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  • Cataract Surgery, Complex Lens Disorders & Iris Repair

    Cataract Surgery, Complex Lens Disorders & Iris Repair

    cataract1 cataract2

    Dr Khng is experienced in advanced cataract surgical techniques, but has also completed overseas clinical fellowships in the US in complex lens surgery and iris repair.

    A cataract is the term given to any clouding of the normally clear human natural crystalline lens. This can occur as a result of normal aging, or may be accelerated by some medical illnesses such as diabetes. Other types of damage to the lens from trauma, eye inflammation (iritis and uveitis), or certain drugs taken for other illnesses (corticosteroids) may also cause cataracts to form. The appearances of different types of cataracts are shown in these photos.

    Cataract surgery is normally a quick and safe operation, usually taking about 15 minutes by an experienced surgeon. During this process, the old cloudy yellowed lens is removed through a tiny incision, and it is replaced by a new flexible man-made lens implant which is then inserted though the same tiny incision. The optical power of the new lens is usually chosen so that the patient will have good distance vision without glasses. Newer premium lens implants also make it possible for near vision to also be perfect. Other optical problems present before surgery may also be corrected at the time of cataract surgery, such as astigmatism (cylinder), myopia, hyperopia and presbyopia (Aging sight).

    Although generally very safe, cataract surgery has a complication rate of 0.5-5%, depending on the difficulty of the eye and surgeon experience. Fortunately, Dr Khng has trained under some of the world’s best surgeons in difficult and complicated cataract surgery. He frequently is referred cases for surgical repair when some surgeons encounter cataract surgery complications, or for the more complex cataract cases (pics).

    Part of his time is spent as a visiting consultant in a major eye hospital in Singapore, where he sees only difficult cataract cases, and cases requiring cataract complications repair. Fortunately, many of these complicated cases can be satisfactorily repaired with no or minimal visual compromise. The repair of these cases requires extensive experience and exposure to specialized surgical techniques and implant devices, which include standard and modified capsular tension rings, special capsular and iris hooks, specialized sutures, as well as special lens implants that can be secured by stitching them to the wall of the eye in badly injured eyes.

    Cataract Q&A

    Having a cataract is one of the feared problems of aging. Fortunately, modern small incision cataract surgery has advanced to such high standards that removing the cataract and replacing it with a premium lens implant not only restores, but also enhances vision.

    Indeed, cataract surgery is one of the most commonly performed operations in any field of surgery. It is also the most successful with a very low complication rate when performed by an experienced surgeon.

    What is a cataract?

    A cataract is what we call any opacification in the human lens. The normal human lens is clear, but with age and certain conditions like diabetes and trauma the lens becomes cloudy, leading to cataract formation.

    How do I know if I have a cataract? What are some of the symptoms?
    Many people may discover they have a cataract when they make new glasses and still cannot see well, especially if they are over the age of 50y. Cataracts usually cause a gradual, progressive, painless, blurring of vision in one or both eyes. Some patients also complain of increasing glare in bright light or difficulty seeing while driving at night. Certain types of cataracts also cause progressive myopia (increased short-sightedness) with frequent changes of spectacle power.

    When should I consider going for cataract surgery?
    When you are no longer happy with your vision for your work or leisure activities.

    Should I wait for my cataract to be ‘ripe’ or ‘mature’?
    This was the thinking for old-style cataract surgery. Because modern cataract surgery has advanced radically, this thinking is now incorrect. In fact, surgery is much easier when the cataract is not too ‘ripe’ or ‘mature’.

    Is cataract surgery painful?
    No. There should be no pain at all. Sometimes there is a feeling of pressure or tightness in the eye during surgery.

    Are there any risks in cataract surgery?
    No surgery is completely risk-free. One major complication that we try very hard to prevent is post-operative infection. There is less than a 1 in 1000 risk of this happening. Even if this happens, it can usually be treated.

    Who should I choose to do my cataract surgery?
    Ideally, your surgery should be done by a cataract subspecialist, who is a surgeon trained to a higher level in advanced cataract surgery. Although every eye surgeon can do cataract surgery, the level of skill and training may vary. A cataract subspecialist experienced in dealing with difficult cataract surgery and complex lens repair would be preferable, as he would be familiar with dealing with cataract complications. Although cataract complications are not very common, you would want a surgeon with more experience in this area, when it is your turn to have your cataract removed.

    Will my cataract come back again?

    No, your cataract will never come back again. What sometimes happens in under 10% of patients a few years after surgery is thickening and haziness (called an “after-cataract”) of the lens envelope(capsule) that supports the lens implant. This leads to blurred vision similar to a cataract, but is easily, painlessly and safely treated at a YAG laser to restore clear vision again.


    Iris repair

    The iris is the coloured part of the eye surrounding the pupil. It acts as a diaphragm or sphincter to control the amount of light entering the eye, and the quality of the visual image.

    Common causes of iris damage include accidental and surgical trauma, for example during cataract surgery, where it may be more common in male patients taking prostate medications. Surgical trauma to the iris may be noticed after surgery as increased glare and light sensitivity, as the eye can no longer effectively control the amount and quality of the light entering the eye. In the past, these types of injury were left alone because it was thought that “nothing can be done”, and the patient had to live with the discomfort. Fortunately, this is no longer the case since Dr Khng has acquired a wide array of surgical techniques for iris repair, having received a clinical fellowship in the US in advanced techniques of iris repair and anterior segment reconstruction.

    Accidental eye injury, as in industrial accidents is another major cause of iris damage. In more simple cases, the iris may be sutured (stitched) back in place with delicate sutures. More extensive damage to the eye may require iris implant devices, which may also be combined with cataract surgery if the lens has also been damaged.

    These accidental injuries are all preventable with the proper protective eyewear. Kindly make sure that protective polycarbonate glasses/goggles are worn during activities that could general eye injuries, such as drilling or hammering. If you would like to purchase these protective eyewear, kindly call the clinic to order them.

    Children of The Moon

    Benefits of Artificial Iris Implants for albino children

    According to the Native American tribe, people with albinism are referred to as “children of the moon.” This is because of the fair coloration which they share with their legendary Moon Goddess and because they need to stay out of strong sunlight during the day. Such children were rarely seen in every society, as they form a quiet minority. They are considered deviant or strange and the main difficulty people with albinism face is fitting into society, as there is a tendency for others to treat them as freaks of nature or objects of morbid curiosity. But they are unmistakably part of every society in this world.

    The word “albinism” refers to a group of inherited conditions. People with albinism have little or no pigment in their eyes, skin, or hair. They have inherited genes that do not make the usual amounts of a pigment called melanin.

    Albinism affects people from all races. Most children with albinism are born to parents who have normal hair and eye color for their ethnic backgrounds. A common myth is that by definition people with albinism have red eyes. In fact, there are different types of albinism, and the amount of pigment in the eyes varies. The colour of the eyes may be described as reddish, violet, greyish blue, hazel or brown eyes.

    Everyone knows that there are contact lens that can change the colour of your iris and be a fashion statement. Many fashion setters like celebrities & pop stars can now choose to have blue, brown or green eyes. But did you know that this concept is similarly used in artificial iris implants, which provides numerous medical benefits to patients with visual problems. Artificial iris implants often benefit patients who have missing or defective iris, born without an iris (a condition called aniridia) or albinos who have non-coloured iris? This life changing procedure is particularly useful to this unique group of individuals ie “children of the moon”.

    Vision Problems

    Dr Christopher Khng, Medical Director of EyeWise Vision Clinic, explains “the iris is the coloured part of the eye surrounding the pupil. It acts as a diaphragm or sphincter to control the amount of light entering the eye, and the quality of the visual image.”

    In general, common causes of iris damage to eye patients are accidental and surgical trauma, for example during cataract surgery, where it may be more common in male patients taking prostate medications. Surgical trauma to the iris may be noticed after surgery as increased glare and light sensitivity, as the eye can no longer effectively control the amount and quality of the light entering. In the past, these types of injury were left alone because it was thought that “nothing can be done”, and the patient had to live with the discomfort. Fortunately, this is no longer the case. Dr Christopher Khng strongly emphasized that there are a wide array of surgical techniques for iris repair these days. He received his clinical fellowship at the world renowned Cincinnati Eye Institute in Ohio, USA, where he acquired skills in advanced techniques of iris repair and anterior segment reconstruction. He is at the forefront of this field.

    A major problem faced by albinos is their visual sensitive to light. As the iris usually helps control the amount of light coming into your eye and hitting your retina, which is located at the back of your eyeball, its function is crucial. When a person has albinism, the iris does not have enough color and can not properly shield the retina from light. So, children with albinism often squint in bright light. Wearing sunglasses or tinted contact lenses can help make them more comfortable out in the sun.

    In albinos, the lack of pigment during the development of the eye causes an abnormal development of the retina and affects the formation of the nerve pathways from the eyes to the brain, which causes decreased visual acuity or low vision. They often describe their vision as lacking fine detail. Corrective lenses (i.e. implantable lens, glasses or contact lenses) and low vision aids (i.e. magnifiers or telescopes) can provide some clarification. Some kids with albinism wear glasses or contact lenses to help them see better. Others might need eye surgery.

    People with albinism also can have these problems affecting their ability to focus. That’s why it can be important for them to wear glasses. The back of the eye and the use of their vision can both develop more fully if they have the most focused image possible on the back of the eye. This focusing problem can be solved with Intraocular Lens Implants (ICL), glasses and contacts can correct these problems by reshaping the light entering the eye so that it does send an in focus image to the back of the eye, a little like correcting a blurry slide projector or a blurry image in binoculars.

    To summarise, Dr Christopher Khng, (MD), highlighted that with the advancements in interior ocular technology and artificial iris implant can refine sufferers of bright light glare and improve their quality of vision and this in turn has changed and improve the quality of life and self image in society. Children of the moon are an integral part of our society and they need to talk to their eye doctor about taking care of their eyes, especially if they are going to be in the sun. The benefits and the technology is here to give focus light on medical advancements.

    If you would like an assessment to see what can be done for your iris damage, please call EyeWise Vision Clinic now.

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