• Eye Diseases

    Many eye problems come with advancing age. Presbyopic, the need for reading glasses, is inevitable. Other examples include cataract, glaucoma, age related macular degeneration, diabetic retinopathy.

    The risks of having eye diseases increase with a positive family history, hypertension, cardiovascular diseases, diabetes, smoking and alcohol abuse.

    People over age 55 years are recommended to have regular eye check up every one or two years in order to initiate treatment during the early stages of the disease.

  • Cataract

    What is cataract?

    An opacified lens in the eye is a cataract. The eye is similar to a camera, light rays are focused by the lens onto the retina in order to form a sharp image. When a lens becomes opacified, the image formed will be blurred. The commonest cause of cataract is aging; other causes include diabetes, trauma, inflammation and congenital.

    Symptoms of cataract

    Most patients with cataracts will notice gradual blurring of vision. Others symptoms include glare under bright light, double vision in one eye, frequent change of glasses prescriptions, reduced dependence on reading glasses. The eye is not painful nor red unless in advanced cases with complications.

    Can drugs prevent or treat cataracts?

    While some medications may slow down cataract development, in order to prevent cataract formation one should avoid strong ultra-violet light exposure by the use of sunglasses.

    Cataract extraction surgery

    Surgery is the only treatment for cataract, and over 95% of patients can restore their vision after surgery. After the removal of cataract, an individualised intraocular lens implant will be fitted in place for best visual outcome. Usually this microscopic surgery is performed under local anesthesia and lasts less than 30 minutes. There is no need to stay in the hospital after surgery. Most cataract are removed by ultrasound phacoemulsification. This minimally invasive approach ensures faster recovery due to a small wound size.

    Does the cataract need to be mature before operation?

    No, this approach is outdated. As the outcome for cataract surgery is excellent nowadays, the timing is based on visual needs. When eyesight has effected the activities of daily living, then cataract surgery should be considered.

    What is posterior capsular opacity?

    Some patients experience visual deterioration a few years after cataract surgery. When a cataract was removed, its transparent capsule was left intact in order to support the intraocular lens implant. In some cases, the capsule may become opacified or scarred with time and vision is then affected. The opacified capsule can be treated with a simple laser procedure call Nd:Yag capsulotomy, after which lights rays can again be focused sharply on the retina forming a clear image.

  • Glaucoma





    Glaucoma is usually caused by elevated intraocular pressure leading to visual loss.

    When the drainage channels are blocked, fluid trapped inside the eye leads to elevated intraocular pressure. Such pressure damages the optic nerve fibres causing irreversible visual deterioration and ultimately blindness.





    • Acute Glaucoma:Acute glaucoma occurs when the aqueous drainage channels are blocked within a short period of time. Pressure inside the eye quickly builds up due to the trapped fluid. Symptoms may include aching pain in the eye, headache, blurring of vision, halo, nausea and vomitting. The immediate treatment is to reduce the intraocular pressure, after which treatment will be directed to manage complications such as recurrence and chronic glaucoma. The other eye will require medication or laser therapy to prevent similar glaucoma attack.
    • Chronic Glaucoma
      • This is the commonest type of glaucoma. At the early stage, only the peripheral visual field is affected, hence it is frequently overlooked. If it is uncontrolled, visual loss will eventually affect central vision.
      • The risk of chronic glaucoma rises with age, it usually develops in patients over the age of 35 and sometimes runs in the family.
      • During the early stages, patients with chronic glaucoma do not have any symptoms. When the intraocular pressures becomes high, patients may experience some aching in the eye with headache, hazy vision and halo when looking at lights.
      • The diagnosis of glaucoma requires clinical examination of the optic nerve heads, visual fields and intraocular pressures.
      • Chronic glaucoma can be treated and controlled. As it cannot be eradicated, observation and treatment are required for life. Permanent visual damage can be avoided if glaucoma is detected and treated early.
    • Secondary Glaucoma : Secondary glaucoma occurs in relation to other eye diseases, such as iritis, eye injury, mature cataract, prolonged steroid usage and diabetes. Treatments of both glaucoma and the underlying ocular diseases are required.
    • Congenital Glaucoma : This kind of glaucoma is found in newborn. Symptoms may include watery red eyes, high sensitivity to light, squint and cloudy large corneas. Early surgery is mandatory.
  • Floaters





    What are floaters?

    Floaters are sometimes described as seeing black spots. While they can be caused by different diseases, the majority is due to vitreous condensation. The vitreous body is a transparent gel - like substance filling up the space between the lens and the retina; light rays pass through the vitreous and project onto the retina. With advancing age, the vitreous body contracts and detaches itself from the surface of the retina. Additionally the vitreous body may develop opacities during this condensation process which form shadows onto the retina. These can be seen as dots, lines, small patches or spider webs. On the other hand, vision threatening diseases such as retinal tear, retinal detachment, vitreous haemorrhage, uveitis can present with similar floaters. Therefore prompt examination by an experienced ophthalmologist is recommended.

    Can floaters be cured?

    Though most floaters are benign and may become less apparent overtime, there are some medications that may reduce the vitreous condensations.

  • Age Related Macular Degeneration

    What is maculopathy?

    The central region of the retina is the macula. When there is pathological changes in the macula, central vision will be distorted and blurred. In maculopathy, fine vision and reading will be affected most, while peripheral vision is preserved. Frequently such changes are related to ageing, where it is known as age related macular degeneration. Age related macular degeneration usually occurs after the age of 50, and it is a major cause of permanent blindness after the age of 60. At the early stages, the symptoms experienced may not be very obvious. If the maculopathy is the educative type however, vision may deteriorate rapidly during the two years after diagnosis, leading to blindness.

    Two types of age related macular degeneration

    1. Dry type

    • Commoner, with lesser visual deterioration
    • Yellow white druses spots in the macula
    • Slow progression
    • May worsen and develop wet type
    Dry type
    Dry type

    2. Wet type (exudative)

    • Abnormal blood vessels grow within the macula region, where
    • Exudation and
    • Blood may accumulate
    • Severe worsening of vision, usually irreversible
    Wet type
    Wet type

    What are the causes of age related macular degeneration?

    It is usually found in patients over the age of 50, more with advancing age, but no sexual predominance. The retinal degenerates with thinning causing deterioration of macular function. Possible factors include familial history, dietary habit, smoking, exposure to excessive radiation, cardiovascular diseases and anxiety.

    How to use the Amsler Grid

    • Under adequate lighting, place the Grid at 30 cm distance from the eyes.
    • Wear adequate spectacle correction or reading glasses if required.
    • With the left eye covered, fixate the right eye onto the central spot on the grid.While fixating at the central spot, note if there is any distortions or defects with the grid.
    • Repeat with the left eye.
    • Any distortion may an early warning sign and must be checked by the doctor quickly.
    What are the causes of age related macular degeneration

    Treatment of maculopathy

    One of the treatment is by photodynamic therapy. A photosensitizing agent is injected which will attach onto the abnormal blood vessels. A low energy laser is then applied locally onto the affected area, and those treated abnormal vessels will stop growing and leaking. The advantages are that there is no damage to the retina and there is no scar formation.

    • Regular self examination using the Amsler Grid.
    • Flourescein Angiography Flourescein angiography examines the retinal blood vessels by taking photographic images of the vessels at different time intervals after an injection of dye.

    Anti-VEGF injection have been shown to be effective in treating AMD. These injections are usually administered in our day surgery centre, while the injections are given in a sterile and clear setting. Monthly injection schedules are usually tailored-made to the patients conditions in order to achieve the maximum benefits of the anti-VEGF therapy.

  • Retinal Detachment



    Retinal Detachment

    Retinal Detachment

    What is retinal detachment?

    retinal detachment

    retinal detachment

    When the vitreous humour contracts, it may cause breaks in the retina. When fluid seeps under the retina through these retinal breaks, the retina will become detached.

    What are the signs for retinal detachment?

    During the acute phase of a retinal detachment, the patient may experience:

    • An increase in floaters
    • Seeing flashes of light, development of a shadow like a curtain in the peripheral vision
    • Blurring of vision

    Who are more at risk of retinal detachment?

    • Those with thinning of the retina.
    • High myopia (Short sightedness).
    • Positive family history.
    • History of trauma to the eye or head.

    Can retinal detachment be prevented?

    Retinal detachment cannot be prevented by medication. If retinal breaks are recognised early by an ophthalmologist through examination with pupil dilation, laser barrier or cryotherapy may be applied to seal off such breaks, thereby prevent the development of retinal detachment. Therefore the most effective prevention is to be aware of the warning signs such as floaters and light flashes, and seek the help of an ophthalmologist promptly for a complete eye examination. For those with severe short-sightedness, it is advisable to avoid contact sports and have regular check ups.

    Can retinal detachment be repaired?

    retinal detachment
    retinal detachment

    Retinal detachment is a serious situation, and surgery to repair retinal detachment is complicated. The success rate may be up to 90%, but multiple surgeries are at times required. There are basically two categories of surgeries: by the insertion of an explants onto the sclera in the form of a silicone band or buckle then application of cryotherapy to the retinal breaks, or by pars plana vitrectomy where the laser is applied to seal off the retinal breaks and gas may be injected in place of the vitreous removed in order to flatten the retina.