Mar 8, 2016 - Malays and Indians conducted by the Singapore Eye Research. Institute, more than two-thirds of those with
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MIND&BODY
| THE STRAITS TIMES | TUESDAY, MARCH 8, 2016 |
DocTalk
Glaucoma, the silent thief of sight Early diagnosis can help prevent vision loss and stave off painful symptoms
Dr Loon Seng Chee
Typically, most patients with open-angle glaucoma and chronic forms of narrow-angle glaucoma have no symptoms until much later on in the disease state. By then, they might notice vision loss in the periphery or, as the condition progresses even further, central vision loss. This is why we often refer to glaucoma as the ‘silent thief of sight’.
HealthDiary TODAY UNTIL MARCH 10 FIGHT MALNUTRITION Learn more at Dietitian’s Day at Tan Tock Seng Hospital (TTSH). The first day will feature interactive booths with dietitians. They will be joined by chefs and speech therapists on the second day. The third will bring together dietitians, occupational therapists, physiotherapists and podiatrists. TTSH, Level 1 atrium, 10am to 3pm. Free. For more info, go to www.facebook.com/ events/984175808297067
FRIDAY, MARCH 11 COMMON EYE CONDITIONS IN CHILDREN Find out how to slow myopia progression, why children squint and what can be done about lazy eye. National University Hospital, 1 Main Building, O & G Seminar Room, Level 6, (between Wards 61 and 63), 1pm to 2pm. Free. To register, call 6772-2184.
SATURDAY, MARCH 12 DENTAL BOOT CAMP FOR KIDS Kids aged three to 12 can learn about healthy dental habits through games and activities at this first dental boot camp organised by the paediatric dentistry unit of the National Dental Centre Singapore (NDCS). NDCS, 10am to 4pm. $30 (child) and $5 (parent). To register, go to www.ndcs.com.sg/ dentalbootcamp
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In my work, I often help patients see better, and that gives me a great deal of satisfaction. However, there are others I wish I could do more for. I have been seeing two patients with glaucoma, and they represent the two ends of the glaucoma spectrum. The first is an old schoolmate, who had an eye check-up during his university days. There were early findings that suggested he might be at risk of glaucoma. As a result of the screening, he began seeing a glaucoma specialist. When there was evidence of deterioration in his visual fields, which affected his peripheral vision, he was started on anti-glaucoma eye drops. This kept his eye pressure low, and has helped retard the progression of his condition. Now, after nearly 30 years, he still has good vision, with minimal
loss of his peripheral vision. The other patient came to see me because she felt her vision was a little “fuzzy”. During the course of my examination, I found that she already had advanced loss of peripheral and central vision in one eye, and there was nearly tunnel vision in the other. I spent almost an hour explaining it to her. After 10 visits, she is still unable to come to grips with the severity of her condition. Each time I see her, I feel her pain. She is in the prime of her life and, in all likelihood, she will lose what remaining sight she has in both eyes. During each visit, she asks when she will be able to see clearly again. I have to face her and try to tell her, as gently as I can, that she
cannot regain the vision lost. Her eyes then well up in tears. This is the difference between an early diagnosis and a late one. Typically, most patients with open-angle glaucoma and chronic forms of narrow-angle glaucoma have no symptoms until much later on in the disease state. By then, they might notice vision loss in the periphery or, as the condition progresses even further, central vision loss. This is why we often refer to glaucoma as the “silent thief of sight”. While glaucoma has not become significantly more prevalent in the past decade and glaucoma rates are not that different from those in other nations, there is a larger proportion of narrow-angle glaucoma patients among Chinese here, particularly women.
This condition can result in severe symptoms such as nausea, headaches or pain if the eye pressure goes very high. In a local study of Chinese, Malays and Indians conducted by the Singapore Eye Research Institute, more than two-thirds of those with glaucoma were undiagnosed and not receiving treatment. It affected 3.4 per cent of the Chinese population, 1.95 per cent of the Indian population and 3.2 per cent of the Malay population. The prevalence of glaucoma in women here is between 1.66 per cent and 3.4 per cent, among the various races. The good news is that, with more proactive screening, we are picking up glaucoma in the earlier stages and, with proper monitoring and
treatment, we are preventing more people from suffering the end-stages of glaucoma and losing their vision. For those who have been diagnosed with glaucoma or who are undergoing investigations, take heart. Early screening makes it possible to offer preventive treatment, including laser therapy, which can significantly decrease the chances of suffering painful attacks of nausea, headaches or severe eye pain. Furthermore, research has shown that modern anti-glaucoma medications have cut down the need for surgery by almost 80 per cent. Some of these medications are available in doses that need to be taken only once a day, which is more convenient for patients. If surgery is required, there are newer procedures that involve less traumatic surgery, and are suitable for those with milder glaucoma. However, they will not restore nerves that have been damaged by glaucoma. In general, for most eye problems, 50 is a good age to get screened. But those with a positive family history of glaucoma and/or visual symptoms should get screened even if they haven’t reached 50 yet. Depending on what is found, the need for further follow-ups can be determined. I would like to end with a story about another patient. He has severe glaucoma and retinal detachments arising from other causes – yet, he runs a business, serves on many committees and always has a smile on his face. Being diagnosed with glaucoma doesn’t mean you can no longer live a full life. Keep going for regular eye checks, and take the medications prescribed. With a healthy diet and a positive attitude, you can continue to lead an active lifestyle.
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• Dr Loon is head and senior
consultant in glaucoma services at the National University Hospital Eye Surgery Centre.
ThePro
Putting children to sleep in the operating theatre Q I sub-specialise in paediatric anaesthesia because… A I can provide anaesthesia care and pain relief to children of all ages, ensuring that they remain safely asleep or sedated throughout the duration of surgical or imaging procedures that require them to remain still. Q Paediatric anaesthesia is different from adult anaesthesia because... A Each age group presents unique challenges in terms of their anatomy, physiology and the way their bodies respond to and handle drugs (pharmacology). Airways in young children are different from those in adults, so the equipment used is different. Their veins are tinier, so it is harder to perform medical procedures such as inserting intravenous drips. Children are physically smaller, and have higher metabolic rates and lower oxygen and energy reserves. If there is an acute problem such as an airway obstruction or bleeding, their bodies are less able to correct the problem when compared with adults, so the medical team needs to act a lot more quickly to prevent harm. We usually put children to sleep using a mask through which anaesthetic gas is administered, instead of using an anaesthetic injection, as we usually do for adults. Q The effect of anaesthesia on children is fascinating because… A The drugs work to make parts of the brain less active, to achieve a reversible state of unconsciousness, but no one is really quite sure how exactly this state of unconsciousness is achieved. A young child’s brain develops rapidly and is vulnerable to the effects of anaesthesia and sedatives. General anaesthesia is very safe for children in terms of short-term effects on the heart and vital organs, leading to a lowered breathing rate and a slower heart rate. Studies are under way to determine long-term effects of early exposure to anaesthesia in humans. Q One little-known fact about putting children to sleep is... A We have fun before that. We blow bubbles and use things like tablets to entertain them and put them at ease before we put them to sleep. When they wake up, they get a
printed certificate telling them that they performed bravely for the surgery.
BioBox BONG CHOON LOOI
Q What I do is like being... A A pilot who works in a cockpit. I work in an operating theatre with high-tech machines and a medical team that includes surgeons and nurses. My aim is to take care of the patient from take-off (going to sleep) to landing (waking up) and beyond, making sure he is safe, sedated and comfortable throughout, while facilitating the operation. As with many segments of the aviation industry, anaesthesia is a high-risk speciality and there should be zero mistakes.
Age: 42 Occupation: Senior consultant at the department of paediatric anaesthesia at KK Women’s and Children’s Hospital (KKH). Dr Bong graduated from the University of Edinburgh and completed her basic anaesthesia training in Edinburgh, Scotland. She returned to Singapore for her advanced speciality training in Singapore General Hospital before joining KKH to specialise in paediatric anaesthesia in 2005. She subsequently obtained her paediatric anaesthesiology fellowship from the Children’s Hospital Boston in the United States, and was an instructor in anaesthesia at Children’s Hospital Boston and assistant professor at Harvard Medical School before returning to Singapore in 2008. Her research interests include the effects of general anaesthesia on neurocognitive development in children, and the stress response of trainees during medical simulation. Dr Bong is married to a 45-year-old cardiologist. They have two daughters, aged 12 and eight.
Q I come across all types of cases... A From newborns needing major heart and bowel operations to toddlers with airway emergencies in the middle of the night and older children with acute appendicitis. There are also routine hernia operations, circumcisions and tonsillectomies, which are more common. The smallest child I ever anaesthetised was a premature baby who weighed only 400g and needed a major operation to resect the intestines. We took extreme caution and the surgery was a success. Q Most of my patients are too young to... A Be at fault. On very rare occasions, I see a developmentally normal child who is rude and physically aggressive to his or her own parents and/or the hospital staff. I respond by being firm and the child usually cooperates after that. Q It breaks my heart when... A I see a child who is battling cancer come in repeatedly for operations. To see such children and the strength and dignity shown by their families in the face of pain and adversity is a humbling experience. Q I wouldn’t trade places for the world because... A I love my job. I get to look after the youngest and most vulnerable group of patients, and to protect them from pain and other potential dangers related to surgery. They might not remember me, but I like to think that I have helped in their long-term well-being.
Joan Chew Dr Bong loves her job as she gets to care for the youngest and most vulnerable group of patients, and to protect them from pain and other potential dangers related to surgery. ST PHOTO: ALICIA CHAN
I work in a great department where everyone is helpful and supportive – it is like working with one’s own family.
Q My best tip... A Treat others as you would want your loved one or yourself to be
treated. Medical professionals should put themselves in the patient’s shoes or see the patient as a loved one, and this should determine the way they treat patients who are under their care.
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