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									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.
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.

                      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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