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FAQ

1.      Cataract

2.      Glaucome

3.      Retina disease

4.      Ocular inflammatory disease

5.      General eye problems

a.      Pterygium  

6.      General paediatric eye care

7.      DR screening

8.      Optometrist Services

 

 

 

 

 

CATARACT

Can I do both my cataracts at the same sitting.?

For safety and avoidance of unforeseen very rare complication like infection, cataract is generally done one eye at a time in each sitting.

However, technology is very advance nowadays that performing a cataract surgery takes a mere 10 minutes that surgery in both eyes can be completed within 30minutes.; therefore sometimes the surgeon or the patient may according to their convenience  may opt for bilateral simultaneous cataract surgery. The other advantage is that by doing bilateral simultaneous cataract surgery , patients, especially elderly patients avoid the inconvenience of making multiple visits to the eye centre.

 

Can I avoid cataract operation?

Initially when the cataract is not so mature and the symptoms are quite tolerable, one can delay his or her cataract operation. In the meantime, vision can be enhanced by glasses or change of glasses or doing task under  better lighting conditions.

Eventually , as the cataract becomes more mature, the symptoms  will become more disturbing and when  your usual  daily activities are being affected, you would have to consider surgery. Surgery is the only effective way of curing your cataract.

 

Must I continue my usual medication ?

Yes please do  continue your usual medication ( heart, hypertension , DM etc ) ;However, if you are on blood thinning medications, you may opt to stop the medication about 4-5 days prior to the intended day of surgery. However, as most cataract operation is performed through the avascular cornea, this  temporary stopping of medication is not absolutely necessary.

 

How often must I come for my eye  check up after surgery?

Usually post cataract review is done at Day 1 post operation ,1 week post operation and subsequently at 6 weeks. However, the frequency of post operation visit depends entirely on the Surgeon. You may be asked to come for a review more frequently or less frequently, depending on the Surgeon’s instructions.

Do I need glasses after cataract surgery?

In certain cases, there might be some residual refractive power after cataract  operation.

You may need glasses to enhance your already clear vision for distance and near.Usually the Surgeon would suggest refraction to be done  and glasses prescribed about 1 month after  the cataract operation when the wound has become more stable.

 

Do I need to be warded ?

Cataract surgery nowadays is very safe, effective and fast. It is usually done as a day care  procedure or even as an outpatient procedure, meaning that you can go home a few hours later on the same day.

Therefore, one need not be admitted overnight. Only in certain circumstances will a patient need to be admitted for observation and close monitoring post surgery.

 

My vision initially after cataract surgery is very clear, but it becomes blur a few months later. Why is that?

During cataract surgery, the IOL is placed in front of a layer of membrane  to support it. This membrane is initially very  transparent. However in certain cases, the membrane becomes transluscent or  opaque  months or even years later. This is called posterior capsular opacification.It happens more in younger patients. It causes mild blurring of vision, glare or a feeling of something  blocking the eyesight.

However, do not be worried over it. This  opacity can be cleared by a minor laser procedure called YAG laser capsulotomy. The procedure is painless and it takes only a few minutes to  do the procedure.

 

I experience something moving about  across my   field of view after  cataract surgery. It disturbs my otherwise clear vision.Why is that ?

Sometimes after cataract surgery, one experiences something floating across one’s field of vision. This condition termed ‘floaters” is due to vitreous degeneration at the back of the eye (  the vitreous ). Most of the time , the condition is harmless ; however it is good to have your eyes checked by an Ophthalmologist to exclude more sinister  causes like retinal tear.

If it is harmless, the floaters may get less over a period of time.

 

I develop tearing in my eyes after cataract  surgery. Why is that?

After a routine cataract operation , one may sometimes experience tearing of the eyes. Most of the time, this symptom is quite tolerable and harmless and is likely due to dry eyes. However do have a check by your Ophthalmologist  to exclude  other local causes of tearing.

 

Glaucoma

Can glaucoma be cured?

 

No. Unfortunately there is no cure for glaucoma. Vision lost from the disease cannot be reversed or restored. Hence, diagnosis & treatment for early stage glaucoma is important to delay progression of the disease.

 

What can I do if I’m treated for glaucoma?

Be sure to take your glaucoma medications everyday as prescribed and see your eye care professional regularly as scheduled.

 

You can also help protect the vision of family members or friends who may be at high risk for glaucoma, and people with a family history of glaucoma. Encourage them to have a comprehensive dilated eye exam at least once a year. Remember that lowering eye pressure in the early stages of glaucoma slows progression of the disease and helps save vision.

 

How do I apply my eye drops? What happens if I have more than one eye drop?

After applying an eye drop, close your eye OR press the inner angle of the lower lid lightly with your finger for at least 1 minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase the risk of side effects.

If you are using more than one eye drop, be sure to wait at least 5 minutes before applying the second drop.

 

 

Retinal Disease

FAQ for intravitreal injections:

 

How is an intravitreal injection given?

The drug is injected into your eye with a very fine needle. Minimal discomfort is to be expected (equivalent to having blood taken from your arm). The procedure takes five to seven minutes, but the injection itself is over in less than 20 seconds. The injection is given with you lying down comfortably on the couch. After applying local anaesthetic drops, your eyelids and eye surface are cleaned to prevent infection. A small clip (speculum) will be used to keep the eye open. The injection site is marked, your eye is stabilised and the injection is given a few seconds later.

 

What happens after an injection?

You may expect minor blurring of vision, blobs or specks in your vision (floaters), transient flashing lights or swirls of light, some pain or scratchy sensation after the injection, which may last a day or two.

 

Sometimes, bleeding on the surface of the white of the eye, increase eye pressure or inflammation may occur after injection. These side effects typically resolve spontaneously or can be treated with eye drops.

 

Less common risks include infection, retinal tears & detachment, and cataract formation.

 

If your eye become progressively red, sensitive to light, swollen and painful, or your vision gets worse after the injection, you must seek medical consult as this might indicate a serious eye infection (1 in 1000 cases).

 

What are the precautions after an injection?

There are no special precautions following an injection. You can continue with your daily activities or travel. Avoid getting water into your eye or swimming for the first few days.

If you have any of the above problems, please see an ophthalmologist.

 

Do I need repeated injections?

Most patients require a loading course of 3 injections at a regular interval of 4 weeks. After the first 3 injections, majority of patients will require further injections, depending on the leakiness of the blood vessels.

 

You will need to attend follow-up at regular intervals as decided by your doctor, even if your vision has improved after the first few injections.

 

Who should not be treated with anti-VEGF?

You should not be given anti-VEGF if you have any of the following conditions:

• Allergy to anti-VEGF or any of its ingredients.

• If you have an infection in or around either eye or severe infection anywhere in your body

• If you are trying to become pregnant, are already pregnant, or are breast-feeding

 

Anti-VEGF should be used with caution in patients with the following conditions:

• If you have had a heart attack or stroke in the last six months

• If you have uncontrolled angina or uncontrolled high blood pressure

 

DR screening

How is an intravitreal injection given?

The drug is injected into your eye with a very fine needle. Minimal discomfort is to be expected (equivalent to having blood taken from your arm). The procedure takes five to seven minutes, but the injection itself is over in less than 20 seconds. The injection is given with you lying down comfortably on the couch. After applying local anaesthetic drops, your eyelids and eye surface are cleaned to prevent infection. A small clip (speculum) will be used to keep the eye open. The injection site is marked, your eye is stabilised and the injection is given a few seconds later.

 

What happens after an injection?

You may expect minor blurring of vision, blobs or specks in your vision (floaters), transient flashing lights or swirls of light, some pain or scratchy sensation after the injection, which may last a day or two.

 

Sometimes, bleeding on the surface of the white of the eye, increase eye pressure or inflammation may occur after injection. These side effects typically resolve spontaneously or can be treated with eye drops.

 

Less common risks include infection, retinal tears & detachment, and cataract formation.

 

If your eye become progressively red, sensitive to light, swollen and painful, or your vision gets worse after the injection, you must seek medical consult as this might indicate a serious eye infection (1 in 1000 cases).

 

What are the precautions after an injection?

There are no special precautions following an injection. You can continue with your daily activities or travel. Avoid getting water into your eye or swimming for the first few days.

If you have any of the above problems, please see an ophthalmologist.

 

Do I need repeated injections?

Most patients require a loading course of 3 injections at a regular interval of 4 weeks. After the first 3 injections, majority of patients will require further injections, depending on the leakiness of the blood vessels.

 

You will need to attend follow-up at regular intervals as decided by your doctor, even if your vision has improved after the first few injections.

 

Who should not be treated with anti-VEGF?

You should not be given anti-VEGF if you have any of the following conditions:

• Allergy to anti-VEGF or any of its ingredients.

• If you have an infection in or around either eye or severe infection anywhere in your body

• If you are trying to become pregnant, are already pregnant, or are breast-feeding

 

Anti-VEGF should be used with caution in patients with the following conditions:

• If you have had a heart attack or stroke in the last six months

• If you have uncontrolled angina or uncontrolled high blood pressure

 

General Paediatric eye care FAQ

How do I know if my child has squint ?

 

When you suspect that your child has a squint, it is pertinent that you bring your child to your Ophthalmologist for an eye assessment.

The Ophthalmologist, with the assistance of the Optmetrist and Orthoptist will assess whether there is  a squint in the first place,  whether there is a refractive error and also the type of squint once it is noted .Once a squint is determined , a plan of management is done; it may include glasses, patching of the eye to prevent  amblyopia and sometimes even surgery is necessary.

 

There is a condition called pseudo squint which is really not a squint at all(fig 7). The eyes appears to  have squint due to the wide inner skin folds(  broad epicanthic folds )   of the eye; this gives an appearance of a false squint. This is common in Oriental eyes whereby the skin fold is wide and the root of nose usually flat. No further  action in squint management is necessary in this instance.

Figure 7

 

When is surgery necessary  for squint?

Surgery to correct the misalignment is indicated when other conservative measures to correct the misalignment has failed to produce its desired result.

This is especially to regain binocular vision and also stereopsis( depth perception ).Once  surgery  is indicated, it is preferably done  before school going age, or even younger if possible.

Surgery is also done for cosmetic reasons ; this is especially done in adults. However the patient has to be fore advised that double vision may develop post  surgery and a form of exercise therapy is necessary to reduce this sometimes disturbing symptoms.

 

Surgery is usually done under general anaesthesia  and the patient is usually warded for 1 night  for observation.

Post operatively, eye drops and ointment  will be instilled to  reduce inflammation and discomfort.

 

 

Pterygium FAQ

 

What can you do ?

Avoid prolonged exposure to sunlight.- wear sunglasses

Avoid dusty environment.

Instill lubricant eye drops to lubricate the eyes regularly.

When is surgery necessary.?

Usually when the pterygium is very small, surgery can be avoided. Lubricant drops can be instilled to prevent irritation and discomfort.

Surgery is indicated when :

·it has encroached onto the cornea

·it caused frequent irritation and redness.

·For cosmetic reasons, especially in young people who do not wish to face the embarassment of frequent “red eye”

 

 

How is surgery done ?

Nowadays, the  gold standard operation for pterygium is excision with autologous conjunctival transplantation ie the pterygium is excised out and a  piece of healthy  conjunctiva is obtained from another area of the eye and patched onto the excised bare area .Previously,the patching is secured with stitches, but this caused a lot of discomfort post operatively .

Since 2007, we have been using a special glue to patch the healthy piece of conjunctiva to the excised bare sclera, something which I call a ‘copy and paste’ technique. It is so much more soothing and faster than using stitches. The discomfort of post surgery irritation from stitches is greatly minimised .The surgery time last  usually  about 10 to 15minutes.

The recurrence rate is extremely rare with this method.

Post surgery, the eye will be patched up for usually 1 day. Pain medication will be prescribed to you in case you experience some pain, but this is rare.

You will be required to come for a review the next day and your eye cleaned up. You will then be instructed on how to instill your eye drops and ointment.