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Cataract Surgery, Complex Lens Disorders & Iris Repair in Singapore

EyeWise Vision Clinic’s eye specialist, Dr Khng, is knowledgeable in complex cataract surgical methods, having completed overseas clinical fellowships in the US in complex lens surgery and iris repair.

Types of Cataract Removal Surgeries

1. Micro-Incision Phacoemulsification

During this process, the surgeon emulsifies cataracts in the lens of your eye using ultrasound energy before removing the old cloudy, yellowed lens through a tiny incision. Thereafter, the surgeon replaces it with a new flexible man-made lens implant inserted through 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. These lens implants also make it possible for near vision to also be perfect. Unlike extracapsular cataract extraction, the incision is typically sealed up with a special liquid when this treatment is used. Meanwhile, the significantly smaller incision translates to reduced risk of complications.

As a bonus, your cataract surgery can benefit you in more ways than one, as other optical problems present before surgery may also be corrected at the time of cataract eye surgery. These include astigmatism (cylinder), myopia, hyperopia and presbyopia (ageing sight).

2. Extracapsular Cataract Extraction

During extracapsular cataract extraction, the natural lens with the cataract is removed as a single piece after a large incision of about 10 mm is made. The incision is then closed with sutures or stitches. However, as a larger incision increases the risk of complications, this procedure is increasingly phased out in favour of eye surgeries such as the micro-incision phacoemulsification procedure.

About Dr Christopher Khng - Cataract Specialist

Dr Christopher Khng, specialises in Complex Cataract and Anterior Segment Reconstruction Surgery, in particular, Iris Reconstruction and Surgery for Aniridia. His other areas of expertise include Complex Lens surgery, New Lens and Phacoemulsification technologies, Refractive surgery, Phakic IOLs (the Implantable Collamer Lens, ICL), and small-incision, topical 22 phacoemulsification cataract surgery.

He completed his first two  years of medical undergraduate studies in Aberdeen University, Scotland (UK). Because of cost, he completed his medical degrees of MBBS at National University of Singapore (NUS).

Dr Khng served as Registrar, then Associate Consultant Ophthalmic Surgeon at the Singapore National Eye Centre (SNEC). Following his stint in SNEC, Dr Khng was a Consultant at The Eye Institute, Tan Tock Seng Hospital, Singapore.

Dr Khng has trained under several surgeons around the world in difficult and complicated cataract surgery. He frequently is referred to cases for surgical repair when some surgeons encounter cataract surgery complications or for the more complex, advanced cataract cases (pics).

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Dr Christopher Khng

MBBS, M.Med(Ophth), FRCS(Edin), AMS(Ophth 2003) Consultant Ophthalmologist

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

For more information, contact us to book an appointment at our eye care clinic in Singapore.

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What is a Cataract?

A cataract is a term specialists use to refer to any clouding of the normally clear human natural crystalline lens. This can occur as a result of normal ageing 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 appearance of different types of cataracts is shown in these photos.

Types of Cataracts

The three types of cataracts commonly identified by eye specialists are as follows:

  • Nuclear cataracts: This occurs at the centre of the lens.
  • Posterior subcapsular cataracts: These form at the back of the lens and can be caused by prolonged steroid use or diabetes.
  • Cortical cataracts: These start from the edges of the lens before progressing towards the centre.

Causes of Cataracts

Cataracts are often an age-related eye condition. However, it can also be caused by other reasons, including:

  • Family history of cataracts
  • Diabetes
  • Eye trauma
  • Previous eye surgery for eye conditions, including glaucoma
  • Prolonged use of steroids
  • Radiation exposure, such as cancer treatment

Besides these, doctors and specialists have also identified the following as factors that speed up the formation of cataracts:

Symptoms of Cataracts

If you’re experiencing any of the following symptoms, it may be time to consider consulting a cataract surgeon for a thorough evaluation and potential cataract eye surgery:

  • Blurred Vision: Experiencing blurred or cloudy vision is one of the earliest signs of cataracts, making daily activities difficult.
  • Difficulty with Night Vision: A noticeable decline in night vision indicates that cataract removal surgery is necessary.
  • Sensitivity to Light: If bright lights or sun glare become intolerable, this could be a symptom requiring cataract surgery or eye treatment.
  • Seeing Halos: Seeing halos around lights is a common symptom, often leading to a consultation with a cataract surgeon.
  • Colour Distortion: Fading or yellowing of colours is another red flag that you might need cataract eye surgery.

When you are no longer happy with the vision of your eyes and face difficulty performing routine work or leisure activities, you can book an appointment with our cataract specialist in Singapore. After a thorough evaluation of your vision, the ophthalmologist may prescribe cataract surgery.

Diagnosis of Cataracts

As prevention is better than cure, it is advised that you undergo regular examinations with an eye specialist to ensure that abnormalities are detected early. During the examination, your doctor will administer several tests:

  • Prescriptive power measurement: Lenses of different degrees will be placed before your eye.
  • Eye pressure measurement: This test determines your risk of contracting glaucoma.
  • Cataract test: The doctor or surgeon will dilate your pupil with eye drops before using a Slit Lamp to examine your eye for cataracts and other conditions.

After completing all tests, your doctor will discuss the results and the available options. Surgery is the typical treatment recommendation for cataract treatments in Singapore.

When to Have Cataract Surgery?

Deciding the right time to undergo cataract surgery is crucial in managing your eye health. Here are some key factors to consider:

  • Progressive Vision Impairment: If eye cataracts have advanced to the point where they’re significantly affecting your daily life—such as reading, driving, or even recognising faces—it may be time to discuss cataract surgery with a qualified cataract surgeon.
  • Inadequate Results from Glasses or Contacts: When corrective lenses no longer improve your vision, it could indicate the need for cataract eye surgery.
  • Impact on Professional Life: If poor vision starts interfering with your job performance, it’s a strong signal to consider cataract surgery in Singapore.
  • Diminished Quality of Life: Cataracts can make leisure activities like reading, cooking, or watching TV increasingly challenging, lowering your overall quality of life.
  • Complications in Other Eye Treatments: Sometimes cataracts can interfere with treating other eye conditions. In such cases, your cataract surgeon may recommend cataract surgery to improve overall eye health.
  • Failed Night Vision Test for Driving: Difficulty with night vision is a common symptom of cataracts. If you fail a night vision driving test, consult a cataract surgeon about potential cataract surgery and eye treatment.
  • Increased Sensitivity to Light: Experiencing intense glare from headlights or sunlight could be a deciding factor for undergoing cataract surgery.

If you identify with any of these scenarios, it’s advisable to consult a cataract surgeon for a comprehensive eye examination and to discuss the options for cataract surgery in Singapore.

Pre-Cataract Surgery Preparation

To induce relaxation and sleep, intravenous sedation will be administered. However, you will first undergo an electrocardiogram (ECG) and a blood test before your cataract surgery to confirm if sedation is suitable for you. Anaesthetic eye drops will also be applied to numb your eye, and this can cause you to experience pressure and a cold sensation around the eyelids and on the eye.

Post-Operative Surgery Guidelines and Recovery

As driving is not advised, you must arrange for someone to accompany you home or take a cab after your procedure. You will also have to protect your eyes with sunglasses after the cataract surgery as they may be sensitive to light. Many individuals can typically resume work quickly after cataract surgery. However, it can take about a month or more for the eye to recover. Attending follow-up private consultations is necessary.

Following your cataract surgery, you will also have to adhere to the following advice to ensure that your eyes adjust well:

  • First 12 hours: Avoid reading, using the computer, and watching television for prolonged hours.
  • First 24 hours: Refrain from driving or operating heavy machinery.
  • First week: 
    • Wear eye shields during sleep.
    • Refrain from travelling.
  • First two weeks:
    • Prevent water from entering your eyes when showering.
    • Avoid applying eye makeup.
    • Avoid cooking and dusty or smoky areas where particles can cause eye irritation.Stay indoors.
    • If you must leave your house, please wear protective glasses.
  • First month:
    • Refrain from engaging in contact sports, heavy lifting, swimming and hot yoga, or using a hot tub, jacuzzi or sauna.
    • Prevent sweat from entering your eyes while exercising.

Post Surgery Medication

Please also adhere to the following medication instructions:

  • Apply your prescribed eye drops as instructed after washing your hands thoroughly.
  • Ensure that the bottle tip does not come into contact with your eye and eyelashes during application to prevent contamination. In the event of contamination, please use a new bottle.
  • Use a different set of medications for each eye.

Possible Risks And Side Effects of Cataract Surgery

Although generally safe and low-risk if you comply with the post-operative care instructions, cataract surgery has a complication rate of 0.5 – 5%, depending on the difficulty of the eye and surgeon experience. The most common complication of cataract surgery is a condition called posterior capsular opacification (PCO), also referred to as after-cataract. PCO occurs when the back surface of the clear lens capsule becomes cloudy. This can happen months or even years after your eye surgery and, if left untreated, can cause blurry vision. Fortunately, PCO is treatable with a simple laser procedure.

Other possible risks and side effects of cataract surgery you should be aware of include the following:

  • Infection: Though rare, post-operative infections can occur. Following your surgeon’s care instructions minimises this risk.
  • Retinal Detachment: A more serious but uncommon complication involving the retina separating from the back of the eye.
  • Increased Eye Pressure: Some patients may experience elevated intraocular pressure shortly after the procedure, which is usually temporary but requires immediate attention.
  • Swelling or Edema: In some cases, the cornea or retina may swell, affecting vision temporarily.
  • Lens Fragments: On rare occasions, fragments of the cataractous lens may fall into the vitreous cavity, requiring a second procedure for removal.
  • Secondary Cataract: A condition known as posterior capsule opacification can occur, requiring a simple laser procedure for treatment.

Being informed about these risks will help you thoroughly discuss with your cataract surgeon in Singapore whether cataract eye surgery is an appropriate option for you.

Average Cost of Cataract Removal Surgery

In Singapore, the average cost of a cataract surgery can range from S$9,000 to S$12,000 per eye, depending on factors such as the complexity of your case, the seniority of your surgeon, and whether your operation is at a private or public hospital. Below is a detailed look at the estimated cost breakdown for a cataract eye surgery.

Public Hospitals vs Private Clinics

  • Public Hospitals: If you are a Singaporean citizen and qualify for government medical subsidies, the average cost for cataract surgery on one eye in a public hospital is around $1,269. This fee encompasses the operation, implant, and other related charges. More information can be found on the MOH website.
  • Private Hospitals: According to the Singapore Doctor’s Directory, the average cost at five private hospitals for cataract surgery is approximately $4,490 per eye. However, this cost can escalate to as much as $10,000 per eye, depending on various factors, such as the complexity of your condition and the seniority of the surgeon.

Cataract Surgery Cost Breakdown at Private Eye Centres 

The breakdown below are estimated by a senior cataract eye surgeon to give you an idea of the costs of a cataract surgery at a private eye centre:

  • Cataract Assessment: Fees range from $150 to $500.
  • Cataract Surgery (1 eye): The surgery can cost between $6,000 to $12,000, depending on the specifics of your case.
  • Post-op Medication: Expect to spend between $100 to $300 for your post-operative medication.
  • Post-op Review: A follow-up consultation may cost you between $150 to $300.

Note on Costs for Operating on One vs Two Eyes

Interestingly, the cost of cataract surgery on just one eye is usually more than half that of two eyes. This is primarily due to fixed costs like consumables and operating theatre booking, which remain constant regardless of whether one or two eyes are being operated on.

Customised Estimates

Most eye centres can provide a tailored estimate based on your eye condition and lifestyle needs, allowing you to plan your finances accordingly. Speak to our team today for more details about the fees for treatments at EyeWise Vision Clinic.

Frequently Asked Questions About Cataract Surgery in Singapore

This was the approach applicable to old-style cataract eye surgery. A cataract does not need to be ‘ripe’ or ‘mature’ before it can be removed. With modern advances in cataract surgery, the lens can now be removed from the eye at any stage of development. In fact, surgery is much easier when the cataract is not too ‘ripe’ or ‘mature’.

Ideally, your surgery should be done by a cataract specialist, 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 specialist experienced in dealing with difficult cataract eye surgery and complex lens repair would be preferable, as he would be familiar with cataract complications.

No, your cataract is unlikely to return. What sometimes happens in under 10% of patients, a few years after their eye surgery, is thickening and haze (called an “after-cataract”) of the lens envelope (capsule) that supports the lens implant. This leads to blurred vision similar to cataracts but is easily, painlessly and safely treated with a YAG laser to prevent aggravation.

Typically, in Singapore, surgery for eye cataract removal takes 15 minutes on average if done by a surgeon.

After cataract surgery, you can expect your vision to improve within a few days as your eye heals and adjusts.

It is not necessary to wear glasses after cataract surgery, although some people may find them helpful for reading or other activities. If you do need glasses, your doctor or eye specialist can prescribe the appropriate type and strength for you.

The timeline for resuming normal activities post-cataract surgery can vary from person to person, but most patients can expect to return to their usual routine within a week. However, it’s important to avoid strenuous activities and follow post-operative care instructions from your eye surgeon. A follow-up consultation will provide a more personalised recovery plan tailored to your condition and lifestyle.

While the formation of cataracts is often age-related and not entirely preventable, certain lifestyle choices can help slow their progression. Maintaining a healthy diet rich in antioxidants, wearing UV-protective sunglasses, and avoiding smoking can contribute to eye health. Regular eye exams are crucial for early detection and intervention, especially as you age or have risk factors like diabetes.

Typically, cataract surgery is performed on one eye at a time, with a recovery period of about two weeks before the other eye is treated. However, simultaneous bilateral cataract surgery may sometimes be considered, depending on the surgeon’s assessment and patient needs. Always consult your eye specialist for advice.

Yes, cataract surgery is generally possible even if you’ve previously undergone LASIK. However, prior laser surgery may affect the measurements needed for selecting the intraocular lens implant for the cataract procedure. It’s crucial to consult with an experienced eye specialist who can assess your situation and suggest the most appropriate course of action.

Generally, LASIK after cataract surgery is seldom necessary, as the intraocular lens (IOL) implanted during cataract eye surgery usually corrects vision. However, if you’re not fully satisfied with your vision post-cataract surgery, some forms of laser vision correction, like LASIK, could be considered. Always consult your cataract specialist for a comprehensive evaluation to determine the next course of action.

Presbyopia can often be addressed during cataract eye surgery by implanting multifocal or accommodative intraocular lenses (IOLs). These specialised lenses aim to restore distance and near vision, reducing the need for reading glasses. Consult your cataract eye specialist to discuss the suitable lens options for your condition and lifestyle needs.