Minimally invasive technique now spells less pain for the patient, reports MELISSA HENG
LOSING one’s sight suddenly can be a terrifying experience, and the thought of painful eye surgery often compounds the worry. For Madam Astrid, there was an added problem: she was working as a chemist and sight was crucial to her job.
‘My world became slanted, wavy and irregular. Even straight lines appeared wavy to me. I couldn’t see the glass door even if it was in front of me, and I had difficulty judging steps on stairs and escalators,’ she says. Accidents and falls became her lot. Diagnosed with Age Related Macular Degeneration (ARMD), doctors had initially told her that there was no cure for her condition. But she did find cure, thanks to advancement in surgical technology and one doctor’s insight.
Raffles Hospital consultant ophthalmologist, Dr Lee Jong Jian was the retina eye surgeon who pioneered the use of a minimally invasive technique to correct retinal problems in Asia. The procedure is called a vitrectomy, and the surgical equipment used is called the 23 gauge system. Treating problems with this method will result in less pain and faster recovery for the patient, says Dr Lee, who has successfully performed more than a hundred cases in the past one year.
A vitrectomy uses specialised instruments to repair retinal disorders, many of which were previously considered inoperable. The initial step in this procedure is the removal of the vitreous – a jelly-like substance in the eye – by making three small incisions in the eye wall. Often performed under general anaesthesia, the operation can last an hour or more.
Conventionally, surgeons here use the 20-gauge system, which is larger in size. Because of this, the wound is too large to heal by itself and must therefore be stitched up. This will add at least half an hour to the procedure and for any surgery, the longer it takes, the more risk of infection and complications, explains Dr Lee. In comparison, the new 23-gauge system uses smaller instruments and this allows the wound to heal by itself sans stitches.
According to Dr Lee, who has been invited to Manila, Jakarta and Shanghai to train doctors in the proper handling of the new instruments, the procedure can benefit several conditions, including ARMD, diabetic retinopathy, vitreous haemorrhage and retinal detachment. The latter, which can happen to anyone of any age, is a common problem in highly myopic Singapore. Retinal detachment can be caused by trauma. For example, people who play contact sports like football or rugby do run a higher risk of injury, but it can also happen spontaneously as a result of changes in the vitreous, says Dr Lee.
As a person ages, the vitreous in his eye may change in consistency. This jelly could shrink and sag and separate from the retina. Those with advanced diabetes are also more prone to such a disorder. Dr Lee stressed that retinal detachment must be corrected quickly or blindness could eventually follow. Tell-tale signs include visual disturbances such as light flashes or black spots.
If left untreated, the patient may experience some kind of visual shutdown. If the condition worsens, you may have blurred vision either top down or bottom up. Basically, it looks like a curtain coming down over your eyes, explains Dr Lee. With quick diagnosis and treatment, however, retinal detachment can be corrected to a high degree.
Some patients even regained full vision, like Madam Ivy Ng. Her right eye suddenly went dark one day for no reason. Recalling the incident, she says: ‘I totally lost my sight. It was very scary. The doctor said it was an emergency. The good thing was there was absolutely no pain after the operation.’ Madam Ng, 58, had to keep her head straight for a while and was not allowed to fly in case the pressure in her healing eye was affected. Apart from that, she could resume normal activities after two weeks and her vision returned fully after three months.
With a high success rate of 85 per cent and a low risk rate of less than one per cent, Dr Lee felt that the 23-gauge vitrectomy system will soon set the standards in retina-related surgeries. Raffles Hospital has so far invested more than $250,000 in the new system. Each procedure costs between $9,000 and $13,000, depending on the complexity of the case. Stressing the need for good eye care, Dr Lee advises that those who are highly short-sighted should get a yearly eye check-up, especially for children.
These days, the majority of children become short-sighted at a very young age. In fact, about 70 per cent of children would be wearing glasses by the time they reach primary six, says Dr Lee, whose youngest patient with a detached retina was only nine years old. The problem may not be due to reading books too close up.
‘Short-sightedness in children can stem from too much computer games, that’s why I forbid my own kids to play X-Box or PlayStation!’ confides Dr Lee. And where working adults are concerned, he advises at least a 50cm distance from the eye to the computer screen. He adds: ‘Ideally, you should rest your eye every half an hour. Just stop what you do and stare far away.’
Short-sightedness in children can stem from too much computer games… Ideally, you should rest your eye every half an hour. Just stop what you do and stare far away.’
