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A Guide To Eye Conditions And Ophthalmological Services In Singapore

women undergoing an eye check up

A Guide To Eye Conditions And Ophthalmological Services In Singapore

Ophthalmology is a subspecialty within the medical field that specifically deals with diagnosis and treatment of eye disorders. Ophthalmologists are doctors who have completed medical school and have gone on to specialise in eye diseases. With at least 12 to 17 years of training and education, they are licensed to practise both medicine and surgery and use a variety of techniques to diagnose and treat various eye conditions.

Ophthalmologists are able to diagnose eye diseases, perform eye surgery, and prescribe medication for vision problems. As medical doctors, they may also be able to recognise other health problems unrelated to your eyes.

Causes Of Eye Conditions

Some patients may be born with eye conditions that need correcting for them to have proper eyesight. Congenital blockages may lead to blocked tear ducts in newborns and eyelid conditions like ptosis may also be present as a birth defect.

More commonly however, eye conditions develop as you get older. The ageing process can result in parts of your body breaking down. When this happens, eyesight disorders like cataracts, age related macular degeneration, or glaucoma may occur. Scheduling regular exams at an eye clinic in Singapore is important for early detection of vision problems and preventive treatment.

More commonly however, eye conditions develop as you get older. The ageing process can result in parts of your body breaking down. When this happens, eyesight disorders like cataracts, age related macular degeneration, or glaucoma may occur. Scheduling regular exams at an eye clinic in Singapore is important for early detection of vision problems and preventive treatment.

Common Eye Conditions Faced By Patients

To help patients recognise when to visit an Ophthalmologist and what their possible treatment options are, here is an in-depth view of some of the most common eye conditions faced by patients in Singapore.

Blocked Tear Ducts – Symptoms, risks, & treatment

Blocked tear ducts are caused by a partial or total obstruction to the tear drainage system.

Glands located in the upper eyelid are responsible for producing most of your tears. These tears usually drain into the corners of your eyelids and flow down to your nose. A blocked tear duct can be due to an obstruction at any point in the entire tear drainage system.

The causes of the blockage can vary from patient to patient. As you age, the openings that drain your tears may narrow. Other factors include infection, inflammation, injury, tumours, or side effects from cancer treatments.

Symptoms of a blocked tear duct involve excessive tearing, redness on the whites of your eyes, recurrent eye infections, swelling near the inside corner of your eyes, mucus or pus discharge, and blurred vision. If you experience any one of these symptoms, you should set up an appointment with an eye doctor in Singapore immediately.

Ophthalmologists can diagnose a blocked tear duct using a number of different tests. A tear drainage test involves placing a dye on the surface of each eye to see how quickly it is drained. A saline solution might also be flushed down through your tear drainage system to check its function.

Small slender probes can be inserted into the drainage holes at the side of your eyelids to check for blockages. In some cases, the probing itself may dislodge obstacles. If the blockage isn’t immediately obvious, an eye imaging test using X-ray computerised tomography (CT) scans, or magnetic resonance imaging (MRI) machines may be used.

If your tear drainage system has been narrowed, your Ophthalmologist may dilate the opening of your tear duct with a probe, and flush the tear duct in a procedure that can provide temporary relief.

Stenting or intubation, where a thin tube is passed through your tear drainage system, is an option for treating blocked tear ducts. If the above treatments don’t work or if the blockage returns, then a balloon catheter dilation may be prescribed.

Surgery to treat blocked tear ducts is called dacryocystorhinostomy (DCR surgery). If non-invasive attempts to dilate or clear your tear ducts are unsuccessful then surgery can help bypass the obstruction and open a new path for your tears to drain into your nose.

Myopia, Hyperopia, & Astigmatism

Myopia, hyperopia, and astigmatism are known as refractive errors. They occur when images that enter the eyeball cannot be precisely focused onto the retina, resulting in blurred vision.

 

Myopia, also known as short-sightedness, is a vision problem where distant objects are blurry. It is the most common refractive error seen in children and usually stabilises by the late teens. Hyperopia is the opposite of myopia and is known as far-sightedness. It causes objects nearby to look blurry.

 

Astigmatism results from abnormal curvature of the cornea. It causes both near and far objects to look distorted. It can occur alongside other refractive errors like myopia or hyperopia.

 

Vision problems due to refractive errors can be solved with prescription lenses in the form of spectacles or contact lenses. These lenses work by bending light in a manner that compensates for the abnormalities in the eye.

 

Laser eye surgery is another option for patients who want to permanently fix their vision issues. It allows for clear vision without the use of corrective lenses by changing the shape of the cornea. The two main types of laser eye surgery are known as LASIK and ReLEx SMILE in Singapore.

Source: https://abelleyes.com/2018/10/11/the-5-reasons-people-get-laser-eye-surgery/ LASIK is the best-known and most performed laser eye surgery for refractive vision problems. During the procedure, a flap is created on the outer layer of the cornea to access the underlying corneal stroma tissue. This tissue is then precisely reshaped to fix the refractive error. ReLEx SMILE is a newer procedure that aims to achieve many of the benefits of LASIK surgery while remaining minimally invasive. ReLEx SMILE has fewer risks of complications, and less downtime than LASIK. However there are certain vision problems that cannot be fixed with ReLEx SMILE and not all patients may be suitable for this procedure. Learn More: Is LASIK Surgery Right For You?

Cataracts

Cataracts refer to the cloudy occlusion of vision due to the breakdown of proteins and fibres in the lenses of your eyes. Cataracts can make it difficult to see and may severely disrupt a person’s daily routines. They develop slowly and may not display any symptoms at the early stages. As it develops, cataracts can cause cloudy, blurry, or dimmed vision. Patients may have difficulty seeing at night or in low-light conditions. They might see halos around lights and colours may seem faded or appear with a yellowish tinge. Double vision is also a common symptom. Ageing is the most common risk factor behind cataract development. As you get older, molecules in your eye lens break down and clump together to occlude the lenses. Other risk factors behind cataracts include injury, eye surgery, medical conditions, long-term steroid usage, exposure to excessive sunlight, smoking, or other eye diseases. Cataract surgery involves removing the cloudy lens and replacing it with a clear artificial lens. Done as an outpatient procedure at an eye specialist clinic in Singapore, it is generally safe for patients with minimal risk of complications. The process takes about 30 to 45 minutes on average and you can go home on the same day. The artificial lenses are designed to last a lifetime and most patients do not face further issues.

Age Related Macular Degeneration

Age related Macular Degeneration (AMD) is an eye disease that affects a part of the retina known as the macula. It affects your ability to see fine details and is the leading cause of vision loss in people above the age of 50. Only the centre of your vision is affected while your peripheral vision continues to work. Patients rarely go fully blind due to AMD.

About 80% of patients have the dry form of AMD. Symptoms include distorted vision, blurred vision, difficulty recognising faces or seeing in low light, and blind spots in vision. It may affect either one or both eyes. If one eye is affected, you might not notice any changes as the other eye can compensate.

Dry Age-Related Macular Degeneration is caused by the thinning of the macula with age. The underlying reasons for this thinning are unknown, although research indicates it may be due to genetics, environment, lifestyle choices and diet. Dry AMD progresses as you age and may lead to central vision loss.

 

Dry AMD can be diagnosed by an Ophthalmologist through an eye examination and a battery of tests. There are no treatments to reverse dry AMD, although nutritional supplements may help in slowing progression. Other possible treatment methods include surgery to implant a telescopic lens in the eye which can improve distance and close up vision.

The other type of AMD is known as wet  age-related macular degeneration. It is less common than dry AMD but the symptoms appear quicker and the disease progresses faster. Wet AMD is caused by abnormal blood vessels at the back of the eye that leak fluid or blood into the macula. Wet AMD always starts as dry AMD, although not all cases of dry AMD will lead to wet AMD.

Like dry AMD, the exact causes of wet AMD are unknown. Risk factors are similar to those found in dry AMD. However there are certain treatment protocols that can help slow wet AMD and preserve existing vision. If medical intervention done at an eye specialist clinic is performed early enough, it may even help recover some vision.

Medications known as anti-VEGF drugs can help stop the growth of new blood vessels which cause wet AMD. These have to be injected into the eye every 4-6 weeks. Risks of this treatment include conjunctival haemorrhage, infection, retinal detachment, and eye inflammation.

Diabetic Retinopathy

Diabetic retinopathy is an eye condition that is caused by damage to the blood vessels to the light-sensitive tissue at the back of the eye. It is a diabetic complication and the symptoms are seeing floaters, blurred vision, fluctuating vision, black spots in your eyesight, and vision loss. Early stage diabetic retinopathy exhibits no symptoms, although some patients may experience intermittent issues with their vision.

Diabetic patients typically have high sugar levels in their blood. This can in time lead to the damage of blood vessels that supply the retina. To compensate for the damaged vessels, the body attempts to grow new blood vessels which are fragile and break easily, leaking blood into the vitreous.

Anyone with either type 1 or type 2 diabetes can develop diabetic retinopathy. Control of your blood sugar is very important in preventing this condition. Other risk factors include high blood pressure, high cholesterol, pregnancy, and smoking.

Diabetic retinopathy is diagnosed with a dilated eye exam conducted by a trained eye doctor. Eye drops which dilate the pupil are placed in the eye for your Ophthalmologist to take a closer look. A fluorescein angiography, where images are taken after a dye is injected into your bloodstream, can be useful to identify damaged blood vessels.

An Optical Coherence Tomography (OCT) test is able to provide images of the cross-section of your retina to determine if any unwanted fluid has leaked into retinal tissue.

Treatment for diabetic retinopathy is dependent on how far the disease has progressed and how severe the condition is. In early stages, good diabetic management can slow the progression of the condition.

If the disease has progressed to the advanced stage, then medication to stop growth of new blood vessels will be required. Injected into the vitreous of the eye under topical anaesthesia, these can cause discomfort after treatment and multiple sessions will be required.

Other eye treatment modalities include photocoagulation and panretinal photocoagulation. These are laser treatments that can slow the leakage of blood and fluid into the eye and shrink blood vessels. A vitrectomy, where an incision is made in your eye to remove blood and scar tissue, is a complex eye surgery that can be done if laser treatment is not possible because the condition has progressed too far.

Misconceptions & Common Questions About Eye Conditions

Our eyes are precious and sensitive organs. Understandably, there are many myths and misconceptions about eye health. To ensure that patients are not led astray and seek treatment in a timely manner, we’ve addressed some popular misconceptions and common questions about eye conditions.

Misconceptions about common eye conditions

1) Adults cannot develop myopia 

It is commonly thought that only children develop refractive vision problems like myopia or hyperopia. In the past, the understanding was that your eyesight stabilises after the teenage years. While this is still mostly true, myopia can occasionally develop in adults due to visual stress and might require eye treatment.

With the prevalence of digital devices, it’s important to limit screen time even as an adult to prevent myopia from developing. Other tips include working in brightly lit areas, taking screen breaks, going outdoors, and scheduling regular eye exams. 

2) Cataracts can spread from one eye to the other

Cataracts cannot spread from one eye to another. However if you develop cataracts in one eye, there is a good chance you will develop it in both eyes eventually. In fact, given enough time, everyone will develop cataracts as it is a part of the natural ageing process. So if you notice cataract symptoms in one eye, it could mean that the other eye may already be at the early stage of cataract development. It’s always best to get a consultation from a trained eye specialist to get an accurate diagnosis in these situations.

3) Cataract surgery can only be performed at an advanced stage of the disease

In the past, it was common to wait until the cataracts reached the “ripe” stage before proceeding to remove the occluded lens. However with modern surgical methods this is no longer the case and cataracts can be removed at any stage of development.

However there are factors to consider. As with any medical procedure there are risks involved, even though cataract removal is a highly effective and relatively safe surgery. Other things to consider include cost and quality of life after the surgery. Usually surgery is recommended if the cataracts are interfering with your ability to see clearly or perform complex tasks.

Learn More: 4 Benefits of Cataract Surgery

4) Age related Macular Degeneration will lead to total blindness

Age related Macular Degeneration in Singapore affects only central vision. You should still have some level of peripheral vision. In advanced cases, patients may be legally blind but should preserve some eyesight.

 5) You cannot prevent Age related Macular Degeneration

While you may not be able to completely prevent AMD, there are proven factors that increase your chance of getting this disease. By taking steps to make lifestyle changes, you might decrease the risk of you developing AMD. Stopping smoking and reducing consumption of red meat are two easy changes that you can make. Certain nutrients found in fresh fruits and dark-green leafy vegetables can also help promote eye health.

If you already have the dry form of AMD, you should consult with your Ophthalmologist about supplements you can take to reduce the chance of the disease progressing to the wet stage of AMD.

Misconceptions about ophthalmological treatments

1) Laser refractive surgery is dangerous

LASIK surgery in Singapore is considered a generally safe procedure with a very low risk of complications. It’s a well-established elective surgery and is performed on over a million patients every year. Side effects like dry eyes or glare go away some time and are not usually considered long-term problems.

2) There is a long recovery period after laser eye surgery

After a LASIK procedure, you may feel discomfort for a few days which should improve. You should be able to see clearly after 24 hours, but 2 to 5 days may be required to recover.

While you may experience significant improvement to your eyesight during this time, recovering fully from LASIK and experiencing the full benefits of the procedure may take about 3 to 6 months as your vision stabilises. During this period, you should have regularly scheduled visits with your Ophthalmologist to track your recovery.

3) Refractive surgery can only fix myopia

Refractive surgery is any form of laser surgery used to correct common vision problems. This includes myopia, along with other conditions like hyperopia and astigmatism. Talk to your Ophthalmologist to see if you are a good candidate for refractive surgery.

4) Laser eye surgery is not permanent

LASIK treatment in Singapore for myopia or hyperopia permanently reshapes your cornea. However, as you age, your eyesight may be affected in ways that might require prescription glasses.

5) Cataract surgery is unsafe and painful

Numbing eye drops are administered before the procedure to ensure that there is no pain and only minimal discomfort once the numbing effect wears off.

Cataract surgery in Singapore is a well-established and commonly performed surgery with a high success rate and low risk. Patients should talk to their Ophthalmologist about cataract surgery if they have concerns, but it is generally considered safe and the benefits outweigh the minimal risks.

Common Questions about Ophthalmological services

1) What can an Ophthalmologist do that an optometrist cannot?

Optometrists and Ophthalmologists play important roles in eye care. Optometrists are able to examine and diagnose minor eye conditions. They specialise in performing eye tests to detect diseases like eye infections, cataracts, glaucoma, diabetic retinopathy, and AMD.

Optometrists can also conduct refraction eye tests to determine the degree of long or short sightedness and prescribe the appropriate corrective lenses. However, they are not medical doctors and will refer patients to Ophthalmologists for further follow up and various eye treatments.

Ophthalmologists are medically trained doctors who have years of training in the medical and surgical field, along with years spent specialising in eye care. They can diagnose, treat, and perform surgical procedures for eye conditions. 

2) Why might a patient be referred to an Ophthalmologist?

Ophthalmologists deal with serious eye conditions that could potentially lead to blindness. You might be referred to an Ophthalmologist if you experience any sudden changes in your eyesight like partial or total vision loss. Pain, infection, injury, inflammation, or discharge from your eyes is another reason for a visit to an Ophthalmologist to determine if you need and follow up treatment.

Other symptoms of eye disease can include excessive floaters, red eyes, night blindness, headaches, light sensitivity, flashes in your vision, excessive tearing, blurry or distorted vision, and swelling. 

3) When should I make an appointment with an Ophthalmologist?

If you realise you have any of the symptoms mentioned above, it’s best to make an appointment as soon as possible. Many eye diseases are best treated in the early stages where outcomes tend to be more positive.

You could also be referred to an Ophthalmologist if your optometrist suspects you may have a serious eye condition. You might also schedule a visit with an Ophthalmologist for treatments such as laser eye surgery, cataract surgery, and other medical or surgical procedures.

4) Why are regular eye exams so important?

Regular eye exams are important as getting your vision corrected can significantly improve your quality of life. For young children, ensuring their vision is unimpaired allows them to focus better in school and lowers the risk of their eyesight getting worse.

Eyesight loss can also be prevented by catching eye diseases early and taking corrective measures to limit the damage. Poor vision can also lead to issues with everyday activities like driving or operating machinery. It can also cause dangerous falls.

5) What conditions can an Ophthalmologist diagnose with an eye exam?

Other than common eye conditions like glaucoma, cataracts, diabetic retinopathy, and AMD, Ophthalmologists can also diagnose other diseases like diabetes, brain tumours, cancer, heart disease, high cholesterol, and vascular diseases.

Eyes are organs essential to our everyday functioning. Disruptions to our vision can severely affect other areas of our lives. Thankfully several eye conditions today are highly treatable and many eye surgeries and procedures are generally safe and have good outcomes.

Among children refractive errors may be present and affect their eyesight without them even realising it. If you notice signs like squinting or difficulty seeing distant objects, it’s best to send them to an eye specialist to determine if they need prescription glasses to see clearly. As you age your eyesight also deteriorates and regular eye exams can help diagnose conditions like cataracts, hyperopia, or AMD. 

Good vision is something that cannot be taken for granted. To protect your eyesight, avoid lifestyle habits that increase your risk of getting eye conditions and always seek the advice of a trained Ophthalmologist if you have any symptoms or signs of eye disease.

Dr Eugene Tay is a Senior Consultant Ophthalmologist with over 2 decades of experience in the medical and surgical field. Trained to sub-specialist fellowship levels in laser refractive and anterior segment surgery, Dr Tay offers a wide range of eye care services at the Nova Eye Centre. Contact us today to schedule an appointment and our team will get back to you.

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