Common Eye Diseases and How an Eye Surgeon Can Help

Our eyes are vital sensory organs. An effective way to maintain optimal eye health is to have checkups with an eye doctor (ophthalmologist), especially if you are at risk of certain conditions or already have one. Here are common eye conditions in Singapore to look out for.

Cataracts

A cataract is the clouding (opacity) of the natural lens in the eye, which often develops slowly and can affect one or both eyes. This happens when the protein inside the lens starts to break down and clump together. As the condition progresses, it can severely impair vision.

Common Causes

Cataracts are primarily associated with ageing. Several factors can increase the risk of cataract formation, including diabetes, excessive UV radiation, smoking and alcohol use, as well as certain medications, such as long-term use of steroids.

Symptoms

Cataracts often begin with minor vision problems, which gradually progress into:

• Cloudy or blurry eyesight
• Fading colours
• Difficulty seeing at night
• Light sensitivity
• Seeing halos around lights
• Double vision in one eye (advanced stages)

Treatment

Cataract surgery involves removing the cloudy lens and replacing it with lens implants. This procedure can be done through one of the two methods: traditional phacoemulsification, which employs ultrasound to remove the lens, or the advanced femtosecond laser technique for precise corneal incisions and lens fragmentation.

Glaucoma

Glaucoma is a group of eye conditions that cause damage to the optic nerve due to abnormally high pressure within the eye (intraocular pressure). Without treatment, this condition may lead to loss of peripheral vision and eventually irreversible blindness.

Glaucoma can be classified into two main types:

• Open-angle Glaucoma – This occurs when the fluid inside the eye can reach the drainage pathway, but the pathway itself is blocked, causing fluid pressure within the eye.
• Angle-closure Glaucoma – This form of glaucoma develops when the eye’s drainage angle becomes very narrow or closed, which restricts the natural flow of fluid into the drainage pathway.

Symptoms

Glaucoma is often referred to as ‘the silent thief of sight,' as it typically develops without any obvious symptoms initially. When this condition progresses, one may begin to observe the following signs:

• Gradual loss of peripheral vision
• Blurred or hazy vision
• Eye redness
• Frequent and severe eye pain and headaches
• Sudden visual disturbances (often in low light)
• Tunnel vision (advanced stages)

Treatments

• Medications – Prescription eye drops and oral medications are often the first line of treatment for glaucoma, which must be taken daily to reduce pressure.
• Laser Therapy – Laser trabeculoplasty can help increase fluid outflow from the eye.
• Minimally Invasive Glaucoma Surgery (MIGS) – This type of glaucoma surgery involves the placement of microscopic-sized stent implants through tiny incisions to improve fluid drainage and reduce eye pressure.

Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a condition that affects the macula, the central portion of the retina responsible for sharp central vision. It is one of the leading causes of vision loss for individuals aged 60 and older.

Types and Causes

• Dry (Atrophic) AMD – Dry AMD is characterised by the gradual thinning of the light-sensitive layer of cells in the macula due to wear and tear. This typically worsens with advancing age and contributes to central vision loss.
• Wet (Exudative) AMD – Wet AMD occurs when abnormal blood vessels form under the retina (choroidal neovascularisation). These blood vessels can leak blood or fluid and lead to macular swelling and damage, creating a large blind spot in the centre of the visual field.

Symptoms

AMD can significantly impact one’s vision, leading to blurred or distorted vision, a central blind spot, and ultimately, loss of central vision. This makes it challenging to discern fine details, hindering everyday tasks like recognising faces, reading, perceiving colours, or driving.

Treatments

While there is no cure for AMD, several treatments can slow down the disease’s progression, including:

• Injections – Intravitreal medications are administered directly to the eye to inhibit the growth of abnormal blood vessels.
• Laser Therapy – This procedure employs targeted light energy to destroy abnormal blood vessels, particularly in wet AMD.

Diabetic Retinopathy

Diabetic retinopathy (DR) is a complication of diabetes mellitus which can compromise vision and lead to blindness if not managed properly.

Cause

When diabetes is not managed effectively, elevated glucose levels damage the tiny blood vessels in the retina. This damage can lead to various problems, including bleeding, fluid accumulation (oedema), and diminished blood flow to the retina.

Signs and Symptoms

Early symptoms might go unnoticed, but as the disease progresses, individuals may experience:

• Spots or dark strings floating in vision (floaters)
• Blurred vision
• Fluctuating vision
• Impaired colour vision
• Dark or empty areas of vision

Treatment

Surgical intervention may become necessary in advanced stages of diabetic retinopathy to impede disease progression and prevent further vision loss. One standard treatment for diabetic retinopathy is vitrectomy.

A vitrectomy removes the vitreous gel, a jelly-like substance that maintains the eye's shape. It is often done when there is severe bleeding (haemorrhage) within the vitreous cavity or when substantial scar tissue forms in the retina.

Retinal Detachment

Retinal detachment is a serious condition that occurs when the retina pulls away from its normal position along the back wall of the eye. This separation causes the retina to lose contact with its blood supply, leading to functional impairment.

Causes

When a tear in the retina forms, it creates an opening that allows fluid to penetrate beneath the retinal tissue and separate it from the eye's inner wall.

Several factors can lead to retinal detachment, including:

• Ageing – Thinning of the retina is more common in individuals over the age of 40
• Underlying Conditions – Individuals with severe myopia (nearsightedness), diabetic retinopathy, or inflammatory disorders
• Trauma – Previous eye injury or surgical procedures on the eye may lead to retinal tears or holes

Symptoms

Symptoms of retinal detachment are usually sudden and include:

• Floaters
• Flashes of light
• Curtain-like shadow in the periphery of the visual field
• Pain in the eye area
• Blurred vision

Treatment

Retinal detachment typically requires emergency surgery following diagnosis to slow down or prevent the condition from progressing to irreversible loss of vision.

• Scleral Buckle – A piece of silicone band is attached to the sclera—the white part of the eye—to push the wall of the eye against the detached retina and relieve the force exerted by the vitreous gel on the retinal tear.
• Vitrectomy – This procedure uses a specialised tool (vitrector) to extract the vitreous gel and any tissue tugging at the retina. Following removal, the vitreous space is temporarily filled with either gas or silicone oil to help support the retina.

Refractive Errors

Refractive errors are a common type of vision problem that blurs your sight. These include myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia (age-related farsightedness).

Causes

Refractive errors develop due to irregularities in the shape of the eye, particularly in the cornea or lens, which prevent light from focusing directly on the retina. While often present from a younger age, they can also develop or worsen as you get older. Additionally, some individuals may experience a refractive error after cataract surgery.

Symptoms

In addition to blurry vision, refractive errors can also have other accompanying symptoms, such as:

• Double vision (diplopia)
• Headaches
• Squinting
• Eye strain
• Eye pain

Treatment

Treatment

• Laser-Assisted In Situ Keratomile (LASIK) – LASIK surgery is a bladeless procedure that involves creating a flap of the cornea using a femtosecond laser. Afterwards, an excimer laser is used to reshape the cornea beneath the corneal flap.
• Photorefractive Keratectomy (PRK) – In this procedure, the outermost layer of the cornea (epithelium) is first removed, after which an excimer laser carefully reshapes the underlying corneal tissue.
• Implantable Contact Lens (ICL) – For high refractive errors, an artificial lens is surgically implanted inside the eye, positioning it in front of the natural lens and behind the iris.

Other Eye Conditions

Eye Injuries

Eye injuries encompass bruises, perforations, and burns, often resulting from traumatic accidents, chemical exposure, or foreign objects. Even seemingly minor issues can cause significant damage, leading to discomfort and potential short-term or permanent vision impairment.

Eye Infections

When viruses, bacteria, or other microbes enter the eye, they can cause infections like conjunctivitis (pink eye), eyelid styes, and keratitis (corneal ulcers). Symptoms typically include redness, irritation, swelling, and discharge.

Eyelid Conditions

Certain eyelid conditions may require surgical correction, particularly when they obstruct vision, cause severe discomfort, or present major cosmetic concerns. Examples include ptosis (drooping eyelid) and entropion (inward-turning eyelid).

When to See a Surgeon for Your Eye Problem

Visit an eye surgeon for a check-up if you experience any of the following:

• Flashes, floaters, or curtain vision
• Severe eye infections or eye styes (lumps or bumps)
• Persistent eye pain, discomfort, and redness
• Eye discharge or pus
• Difficulty moving the eye or keeping it open

Schedule a consultation with our experienced eye surgeons at Eye & Retina Surgeons today. We can help determine the appropriate course of treatment for all eye conditions to ensure improved vision and quality of life for patients.