Opening Hours : Monday to Friday: 8:30 am to 5 pm,
  Saturday : 8:30 am to 12:30 pm

All Posts in Category: Front

More than meets the eye

More than meets the eye

What conditions do you see?

From simple ones like viral conjunctivitis to severe traumatic injuries to the eyes. My sub-specialty is in re-fractive surgery, which focuses on helping patients gain independence from glasses through surgery. I also deal with complex cases of cataract surgery, and repairing dam-age to the front portion of the eye.
Folks tend to get ophthalmologists, optometrists and opticians mixed up.

What do you do exactly?

All three, to varying degrees, are in-volved in patients’ eye health. It takes one 11 to 13 years to become an ophthalmologist. Should he de-cide to extend his training, and pick up advanced surgical skills and tech-niques to deal with complex prob-lems, he would be looking at anoth-er one to two years. He’s pretty much the oldest stu-dent amongst his contemporaries.

Do eyeballs feel like skinless grapes?

Not really. The eyeball is tougher than we realise. I once had a patient suffer a two-inch nail penetrating the orbit of the eye. The eyeball was intact, with the nail tip just millimetres from the op-tic nerve. The nail was safely re-moved, and the patient escaped with vision unscathed and was back to work in a couple of weeks.

Do eyeballs fall out of their sockets?

Yes. Once, a mentally unstable patient removed his own eye with his bare hands. Unfortunately, it was too late to save the eye and he ended up with a prosthetic. The key to salvaging the eye is to ensure that the optic nerve is still attached to the back of the eye. All oth-er structures including ligaments, muscles and the bony orbits can be surgically repaired.

What is the grossest case you have dealt with?

A patient came in at the end of a long day with a “swollen” eyelid. It initial-ly sounded like a garden-variety stye. But under observation, it had eyes and legs that were wiggling happily. What I found was a very well-fed tick that had latched onto the upper eyelid. I unceremoniously dislodged it with a pair of forceps.

Any truth in the old wives’ tale about eating carrots for better eyesight?

There are studies that have shown that vitamin A can have beneficial effect to eye health in many ways. Statistically, significant benefits have been shown in the prevention of age-related macular degeneration, improvements in patients suffering from dry eyes and slowing the progression of peripheral vision loss of patients with retinitis pigmentosa (a chronic hereditary eye disease char-acterised by black pigmentation and gradual degeneration of the retina). Carrots, among other foods like sweet potatoes and kale, are good sources of vitamin A.

We’re curious. If Lasik Is that good, why do most doctors still wear eye glasses?

Many people assume that there must be something very wrong with laser vision correction if there are eye doctors still wearing glasses. It’s a fair perception but one that requires closer examination. It must be understood that laser eye surgery is a very safe procedure, provided the right patient is select-ed. Often, this requires an eye assessment to rule out problems that may lead to an unsuccessful outcome. Also, the patient must be clear that laser vision correction merely helps him gain independence from spectacles or contact lenses. If an individual is happy with his spectacles or contact lenses, he might not necessarily see any tangible benefits in having laser eye surgery. Similarly, many patients benefit from laser vision correction differently, from helping them do their jobs better, to performing sports at a higher level or just enjoying the convenience of not having to wear spectacles and contact lenses. Doctors are no different than anyone else. Some may have eyes that are not suitable for laser vision correction, while some are happy with their spectacles or contact lenses. What is certain though, is that statistically, doctors — as a community — have a higher percentage of having had laser eye surgery compared to the population as a whole.

Is it possible to get eye Infections from the strangest sources? How bad it can be?

Eye infections can be picked up via physical contact. This includes the run-of-the-mill pink eye, viral conjunctivitis and more serious ones that spread as a form of sexually transmitted disease. With mascara or false eyelashes, we do regularly see patients suffering chemical burns to the external surfaces of the eyes. It can be painful, of-ten described as a burning sensation. Fortunately, with timely treatment, patients often make a full recovery within a week.

Read More

New laser refractive treatment

New laser refractive treatment 339877_113659

JUST about 6 years ago, patients who wanted to correct their eyesight with laser refractive treatment had only 2 procedures to choose from. The 1st generation laser treatment was Surface Ablation (or PRK, for photorefractive keratectomy) and the second, LASIK, which stands for Laser-Assisted in-Situ Keratomileusis. Now, the 3rd generation, ReLEx® SMILE (SMall Incision Lenticule Extraction), is available in Singapore. It melds the qualities of both LASIK and PRK and is less invasive.

First, a brief overview of the 2 earlier treatments: During PRK, the surface of the cornea is scraped off so that the laser can be used to reshape the cornea. It takes longer, about a week, for the cornea to heal before patients can return to normal daily activities.

During LASIK, a 22mm circumferential cut (or side cut with a cleavage plane) is made to create a flap in the cornea, after which the laser is used to reshape the cornea. The downtime is about 3 days. However, the flap doesn’t reattach completely, so it is a potential weak link. In a small percentage of patients, there can be inflammation under the flap and even years later. If there is direct trauma to the eye, there is potential for the flap to shift or be dislodged. When the flap is made, it also cuts the nerves of the eye that are connected to the tear glands, therefore LASIK is associated with increased risk of dry eyes. The whole corneal integrity is also weakened to a greater degree in LASIK than Surface Ablation.

Although LASIK was very popular in the 2000’s because of its shorter downtime, doctors have now realised that it’s not suitable for everyone – such as those whose corneas are too thin or shaped in a certain way. “Corneal ectasia is a concern for post-LASIK patients. The main advantage of LASIK is the faster healing time but the downside are a larger incision, potential for dry eyes and corneal weakening. When doctors learnt of this, there was a shift towards Surface Ablation which is safer in the long run although it has a longer healing time and is associated with more discomfort.

ReLEx® SMILE is suitable for individuals aged 18 years and above with myopia and astigmatism. The procedure is less invasive and relatively painless. Only a small 2mm laser side cut is made on the cornea. The laser creates a small spherical membrane from underneath the corneal surface which is then removed through the small side cut. “The surface of the cornea is largely kept intact except for the small side cut so there’s no risk of flap dislodgement. Because of the absence of flap, the cornea is also left stronger. So SMILE has the benefits of PRK in preserving corneal structural integrity and LASIK with rapid vision recovery and minimal discomfort.

The removal of the spherical membrane is enough to change the shape of the cornea. The dimensions of the membrane will vary according to the prescription. But once it’s removed, the cornea’s curvature is changed in a very precise way and that would be sufficient to correct the patient’s prescription or refractive error. The laser time at 24 seconds is the same whether one has a low or high degree of myopia and that allows for more consistent results regardless of the level of refractive error corrected. The smaller incision also minimises dry eye conditions as fewer nerves are damaged.

In addition to this, ReLEx® SMILE can be combined with Collagen Cross Linking to further strengthen the cornea and reduce the risk of corneal ectasia. This is done by adding a few drops of a Vitamin B solution to the eye and shining ultraviolet light on the eye for 1 minute immediately after the SMILE procedure. The cost for SMILE is S$4,999 for both eyes while LASIK is about S$3,799.

Patients now have 3 options for laser vision correction, each with its own limitations and benefits. They should learn more about them and find out about what best suits their needs for today and the future.

Read More

Don’t be hard on your eyes

Regular eye tests at the specialist is necessary for silent eye conditions such as glaucoma.

GOING for regular eye tests is not just about checking if your myopia has worsened or changing prescription glasses. Jennifer Tan (not her real name), in her 50’s, didn’t think much of it when her eyes felt very dry one day and then suddenly started tearing uncontrollably during a meeting. An emergency check at a specialist eye centre later showed that she had acute glaucoma which had to be operated on almost immediately.

Glaucoma was a rude surprise to her but it was thankfully treated in time and has made her more aware of glaucoma risks as she ages. Dr David Chan of Atlas Eye Specialist Centre said: “Surgery was done to relieve the pressure on the eyes. Immediate treatment is necessary otherwise there’s irreversible damage to the optic nerves? For those above 45 years, annual eye check-ups are important, especially tests that examine field of vision and also eye-ball pressure. Such tests can pick up on chronic or potential acute glaucoma.

While acute glaucoma might be accompanied by signs of headache, nausea, blur-ring of vision and pain in the eyes, chronic glaucoma has no symptoms and is known as the silent thief of sight, says Dr Lee Hung Ming of Lee Hung Ming Eye Centre. Acute glaucoma is common among Chinese ladies above 55 years old because of the narrow angle of their eyes. “Because the eye structure is smaller in size, the angle or ‘door’ that allows fluids to drain out of the eye gets closed,” he says.

In chronic glaucoma, the optic nerves get increasingly damaged and the field of vision narrows. But by the time patients realise they have “tunnel vision”, it is too late and the damage is permanent “If the patient comes in early, then there is treatment, usually in the form of eye drops, laser or surgery to stop glaucoma,” Dr Lee explains. The pressure build-up on the eye slowly damages the optic nerves and what’s damaged is irreversible?
By the time patients realise they have ‘tunnel vision’, it is too late and the damage is permanent.

Aside from the age, those who have a history of high myopia, diabetes and previous eye injuries are at risk. With medical advances in the field, there are now several types of eye drops which can control pressure to help the condition. There is an increasing awareness these days as more are coming to have their eyes checked regularly. Says Ho Ching Lin, adjunct associate professor, head (Clinical Services) and senior consultant of the Singapore National Eye Centre’s Glaucoma Department “Everyone is at risk for glaucoma. Older people are at a higher risk although it can also affect children and young adults. Glaucoma has a strong genetic basis and family history is known to be a risk factor? In Singapore, approximately three per cent of people over the age of 50 have glaucoma. This percentage increases with age and is almost 10 per cent for those over the age of 70. Glaucoma accounts for 40 per cent of blindness in Singapore.

Read More