Cataract Surgery, Complex Lens Disorders & Iris Repair in Singapore
EyeWise Vision Clinic’s eye specialist, Dr Khng, is skilled in complex cataract surgical methods, having completed overseas clinical fellowships in the US in complex lens surgery and iris repair.
What is 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
- Eye trauma
- Previous eye surgery for eye conditions, including glaucoma
- Prolonged use of steroids
- Radiation exposure, such as cancer treatment
Besides these, specialists have also identified the following as factors that speed up the formation of cataracts:
- Excessive alcohol consumption
- UV radiation exposure from sunlight
Checks and 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 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 cataracts in Singapore.
About Cataract Removal Surgery
In Singapore, cataract surgery is normally a quick and safe operation, usually taking about 15 minutes by an experienced surgeon.
Types of Cataract Removal Surgeries
1. 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 that promote quicker healing, such as the micro-incision phacoemulsification procedure.
2. 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 a speedier recovery and 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 surgery. These include astigmatism (cylinder), myopia, hyperopia and presbyopia (ageing sight).
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 and the seniority of your surgeon. This amount also excludes the fee charged for the following services:
- Eye tests
- Post-operative review
- Post-operative medication
Speak to our team today for more details about the fees for treatments at EyeWise Vision Clinic.
Cataract Removal Surgery Procedures
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.
You will have to fast for at least six hours before the cataract removal surgery.
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 fully. Attending follow-up private consultations is necessary.
Following your cataract surgery, you will have to adhere to the following advice to ensure that your eyes heal 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.
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.
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. Fortunately, our specialist, 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).
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.
Frequently Asked Questions About Cataract Surgery in Singapore
A cataract is what we call any opacification in the human eye lens. The normal eye lens is clear, but with age and certain conditions like diabetes and trauma, the lens becomes cloudy, leading to cataract formation and the subsequent need for surgery.
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 50. 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 in spectacle power. If you notice any such signs, you can see a cataract eye specialist for a proper diagnosis.
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.
This was the approach applicable to old-style cataract 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’.
No, cataract removal surgery is not painful. Numbing eye drops are applied to the eyes so you won’t feel any pain.
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 surgery and complex lens repair would be preferable, as he would be familiar 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. You can visit our ophthalmologist in Singapore for cataract surgery or any complex eye issues such as eye trauma, sports eye injury, or glaucoma surgery.
No, your cataract will never come back again. 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 restore clear vision.
Typically, in Singapore, surgery for cataract removal takes 15 minutes on average if done by a skilled surgeon.
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.
About Dr Christopher Khng
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 anesthesia phacoemulsification cataract surgery.
He completed his first two years of medical undergraduate studies in Aberdeen University, Scotland (UK), finishing top in his medical class in both years. 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 Christopher Khng
MBBS, M.Med(Ophth), FRCS(Edin), AMS(Ophth 2003) Consultant Ophthalmologist