216 Primary Eye Care In Singapore – Looking Back, Looking Forward History of the Department of Ophthalmology, Tan Tock Seng Hospital by DR WONG HON TYM and MS LIM SING YONG Executive, Department of Ophthalmology, Tan Tock Seng Hospital MBBS, MMed(Ophth), FRCS(Ed), FAMS Head & Consultant, Department of Ophthalmology, Tan Tock Seng Hospital Deputy Director, National Healthcare Group Eye Institute Head, Glaucoma, National Healthcare Group Eye Institute Primary Eye Care In Singapore – Looking Back, Looking Forward 217 The Early Years TTSH’s Department of Ophthalmology, Singapore’s second largest eye unit, began life in 1979 as a satellite to the eye department of Singapore General Dr Victor Yong addressing delegates of the Advanced Course in Vitreoretinal Surgery. Hospital (SGH). Dr Victor Yong was the Head and Visiting Consultant, and led The reins of the department and NHG a team of 1 medical ofﬁcer and 4 nurses. Eye Institute were handed over to A/Prof Besides daily clinics, cataract operations (then Dr) Lim Tock Han in 2002 and 2004 were performed once a week. respectively. Our consultant numbers had swelled to 15 by this juncture. Our next leaders were also pioneering ophthalmologists who remain active to A/Prof Lim established many this very day. In 1986, Dr Cheah Way cornerstones that still deﬁne and Mun became the ﬁrst full-time Head, distinguish this department. These building on the basic eye services already include surgical audits; a Clinic in place. Dr Richard Fan took over in Above all, Dr Yong’s emphasis on a Management Committee to deal with 1988, and oversaw the introduction of strong culture of teaching, discipline service quality issues; the TTSH LASIK day surgery for cataract patients and and teamwork continue to underpin the Centre in 2002; the TTSH Eye Centre outpatient laser facilities. The department department’s work ethic on a daily basis. (Atrium) in 2003, the hospital’s ﬁrst by then had grown to 7 full-time dedicated clinic for non-subsidised clinicians. patients; the Cytomegalovirus Retinitis The formation of the NHG Eye Clinic at Communicable Diseases Centre; Dr Victor Yong returned from SGH to Institute and the Mobile Diabetic Retinopathy helm the department in 1990, embarking In 2001, the department came under Photography Unit. on a remarkable 12-year leadership arc the National Healthcare Eye Institute that remains a milestone in terms of (NHG Eye Institute), previously known The department by this time had also duration and evolution. The department as The Eye Institute, NHG. It took on a attained the full spectrum of sub- witnessed the maturation of our clinical new name, NHG Eye Institute @ TTSH. specialties, and our annual outpatient services and the establishment of a Dr Yong was the ﬁrst director of this attendances hit 102,000 in 2004, despite a much-admired training culture. During virtual institute, which oversaw the three sharp dip due to the SARS crisis in 2003. this period, we produced three Gold eye departments in NHG. Annual total Day surgery volume (now including Medalists in the MMed/FRCS(Ed) outpatient attendance for the department LASIK) rose to 10,000 cases. examinations. Dr Yong also actively was recorded at 77,000 that year, with nurtured sub-specialty development, 8,000 day surgery operations. In 2007, Dr Wong Hon Tym took over as with vitreo-retina and cornea in Head, with A/Prof Lim maintaining his particular making massive strides. stewardship of NHG Eye Institute. 218 Primary Eye Care In Singapore – Looking Back, Looking Forward Milestones 2003 2005 Since its inception, NHG Eye Institute @ February Joint Commission International (JCI) TTSH has been growing from strength to Accommodative intraocular lenses accreditation achieved along with rest strength, honing its subspecialties with were used for cataract surgery to enable of TTSH. the adoption of new technologies and patients to experience near and far the revision and expansion of existing accommodative focusing. July capabilities aiming to serve our patients Vision restorative therapy service was set better. June up for patients who have lost their ﬁeld Yew Tee Specialists Clinic was set up for of vision from cerebro-vascular accidents 2000 the convenience of patients living in the or stroke. Under the umbrella of the National north-western region of Singapore. Healthcare Group Eye Institute, we also August became known as National Health Group October Implantable contact lenses surgery was Eye Institute @ Tan Tock Seng Hospital Ptosis correction (conjunctiva-Muller’s also introduced as an alternative to (NHG Eye Institute @ TTSH). muscle resection) via a posterior patients unsuitable for LASIK. approach with the Putterman ptosis 2001 clamp was introduced by Dr Yip September April Chee Chew. The surgery avoids skin 23-gauge vitrectomy surgery was Telemedicine screening for cyto- incision and minimises eyelid contour introduced. megalovirus retinitis. abnormality. 2006 2002 December June April TTSH Eye Centre (Atrium) was opened The NHGEI @ TTSH started its evening Mobile Diabetic Retinal Photography in TTSH to cater to our private patients, clinic for the convenience of patients who programme was launched as an initiative as well as to accommodate new services are unable to come during the day. to help general practitioners (GPs) detect such as age-related macular degeneration diabetic retinopathy. Up to 45 GPs now clinic, contact lens counselling and August subscribe to this unique service. transpupillary thermal laser treatment. For the convenience of patients living in the north & north-east region of Tan Tock Seng Hospital LASIK Centre 2004 Singapore, eye clinic sessions were was ofﬁcially opened. June started at Northern Hope Medical Intralase technology was used to perform Specialist. October LASIK surgery without the use of a Macular translocation surgery mechanical blade for safer outcomes. introduced. Dr Balaji Sadasivan, then Minister of State (Health & Environment) unveiling the plaque at the launch of the TTSH LASIK Centre on 6 April 2002. With him are (L to R) Dr Lim Suet Wun, TTSH CEO, Mr Tan Tee How, then NHG CEO and Prof Chee Yam Cheng. Primary Eye Care In Singapore – Looking Back, Looking Forward 219 First in the World • Advanced treatment for macular • Iris tracker technology for LASIK degeneration The iris tracker can accurately track every tiny eye movements during • Cytomegalovirus (CMV) retinitis LASIK surgery, in turn maximising telemedicine screening the chance of having best surgical Patients will undergo digital outcomes, making LASIK safer and photography at the Communicable more predictable. Disease Centre and after a panoramic reconstruction, an First in the Region ophthalmologist from Tan Tock • Fully digital ﬁlmless and paperless Seng Hospital will be able to read fundus angiography the images. Patients found to have Instead of imaging on slides and CMV retinitis will be referred negatives, this is a totally ﬁlmless to the clinic for treatment with and paperless digital imaging and intravitreal ganciclovir. More than archival system. Fundus photos and 300 screenings are done annually. angiography images are captured directly by the Zeiss FF450 system • NovaVision Vision Restoration into DICOM compatible digital Therapy ﬁles and saved on a central server. It is used to treat patients with Images can be viewed online at visual ﬁeld defects resulting from several viewer stations. damage to the postchiasmatic visual pathways from cerebral vascular • Confocal SLO dynamic accidents, neuro-surgery and head angiography injury. 220 Primary Eye Care In Singapore – Looking Back, Looking Forward Primary Eye Care In Singapore – Looking Back, Looking Forward 221 • Intralase upgraded to 60 kHz First in our Nation Today With the 60 KHz Intralase, suction • Mobile Diabetic Retinal A full range of eye services is available: and ﬂap cutting time has been Photography (DRP) services cataracts, LASIK, complex lens & reduced by 4 folds, which translates The mobile DRP service brings DRP anterior segment reconstruction, cornea, into better safety and more comfort to the patients right at the private eye problems in children, glaucoma, for the patients. family physicians’ premises where medical retina, neuro-opthalmology, retinal images of patients will oculoplastics, surgical retina, and squints • Online Optical Coherence be taken, and then read at TTSH in children & adults. Our clinic currently Pachymetry (OCP) later. This service provides more handles about 122,000 outpatient visits The online OCP allows continuous convenience for patients doing the and performs about 12,000 surgeries central corneal thickness screening. a year. measurement of the patient during LASIK surgery. With the knowledge • Intralase 15kHz (blade-less LASIK) A Leap Forward of corneal thickness after creating technology The NHG Eye Institute @ TTSH will the corneal ﬂap, the surgeon is able LASIK with Intralase is the all-laser take several major evolutionary steps to decide if there is sufﬁcient tissue bladeless approach to LASIK. In this year, with the proposed relocation for the procedure and will then able Intralase, a computer-controlled and expansion of our LASIK Centre, to make adjustments accordingly, if machine uses a laser to create and the proposed inauguration of a necessary. This increases safety and microscopic cavities within the facility dedicated to paediatric eye will contribute to a better outcome. cornea. By connecting these areas problems. Our subsidised clinic will also into a single plane, a very precise be expanded, reafﬁrming our continued • Amadeus Epi-keratome for EPI- ﬂap is created. Computer-controlled commitment to all levels of eyecare in LASIK laser beams then reshape the Singapore. Also in the pipeline is the underlying tissue of the cornea. The tele-ophthalmology project to link us • Different microkeratomes for ﬂap is then replaced. No stitching with primary eye care providers, and different types of eyes is needed as the ﬂap will adhere a shared eyecare partnership scheme XP, Hansatome, Amadeus II, naturally to the cornea and will re- with optometrists in Singapore, a pilot Intralase attach itself within months. move which we hope will raise the level of ophthalmic disease detection in the • 23G sutureless vitrectomy • Pioneer in phakic IOL (Verisyse community. & ICL) Phakic intraocular lenses (IOL), also known as implantable contact lenses, are introduced as an alternative to patients unsuitable for LASIK.
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