.Further studies are needed to enhance our knowledge and understanding of TI in the healing of DK.

Ocular syphilis: resurgence of an old disease in modern Malaysian society

Dear Editor,Syphilis is a spirochaetal bacterial sexually transmitted disease（STD） caused by Treponema pallidum. Outbreaks of syphilis have been described in Western communities, especially in men who have sex with men（MSM） and people infected with human immunodeficiency virus（HIV）^（[1]）. Reports of the condition from Asian countries remains limited.

Review of the management of sight-threatening diabetic retinopathy during pregnancy

Diabetes mellitus(DM)is a noncommunicable disease reaching epidemic proportions around the world.It affects younger individuals,including women of childbearing age.Diabetes can cause diabetic retinopathy(DR),which is potentially sight threatening when severe nonproliferative DR(NPDR),proliferative DR(PDR),or sight-threatening diabetic macular oedema(STDME)develops.Pregnancy is an independent risk factor for the progression of DR.Baseline DR at the onset of pregnancy is an important indicator of progression,with up to 10% of women with baseline NPDR progressing to PDR.Progression to sight-threatening DR(STDR)during pregnancy causes distress to the patient and often necessitates ocular treatment,which may have a systemic effect.Management includes prepregnancy counselling and,when possible,conventional treatment prior to pregnancy.During pregnancy,closer follow-up is required for those with a long duration of DM,poor baseline control of blood sugar and blood pressure,and worse DR,as these are risk factors for progression to STDR.Conventional treatment with anti-vascular endothelial growth factor agents for STDME can potentially lead to foetal loss.Treatment with laser photocoagulation may be preferred,and surgery under general anaesthesia should be avoided.This review provides a management plan for STDR from the perspective of practising ophthalmologists.A review of strategies for maintaining the eyesight of diabetic women with STDR with emphasis on prepregnancy counselling and planning,monitoring and safe treatment during pregnancy,and management of complications is presented.