Glaucoma Surgery in Singapore

Q: What is the root cause of glaucoma?

There are many factors that could contribute to glaucoma, but one common cause is the increase in eye pressure. Elevated eye pressure is caused by the buildup of fluid that flows throughout the inside of the eye. When there’s an overproduction of the fluid and it doesn’t drain out of the trabecular meshwork at the angle where the iris and cornea meet, eye pressure increases, resulting in glaucoma. This can be treated with eye drops that can lessen eye pressure. However some complex cases may require laser surgery.

What is Glaucoma?

Pressure in the eye that is above range may damage the nerve by affecting the blood flow to the nerve, or may directly damage the nerve itself. Sometimes, the nerve itself is unusually susceptible to damage, even at a normal level of eye pressure. Eye doctors carry out glaucoma treatments or surgeries are carried out to regulate or lower intraocular pressure, preventing damage to the optic nerve. People with a family history of glaucoma are at higher risk and should be screened by an eye specialist in Singapore to check signs for raised eye fluid or other symptoms.

Types of Glaucoma

Understanding the different types of glaucoma is crucial for managing visual health. Here are the some you should be aware of:

1. Open-angle glaucoma

Open-angle glaucoma primarily occurs due to a slow and progressive obstruction in the eye’s natural drainage system, known as the trabecular meshwork. This blockage elevates intraocular pressure, posing a risk to the optic nerve over time. What sets this type apart is its silent onset; it often manifests without noticeable symptoms until vision loss occurs. Therefore, regular checkups with an eye specialist are indispensable for early intervention.

2. Angle-closure glaucoma

Angle-closure glaucoma is less common but more severe. It occurs when the drainage angle between the iris and cornea closes abruptly, causing a rapid increase in intraocular pressure. Immediate medical attention from a glaucoma doctor in Singapore is crucial to prevent permanent vision loss. In extreme cases, glaucoma surgery may be necessary to alleviate the pressure and preserve vision.

3. Normal tension glaucoma

In normal-tension glaucoma, the optic nerve incurs damage despite the eye pressure being within what is generally considered the “normal” range. Unlike other forms of glaucoma, the risk factors may extend beyond eye pressure to include issues like poor blood flow to the optic nerve or a more vulnerable nerve structure.

4. Secondary glaucoma

In secondary glaucoma, the elevated eye pressure is a byproduct of another underlying health issue or medication side effect. For instance, conditions such as diabetes, eye trauma, or even certain medications can trigger this form of glaucoma. Unlike primary glaucomas, the treatment strategy for secondary glaucoma often includes tackling the root cause alongside eye-specific interventions. A multi-disciplinary approach by a glaucoma specialist is essential for a holistic treatment plan.

Symptoms of glaucoma

While early-stage glaucoma may not show any noticeable symptoms, staying alert to subtle changes in your vision is essential. Here are some key symptoms to take notice of:

1. Severe Headaches

While severe headaches can have various underlying causes, they are also recognised as an exemplary indicator for certain types of glaucoma, particularly angle-closure glaucoma. These headaches often arise due to increased intraocular pressure, which not only impacts the eyes but also exerts pressure on surrounding ocular structures, leading to head pain. The discomfort generally originates around the eye and may radiate to the temples or back of the head. Such symptoms necessitate eye examinations for early diagnosis and intervention.

2. Blurred vision

Blurred vision can be a symptom of several eye conditions, but when it occurs suddenly and is accompanied by other symptoms like eye pain, it may indicate a form of acute glaucoma. Medical evaluation is essential to rule out this condition.

3. Gradual loss of peripheral vision

Another potential sign of glaucoma is the subtle narrowing of your field of vision, particularly on the sides. This phenomenon is often described as tunnel vision, where the edges of your visual field begin to close in, leaving only the central vision intact. Because the progression is usually slow and subtle, many individuals don’t realise they’re experiencing vision loss until it has reached a more severe stage.

4. Halos around lights

The appearance of halos or luminous circles around lights, particularly noticeable in darker settings, can be a concerning symptom of glaucoma. This can make activities such as nighttime driving or navigating in low-light conditions challenging, and may warrant further evaluation for appropriate treatment options.

5. Eye pain and redness

If you encounter eye pain accompanied by redness, it could be a sign of a specific, urgent form of glaucoma called angle-closure glaucoma. These symptoms should not be ignored and require immediate consultation with a glaucoma doctor to assess the severity and determine a suitable approach, ranging from medication to glaucoma laser surgery.

Causes of Glaucoma

Many factors that could contribute to glaucoma, but one common cause is increased eye pressure. Elevated eye pressure is caused by the buildup of fluid that flows throughout the inside of the eye. When there’s an overproduction of the fluid and it doesn’t drain out of the trabecular meshwork at the angle where the iris and cornea meet, eye pressure increases, resulting in glaucoma. This can be treated with eye drops that can lessen eye pressure. However, some complex cases may require laser surgery.

Genetic predisposition also plays a significant role in glaucoma risk. Your likelihood of developing glaucoma increases substantially if you have a family history of the condition. It’s crucial to share any family medical history with your eye care specialist for early intervention.

Checks and Diagnosis of Glaucoma

Our glaucoma doctor in Singapore carries out these tests to evaluate various aspects of your eye health and are crucial for diagnosing glaucoma correctly. Here’s a breakdown of the key checks and diagnostic process:

1. Initial comprehensive eye exam

The diagnostic process usually begins with a comprehensive eye exam, often conducted by a glaucoma eye specialist in Singapore. This exam includes measuring your eye pressure with a tonometer.

2. Visual field test

A visual field test is conducted to assess your peripheral vision. Loss in this area could be an early indicator of glaucoma and help determine the approach for the treatment.

3. Examination of the optic nerve

An ophthalmoscope is used to examine the optic nerve for any signs of damage closely. This step helps in early detection of glaucoma and other optic nerve disorders.

4. Optical Coherence Tomography (OCT) scans

OCT scans provide detailed images of the eye’s internal structures. These scans are invaluable for assessing the severity of the condition and may influence the decision to proceed with glaucoma surgery.

5. Gonioscopy

This test evaluates the drainage angle where the iris and cornea meet, which is essential for fluid drainage. Gonioscopy results can further refine the glaucoma treatment plan.

By following this diagnostic pathway, you can ensure that you’re taking the necessary steps for early detection and effective management of glaucoma, potentially reducing the need for glaucoma surgery in Singapore.

Suppose you have a history of glaucoma or blindness, especially in immediate family members; getting a thorough eye screening from our glaucoma eye specialist in Singapore can be useful to rule out the condition. Do take note to mention this family history during your eye screening for a better understanding of your situation

During its early stages, glaucoma has no symptoms or pain. Because of this, it has often been labelled “the silent thief of sight”, which underscores the importance of regular eye checkups for timely detection.

Glaucoma Treatment Options

Managing glaucoma involves various treatment options aimed at controlling eye pressure to prevent vision loss. Here’s a closer look at these options:

1. Glaucoma Eyedrops

The initial treatment for glaucoma is usually with eyedrops to reduce eye pressure. Many of these eyedrops now come with convenient once or twice-a-day dosing and work for many patients. Sometimes, 2 or 3 eyedrops may need to be combined to achieve a low enough eye pressure.

2. Glaucoma Surgery

Some patients will need laser or glaucoma surgery to control their eye pressure when even multiple eyedrops provide unsatisfactory control. Laser treatment for glaucoma usually involves enhancing fluid drainage from the eye or reducing fluid production, resulting in a drop in eye pressure.

Glaucoma surgery is usually quick and effective and is done as day-case surgery. With adequate anaesthesia, patients may not feel uncomfortable during surgery. Certain chemicals may be used during glaucoma surgery to reduce the amount of scarring at the surgical site. Following surgery or laser treatment, eyedrops are prescribed to reduce inflammation and infection and usually need to be instilled for a few weeks to months.

Pre Glaucoma Surgery Preparation

Preparing for glaucoma surgery begins with a comprehensive consultation with your eye specialist. In this initial session, the glaucoma doctor will conduct visual field assessments, eye pressure measurements, and corneal thickness evaluations to match the surgery to your needs.

A visual field assessment is a common investigation used to determine glaucoma progression. An automated machine projects light in the patient’s field of vision, and the patient responds by pressing a button if the light is seen. The machine then goes on to map the area of functional vision by assessing which parts can and cannot see the light. This process takes about 5-10 minutes for each eye, and gives the doctor an idea of the function of the eye and its optic nerve.

At EyeWise Vision Clinic, our glaucoma specialist in Singapore uses the Humphrey Visual Field system, considered the gold standard in glaucoma assessment. This system helps in collecting detailed information for a more comprehensive surgical plan.

Following this, reviewing your current medications with your glaucoma doctor is essential, as some could potentially interfere with the surgery. Additionally, fasting may be required before the procedure, so be sure to follow your healthcare team’s guidelines.

Post Glaucoma Surgery Guidelines And Recovery

Approaching the post-surgery phase correctly is vital to prevent aggravation. Patients are generally advised to avoid strenuous activities and follow a prescribed regimen of eye drops to control inflammation and infection. Regular follow-up appointments for glaucoma surgery in Singapore are essential for monitoring changes or possible side effects.

During these follow-up visits, the eye doctor will assess several parameters to determine whether the glaucoma surgery is effective. This also includes a visual field assessment, eye pressure measurements, and the evaluation of the optic nerve hollowing, also known as the cup-disc ratio.

Be vigilant about any unusual symptoms, such as persistent redness, pain, or vision changes, and report them to your eye doctor immediately.

Possible Risks and Side Effects of Glaucoma Surgery

Awareness of potential risks is essential for a well-rounded approach to glaucoma surgery.

Infection: Infections can arise from bacterial exposure during glaucoma surgery, leading to complications like corneal ulcers or endophthalmitis, risking irreversible vision loss if not promptly treated with antibiotics.
Scarring: Tissue healing post-surgery can lead to scarring, which may block drainage pathways. Blocked channels can elevate eye pressure, necessitating additional treatments to maintain vision.
Bleeding inside the eye: Disrupting fragile vessels during surgery can trigger internal bleeding, potentially causing a haemorrhage that impairs vision.
Accelerated cataract formation: Surgical intervention can disturb the eye’s natural lens, accelerating cataract formation. This leads to blurred vision more quickly, making earlier cataract surgery likely necessary.

Reach out to Eyewise Vision Clinic for proper glaucoma preventative measures and treatment. In addition, we offer diabetic eye screening, known to be a common contributor to glaucoma. Take proactive steps for your eye health. Book an appointment at our eye clinic in Singapore today.

About Dr Christopher Khng

Dr. Christopher Khng specialises in Complex Cataract and Anterior Segment Reconstruction Surgery, particularly 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 anaesthesia phacoemulsification cataract surgery.

He completed his first two years of medical undergraduate studies at Aberdeen University, Scotland (UK). Because of cost, he completed his medical degree of MBBS at the 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 brings a comprehensive approach to glaucoma care, offering a variety of treatment modalities. His expertise encompasses both medical and surgical management of glaucoma, including trabeculectomy and laser surgery. With a focus on early detection and appropriate treatment plans, Dr. Khng aims to manage the progression of glaucoma to help maintain the vision of his patients.

Frequently Asked Questions About Glaucoma Treatment

How long does it take to go blind from glaucoma?

Untreated glaucoma will lead to blindness within several years, but you can get treatment to slow down the progression of blindness or prevent it. You can visit our glaucoma doctor in Singapore for an eye screening to catch glaucoma at its early stages and prevent the loss of sight.

How long does recovery after glaucoma surgery last?

The length of the recovery period will depend on the extent of surgery and the severity of glaucoma. Some people will see improvement in their vision in days to weeks, but others may take months.

Are there lifestyle changes that can help prevent glaucoma?

Regular exercise and a balanced diet rich in omega-3 fatty acids are key factors to help prevent glaucoma. Additionally, quitting smoking is highly recommended for maintaining eye health and pressure. These changes can be useful when monitored by a glaucoma specialist.