Related Articles

Enhancing care in nursing homes: Qualitative insights from the ENHANCE programme

Dear Editor, Empower Nursing Homes And improve staNdards of CarE (ENHANCE) was a pilot programme introduced by Sengkang General Hospital to address the challenges faced by Singapore’s ageing population. With nearly 1 in 4 Singaporeans projected to be aged 65 years and above by 2030, the demand for effective long-term...

Unplanned hospitalisations among subsidised nursing home residents in Singapore: Insights from a data linkage study

Hospitalisations pose hazards and safety risks to nursing home (NH) residents who may be frail, cognitively impaired, suffering from multi-morbidities and physically dependent,1 with propensity to develop adverse outcomes such as functional, psychological or cognitive decline, iatrogenic complications, and be subjected to over-investigation.2 There is an imperative for health...

Enhancing guidelines for managing cognitively impaired drivers: Insights from Western evidence for Asian adaptation

Licensing authorities rely on medical certifications of fitness-to-drive when renewing licence for drivers who are at higher risk of crashes. Drivers with cognitive impairment are 2 to 8 times more likely to be involved in a crash compared to those without such impairments,1 and studies show they have a...

Impact of family and caregiver factors on development and behaviours in maltreated young children

Child maltreatment is defined as the neglect and abuse of children under 18 years old. It encompasses physical/emotional ill-treatment, sexual abuse, negligence and/or exploitation that causes harm to the child.1 Evidence has shown that Adverse Childhood Experiences (ACEs), such as maltreatment experienced during childhood, have a significant impact on...

Assessing the impact of frailty in elderly patients undergoing emergency laparotomies in Singapore

The ageing population is a growing global phenomenon. In 2019, 14.4% of the population in Singapore, equivalent to 3.9 million people, were aged 65 years or older.1 This percentage is expected to increase to 25% by 2030, primarily due to increased life expectancy and lower fertility rates.1 Consequently, older...

The value of frailty assessments in older surgical patients undergoing emergency laparotomies in Singapore

Mortality in emergency laparotomy (EL) far exceeds that of elective bowel surgery, and standards for the National Emergency Laparotomy Audit (NELA) in the UK were introduced due to the high mortality within 1 month of EL.1 In Singapore, 30-day mortality varies between 5.4% and 14.7% after EL.2,3 However, 30-day...

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 uveitis was estimated to be 7.6% at 12 months after acute uveitis, and 11.1% at 5 years with chronic uveitis.1,2 Uveitic glaucoma is usually associated...

Emergency department falls interventions improve osteoporosis management in frail older adults

Dear Editor, Singapore’s population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21–40% of emergency department (ED) users and proportionally are the highest users of ED services.2 One-third of community dwellers over 65 years of age fall each year,...

Transitional care strategies at emergency department for elderly patients: A multicentre study in Singapore

In Singapore, greater efforts are being directed towards developing an integrated health and social ecosystem under the new Healthier SG strategy announced by the Ministry of Health. This life-course approach aims to promote overall healthier living in collaboration with key community partners (e.g. intermediate and long-term care service providers)...

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 has increased, particularly in the ageing population which is commonly affected by dementia, stroke and brain tumours.1,2 The increasing number of patients suffering from neurological...

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 hold more truth than previously thought. We are currently able to distinguish a variety of systemic diseases by funduscopic inspection. Following the dawn of high-resolution...

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 infection. Endogenous endophthalmitis (EE) results from haematogenous spread of microorganisms in patients with bacteraemia or fungaemia into the eye and represents 2–15% of endophthalmitis cases.1-3...

Nutrition therapy in the older critically ill patients: A scoping review

The increasing levels of life expectancy and decreasing fertility are shifting the age structure of the world population towards older ages.1 From year 2020 to 2050, population aged ≥65 years is expected to rise from 9.3% to 16%.1 The number of older intensive care unit (ICU) patients are expected...

A Descriptive Study of the Demography, Symptomology, Management and Outcome of the First 300 Patients Admitted to an Independent Hospice in Singapore

Modern society views death as an aberration which has to be postponed and, if possible, prevented at all cost. Death is just unacceptable and cannot be regarded as a natural process of life. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 the blind due to glaucoma reside in Asia, the majority being Chinese. This article is available only as a PDF. Please click on “Download PDF” on...

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 due to congenital anomalies, infection, trauma, allergy, neoplasms or surgical procedures in the nose. This article is available only as a PDF. Please click on “Download...

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 features received little attention until 1936 when Heerfordt’s syndrome of uveitis, salivary gland enlargement and cranial nerve palsies was recognised as a sign of sarcoidosis. This...

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 was 2 074 507, compared to 3 103 500 in 1997. This article is available only as a PDF. Please click on “Download PDF” on top...

Day Hospital Rehabilitation for the Elderly: A Retrospective Study

Alexandra Hospital is the first hospital in Singapore with a Day Hospital for the elderly. One of the main functions of the Day Hospital is to rehabilitate the disabled elderly. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Self-Perception of Health among Elderly Community Dwellers in Singapore

The single most important determinant of the quality of an elderly person’s life is health. In the elderly, health matters affect all other areas of life, including his willing ness to seek and accept help. This article is available only as a PDF. Please click on “Download PDF” on top...

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 UK. Peak fertility and childbearing years correspond to the first half of this period. This article is available only as a PDF. Please click on “Download...

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 PDF” on top to view the full article.

Chryseobacterium meningosepticum (Flavobacterium meningosepticum)—A Report of Five Cases in a Local Hospital

Chryseobacterium meningosepticum has been known to be a causative agent of meningitis particularly in the premature and newborn infants. The first case of human infection with this organism was reported by King in 1959. This article is available only as a PDF. Please click on “Download PDF” on top to...

Bilateral Caudate Infarct—A Case Report

The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply is from the deep penetrators from the middle cerebral and anterior cerebral arteries. This article is available only as a PDF. Please click on “Download PDF”...

Perceived Need for Community Geriatric Services: A Survey at a Regional Hospital in Singapore in an Inpatient Setting

Singapore has one of the most rapidly ageing populations in the wor1d. The number of the very aged (>75 years old) has already increased from 42,700 in 1985 to 75,500 in 1995. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Swallowing Impairment and Feeding Dependency in the Hospitalised Elderly

Loss of ability to feed independently and swallowing impairment are common problems in the elderly and will be an increasing cause of disability as the population ages. A study in Europe suggested that up to 10% of people older than 50 experience troublesome dysphagia. This article is available only as...

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 between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...

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 diabetes mellitus (Type 2) patients would develop retinopathy after 20 years of disease. This article is available only as a PDF. Please click on “Download PDF”...

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 is thought to be a multifactorial disease with both genetic and environmental factors. This article is available only as a PDF. Please click on “Download PDF”...

The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong

The Alzheimer’s Disease Assessment Scale (ADAS) is a 21-item scale designed to assess the severity of cognitive and non-cognitive impairment in patients with Alzheimer’s disease (AD). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 in corneal epithelial damage that may predispose to vision-threatening infection and irreversible corneal scarring. This article is available only as a PDF. Please click on “Download...

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 those among Caucasians and Blacks in the United States and Europe. This article is available only as a PDF. Please click on “Download PDF” on top...

Screening for Hearing Impairment in Hospitalised Elderly

The prevalence of hearing impairment in the local elderly population is not known. Hearing loss prevalence estimates that 25% to 40% of individuals over 65 years of age are hearing impaired. However, there is no universal agreement on the definition of “normal hearing” and comparison between studies that report...

End-of-life Issues—Preferences and Choices of a Group of Elderly Chinese Subjects Attending a Day Care Centre in Singapore

Doctors caring for elderly, dying and terminally ill patients are often faced with the dilemma of having to make difficult decisions especially regarding treatment where the benefit and burden is not clearly defined. Issues relating to death and dying, such as whether to disclose the diagnosis and prognosis to...

Preparing for the silver boom: A falls prevention tool for older adults in the emergency department

Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls also account for 85% of all geriatric trauma presenting to the emergency department (ED) in Singapore,3 with the crude incidence rate of unintentional falls at...

Critical Role of Functional Decline in Delayed Discharge from an Acute Geriatric Unit

In the last decade, many countries have experienced alarming transformation in their demographic patterns, with the elderly population emerging as the fastest growing segment of the population. Owing to their generally poorer health status in terms of chronic illnesses and long-term disability, the elderly consume a disproportionate amount of...

Urinary Retention in Hospitalised Older Women

Voiding dysfunction is a relatively common problem in hospitalised older patients. Up to one-third of hospitalised elderly were reported to have post-void residual urine volume (PRUV) of more than 50 mL. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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 small dimensions during cataract extraction of minor consequence. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Body Mass Index and Its Related Factors in the Elderly

Cardiovascular disease is one of the leading causes of mortality and morbidity in developed countries, especially among the elderly. In Taiwan, cardiovascular disease is the third leading cause of death after neoplasm and cerebrovascular disease. This article is available only as a PDF. Please click on “Download PDF” on top...

The Practice of Foregoing Life Support in the Critically Ill “Old Old”: A Singapore Perspective

Studies on the foregoing of life support (FLS) in North America, Europe and Australia have shown diversity in terms of the incidence, decision-making process and outcome. However, they have not specifically looked into such practice in the elderly. This article is available only as a PDF. Please click on “Download...

The Impact of Swallowing Disorders in the Elderly

In 1898, Bastian first reported on the case of a man who had been admitted to hospital with hemiplegia and aphasia, but who had transient difficulty in deglutition. Necropsy revealed that apart from two limited lesions in the left hemisphere, the patient’s brain was normal. This article is available only...

Early Unplanned Readmission of Elderly in Singapore: A Retrospective Study

The number of elderly people in Singapore is expected to increase over the next 2 decades. The proportion of those 60 years and above is estimated to increase from the present 11% to 27% by the year 2030. This article is available only as a PDF. Please click on “Download...

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 to what for most patients is already a traumatic event. This article is available only as a PDF. Please click on “Download PDF” on top to...

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 registered blindness. The prevalence of AMD seems to be increasing at a rate not commensurate with the increasing age of the population, although this observation...

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 conditions and conventional rigid gas-permeable (RGP) corneal contact lenses though useful in less severe disease, are poorly tolerated by those with progressively worsening keratoconus and...

Epidemiology of Beta-haemolytic Group G Streptococcal Bacteraemia in Singapore (1996 to 1998)

Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause a range of serious infections. These included infective endocarditis which had been emphasised in older reports1 but was found to be uncommon in later studies. This...

Correlates of Habitual Walking and Sports/Leisure-time Physical Activity in Older Persons in Singapore: Interaction Effects Between Educational Attainment and Gender

Physical inactivity has been identified as a major cause of morbidity and mortality secondary to cardiovascular disease, diabetes mellitus and hypertension. It contributes to the loss of physiological and psychological capabilities that result in overall reduction in function and independent living. This article is available only as a PDF. Please...

Nursing Home Falls: A Local Perspective

Falls in the elderly has been a well-studied subject and now occupies an important place in geriatric medicine. While many studies have been done on falls in community-dwelling elderly, relatively few studies have focused on the problem in institutionalised elderly. This article is available only as a PDF. Please click...

Bedside Clinical Methods Useful as Screening Test for Aspiration in Elderly Patients with Recent and Previous Strokes

Cerebrovascular disease is the fifth commonest cause of hospitalisation in Singapore, and accounts for 2.7% of all hospital discharges. Neurogenic dysphagia is a common complication of stroke disease and it has been shown that post stroke dysphagic patients have 6.95 times higher risk of developing pneumonia when compared to...

End-of-life Care: Challenges and Obligations in Setting Limits to Life-sustaining Therapy

A patient with recurrent stroke disease and severe pneumonia did not respond to the previous courses of antibiotics. The medical team decided to switch to another broad-spectrum antibiotic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Considerations in the Assessment and Management of Older People with Chronic Pain

Persistent pain has been estimated to occur in 50% of community dwelling older people of age 65 years and above. It has been associated with multiple functional and psychological complications. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Late-life Depression: Current Issues and New Challenges

Depression in late life (>60 years old) is one of the most common and treatable psychiatric disorders in the elderly. It not only causes distress and suffering, but leads to impairment of physical, mental and social functioning, worsens prognosis for certain medical conditions, aggravates suicidal risk and increases utilisation...

Neurofibrillary and Ethico-legal Tangles: In Search of Surrogates for Dementia Patients Lacking Decision-making Capacity and Relatives

Dementia is an age-prevalent chronic degenerative disease that causes gradual and progressive deterioration of a patient’s cognitive abilities. With Singapore’s rapidly ageing population, the prevalence of dementia has been rising inevitably and steadily. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Assessing Decision-making Capacity in Dementia Patients: A Semi-structured Approach

Given the rapid ageing of Singapore, all practising clinicians can expect to see an exponential rise in the medical and surgical problems of the elderly. One such condition is dementia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

An Evidence-based Clinical Approach to the Diagnosis of Dementia

The prevalence of dementia or cognitive impairment in local studies has been shown to range from 2% to 13%. These differences in prevalence rates depend very much on the sensitivities of the different locally validated cognitive screening instruments used, as some may be better at detecting early dementia and,...

Urinary Incontinence in Older Persons: A Simple Approach to a Complex Problem

Urinary incontinence is the involuntary loss of urine which is objectively demonstrable and is a social or hygienic problem. Trivial as it may sound, it is in fact a major geriatric syndrome which may pose as major public health threat with increasing magnitude in this ageing society, due to...

The Development of Geriatric Psychiatry Services in Singapore

The population of Singapore is ageing. In 2002, it was estimated that there were 252,700 persons aged >65 years, forming 7.5% of the population. By 2030, there will be 794,000, forming 18.4% of the population. This article is available only as a PDF. Please click on “Download PDF” on top...

Aged Care Issues and Services in Australia

In Australia, the number of elderly people is increasing rapidly. In 2001, the population of Australia was approximately 19 million people and about 12.6% of this population were >65 years old. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Aged Care Services in Singapore – An Overview

The last century has witnessed the establishment of geriatric medicine as a well-recognised medical specialty supported by a respectable body of evidence, which shows that it is able to improve the health outcomes of frail older persons. Since the pioneering work of Marjory Warren in the 1930s, different models...

Challenges in Geriatric Medicine: Geriatric Services and Education

Ignatz Nascher first proposed disease and medical care of the aged as a separate specialty and invented the term “geriatrics” in 1909. However, the growth of geriatric medicine and healthcare of the elderly is often attributed to the pioneering work of Majorie Warren who successfully treated and rehabilitated seemingly...

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 reactive arthritis and acute dermatitis-arthritis syndrome. We describe a case of PMA and meningococcal endophthalmitis occurring together. This article is available only as a PDF. Please...

Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations

It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in nursing homes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital

Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly population above the age of 65 will rise from 7.5% in 2002 to 18.9% by the year 2030. This article is available only as a PDF....

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 and night vision. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Thyroid Dysfunction in Elderly Patients

Symptoms and signs of thyroid dysfunction in the elderly tend to be atypical and may be mistakenly attributed to the ageing process. Currently, thyroid function tests are performed on patients who manifest signs and symptoms of overt thyroid disease or as part of the investigations for dementia in the...

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 common cause of CNV is age-related macular degeneration but it may also occur secondary to a variety of other aetiologies such as pathological myopia, ocular...

Improving the Diagnosis Related Grouping Model’s Ability to Explain Length of Stay of Elderly Medical Inpatients by Incorporating Function-linked Variables

Casemix refers to the numbers and types of patients within a healthcare setting and Diagnosis Related Groupings (DRGs) represent one mode of classifying casemix. In essence, DRGs are categories of clinically meaningful patient conditions which require similar levels of hospital resources for their treatment. This article is available only as...

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, as well as protection of the eye against microbial and mechanical insults. The ocular surface epithelium comprises corneal, limbal and conjunctival epithelia, of which the...

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 East Asia for several reasons. In particular, they criticise the 2 best documented sets of cohort data, from Taiwan and Singapore, on methodological grounds. This article...

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 topical steroids before the diagnosis of bacterial keratitis significantly predisposed eyes with preexisting corneal disease to ulcerative keratitis. This article is available only as a PDF....

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, with the coralline (such as the Bio-Eye) {Integrated Orbital Implants, Inc., San Diego, California, USA} type dominating its cancellous bone counterpart (the Molteno M-sphere) {IOP,...

Impact of a Pharmacist Consult Clinic on a Hospital-based Geriatric Outpatient Clinic in Singapore

A general philosophy in the care of elderly patients is to use the least drugs possible to achieve the desired clinical outcome. In the United States (US), however, although patients >65 years old represent only 13% of the total population, they consume nearly 30% of all prescription medications. This article...

Polypharmacy and Inappropriate Medication Use in Singapore Nursing Homes

The elderly usually have multiple medical problems, requiring prescription drugs to treat diseases and to prevent complications arising from them. Currently, in the United States, those who are 65 years and older (geriatric age group) make up 13% of the total population but consume 33% of all prescription drugs. This...

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 unique issues relevant to a particular condition or disease, overarching common guidelines for all studies provide the framework for obtaining meaningful results. This article is available...

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 eye problem worldwide. Its prevalence varies in different parts of the world – myopia occurs in 25% of the adult population in the United States,...

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. It occurs when the refractive power of the eye is too great compared to the length of the eyeball and this may occur because the...

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. This is true elsewhere also, especially in Asia. In Asia, there is currently a high prevalence of myopia, especially among the Chinese and Japanese. This article...

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 Chinese descent. It has been reported that the prevalence of myopia among some populations in this area has reached 90%. This article is available only as...

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 that the image of an object at infinity falls in front of the retina, with the lens at rest. Accommodation, therefore, cannot focus the blurred...

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 cornea and lens. For higher degrees of myopia and myopic progression, this mismatch develops primarily as a consequence of disproportionate ocular growth, chiefly 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 public health problem are urgently needed. Many researchers agree that myopia is not determined solely by genes and that environment may play a huge role. This...

Issues and Challenges for Myopia Research

Myopia is an ocular disorder of major public health and socioeconomic significance in many East Asian urban cities. In Singapore, the prevalence of myopia is one of the highest worldwide, affecting 28% of school children at the start of their primary education and 70% of those completing university education. This...

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 in Singaporean children may be related to an increase in near work demands such as reading. Although the mechanism by which near work affects 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 post-receptoral pathways. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 the literature on Medline revealed very few reports on infective keratitis caused by N. meningitidis. This article is available only as a PDF. Please click on...

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 results from central retinal artery occlusion or optic neuropathy from direct compression or from compression of optic nerve venous drainage. This article is available only as...

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 central vision. Lutein (L) is a carotenoid, which, along with its stereo isomer zeaxanthin (Z), is concentrated at the macula lutea, to give it its...

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 accurate diagnosis and optimal management of macular disorders. This book is a quick reference guide for common macular disorders encountered in an ophthalmic practice and...

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 segments of the eye secondary to an infectious agent, is an uncommon but devastating complication. This article is available only as a PDF. Please click on...

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 only 8.6% (11 patients) of cases. A series of orbital tumours from 1976 to 1999 by Rootman et al reported only 2 cases of metastasis...

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 patients blind from their injuries. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 findings that complement factor H (CFH) polymorphisms are associated with an increased risk in the development of age-related macular degeneration (AMD) and that the histopathology...

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 anatomy of the eyelids, bony orbit, nasal bridge and other facial features, as well as the globe itself among different races may influence such factors...

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 clinically significant irregular and asymmetric corneal changes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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 as a PDF. Please click on “Download PDF” on top to view the full article.

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 undergoing LASIK surgery, with the majority of them having unaided vision that meets the minimum recommended criteria for driving. This article is available only as a...

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 be accurate. Posterior segment foreign bodies are detected by clinical examination and imaging techniques such as computed tomography (CT) and low-frequency (5 MHz to 10...

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 would increase by 150% in 2025. As the population with type II diabetes increases, so does the prevalence of diabetic retinopathy and other microvascular complications. This...

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 asthma study in 2002. Investigations showed that there had been serious deficiencies in the ethical review and research work was suspended in Johns Hopkins until...

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 atrophy that may represent sequelae of previous episodes. CSCR can arise secondary to chronic treatment with steroids. This article is available only as a PDF. Please...

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 the most prevalent group of inherited retinopathies, affecting approximately 1 in 3500 individuals. This article is available only as a PDF. Please click on “Download PDF”...

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 as primary and secondary outcome measures in clinical trials. Measurements of health-related quality of life (HRQOL), a multidimensional concept encompassing physical, emotional and social aspects...

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 new, distinct form of exudative age-related macular degeneration (AMD). In choroidal neovascularisation (CNV), the choroidal new vessels may proliferate through the retinal pigment epithelium (RPE),...

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 glaucoma. Epidemiological research has been confounded by co-existing risk factors that are difficult to measure. This article is available only as a PDF. Please click on...

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 only as a PDF. Please click on “Download PDF” on top to view the full article.

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 from abnormal accumulation of lipofuscin in the retinal pigment epithelium (RPE). This article is available only as a PDF. Please click on “Download PDF” on top...

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 plasma, urine, cerebrospinal fluid (CSF) and saliva. An important objective is to search for potential biomarkers for the diagnosing and monitoring the progression of disease. This...

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 high at about 110/100,000. The male elderly (>60 years) are at the greatest risk. This article is available only as a PDF. Please click on “Download...

Evaluation of Dementia: The Case for Neuroimaging All Mild to Moderate Cases

Dementia has been reported to affect 4% to 13% of individuals above the age of 65, with the difference in prevalence rates being dependent on the screening tools used and the criteria adopted for the diagnosis of dementia. The evaluation of any individual presenting with suspected dementia has a...

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, and since then has been regularly reviewing and revising its laws and their enforcement. This article is available only as a PDF. Please click on “Download...

“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 surgeries are currently performed under local anaesthesia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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 in the past on a roller-coaster ride. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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 consume people from within with its symptoms of bloody cough, fever, pallor and long relentless wasting) as the most widespread disease of the times, which...

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 and non-caseating epithelioid granulomas in affected organs. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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 interests. Because of this, and because of its rarity, it has received little attention in the literature. This article is available only as a PDF. Please...

Are Sensory and Cognitive Declines Associated in Older Persons Seeking Aged Care Services? Findings From a Pilot Study

Many cross-sectional and longitudinal studies have reported an association between sensory and cognitive functions in the normal ageing population. Few studies have assessed the association between sensory and cognitive impairment as most studies on cognitive ageing excluded those with sensory and cognitive impairments. This article is available only as a...

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 by one or more of the authors. The text is organised logically, with clear headings and subdivisions, and is generally well-written and quite readable. This article...

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 Vision 2020 – 20/20 or 6/6 visual acuity for all by year 2020 – worldwide, and for Singapore in particular, and whether it is relevant...

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 human amniotic membrane (HAM) as a substrate and cell carrier. Although the results are quite promising, this new procedure is still facing some challenges. This article...

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 agent of this disease in 1882 led to the acceptance of “Koch’s postulates,” which remain the gold standard for linking a pathogen to a disease. This...

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 choroidal neovascularisation (CNV), pathologic myopia-related CNV, and subgroups of AMD-related occult CNV. Visual results following verteporfin treatment of subfoveal, non-AMD related CNV have been variable....

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 of medical conditions in participants of the Manitoba Longitudinal Study. Since then, many population-based longitudinal studies have confirmed that global self-rated health remains an independent...

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 treat, as they are unwilling and sometimes unable to cooperate during active management. This article is available only as a PDF. Please click on “Download PDF”...

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 systems for surgery, illumination systems allowing bimanual dissection, the use of dyes and the use of retinotomies have all contributed to achieving a complete re-attachment...

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 towards minimally invasive surgical intervention in the case of current cataract surgery, smaller incisions with self-sealing wounds in vitrectomy might decrease surgical trauma and operating...

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 are the most common tumours of the optic nerve sheath. Although ONSMs are said to comprise 1% to 2% of all meningiomas, their reported incidence...

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 of the proposed surgery, the surgeon’s preference and the patient’s wishes. This article is available only as a PDF. Please click on “Download PDF” on top...

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, occurring in patients who have undergone radiation therapy for tumours and other lesions in sites near the visual apparatus, such as the choroid, orbit, paranasal...

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 (AMD). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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) is the leading cause of inherited blindness with 1.5 million people worldwide affected and an incidence of 1/3500 live births. This article is available only as...

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 retina. Choroidal neovascularisation (wet AMD) leading to haemorrhage and scar formation beneath the central retina accounts for most cases of legal blindness from AMD (80%...

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 been disappointing. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 the most common site for its development, and choroidal melanomas grow as dome-shaped or mushroom-shaped tumours. This article is available only as a PDF. Please click...

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, conjunctival epithelium covering the sclera, and a junctional intervening zone of limbal epithelium overlying the limbal region which lies between the corneal and sclera. To...

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, mostly men, between the ages of 20 and 50 years. This article is available only as a PDF. Please click on “Download PDF” on top to...

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, with over 8 million performed globally every year. The majority of cataract surgeries are performed under regional (retrobulbar, peribulbar or sub-Tenon’s) or topical anaesthesia. This article...

Factors Causing Delay in Discharge of Elderly Patients in an Acute Care Hospital

With the introduction of block budget for acute care hospitals, cost containment is an important issue for all secondary and tertiary hospitals. Though health care cost was rising at a rate of 31.2% between the year 2002 and 2003, it is important to keep the cost of health care...

Factors Associated With Functional Decline of Hospitalised Older Persons Following Discharge From an Acute Geriatric Unit

Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced bone density, altered appetite and tendency towards urinary incontinence, predispose older patients to complications during hospitalisation. Studies have shown that about one-third of older persons...

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 join the workforce and perform complex tasks that require perfect visual function. This article is available only as a PDF. Please click on “Download PDF” on...

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 sinus syndrome has been described in immunosuppressed patients. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Attitudes of First-year Medical Students in Singapore Towards Older People and Willingness to Consider a Career in Geriatric Medicine

With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will need to change accordingly. A potential way to fulfill this need is to increase the number of specialists proportionately to manage elderly patients effectively. This article...

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 vision equal to or worse than 20/40, and it varies from as low as 2.72% in South Africa to as high as 15.8% in Chile. This...

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. In 1927, Dorothy Eustis, having gained inspiration from her visit to a guide dog school in Potsdam, Germany, introduced guide dogs into the United States...

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) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...

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 ocular manifestations which include enophthalmos, restrictive strabismus and hypotony. We report a case of keratoconus seen in a patient with PHA after obtaining approval from...

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 such as pegaptanib (Macugen, EyeTech/OSI Pharmaceuticals) and ranibizumab (Lucentis, Genentech) are Food and Drug Administration (FDA)-approved in the US for the treatment of neovascular AMD. This...

Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in Tübingen. The patient, Auguste Deter, suffered memory loss, disorientation, hallucinations and died at an early age of 55. This article is available only as a PDF....

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 problem in East Asia, where it represents the major form of glaucoma. This article is available only as a PDF. Please click on “Download PDF” on...

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 been reported elsewhere. Given the high prevalence of heroin use, however, this phenomenon may have been overlooked. This article is available only as a PDF. Please...

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 with neovascular glaucoma. Inhibition of the vascular endothelial growth factor has been shown to prevent retinal ischaemia-associated neovascularisation of the iris. This article is available only...

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 attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented...

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 is endemic in developing regions such as South America, India and China. This article is available only as a PDF. Please click on “Download PDF” on top...

Resource Consumption in Hospitalised, Frail Older Patients

The number of older adults in Singapore has been steadily increasing over the years and will continue to do so. In 2007, older adults aged 65 years and above accounted for 8.5% of the total population and by the year 2030, it is estimated that this group will account...

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 13.7 million people in 2005 to 64.6 million people in 2050. This article is available only as a PDF. Please click on “Download PDF” on top...

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. In late 1996, the earliest commercially available OCT had an axial resolution of approximately 17 μm. This article is available only as a PDF. Please click...

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 history results in the development of chorioretinal atrophy around the regressed mCNV, causing further progressive central visual loss. This article is available only as a PDF....

Validity and Reliability of the Expectations Regarding Aging (ERA-12) Instrument among Middle-Aged Singaporeans

With increasing life expectancy and low fertility rates, the proportion of the elderly is rapidly increasing in developed nations, Singapore being no exception. The elderly (over 65 years) population in Singapore is expected to grow from 7.2% in 2000 to 18.4% by 2030. This article is available only as a...

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 the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...

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 retina opaque. The fovea, where this layer is absent, retains its normal orange red colour due to perfusion from the underlying choroidal vessels, resulting in...

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 but rare ocular manifestation of multiple myeloma. We present a rare case of IgG-lambda multiple myeloma that manifested as polychromatic crystals in the cornea—a presentation...

Successful Ageing in Singapore—A Viable Goal?

Ageing is a complex process. Achieving it successfully has implications and significance not only for individuals on a personal level but for society at large, where demographic changes and population consequences pose significant clinical and public health issues. This article is available only as a PDF. Please click on “Download PDF”...

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 considered, but it would definitely not be on the top of my list due to the following reasons. This article is available only as a PDF....

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 Annals, Academy of Medicine. We propose a differential diagnosis of Bartonella neuroretinitis for the case reported. This article is available only as a PDF. Please click...

Unipolar versus Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly: Is There a Difference?

Hip hemiarthoplasties are commonly performed for displaced femoral neck fractures. The advantages of hemiarthroplasty over internal fixation include earlier mobility, less reoperations and better functional outcome at 1 year. Considerable differences of opinion exists regarding the choice between unipolar and bipolar designs. The main theoretical advantage of a bipolar over...

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 far describing the use of 27-gauge vitrectomy in a limited number of cases, including epiretinal membranes, idiopathic macular holes, diabetic vitreous haemorrhages, a vitreous biopsy...

Diagnosing Bacteraemia Early in Older Adults

Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...

Anti-BP180 NC16A IgG Titres as an Indicator of Disease Activity and Outcome in Asian Patients with Bullous Pemphigoid

Bullous pemphigoid (BP) is a subepidermal blistering dermatosis characterised by circulating autoantibodies targeting BP180 and BP230 hemidesmosomal proteins. Anti-BP180 NC16A IgG antibodies have been demonstrated to be directly pathogenic in blister formation. Anti-BP180 IgG titres were noted to parallel disease activity in several case series, as well as reflect...

Evidence-balanced Medicine: “Real” Evidence-based Medicine in the Elderly

Case 1: An 85-year-old male with past history of hypertension is otherwise healthy and enjoys his daily walks and good food. During a health screening, he was found to be hyperlipidaemic (LDL 3.4 mmol/L; HDL 1.0 mmol/L). He was started on simvastatin 20 mg nocte by his physician. He...

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 been increasing in the past 2 to 3 decades.3-6 Data on recent incidence of primary ophthalmic cancers, comprising intraocular and extraocular cancers, have not been...

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. It is the most common cause of irreversible vision loss among individuals aged ≥60 years in developed countries, and accounts for about 6% of all...

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 uncommon, can affect both central and peripheral nervous system; producing parenchymal, non-parenchymal and mixed forms of the disease. Ophthalmic findings include ocular inflammation and other...

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, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...

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 is available only as a PDF. Please click on “Download PDF” on top to view the full 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 operating conditions, with the facial nerve block preventing blepharospasm and providing lid akinesia. This article is available only as a PDF. Please click on “Download PDF”...