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Illicit drug consumption in Singapore: Where are we in the fight against drugs?

Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be...

HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?

Dear Editor, Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent...

Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally...

Value the patient as a person: Answering the call for a person-centred model of care

There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm....

Treatment outcomes of micropulse cyclophototherapy in uveitic glaucoma

Dear Editor, We present a case series, describing the utility of micropulse cyclophototherapy in the treatment of uveitic glaucoma. Prevalence of glaucoma in patients suffering from...

Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground

In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for...

Transforming radiology to support population health

The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery...

Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening

In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety...

Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong

Dear Editor, In Hong Kong, the eHealth App was launched in January 2021, as part of Stage Two development of the Electronic Health Record Sharing...

Managing and preventing severe hand injuries among sugarcane juicer operators

Dear Editor, Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food...

Impact of pre-existing depression on severe COVID-19 outcomes

The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the...

Leveraging ChatGPT to aid patient education on coronary angiogram

Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of...

Preferences for oral anticoagulant medications for managing atrial fibrillation

Dear Editor, Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of...

Evaluation of a return to work coordination programme for injured workers in a public hospital in Singapore

Workers who have sustained an injury at work often face difficulties returning to work, according to a study showing that over 40% of injured workers...

Proactive steps to population health: Starting early, starting right

The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic,...

Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore

The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe...

Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside

Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example,...

Benefits of leisure-related physical activity and association between sedentary time and risk for hypertension and type 2 diabetes

Diabetes mellitus and hypertension are serious public health issues. Approximately 451 million individuals worldwide aged 18–99 years were living with diabetes in 2017, and...

Promoting physical activity for population health

The chronic disease burden has risen globally. In Singapore, between 2007 and 2021, the crude prevalence of hyperlipidaemia (8.2–13.9%), hypertension (12.7–15.7%) and diabetes (4.9–6.9%)...

Through the eyes into the brain, using artificial intelligence

Neurological dysfunction is a leading cause of disability, affecting more than 276 million people worldwide.1 Over the last decades, the prevalence of neurological dysfunction...

Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma

Endometriosis is a chronic inflammatory gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.1 Debilitating chronic pelvic pain, dysmenorrhoea, and subfertility...

Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore

Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes...

The eye as a window to the brain

Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact...

Diabetes: Know thy foe

During the COVID-19 pandemic in 2022, Singapore’s Minister for Health Ong Ye Kung mentioned, “After the COVID-19 pandemic has passed, we need to tackle...

Clinical outcome of bacterial endogenous endophthalmitis in 15 patients

Dear Editor, Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to...

Combating a resurgence of poliomyelitis through public health surveillance and vaccination

Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific...

Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients

The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with...

Early COVID-19 booster is beneficial in cancer patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in...

Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication

Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2...

Meeting today’s healthcare needs: Medicine at the interface

The demographic of Singapore has undergone dramatic changes. Historically, younger patients with communicable diseases predominated; however, patients are now older with chronic multimorbidity and...

A strategy to make COVID-19 vaccination more accessible to the elderly

Dear Editor, Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the...

Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore

The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients,...

From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore’s health system

The Ministry of Health, Singapore (MOH) has launched a wide-ranging and ambitious initiative for a life-course approach to drive the population’s health.1 This approach...

Frequent attenders to multiple emergency departments in Singapore

The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its...

Treating acutely ill patients at home: Data from Singapore

Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations...

Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore

Dear Editor, Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall...

COVID-19 vaccination acceptance of healthcare workers in Singapore

The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end...

The Lancet Commission on diagnostics: What it means for Singapore

Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and...

Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore

Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the...

A Randomized Trial of the Use of Print Material and Personal Contact to Improve Mammography Uptake Among Screening Non-attenders in Singapore

Breast cancer is the most common cancer among females in Singapore. Although lower than incidence rates in North America and the United Kingdom the...

Glaucoma Pattern Amongst the Elderly Chinese in Singapore

Glaucoma is a major cause of world blindness in developing and developed nations. The WHO Global data on blindness show that over half of...

Frontal Sinus Mucoceles Causing Proptosis—Two Case Reports

Frontal mucoceles are collections of inspissated mucus which occur when there is obstruction to the outflow of the frontal sinuses. The obstruction may be...

A Case Series of Ocular Disease as the Primary Manifestation in Sarcoidosis

Sarcoidosis is an idiopathic, systemic, non-caseating, granulomatous disease with protean clinical manifestations. Although the first description of sarcoidosis was attributed to Hutchinson, its ocular...

Trends in the Pattern of Blindness and Major Ocular Diseases in Singapore and Asia

Singapore’s population has grown rapidly since 1965, the year in which it gained independence. The total population enumerated at its first census in 1970...

Serum Selenium in the General Population of Singapore, 1993 to 1995

The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...

Serum Ferritin and Iron Status in the General Population of Singapore, 1993 to 1995

Iron, a dietary constituent, is an essential element. Body iron stores can be measured by haemoglobin, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin. This article...

Epidemiological Surveillance of Melioidosis in Singapore

Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention...

A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy

Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the...

Trilateral Retinoblastoma—A Case Report

Retinoblastoma is the third most common tumour in childhood. It is inherited genetically. This article is available only as a PDF. Please click on “Download...

Population-based Mammographic Screening in Singapore: What are Participants’ Views?

Breast cancer is the most common cancer among women in Singapore and has been increasing in incidence since 1968. This rise is particularly marked...

Excimer Laser Phototherapeutic Keratectomy for Recurrent Corneal Erosions

Recurrent cornea1 erosion (RCE) syndrome is a commonly encountered clinical condition which may be difficult to treat. Hansen first described it in 1872. This article...

Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks

Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...

Diabetic Retinopathy

Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent...

Cross-Sectional Study of Near-work and Myopia in Kindergarten Children in Singapore

Myopia is the commonest eye disease worldwide, and is especially prevalent in certain Asian countries such as Taiwan, Japan and Hong Kong. Physiologic myopia...

The Correction of Oriental Lower Lid Involutional Entropion Using the Combined Procedure

Involutional entropion is a frequent cause of ocular irritation in the local elderly patients. The inturning of the lid margin and the eyelashes result...

Myopia: Gene-environment Interaction

Myopia affects up to 70% of adults in Singapore, Taiwan, Hong Kong and Japan. The prevalence rates in these Asian countries are higher than...

Cardiovascular Disease: Genes and Public Health

The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is...

Causes and Management of Descemet’s Membrane Detachment Associated with Cataract Surgery—Not Always a Benign Problem

It is well known that stripping of Descemet’s membrane (DM) occurs not infrequently during cataract surgery. In 1928, Samuels described frequent DM detachments of...

Body Mass Index Profile in Hong Kong Chinese Adults

Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become...

6th Yahya Cohen Lecture: Visual Experience During Cataract Surgery

What a patient can see during his or her surgery can be a cause of anxiety for the patient. It may cause additional stress...

Evidence-based Health Promotion: Applying it in Practice

There has been a growing interest in health promotion among health professionals and policy makers in Singapore. This is partly in response to the...

Age-related Macular Degeneration: What’s New

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of...

Visual Rehabilitation with New-Age Rigid Gas-Permeable Scleral Contact Lenses—A Case Series

Advanced primary corneal ectasia presents a difficult problem in terms of visual rehabilitation. Soft contact lenses do not address the astigmatic aberrations in these...

Is Healthcare Competition Healthy?

There are many problems which all Health Ministers worry about. But we can generally boil them down to one common problem: “money no enough”. This...

Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report

Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of...

Public Disclosure of Healthcare Performance Information and Its Application to the Singapore Context

It has been said that apart from the prevention of diseases, the best chance of improving health is through improving the quality of care...

Gyrate Atrophy of the Choroid: Two Cases

Gyrate atrophy of the choroid (GA) is a rare choroidal dystrophy. It is an autosomal recessive disorder that results in progressive deterioration in peripheral...

Patterns and predictors of sound levels in hospital rooms

Dear Editor,      Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also...

The Role of Public Health and Occupational Physicians in the New Millennium

I want to thank the Chapter and organisers for honouring me with this kind invitation to speak to you. This millennium is only 4...

Initial Experience of Macular Translocation in Singapore – One-year Results

Choroidal neovascularisation (CNV) is a devastating complication of macular degeneration and a major cause of irreversible vision loss in many developed countries. The most...

A Study on SARS Awareness and Health-seeking Behaviour – Findings from a Sampled Population Attending National Healthcare Group Polyclinics

There was a worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) caused by the novel coronavirus between November 2002 and July 2003. Singapore was...

Ocular Surface Stem Cells and Disease: Current Concepts and Clinical Applications

The ocular surface is a complex biological continuum responsible for the maintenance of corneal clarity, elaboration of a stable tear film for clear vision,...

Re: Evidence for an “epidemic” of myopia

In the Annals January 2004 theme issue on Myopia, Park and Congdon have disputed the reality of the increases in prevalence of myopia in...

Contact Lens Microbial Keratitis and Prior Topical Steroid Use: A Disaster in the Making?

Topical steroid use in cornea ulcers is still a very contentious issue in ophthalmology. A recent review by Wilhelmus found that the use of...

Integrated Hydroxyapatite Implant and Non-integrated Implants in Enucleated Asian Patients

Much has been published on the complications of integrated and non-integrated implants. Most studies on integrated implants pertain to experience with the hydroxyapatite implant,...

The Correction of Myopia Evaluation Trial: Lessons from the Study Design

“A properly planned and executed clinical trial is a powerful technique for assessing the effectiveness of an intervention”. While each new clinical trial involves...

Myopia Progression Among Preschool Chinese Children in Hong Kong

Myopia occurs when the image of distant objects, focused by the cornea and lens, falls in front of the retina. It is the commonest...

The Epidemiology of Myopia in Hong Kong

Myopia is a refractive condition in which the image of a distant object is formed anterior to the retina of the unaccommodated (relaxed) eye....

Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000

Today in Taiwan, with increasing level of educational and living standard, the prevalence and severity of myopia appear to be on an upward trend....

Evidence for an “Epidemic” of Myopia

A number of authors have recently proposed that myopia is increasing at an “epidemic” rate, particularly in East Asia, and especially among populations of...

Using Natural STOP Growth Signals to Prevent Excessive Axial Elongation and the Development of Myopia

Myopia in humans results from an imbalance between the refractive power of the cornea and lens and the axial length of the eye, such...

Ocular Shape and Myopia

Myopia develops from a mismatch of the eye’s anatomical axial length and its focal length, as determined by the combined optical powers of the...

Is it Possible to Slow the Progression of Myopia?

The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge...

Accommodative Stimulus Response Curve of Emmetropes and Myopes

There is a strong association between myopia and near work, and it has been reported that the rapid rise in the prevalence of myopia...

Electrophysiological Findings in Persons With Nyctalopia

Nyctalopia is a subjective sensation of poor vision under dark conditions. It may be clinically associated with retinal diseases affecting the rod photoreceptors or...

Neisseria meningitidis Keratitis in Adults: A Case Series

Neisseria meningitidis has been reported as a causative organism for conjunctivitis and endogenous endophthalmitis, more commonly in neonates and young children. A search of...

Visual Recovery Following Emergent Orbital Decompression in Traumatic Retrobulbar Haemorrhage

Acute retrobulbar haemorrhage is a potentially sight threatening condition that can occur spontaneously or following retrobulbar injections and trauma to the orbit. Visual loss...

Macular Carotenoids and Age-related Maculopathy

The macula lutea is an anatomic region of the posterior retina that measures approximately 5.5 mm in diameter, and is exquisitely specialised for sharp...

Book Review

Ophthalmologists today depend heavily on various investigative modalities such as fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) for an...

Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis

Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior...

Orbital Metastatic Tumour as Initial Manifestation of Asymptomatic Gastric Adenocarcinoma

Metastatic orbital tumour from gastric cancer is rare. In a Japanese survey of metastatic orbital tumours seen over 95 years, gastric metastases accounted for...

Eye Injuries in Singapore – Don’t Risk It. Do More. A Prospective Study

The issue of ophthalmic trauma is a major cause for concern. An estimated 55 million eye injuries occur each year worldwide, leaving 1.6 million...

Retrospective Review of Eyes with Neovascular Age-related Macular Degeneration Treated with Photodynamic Therapy with Verteporfin and Intravitreal Triamcinolone

Among the variety of paradigms implicated in the pathogenesis of choroidal neovascularisation (CNV), an inflammatory component has been a recent focus of interest. The...

Rates of Posterior Capsule Rupture During Cataract Surgery Among Different Races in Singapore

Posterior capsule rupture (PCR) is a potentially serious intraoperative complication of cataract surgery. The anecdotal experience of some surgeons suggests that differences in the...

Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)

Changes in corneal curvatures and astigmatism after retinal surgery are well documented. Although some of these changes are mild and transient, some have reported...

Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation

Paediatric cataract has a low incidence compared with adult cataract. The estimated incidence is about 1 to 6/ 10,000 births. This article is available only...

Efficacy of Measuring Visual Performance of LASIK Patients under Photopic and Mesopic Conditions

LASIK is routinely carried out to correct the refractive errors of myopic patients. A high percentage of patients have good high-contrast visual acuity after...

Role of Ultrasound Biomicroscopy (UBM) in the Detection and Localisation of Anterior Segment Foreign Bodies

The presence of an intraocular foreign body (IOFB) is a common complication of ocular trauma. For surgical planning, the localisation of IOFBs has to...

Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice

The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes...

Environmental Planning and Urban Health

Environmental exposures to the adverse effects from climate change are expected to increase for many urban populations in the United States during the next...

Ethical Issues in Ophthalmology and Vision Research

The importance of ethics in research was highlighted in the USA when a healthy volunteer subject, 24-year-old Ellen Roche, died in a Johns Hopkins...

Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE...

A Novel Locus for X-linked Retinitis Pigmentosa

Retinitis pigmentosa (RP) is characterised by initial night blindness followed by progressive loss of visual fields and eventually, loss of central vision. RP is...

Utility and Validity of the Self-administered SF-36: Findings From an Older Population

The shift towards broader health perspectives and the emphasis on patient preferences have led to the development of many health questionnaires and their inclusion...

The Role of Optical Coherence Tomography (OCT) in the Diagnosis and Management of Retinal Angiomatous Proliferation (RAP) in Patients with Age-related Macular Degeneration

Retinal angiomatous proliferation (RAP), initially described as deep retinal vascular anomalous complex in 1992 by Hartnett et al, has been recently defined as a...

Axial Length: A Risk Factor for Cataractogenesis

There are several known risk factors for cataract formation, including older age, lower educational status, smoking, ultraviolet light exposure, trauma, dehydration, diabetes, uveitis and...

Clinical Features of Autosomal Dominant Retinitis Pigmentosa Associated with a Rhodopsin Mutation

Retinitis pigmentosa (RP) is the most prevalent group of inherited retinopathies. This spectrum of diseases affects approximately 1 in 4800 individuals. This article is available...

A Novel Mutation of the VMD2 Gene in a Chinese Family with Best Vitelliform Macular Dystrophy

Best vitelliform macular dystrophy is an autosomal dominant disorder characterised by an egg yolk-like appearance of the macula. The vitelliform “egg yolk” lesions result...

Characterisation of Human Tear Proteins Using High-resolution Mass Spectrometry

Over the last few years, with advances in mass spectrometry, there has been increasing interest in exploring the proteome of body fluids such as...

Scanning Laser Polarimetry in Pulmonary Tuberculosis Patients on Chemotherapy

Pulmonary tuberculosis is a worldwide disease. In Hong Kong, there are about 7000 new cases of pulmonary tuberculosis each year and the prevalence remains...

Time to Raise Awareness of Blindness as Another Smoking-related Condition

Singapore currently has a comprehensive range of tobacco control policies and programmes. It started implementing legislative measures against cigarette smoking in the early 1970s,...

SARS Revisited: Managing “Outbreaks” With “Communications”

In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed...

SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty

The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced...

SARS in Singapore – Key Lessons from an Epidemic

The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and...

“Galaxy in My Eye”: An Artist’s View of Cataract Surgery from Behind the Crystalline Lens

Cataract surgery is the most commonly performed elective surgery in many countries. As a result of advances in surgical and anaesthetic techniques, most cataract...

Methodologies for Interventional Myopia Studies

Past studies on intervention in myopia progression have given conflicting results. For example, in the past, studies on (PMMA) hard contact lenses took researchers...

Ethambutol-associated Optic Neuropathy

Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes...

Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report

The management of pain in the orbital region, whether ocular or orbital in origin, is complex and lies at the margins of several subspecialty...

Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)

A review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1977 to 1996 showed a declining number of all...

Book Review

In Retinal Vascular Disorders, Dr Mohan and co-authors cover common and important retinal vascular disorders in a series of short chapters which are written...

Vision 2020 and Prevention of Blindness: Is it Relevant or Achievable in the Modern Era?

This review article considers the universal definition of blindness, the causes of world/global blindness, and ongoing international efforts in blindness prevention. The prospects for...

Enhancement of the Mechanical and Biological Properties of a Biomembrane for Tissue Engineering the Ocular Surface

The most recent treatment for severe ocular surface disease is the transplantation of cultivated corneal and conjunctival epithelial stem cells, which makes use of...

Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management

Tuberculosis (TB) is an ancient disease that has been detected in 3000-year-old Egyptian mummies. Robert Koch’s discovery of the tubercle bacillus as the aetiologic...

Photodynamic Therapy for Choroidal Neovascularisation Secondary to Inflammatory Chorioretinal Disease

Photodynamic therapy using verteporfin (Visudyne, Novartis Ophthalmics) has been proven safe and effective for the treatment of predominantly classic, age-related macular degeneration (AMD)-related subfoveal...

Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study

In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports...

Multivariate Analysis of Childhood Microbial Keratitis in South India

Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and...

Can the Sequential Use of Conventional Silicone Oil and Heavy Oil be a Strategy for the Management of Proliferative Vitreoretinopathy?

Advances in vitreoretinal surgery have greatly increased the anatomical re-attachment rate in cases with proliferative vitreoretinopathy (PVR). The availability of perfluoro-carbon liquids, indirect viewing...

Surgical Outcomes of 25-Gauge Transconjunctival Vitrectomy Combined With Cataract Surgery for Vitreoretinal Diseases

The recent development of 25-gauge instrumentation for vitreous surgery has promoted a great interest in the transconjuctival sutureless vitrectomy system. Similar to the trend...

New Concepts in the Management of Optic Nerve Sheath Meningiomas

Optic nerve sheath meningiomas (ONSMs) account for one-third of primary optic nerve tumours, are the second most common optic nerve tumours after gliomas, and...

Ophthalmic Regional Block

Patient comfort, safety and low complication rates are the essentials of local anaesthesia. The anaesthetic requirements for ophthalmic surgery are dictated by the nature...

Hyperbaric Oxygen Therapy for Radiation-induced Optic Neuropathy

Radiation optic neuropathy (RON) is an infrequent but usually devastating consequence of radiation to the optic pathways. It is almost exclusively an iatrogenic phenomenon,...

The Natural History of Occult Choroidal Neovascularisation Associated With Age-related Macular Degeneration. A Systematic Review

Choroidal neovascularisation (CNV) is a leading cause of blindness in the western world. It causes 90% of the visual loss in age-related macular degeneration...

Retinal Prostheses for the Blind

Each year, thousands of people are afflicted with photoreceptor degenerative diseases that reduce vision to bare light perception or complete blindness. Retinitis pigmentosa (RP)...

Age-related Macular Degeneration: An Emerging Challenge for Eye Care and Public Health Professionals in the Asia Pacific Region

Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central back portion of the...

Public Healthcare – Welfare, Market Share or Laissez-faire? – A Sentosa Carlsberg Skytower View

Recently, two doctor-administrators commented to me separately, “Singapore probably has the best public healthcare system in the world.” While I understand the basis for...

Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Oedema – A Case Report

Focal and grid laser photocoagulation are the primary surgical treatments for diabetic macular oedema. However, laser treatment of eyes with diffuse macular oedema has...

Bruch’s Membrane Abnormalities in Dome-shaped and Mushroom-shaped Choroidal Melanomas

Uveal melanoma is the most common primary intraocular malignancy and is diagnosed chiefly in the fifth to seventh decades of life. The choroid is...

Human Limbal Progenitor Cell Characteristics are Maintained in Tissue Culture

The surface of the eye is covered by 3 distinct forms of non-keratinising stratified squamous epithelium – transparent corneal epithelium overlying the corneal surface,...

Angiographic Characteristics of Acute Central Serous Chorioretinopathy in an Asian Population

Acute central serous chorioretinopathy (CSCR) is a condition of unknown origin characterised by a serous detachment of the macula. It afflicts young healthy adults,...

A Nationwide Survey on the Knowledge and Attitudes of Malaysian Optometry Students on Patients’ Visual Experiences During Cataract Surgery

Cataract is one of the most common causes of visual impairment in the elderly and its surgery is the most common major ophthalmic surgery,...

Towards 2020 Vision in Singapore

With the increasing demands of contemporary life, higher levels of visual performance are expected. In modern societies such as Singapore, many more adults will...

Disaster Relief and Initial Response to the Earthquake and Tsunami in Meulaboh, Indonesia

A massive earthquake and tsunami hit the South Asian region on 26 December 2004, killing more than 200,000 people and displacing countless more.1 The...

Graduate Public Health Education – Singapore’s Contribution to Strengthening Capacity in the Region and Beyond

The effectiveness with which the world tackles its most pressing public health problems depends crucially on the calibre of its public health workforce. Institutions...

Fungal Pan-sinusitis with Severe Visual Loss in Uncontrolled Diabetes

Fungi are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. Fungal pan-sinusitis complicated with orbital apex syndrome or cavernous...

Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia

Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected...

Opening Our Eyes to Guide Dogs for the Blind in Singapore

The concept of the modern guide dog first began in Germany after World War I in an effort to support veterans blinded in combat....

Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme

Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM)...

The Emerging Challenge of Age-related Eye Diseases in Singapore

Singapore has one of the fastest ageing populations in the world today. The current elderly population, defined as persons 65 years or older, comprises...

Progressive Hemi-facial Atrophy and Keratoconus

Progressive hemifacial atrophy (Parry-Romberg syndrome, PHA) is characterised by slowly progressive atrophy, usually involving one side of the face, and may be associated with...

Effects on the Contralateral Eye After Intravitreal Bevacizumab and Ranibizumab Injections: A Case Report

Vascular endothelial growth factor (VEGF) is recognised as an important mediator in the pathogenesis of age-related macular degeneration (AMD) and retinal neovascularisation. Anti-VEGF therapies...

Risk Communications: In Search of a Pandemic

The first decade of the new millennium has seen a string of disasters worldwide – earthquakes, tsunamis, floods, typhoons and acts of terrorism –...

Prevention and Control of Avian Influenza in Singapore

Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to...

Preparing for an Influenza Pandemic in Singapore

The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild. This article is...

Avian Influenza and Pandemic Influenza Preparedness in Hong Kong

In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred...

Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia

Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases...

A Global Perspective on Avian Influenza

The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat...

Twentieth Century Influenza Pandemics in Singapore

Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population...

A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak

Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic...

Singapore and the Tobacco Pandemic

The World Health Organization, in its 2008 Report on the Global Tobacco Epidemic, has framed the problem in almost apocalyptic terms, in stating that...

Current Understanding of the Treatment and Outcome of Acute Primary Angle Closure Glaucoma: An Asian Perspective

Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness in Asia and many parts of the world. It is a particularly serious...

Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care

The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the...

Public Perceptions of Healthcare in Singapore

Healthcare is increasingly dominating the policy agenda in developed countries. In the United States, healthcare has been ranked only behind the war in Iraq...

Acute Concomitant Esotropia during Heroin Detoxification

Although acute concomitant esotropia following heroin detoxification or withdrawal has been described in a few case reports in Europe and Australia, it has not...

Intraocular Avastin (Bevacizumab) for Neovascularisation of the Iris and Neovascular Glaucoma

Neovascularisation of the iris is associated with many ischaemia retinal disorders and elevated levels of the vascular endothelial growth factor is found in patients...

Public Misperceptions About Transmission of Hepatitis B Virus in Singapore

Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide. CHB is particularly important in Asia,...

A History of the Chapter of Public Health and Occupational Physicians

The history of the Chapter of Public Health and Occupational Physicians began with the founding of the Academy of Medicine in 1957. It was...

Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study

Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor...

Cysticercosis of the Levator Palpebrae Superioris

Cysticercosis cellulosae, the larval form of the pork tapeworm Taenia solium, causes cysticercosis, in which humans serve as the intermediate hosts in the parasite life cycle. Cysticercosis...

The Evolving Role of the Community Pharmacist in Chronic Disease Management – A Literature Review

Pharmacy has matured as a clinical profession and is presently well positioned to transform itself from a product and task oriented (dispensing) to a...

Pathological Video-Gaming among Singaporean Youth

Video-gaming and internet use are a part of the lives of children and adolescents today. Among countries that are highly wired with high speed...

Trends in Importation of Communicable Diseases into Singapore

Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining...

Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden

Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from...

Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study

With the burden of chronic disease rising amongst rapidly urbanising Asian populations, active participation in health screening would allow for early detection and management...

The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening

Experiential learning brings medical students out of the comfort zone of learning in their classrooms to acquire and apply knowledge and skills in an...

Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children

Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can...

Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics

In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and...

Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In...

Intraretinal Segmentation on Fourier Domain Optical Coherence Tomography

Optical coherence tomography (OCT) has become an indispensable tool in the management of retinal and optic nerve diseases as well as in clinical trials....

Intravitreal Bevacizumab for the Treatment of Myopic Choroidal Neovascularisation in an Asian Population

Myopic choroidal neovascularisation (mCNV) is one of the most common causes of permanent central visual loss in patients with high myopia, and its natural...

Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore

The Advance Medical Directive (AMD) Act was passed in Parliament in May 1996. The AMD is a legal document that an individual can sign...

Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures

Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of...

Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?

In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence...

Trends in Long-term Cancer Survival in Singapore: 1968-2002

With increasing health awareness and the greater extent of healthcare provision over the years, the life expectancy of Singaporeans has increased from 75.3 in...

Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore

Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50...

Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report

The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to...

Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007

Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is...

Atypical Presentation of Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) typically presents with a retinal “cherry red spot”. In CRAO, infarction of the retinal nerve fibre layer renders the...

Sleep, Public Health and Wellness: The Elephant in the Room

The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of...

Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma

Dear Editor, Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised...

Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting

The rising occurrence of individuals suffering from multiple chronic diseases, namely multimorbidity, is of public health concern globally.1 The current prevalence of multimorbidity in...

Prevention and management of multimorbidity to ensure healthcare sustainability

Singapore has a healthcare system that is distinguished by its ability to achieve top health outcomes at very low healthcare expenditures.1 Yet one of...

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist...

Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?

Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values. —Louis D Brandeis As a...

A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012

Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over...

Re: An Alternative Diagnosis: Bartonella Neuroretinitis

I would like to thank the authors for the reply to our case report. The differential diagnosis of Bartonella neuroretinitis in this patient was...

An Alternative Diagnosis: Bartonella Neuroretinitis

We refer to the letter ‘Lyme Neuroretinitis in Singapore: A Diagnostic Dilemma’ published in the April 2012 Vol. 41 No. 4 issue of the...

How do English-speaking Cancer Patients Conceptualise Personhood?

Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral...

Too Much Medicine: Time to Stop Indiscriminate Cancer Screening

Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in...

27-Gauge Vitrectomy for Primary Rhegmatogenous Retinal Detachment: Is it Feasible?

Pars plana vitrectomy (PPV) using the 27-gauge transconjunctival approach is the last frontier of small gauge vitrectomy. Only 1 paper has been published so...

MERS-CoV: Where Are We Now?

Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals....

An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit

Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes...

A Decade of Progress in the Understanding, Prevention and Treatment of Age-related Macular Degeneration in Singapore

The year 2014 had marked the 10th anniversary of the nationwide Age-related Macular Degeneration (AMD) Awareness Week in Singapore.1 This public health campaign, organised...

Anaerobic Bacteraemia Revisited: Species and Susceptibilities

Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes...

Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study

Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the...

Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions

Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue...

Health professions education in pandemics and epidemics: A proposed framework for educators

The COVID-19 pandemic has disrupted healthcare systems and health professions education (HPE). There are few frameworks to help educators manage HPE before, during and...

The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown

Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties...

Merits of a harmonised system to classify drug-related problems in Singapore

A drug-related problem (DRP) is commonly defined as an event or circumstance involving drug treatment that actually or potentially interferes with the optimal outcome...

Factors influencing protective behaviours during haze episodes in Singapore: A population-based study

Southeast Asia suffers from recurrent episodic air pollution from biomass smoke known as haze, which is mainly caused by human activities such as the...

Seasonal haze: Knowledge gaps and risk perception behaviours

The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural...

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely...

Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits

Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work...

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight...

Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry

Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have...

Seeing through the eyes of patients with age-related macular degeneration

Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central part of the retina....

Vulnerability to rumours during the COVID-19 pandemic in Singapore

The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found...

Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore

In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community...

The Novel Coronavirus (SARS-CoV-2) Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and...

Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children

Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February...

Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up...

Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months

Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared...

Neuro-Behçet’s disease presenting as isolated intracranial hypertension

Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though...

Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review

The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak,...

Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore

Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years...

Paediatric emergency department attendances during COVID-19 and SARS in Singapore

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases...