Professional Documents
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HEALTHY EYES
Regaining
develops very slowly and the first your likelihood
part of the vision field to be affected of developing
is the outer edges (peripheral glaucoma is
vision). essential in
natural vision
l Acute angle-closure glaucoma preventing this
– Symptoms are often severe robber of sight.
because it develops rapidly. These
include intense pain and redness of
the eye, headache, seeing halos or Because chronic forms of turn 40 and every three to five years
“rainbow-like” rings around lights, glaucoma can destroy vision before after that if the above risk factors do SPECTACLES and contact lenses
misty vision and loss of vision in one
or both eyes.
any signs or symptoms are apparent,
take note of these risk factors:
not apply to them.
If one or more risk factors from
were the most common fix for
blurry vision, but modern
Exploring your
l Secondary glaucoma – This is l Elevated internal eye pressure the list apply to you or you are older medicine has brought us beyond surgical options
will help you be
caused by other conditions or eye l Ethnic background than 60, you should be screened for the need for lenses. Instead of
injuries, such as uveitis l Family history of glaucoma glaucoma every two years. having to depend on
(inflammation of the middle layer of
the eye).
l Having other medical
conditions such as diabetes, heart
Glaucoma cannot be cured, and
damage caused by the disease
prescription eyewear, people
now have a third option – laser aware of what to
Symptoms of this type of
glaucoma such as painful eyes and
disease, high blood pressure,
hypothyroidism, past severe eye
cannot be reversed, but treatment
and regular check-ups can prevent
eye surgery.
Using lasers to improve vision
expect, in addition
headaches can easily be confused injuries and other existing eye vision loss in people with early sounds like it involves your to ensuring
with symptoms of other conditions.
l Developmental glaucoma – In
conditions such as eye tumours,
retinal detachment, eye
glaucoma.
If vision loss has already occurred,
ophthalmologist wielding a
superpower, but laser eye you choose the
developmental or congenital
glaucoma, your child may display
inflammation and lens dislocation.
l Long-term use of steroidal eye
treatment can slow or prevent
further vision loss. – By Dr
surgery is a simple procedure
that can be completed in a
best option
symptoms such as being sensitive to drops Norazlina Bachik Ng, cataract, matter of minutes. available with
light (photophobia) or displaying
abnormalities in eye movement and It is recommended for all adults to
refractive and anterior segment
surgeon, KPJ Pusat Pakar Mata
The surgery is performed by
making subtle adjustments to advice from your
appearance. get a full eye check-up when they Centre for Sight the shape of your cornea with a
cool laser beam, correcting tiny
ophthalmologist.
flaws that eventually make your
vision clearer and sharper.
If you are considering going l Laser-assisted epithelial
under the knife for better vision, keratomileusis (Lasek) –
you may be a little scared by the Similar to Lasik, this option is
prospect of letting someone, suitable for people who are
even an expert, cut into your nearsighted, farsighted or have
cornea and shine a laser beam astigmatism.
into what is admittedly one of People with thin corneas are
the more sensitive parts of the typically not allowed to undergo
body. Lasik but can opt for Lasek.
Fortunately, testimonials from Lasek is different from Lasik in
patients can help allay your that the cornea reshaping is
fears. performed on a different layer
There are many eye health- of the cornea (Bowman’s layer
related Internet forums on instead of the stroma).
which people post personal Another thing that sets Lasek
anecdotes that bare all – from apart from Lasik is how a soft
initial preparation to recovery contact lens is used to hold the
pitfalls – that could help the flap in place while the eye heals
nervous patient anticipate his post-procedure instead of
needs before, during and after leaving the flap to bond to the
laser eye surgery. rest of the cornea.
Exploring your surgical
options will help you be aware l Photorefractive
of what to expect, in addition to keratectomy (PRK) – Used to
ensuring you choose the best correct mild to moderate
option available with advice nearsightedness, farsightedness
from your ophthalmologist. or astigmatism, PRK is more
Some laser eye surgeries surface-level than Lasik or
commonly performed in recent Lasek.
years are listed below. A doctor would use a laser to
l Laser-assisted in-situ reshape the cornea, but only on
keratomileusis (Lasik) – the surface without affecting the
Arguably the most popular of tissue underneath.
the lot, Lasik works for people
who are nearsighted, farsighted l Refractive lens exchange
or have astigmatism. (RLE) – Other names for this
A doctor makes a flap in the procedure are Prelex, clear lens
outer layer of the cornea so she exchange and refractive lens
can get to the stroma replacement.
underneath. A doctor will make a tiny cut
A laser beam is used to correct at the edge of the cornea to
the shape of the tissue so it can remove the eye’s natural lens,
properly focus light onto the later replacing it with a silicone
retina and consequently correct or plastic lens. This procedure
vision. corrects serious cases of
The surgery itself is painless nearsightedness and
and lasts only 15 to 30 minutes. farsightedness.
Most patients can resume While not necessarily a type of
normal activities within a couple laser-assisted eye surgery, it is
of days of the surgery. not unusual to combine RLE
The doctor may also want to with Lasik or a Lasik-related
create a detailed digital image of procedure to correct
your cornea using a type of astigmatism.
computer imaging called As with Lasek, RLE is the ideal
wavefront technology, which she option for people with thin
can use as a guide during the corneas, dry eyes or other minor
surgery. corneal irregularities.
SUNDAY STAR, 11 MARCH 2018 Healthy Eyes 5
Understanding and
LOCATED at the back of the eye,
the optic nerve is responsible for
transmitting visual information
from the eye to the brain. Also
managing glaucoma
known as the second cranial nerve,
it is made of nerve cells consisting
of about a million small and
individual thread-like nerve fibres.
Quite commonly, these
transmitters can be damaged by
high intraocular pressure (IOP),
thus causing what is known to
many as glaucoma, which is the
second most common cause of
blindness worldwide.
Glaucoma is a disease that is
characterised by loss of vision field
that goes unnoticed until it has
reached an advanced stage. This
resulted in glaucoma being known
as the silent thief of sight as it
progresses inconspicuously
without noticeable symptoms.
It is for this reason that
screening for glaucoma is routine
in eye examinations.
The highest risk factor for
glaucoma is elevated IOP, which Datuk Dr Linda Teoh.
can result from either
malformation or malfunction of is essential in limiting visual
the eye’s internal fluid drainage impairment and preventing the
structure. progression towards severe visual
“It is estimated that 4.5 million handicap or blindness.
people globally are blind due to “An eye-care professional can
glaucoma and that this number detect glaucoma in its early stages
will rise to 11.2 million by 2020,” and advise on the best course of
says Datuk Dr Linda Teoh, visiting Early detection is key in preventing and managing glaucoma, especially for people at higher risk of the disease. action,” says Dr Teoh.
consultant ophthalmologist at Tun In the spirit of early detection of
Hussein Onn National Eye Hospital developing glaucoma increases tomography, visual field pyschological – are well taken glaucoma and in conjunction with
(Thoneh) who specialises in with age. In most cases, it occurs examination and central corneal care of. World Glaucoma Week in March,
detecting and treating glaucoma. among those aged 40 and above. thickness examination. These tests Treatment can range from as Thoneh is organising free
Dr Teoh has been one of the There are several types of this are also important in assessing the simple as prescribing eye drops to glaucoma screening for the public
leading glaucoma experts in the disease. The most common are severity of the disease and control the IOP to laser treatment on March 25 from 8.30am to
Asean region over the past 20 primary open-angle glaucoma and managing glaucoma progression. and surgery to fix the drainage 3.00pm as well as a glaucoma
years. angle-closure glaucoma. If diagnosed with glaucoma, it is system. awareness talk at 10.30am at its
Glaucoma can affect anyone of There are several tests that one best to follow the recommended “In general, glaucoma cannot be premises in Petaling Jaya,
any age or gender and is also can opt for to detect glaucoma. course of treatment as it can be cured and will lead to vision loss. Selangor.
hereditary. Some cases occur at This includes a comprehensive slit managed effectively provided that However, it can be controlled to
birth or during infancy and lamp eye examination with IOP all aspects of the disease – be it prevent the damage from n For more information,
childhood but the likelihood of measurement, optical coherence physical, emotional or worsening. As such, early detection call 03-7718 1488.
6 Healthy Eyes SUNDAY STAR, 11 MARCH 2018
The silent
thief of sight
AFTER a decade of adventure on a
yacht, Michael (not his real name)
decided to schedule himself an eye
check-up with an ophthalmologist.
He had been experiencing slightly
blurry vision and had yet to find a
satisfactory prescription for his
glasses and was determined to
find out why.
An appointment with Dr Lee
Ming Yueh, consultant
ophthalmologist and glaucoma
specialist at ParkCity Medical
Centre led to his diagnosis:
glaucoma. glaucoma is the main type but surgery with implantation of
According to Dr Lee, his optic
nerves were damaged yet his Dr Lee Ming Yueh.
Glaucoma is there are childhood glaucoma
cases that occur as secondary
drainage device.
She further clarifies that the
vision was still of normal clarity. characterised by indications of systemic and more advanced the disease, the
Further examination showed
that despite his extremely narrow occurs in about 0.3% of the South- progressive optic syndromic diseases such as the
Sturge-Weber syndrome and
lower the IOP should be to prevent
progression of the disease. With a
visual field, he was able to see
clearly (with visual acuity of 6/9
East Asian population and the risk
factors of developing glaucoma are
nerve damage that anterior segment dysgenesis.
Its reported occurrence is one
trabeculectomy or tube-shunt
surgery, the IOP could be brought
Snellen) through the restricted age, high eye pressure (intraocular corresponds with a in every 20,000 people. all the way down to 10mmHg. A
remaining window in his vision
field. The optometrists he had
pressure or IOP), severe myopia or
hypermetropia and diabetes. visual field defect, Some symptoms associated with
childhood glaucoma are large
much lower IOP could even halt
the progressive disease.
previously seen had not detected
anything wrong with his vision.
Glaucoma patients usually
experience gradual constriction of
which eventually eyeballs, hazy corneas, teary eyes
and photophobia. Blindness occurs
Patient and peer support is very
important for people undergoing
As is typical in glaucoma cases, visual field, which ultimately leads leads to irreversible at a very young age if the glaucoma treatment for glaucoma as it is a
blindness.
Michael had already lost a large to tunnel vision before progression is left untreated. lifelong commitment.
area of his vision in one eye prior to complete blindness. Dr Lee also mentions that some
to the check-up. Michael’s case is
Halting impending patients find the financial burden
an example of how glaucoma can
go virtually unnoticed until it has
Keeping a lookout blindness
of treatment quite distressing,
while others have trouble dealing
advanced too far. Glaucoma is classified into two “These eye drops can cause with the psychological effect from
“An optical coherence broad categories – open-angle and changes in the trabecular Medication is usually the first having a potentially blinding
tomography scan showed how angle-closure types. In open-angle meshwork and thus impair fluid line of defence against progression disease.
depressed the nerves in his eyes glaucoma, the angle in your eye outflow from the eye. IOP then of glaucoma. Currently, there are
already were and he would have
gone blind within a couple of years
where the iris meets the cornea is
as wide and open as it should be,
builds up and results in optic nerve
damage,” says Dr Lee.
four main types of IOP-lowering
agents – prostaglandin, beta-
Making people see the
if he had not consulted me,” says but the eye's drainage vessels Less common are glaucoma blockers, alpha-agonist and light
Dr Lee. become clogged over time, causing cases that occur even when a carbonic anhydrase inhibitors.
an increase in IOP and subsequent patient has normal IOP (11 to These drugs are quite safe and Malaysia still has large pockets
Knowing the culprit damage to the optic nerve.
In acute angle-closure glaucoma,
21mmHg). Normotensive glaucoma
occurs when the optic nerve has
effective, but some side effects
include severe dry eyes, redness,
of people living in rural areas
without access to medical
Glaucoma is characterised by the angle is so narrow that it could pressure-related damage even eyelid irritation and eczema. information and care who come in
progressive optic nerve damage lead to a sudden rise in IOP with when the IOP of a patient falls Different types of laser surgery only when their glaucoma is
that corresponds with a visual field some cases recording pressures as within normal range. are used for different types of already in an advanced stage.
defect, which eventually leads to high as 50 to 70mmHg and causing “Currently, we are seeing an glaucoma. Open-angle glaucoma Even with prescribed medication
irreversible blindness. blindness within hours. increase in normotensive can be treated with selective laser to lower IOP, Dr Lee says she still
We have about 1.2 million nerve Sometimes, glaucoma occurs in glaucoma cases with the advent trabeculoplasty, which involves sees their condition worsening due
fibres that run along the retina and a patient due to secondary causes. and increased popularity of using a laser beam to stimulate the to poor compliance to treatment
converge to form the optic nerve. “Patients with diabetes may have corneal modification procedures. eye’s drainage angle to perform and lack of social and family
In a patient with glaucoma, these diabetic retinopathy where they “The resulting thinner cornea better. support.
nerves deteriorate at a much experience bleeding and growth after these procedures causes IOP “However, not all open-angle “We need more trained
higher rate than the normal ageing of new vessels in the eye. This to falsely appear to be on the lower glaucoma cases can be treated this ophthalmologists and glaucoma
eye. complication could lead to rubeotic end of the normal range and can way, especially if you have new specialists if we are serious about
“Loss of vision only occurs when glaucoma – a condition that causes be easily missed without a proper vessels at the drainage site due to preventing and treating glaucoma
80 to 90% of the optic nerve is very high IOP and is quite resistant eye examination for glaucoma. secondary causes such as diabetes,” effectively.
already damaged. By the time loss to medical treatment. “IOP also varies across different says Dr Lee. “Awareness comes from
of visual acuity occurs and vision “In addition, use of steroidal eye races. In Japan, 90% of glaucoma One commonly performed knowledge but if you ask 10
loss is detected, the disease is drops, which are commonly sold patients are normotensive procedure in glaucoma treatment people, only one or two would
usually already in a very advanced over-the-counter in Malaysia can glaucoma cases,” says Dr Lee. for angle-closure glaucoma is laser know what glaucoma is. Those
stage,” explains Dr Lee. cause blindness in young adults Glaucoma can also occur in peripheral iridotomy. This laser who know are usually the relatives
According to Dr Lee, glaucoma with itchy eyes. children. Primary congenital procedure uses a very focused of a glaucoma patient and the rest
beam of light to create a hole on are completely clueless,” says Dr
the outer edge of the iris. Lee.
“This opens up the eye’s She adds that even with
drainage angle, reducing IOP and advances in modern medicine,
allowing the aqueous humour to current technology cannot reverse
circulate,” explains Dr Lee the effects of glaucoma. However,
Cataract surgery can slow the disease progression can be halted
progression of glaucoma because with early detection. The outcome
the natural eye lens has a of early intervention is usually
substantial volume compared to an very good.
artificial one, which is barely 1mm “While cataract is the number
thick. one cause of blindness, it is still
“Removing the natural eye lens reversible with surgery. We want
dramatically decreases IOP, relaxes to let people know that glaucoma
the iris and opens the eye’s is the first leading cause of
drainage angle, allowing the irreversible blindness,” says Dr
aqueous humour to circulate Lee.
normally,” explains Dr Lee. ParkCity Medical Centre
If a glaucoma patient’s eye organised a screening event in
pressure is uncontrolled even with conjunction with World Glaucoma
maximum prescription of topical Week 2018 yesterday to raise
eyedrops, surgery should be awareness on glaucoma.
considered. Free eye screening tests were
According to Dr Lee, there are provided to all participants during
two types of standard glaucoma the event.
surgery that are extremely
effective – trabeculectomy n For more information, call
(filtration surgery) and tube-shunt 03-5639 1212.
SUNDAY STAR, 11 MARCH 2018 Healthy Eyes 7
Minimising long-term
glaucoma. FDRs were to act on this information with
Glaucoma causes progressive damage to regular optic nerve tests for glaucoma, it
the vision. It does so usually without would likely save their sight.
warning until much later in the disease and The test for glaucoma involves a simple
> FROM PREVIOUS PAGE eyes which is a bad habit that will
deteriorate your eyesight.
Hence, you should always adjust the
brightness of your screens or allow the l Eye check-ups
devices to shift it automatically according Regardless of your age, you are
to your surroundings to ensure that encouraged to go for regular check-ups at
your eyes meet the optimum level of least once annually unless suggested
Antioxidants for
brightness. otherwise by your ophthalmologist.
You can also consider changing brightly With regular eye check-ups you will be
coloured backgrounds duller colours to able to monitor your eye better and know
reduce the glare. more about the overall health of your eyes
Dim your surrounding lights so that the and potential risks.
brightness of your screen or device will not Discovering the risks or diseases earlier
healthy ageing
compete with it which will result in a higher will allow you to have a higher chance of
intensity of glare. preventing or curing it.
Ensure that the placement of your screen
is between a safe distance and that it is just It is not possible for us to avoid interaction
slightly below your eye level. with electronics. We can however try our
Furthermore, increase the text size best to utilise technology wisely and safely to
whenever possible to avoid straining your enjoy longer healthy vision.