A Patient's Guide To Myopia And Myopia Treatment

Chief Author

Dr Gerard Chuah

Contributors

Ms Monica Lim

Ms Janet Chung Suk Ling

Roland J. Izaac

Dr Tony Ho

Dr Lee Jong Jian

Dr Ronaldo R. Jarin

Website: www.retina.com.sg

Email: doctor@eyedoctors.com.sg

Published in Singapore in 2004 by

1 Tras Link Orchid Hotel #02-09

Singapore 078867

E-published in Singapore in 2014 by

Faris Digital Solutions Pte Ltd

North Link Building, 10 Admiralty Street #02-31

Singapore 757695

Website: www.adalsebook.com

E-ISBN: 978-981-4645-01-0

Copyright © 2004

All rights reserved. No part of this book may be reproduced or utilised in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the copyright owners.

Designed and printed by Cityeon Pte. Ltd.

Thank You!

for your generous and kind sponsorship of the publishing costs of this book.

Contents

i. Foreword

ii. Contributors

iii. Acknowledgements

1. What is Myopia (shortsightedness)?

The structure and development of the eyeball.

2. Theories on Myopia

3. Types and Classification of Myopia

Risk factors for Myopia.

4. Symptoms of Myopia.

Evaluation for myopia by an eye surgeon. Do we need to perform cyclopegic refraction for all children? Must all children wear glasses if myopic? Amblyopia or lazy eyes.

5. Complications of Myopia

6. Methods of correction for Childhood Myopia

Spectacles.

Contact lenses (covered in greater detail in Chapter 7, especially types of contact lenses and contact lens care).

Orthokeratology.

Eyedrops and bifocal/progressive power spectacles for control of myopia progression.

Accomodation training exercises, vision training, biofeedback training, accommodation training machines.

7. Correcting Adult Myopia

Spectacles. Types of spectacle frames, most appropriate type of spectacle lens material/lens coating, bifocal/ progressive power spectacles.

Contact lenses. Types of contact lenses, care and maintenance of contact lenses, types of contact lens solutions, special contact lenses for presbyopia, tips on contact lens care.

Surgery (please refer to Chapter 8).

8. Surgery for Myopia

Radial Keratotomy (RK).

Epikeratophakia.

Myopic Keratomileusis.

Photorefractive Keratectomy (PRK).

Laser Insitu Keratomileusis (LASIK).

Corneal Intrastromal Rings(INTACS).

Phakic Intraocular Lenses.

Clear lens extraction with intraocular lens implant.

Scleral reinforcement surgery.

9. Tips for parents with myopic children

10. Myopia with management problems

Patients with high myopia and presbyopia.

Myopia with cataract.

11. Frequently asked questions (FAQs)

12. Future Advances in Myopia treatment

13. Glossary

i. Foreword

Myopia is an increasingly important public health problem in Singapore. The latest data showed that 65% of Primary Six school children had myopia and 70% of Singapore University students are myopic. This is shocking as high myopia carries with it an increased incidence of retinal detachments, glaucoma, cataracts etc which may also lead to a higher incidence of blindness. This also impacts greatly on public health expenditure.

I commend Dr Gerard Chuah for embarking on the task of writing yet another concise and informative book on myopia.

This book will provide useful information and facts on the subject of myopia and will be specially beneficial to parents on how to deal with myopic children and how to seek the appropriate type of treatment for it .

I congratulate Dr Gerard Chuah on his contributions to medical writing and wish him and his book every success.

Mrs Goh Chok Tong

Official Patron of the National Kidney Foundation

Wife of Singapore’s Prime Minister Mr Goh Chok Tong

Antiaging Medicine is the latest specialty of Medicine that seeks to improve the quality of life as we grow older. We realise that aging is a complex process that involves musculoskeletal, endocrinological and neurophysiological changes. Vision is an important contributor to the quality of life in the elderly. Without good vision, a patient may be healthy but yet not happy.

In developed Western countries, age related macula degeneration is an important cause of blindness in the elderly. However, after reading Dr Gerard Chuah’s excellent book on myopia and myopia treatment, I am shocked to discover that the incidence of myopia is so high in Singapore and other predominantly Oriental communities. High myopia has a high incidence of sight threatening complications such as retinal detachments, myopic macula degeneration, glaucoma and early onset cataracts. This will definitely pose a problem for Singapore’s public health officials as the cost of treatment and daily care will be high for such elderly patients with complications of high myopia.

I also enjoyed reading the chapter on tips on myopia prevention for parents with myopic children. It is highly informative and presented in a simple clearly understood fashion.

I wish Dr Gerard Chuah all the best in his future endeavors and I am sure this book will be a great success!

Dr Robert Goldman

Chairman

American Academy of Antiaging Medicine

i. Contributors

The Authors

> Dr Gerard Chuah is a senior consultant eye surgeon presently at Total EyeCare Center. He is the Medical Director of Asian Diabetic and Retinal Disease Center, Singapore Cataract Surgery Center and Total EyeCare Center all of which are located in Orchid Hotel #02-09. A former Public Service Commission scholar, he was the former Head of the Eye Service in Alexandra Hospital and a former consultant eye surgeon in the Eye Institute, National Healthcare Group. He was a visiting consultant eye surgeon to the tertiary vitreoretinal clinic in The Eye Institute@Tan Tock Seng Hospital till 2005. He obtained his Fellowship of the Royal College of Surgeons in Edinburgh in 1993, obtained his Master of Medicine in Ophthalmology from the Postgraduate School of Medicine, National University of Singapore in 1994, finished his advanced specialist training in 1997, obtained his Fellowship of the Academy of Medicine, Singapore in 1998. He underwent his Vitreoretinal Fellowship at the University of Toronto from July 1997 to June 1998, then went to the New York Eye and Ear Infirmary for a short Medical Retinal Fellowship. He obtained his specialist registration in Singapore, his specialist registration with the General Medical Council, United Kingdom and his specialist registration with the Hong Kong Medical Council all in 1998.

He was previously a clinical tutor with the National University of Singapore, a visiting professor to the Qingdao Hai Ci group of hospitals and a visiting lecturer to the Shanghai Ren Ji hospital.

He was the Chairman of the National Kidney Foundation’s Children Medical Fund till 2005.

Other Contributors:

> Ms Monica Lim is a lecturer in the Optometry Section of the School of Chemical and Life Sciences in the Singapore Polytechnic. Her teaching duties include clinical supervision of the optometry students in the General and Paediatric Clinic of the Singapore Polytechnic. After graduating from the Singapore Polytechnic with a Diploma of Optometry, she received the Technologist Diplomate scholarship from the Singapore Polytechnic and completed her Bachelor of Optometry from the University of Melbourne, Australia. She has received numerous awards including the Johnson & Johnson Singapore Award (Singapore Polytechnic) and the General Proficiency Award (Taylor’s College). She is currently enrolled in a postgraduate diploma course in Advanced Clinical Optometry at the University of Melbourne.

> Ms Janet Chung Suk Ling (B Optom) is an honours graduate optometrist from the University of New South Wales, Australia. She has been a resident optometrist in Optic Point, a leading eye care group practice in Singapore for the past four years. Her experience working in Optic Point has allowed her to practise full scope optometry ranging from contact lens practice to children eye care. Ms Chung has also been involved in providing optometry services to eye departments in hospitals and private clinics. She has also performed volunteer work with non-profit organizations in eye screening activities overseas.

> Roland J. Izaac (D.Optom.; B.Sc. Optom; M.Sc. Optom in clinical Optometry). Obtained his degrees from the Pennsylvania College of Optometry in America. He has been practicing optometry at Federal Optik, one of the leading practices in Singapore for over 25 years. He practices general optometry with a special interest in Contact lenses, Orthokeratology and children with reading difficulties.

> Dr Tony Ho MBBS, FRCS, FRCOphth, FAMS, is a senior consultant ophthalmologist in private practice with special interests in retina, myopia management and refractive surgery. A Public Ser vice Commission Scholarship recipient, he received his basic medical degree and post-graduate studies in Singapore. This was followed by three years spent in top eye institutions in the United Kingdom and the United States to obtain his specialist and subspecialist certifications. He has authored numerous scientific articles and written three books on eye care. The first, The Complete Eye Care Book garnered the National Book Development Council Merit Award for non fiction books in 1996. His second book, 18 Steps to Myopia Control published in 1997, takes a focused look at the issue of myopia control for the public. His third and most recent book published in 2001 addresses the two ophthalmic issues closest to the public’s heart, namely Managing Childhood Myopia and Myopia LASIK Surgery.

> Dr Lee Jong Jian is a registrar in The Eye Institute, National Healthcare Group. He was awarded the Academy of Medicine Bronze Medal and the Thambipillae Silver Medal for Anatomy for his academic achievements. In 1995, he was selected into the Dean’s list. He is currently a Member of the Royal College of Surgeons in Edinburgh and obtained his Master of Medicine in Ophthalmology, National University of Singapore in 2001. His main interest is in Vitreoretinal subspecialty and is actively involved in medical student and ophthalmology resident teaching.

> Dr Ronaldo R. Jarin is a consultant ophthalmologist in Manila, Philippines. He is presently affiliated with the Vitreo Retina section in one of the biggest tertiary government hospital in the Philippines, the East Avenue Medical Center. He finished his medical degree at the University of the East – Ramon Magsaysay Memorial Medical Center, Philippines where he served as a councilor of the medical student council. He had his residency training in ophthalmology at the East Avenue Medical center and served as the chief resident in his final year. He did further training in The Eye Institute – Tan Tock Seng Hospital, Singapore in the subspecialty field of Vitreo Retina for one and half years. At present, he is actively involved in research and residency training.

iii. Acknowledgements

I would like to express my sincere appreciation to Mr Vincent Ng, the manager of Effective Health Corp Pte Ltd, Ms Jaslyn Tay, my nursing manager, Mr Pok Tuck Woh, a medical photographer in Mount Elizabeth Medical Centre and Gary Goh, my illustrator, for their help in coordinating and compiling this book.

I am also very grateful to Mr Lee Sen Hui and Mr Johnson Lee for their invaluable help and advice.

Dr Tony Ho contributed excellent slides of glaucoma operations— thanks very much for your support!

Special thanks to the National Eye Institute, National Institutes of Health in the United States for letting me use their eye illustrations which are available from their website it is very