SNEC SingVision Issue 3 (2011)

A PUBLICATION OF SINGAPORE NATIONAL EYE CENTRE

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One of the top 10 discoveries in 2011

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SNEC Visual Awareness Week

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Healthy Eyes, Healthy Children

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About Glaucoma

The

Silent Thief of Sight Often, glaucoma goes unnoticed until there is a loss of vision.

Dr Ho Ching Lin Head of Glaucoma Service (Clinical) & Senior Consultant Singapore National Eye Centre

Normal visual field without glaucoma

Glaucoma occurs when fluid pressure inside the eye slowly increases and damages the optic nerve, which carries visual information from the eye to the brain.

Glaucoma is sometimes referred to as the silent thief of sight because it can cause loss in vision and sufferers may have had the disease for years without knowing it.

The disease progresses slowly and painlessly with little or no symptoms. Many people only find out that they have glaucoma during health or eye checks. There are some who may have redness or feel pain in their eyes, or they may suffer from headache and nausea. Others may also have blurred vision or see coloured rings around lights.

Senior consultant Dr Ho Ching Lin, head of Glaucoma Service (Clinical) at the Singapore National Eye Centre said: “Visual loss from glaucoma is irreversible but medication or surgery can slow down or halt the loss of vision if it’s treated early. Regular screenings are important especially for those with a family history of the disease.”

Early Glaucoma: Peripheral visual field loss only with good central vision Advanced Glaucoma: Increase peripheral visual field loss; central vision may still be maintained End-staged Glaucoma Severe visual field loss with loss of central vision

“Acute glaucoma can leave a patient blind in days, while chronic types, without treatment, may take years. While effective treatment cannot reverse any visual loss, it can slow down or halt the progression to blindness. If diagnosed early enough and if appropriate treatment is started and maintained, vision loss can be prevented.”

Dr Ho who specialises in childhood and adult glaucoma added that it is a misconception that only adults suffer from glaucoma. Although uncommon, young people may also be afflicted by it too. Three out of 10 of her patients are below 35 years old.

Check your family history

In Singapore, about three percent of people over 50 years old and 10 percent over 70 years old have glaucoma. Other risk factors include family history and those who are suffering from medical conditions such as diabetes, high blood pressure, severe short-sightedness or long-sightedness.

First-degree relatives (parents, siblings and children) of glaucoma patients have a higher risk of the disease.

Dr Ho said younger patients with glaucoma are more likely to become blind during their lifetime than older patients.

She explained: “This is because even if the disease progresses at the same rate, a younger patient with the disease starting early in life will have more years to run out of optic nerve fibres compared to older patients afflicted with the disease late in life with fewer more years to live.

Glaucoma has a strong genetic link. If someone in your family has or had glaucoma, it increases your chances of being afflicted by it too.

If you have a sibling with glaucoma, you will have a three to five times higher risk for glaucoma.

If you have a parent with glaucoma, you will have a two to three times higher risk.

If you have a family history of glaucoma, it is advisable that you be examined by an ophthalmologist especially if you are over 40 years old. Thereafter, even if the assessment is normal, you should continue to go for regular check-ups with the ophthalmologist every two or three years until the age of 50. After that, you should have your eyes checked yearly.

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One of the top 10 discoveries in 2011

“Smart lens” gives a clearer picture of the patient’s eye condition for

Glaucoma

Professor Aung Tin, Head of Glaucoma Service (Research Development) & Senior Consultant Singapore National Eye Centre Singapore National Eye Centre is studying the use of a “smart” contact lens that can measure patients’ eye pressure round the clock, even while they are sleeping.

Presently, patients only get their eye pressure measured when they see their doctor.

This “smart” lens which is known as the Triggerfish Sensor was selected by The Straits Times as one of the top 10 local discoveries of 2011.

Senior consultant Professor Aung Tin, head of Glaucoma Service at SNEC (Research Development) who is in-charge of the study said: “Eye pressure fluctuates over 24 hours. With this “smart” lens we can take patients’ eye pressure at five-minute intervals around-the-clock. This will give us a clearer picture of the patients’ eye condition and therefore enables us to manage them better.”

Glaucoma refers to a group of eye conditions that lead to permanent damage of the optic nerve, the nerve that carries visual information from the eye to the brain. The nerve damage affects vision and can progress to complete irreversible blindness if untreated. It affects about six per cent of Singaporeans and accounts for 40 percent of blindness here.

This “smart” lens will be tested on 60 patients here to assess its suitability for Asians. It has already been approved for clinical use in Europe. In the United States, it is pending approval from the US Food and Drug Administration. Here in Singapore, it has not been cleared for use here except for investigative research.

Prof Aung Tin is a clinician-scientist and his research interests are angle closure glaucoma and the molecular genetics of eye diseases.

Prof Aung Tin is instrumental in establishing a world-leading research programme in SNEC focusing on ophthalmic genetics. He is well recognised for his research on glaucoma which is a major cause of blindness in Asia, affecting millions of people. And, he also played a key role in developing national and international collaborations with scientific and healthcare institutions and industry players so as to maximise the impact of his research.

SERI Eye Exhibition

EYES THAT

TELL STORIES More than just windows to your soul, your eyes are also very telling!

It was all eyes at this exhibition.

“Eyes That Tell Stories” was organised by the Singapore Eye Research Institute (SERI) at the Red Dot Museum from June 21 to 30. It was officially launched by then President S R Nathan.

The aim of the exhibition was to raise public awareness of the research being conducted at SERI as well as to inculcate a better appreciation of eye health and the prevention of eye diseases and vision. Such research will help eye specialists to better understand, diagnose, prevent and treat eye diseases.

The extreme close-ups of the eyes which highlight the unique textures of the iris were taken by eye experts and professional photographers with cutting-edge equipment.

With the help of these images, doctors are able to provide diagnosis on patients with eye diseases.

Visitors to the exhibition also got to view eye images of personalities such as Singapore’s first prime minister Mr Lee Kuan Yew and Mr Gerard Ee, Chairman of the National Kidney Foundation as well as those of local celebrities like Mr Gurmit Singh and Ms Fann Wong.

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Training & Education

ADVANCED CORNEA SURGERY COURSE

SNEC Cornea and External Eye Disease Service conducted a two-day course in November on Advanced Cornea Surgery with participants from Indonesia, Phillipines, China and Singapore.

The topics included new techniques in lamellar surgery such as Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) where only the diseased posterior or back layers of the cornea are replaced.

“This is probably the most significant advancement in corneal transplantation today because it is essentially a new form of suture-less, keyhole corneal transplant technique. Only the innermost thin layer of the cornea is replaced, and this is done through a tiny incision at the side of the cornea.

“Without the need for sutures means much faster visual recovery and patients also have better vision because they have much less astigmatism and other refractive errors,” said Professor Donald Tan, Medical Director of SNEC. The course which comprised lectures, hands-on wet labs, live surgeries and clinical case presentations was well received. Due to high demand and recommendations from corneal surgeons from the Asia Pacific region, it was organised twice last year.

ADVANCED PHACOEMULSIFICATION COURSE The two-day course was held from 30 Sep – 1 Oct 2011. This course continues to receive good attendance by ophthalmologists and trainees from the region.

The video-based course was on the management of difficult cataract cases with emphasis on surgical techniques to minimise risks of posterior capsule rupture and corneal oedema (swelling). Among other topics, participants were taught advanced techniques to provide stable lens fixation for patients with subluxated cataracts. A wet-lab session was held on the second day. Participants had the opportunity to practise their skills on the different techniques of Intra-Ocular Lens (IOL) fixation etc. SNEC surgeons also performed live-surgery and demonstrated these techniques.

“The aim was to train the participants to be competent in dealing with complications resulting from cataract surgery in addition to handling complicated cases,” said course director Assoc Prof Chee Soon Phaik, Co-Head of Cataract Service at SNEC.

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SNEC Visual Awareness Week 2011

Vision Awareness Week 2011

was organised to educate and advocate to the staff of SNEC and the public on the needs of the visually impaired. The other activities included a poster exhibition, stalls showcasing vision aids and a skit by the SNEC medical residents.

THEIR WORLD IN THE DARK Understanding what it is like to be visually handicapped Ms Gloria Chan

I had the chance to experience the world of darkness for about 20 minutes in the “Café in the Dark” during the “Vision Awareness Week” organised by the Singapore National Eye Centre in September.

Together with five other members of the staff from SNEC, we were lined up in a single file and told to hang on to the shoulder of the person in-front. And we were led by Ms Evangeline Yeo who is visually impaired.

For someone like me who enjoys going on the rollercoaster, I thought this was going to be fun. Instead, I felt a sense of panic rising in me as soon as the door to the simulated café was closed and the heavy curtains drawn. It was pitch dark – you can’t even see your fingers in-front of you. I was on the verge of “chickening out” but told myself to hang on in there with the rest of them.

It was scary inching our way and I clung on tightly to the person in-front to make sure that I was not left behind. It was a strain on the eyes keeping them open when all I could see was “black.” It made no difference and after a time, I kept my eyes closed.

Arriving at the “café”, Ms Yeo guided us, one at a time to our seats. Very carefully I used my hand to feel for the seat before sitting myself down – not wanting to find myself missing it and crashing to the floor.

It was such a relief when Ms Yeo led us out of the café into the seeing world again after we had our drinks and cookies.

Many people fear losing their sight the most.

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SNEC Visual Awareness Week 2011

Coping with Visual Impairment

by Pamela Chan What insight did I gain from the experience? For me, it was not to take my sight for granted. I’m going to take good care of my eyes like going for screening so that any eye diseases can be detected and treated early. There are diseases like diabetes which are prevalent and can cause blindness. I shall make time to exercise and be more mindful about my diet in order to stay healthy.

In a short interview with SingVision, Ms Yeo dispelled the myth that the visually impaired are unable to do a lot of things independently. “We still have our other senses and we can do most of the things ourselves like using the mobile phone, surfing the internet, emailing, doing household chores and going out with friends,” said Ms Yeo.

Correct way to help the visually impaired

- A skit by SNEC Medical Residents

People often imagine the blind as someone wearing dark glasses and using the cane, and that they totally cannot see anything at all.

Most of us still can see a little light or shadow. Some are able to read and write with the help of a magnifying glass. If we wear glasses, it’s to protect our eyes from being injured if we knock into anything above waist level which the cane is unable to detect

Video Magnifier

- Ms Evangeline Yeo, who is visually impaired

Ms Yeo works with Dialogue in the Dark which among other things runs a museum at Ngee Ann Polytechnic where visitors get to experience how a blind person lives during the one-hour tour. Her hope is that through activities such as this, the public will be more educated about what the blind can do, and in the long term, open up more job opportunities for those who are visually impaired.

The Poster exhibition provided useful information on understanding visual impairment.

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Community Outreach

WORLD SIGHT DAY 2011

Singapore National Eye Centre, Singapore Lions Clubs and Eunos Community Club among other Voluntary Welfare Organisations (VWOs) joined hands to organise the World Sight Day 2011 Eye Screening Programme at Eunos CC on 9 October 2011.

The aim of the event was to increase eye-health awareness among the public through general and diabetic eye screening. 500 residents from Eunos, Bedok Reservoir-Punggol, Changi-Simei and Kaki Bukit constituencies participated. Dr Amy Khor, Minister of State for Health graced the event as Guest-of-Honour.

Guest-ofHon Minister o our Dr Amy Khor, f State for Health.

EYE SCREENING AT HINDU ENDOWMENT BOARD HEALTH FAIR SNEC and Singapore Eye Research Institute (SERI) doctors, nurses and optometrists volunteered and performed eye screening for 300 members of the Indian community at the Hindu Endowment Board Health (HEB) Screening Programme on 4 September 2011. SNEC and SERI partnered Singapore General Hospital and National Cancer Centre Singapore both of whom offered general health screening and mammogram examination. The HEB was pleased with the success of this event and is already planning to make this an annual event.

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Healthy Eyes, Healthy Children Preliminary results of a study on myopia in primary school children showed a decline in the incidence of short-sighted children – from 38 per cent in 2004 to 33 per cent in 2009.

Prof Donald Tan, Medical Director SNEC & Chairman Steering Committee, National Myopia Prevention Programme, speaking on Myopia

Minister for Health Mr Gan Kim Yong highlighted this encouraging trend in his speech at the opening of the 12th National Eye Care Week from Nov 12 to 19.

He said that Singapore has one of the highest prevalence of myopia in the world. To address this, the Health Promotion Board (HPB) launched the National Myopia Programme in 2001.

Working with schools, children are encouraged to spend more time in outdoor activities and cut down time spent on near-work. The programme also introduced eye screening in kindergartens so as to detect the problem earlier and delay the onset of myopia.

Mr Gan said: “These encouraging findings attest to the good efforts we have made. But more can be done.”

He announced that the Singapore National Eye Centre will be starting a Myopia Clinic next year specially to treat myopia in children. In addition HPB will be stepping up its outreach efforts in preschools and childcare centres as well as work with parents to foster healthy eye habits in children.

Mr Gan also highlighted the increasing prevalence of age-related eye diseases in our aging population. And he commended the efforts and the initiatives by SNEC and HPB to help Singaporeans “care for their eyes better, see more clearly, and live well.”

In conjunction with the National Eye Care Week, there was a public forum on myopia in children, diabetic eye screening at Suntec for those over 45 years old and eye screening for the residents of Lions Home for the Elders in Bedok and St Theresa’s home.

“MUMMY, WHY DO I NEED TO WEAR GLASSES :(”

Health Minister, Mr Gan Kim Yong meeting participants at the Forum. With him are Mr Ang Hak Seng, CEO HPB & Prof Donald Tan

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SNEC 21 Anniversary Dinner and Dance 2011 st

Moving into the future Turning 21 is a major milestone. And the Singapore National Eye Centre celebrates its 21st anniversary this year.

Medical Director of SNEC, Professor Donald Tan

Medical Director of SNEC, Professor Donald Tan told the staff at the Annual Dinner and Dance on 23 July 2011 that “turning 21 is a sober reminder of our responsibilities as a national centre and leader in ophthalmology in Singapore.”

Looking ahead, he said: “We have to chart strategies for the future to meet the new challenges of a rapidly ageing Singapore population.”

And to meet the increasing demand, SNEC needs to continuously improve its clinical services, ensure renewal and succession of future generations of ophthalmologists and tackle emerging trends in eye diseases through innovative research. Also, Prof Tan said that we should strive to continue to be the top in the region as well as to be one of the leading centres for ophthalmology globally.

“This means coming together as Team SNEC to deliberate, collaborate and working in unison to shape a better future for our patients,” added Prof Tan.

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Heart of Caring

In total, SNEC together with the other SingHealth institutions raised $260,000 for this mega charity event which was started by former President S R Nathan in 2000 to encourage Singaporeans from all walks of life to help the less fortunate.

Part of the money raised by SNEC came from the sale of pottery works donated by local potter Ms Chew Su-Jin. The theme of the fund-raising activities in SingHealth was - “Heart of Caring” – to show that we not only care for our patients but also to the others in the community.

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SNEC HEF Learning Award

Learning doesn’t stop when you leave school. When you start working, you are learning on the job. And for many people, they continue to take up courses to enhance their qualifications in order to advance in their career.

Investment

in learning

Anyone who has studied and worked at the same time will tell you that it a challenge, having to juggle your time carefully between your job, your studies and for some, raising a family.

But as Dr Benjamin Franklin, one of the founding fathers of America who was an author, a scientist, musician, inventor and politician said – “An investment in knowledge pays the best interest.” Overcome the challenge, and it pays dividends not just in terms of career prospects and monetary gain but also for the sense of achievement and acquisition of knowledge for your own personal development.

Senior clinical trial coordinator Ms Serena Ting, 31, who is one of the recipients of this year’s Singapore National Eye Centre’s Learning awards is an advocate for lifelong learning.

Ms Ting has been working with the Singapore Eye Research Institute for five years. She enrolled for the Bachelor of Science (Nursing) course to expand her knowledge in her chosen field.

She said: “In the job that I’m doing, I think it’s important that I should continually keep myself updated on my knowledge in healthcare and nursing.

“As difficult as it was working and studying at the same time, the course has fired my enthusiasm for lifelong learning and I can see myself continuing to enroll for more courses in time to come.”

Ms Ting is grateful to her husband for his support. She said: “He helped me organise my time and helped out with the housework especially during the exam periods.”

She is also grateful to be a recipient for the SNEC Health Endowment Fund (HEF) Learning Award which pays up to 80 per cent of the course fees. This award is open to staff of SNEC and SERI with at least one year’s service and good track record in performance.

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Our Achievements

THE AWARDS Congratulations!

NATIONAL DAY AWARDS 2011 COMMENDATION MEDAL

EFFICIENCY MEDAL

EFFICIENCY MEDAL

Ms Lim Mein Chee Deputy Director of Nursing

Ms Loh Huey Peng Nurse Clinician

Mr Patrick Ng Principal Ophthalmic Investigation Specialist

SINGHEALTH-LEE FOUNDATION D.S.LEE FOUNDATION NURSING AWARD 2011 REGISTERED NURSE CATEGORY

Ms Santhi d/o Perumal Senior Staff Nurse

HEALTHCARE QUALITY IMPROVEMENT POSTER COMPETITION BEST POSTER AWARD

Ms Audrey Kon Nurse Clinician

3RD PRIZE PROJECT TITLE: IMPROVING SINGAPORE EYE BANK’S TISSUE USAGE

Project Team Members:

Dr Lim Li, Deputy Director SEB and Senior Consultant, Cornea Service, SNEC Dr Howard Cajucom-Uy, Manager SEB Ms Carisa Mariella Alvarez Paraz, Tissue Coordinator, SEB Selvam Sethuraman, Senior Tissue Coordinator, SEB Djoni Agahari, Senior Tissue Coordinator, SEB Ms Isabella Lim and Ms Soh Wee Wee, Senior Staff Nurses, SNEC Ms Ong Lay Hui, Asst Manager, Patient Services, SNEC

AAO/OPS MEETING, ORLANDO, FLORIDA 2011 THE OPHTHALMIC PHOTOGRAPHERS’ SOCIETY BEST OF SHOW, STEREO DIVISION 1ST PLACE FUNDUS PHOTOGRAPHY WIDE ANGLE LARGE POSTERIOR RETINAL TEAR THROUGH LATTICE Mr Kasi Sandhanam Senior Ophthalmic Imaging Specialist

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Our Achievements

THE AWARDS Congratulations!

NATIONAL UNIVERSITY OF SINGAPORE, FACULTY RESEARCH EXCELLENCE AWARDS 2011

Prof Donald Tan

Medical Director, SNEC

PROFESSOR AUNG TIN WAS CONFERRED FULL PROFESSORSHIP

BY THE NATIONAL UNIVERSITY OF SINGAPORE.

Intraoperative Use of Spectral-Domain OCT During Descemets - Stripping Automated Endothelial Keratoplasty to Assess Donor Attachment and Thickness

Prof Aung Tin

Dr Chelvin Sng

Senior Consultant & Head (Research Development) Glaucoma Service

AAO 2011 BEST POSTER AWARD

Medical Officer Training & Education Dept Team Members : Dr Federico Luengo, Assoc Prof Jod Mehta & Prof Donald Tan

MEDICAL STAFF PROMOTION Congratulations!

CONSULTANT

ASSOCIATE CONSULTANT

ASSOCIATE CONSULTANT

Dr Lim Lee Hooi

Dr Boey Pui Yee

Dr Elaine Huang

ASSOCIATE CONSULTANT

ASSOCIATE CONSULTANT

Dr Claudine Pang

Dr Desmond Quek

Oculoplastic and Aesthetic-Eyeplastic Service

Glaucoma Service

Cataract & Comprehensive Ophthalmology Service

Vitreo-Retina Service

Glaucoma Service

FOR OPHTHALMOLOGISTS See http://www.snecmeetings.org for more details BASIC PHACOEMULSIFICATION COURSE Wet Lab & Live Surgery

Audience : Date : Venue :

General Ophthalmologists/Final Year Ophthalmology Trainees Friday - Saturday, 30 - 31 March 2012 Auditorium and Training Room, Level 4, Tower Block, SNEC

This two-day introductory course on phacoemulsification (phaco) surgery aims to provide a comprehensive introduction to the skills required for successful phaco surgery.

The main highlights include familiarisation with basic phaco machine technology, didactic lectures on phaco surgery techniques, wetlab exposure, and live surgery demonstration.

NEW! Now, for the first time in Singapore, we will be using the award winning KITARO wetlab system where different grades of nuclear hardness are available for phacoemulsification and realistic capsulorhexis is possible.

CORNEAL SURGERY AND EXTERNAL EYE DISEASE Wet Lab & Live Surgery

Audience : Date : Venue :

General Ophthalmologists Saturday - Monday, 19 - 21 May 2012 Auditorium and Training Room, Level 4, Tower Block, SNEC

SNEC is a leading centre for corneal transplantation development in the Asia-Pacific. Prof Donald Tan has been designated as the official Moria ALTK and DSAEK trainer in the Asia-Pacific region, and Prof Tan and a team of course instructors will present a detailed programme comprising didactic lectures, hands-on wetlab, live surgery and clinical case presentations to provide corneal surgeons and ophthalmologists looking after corneal patients with advice on the management of such patients. A detailed set of course notes will be issued to each participant. The emphasis of this programme is on lamellar surgery, but will also cover topics such as the management of pterygium, dry eye, and infectious keratitis cases.

FOR NURSING AND ALLIED HEALTH PROGRAMME

See http://www.snecmeetings.org for more details

SNEC EYE-DUCATION SERIES OF PUBLIC TALKS

See http://www.snec.com.sg for updates

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