DxD Session held on 13 August 2018.
Dr Claudine Pang is a Consultant Ophthalmologist who graduated with a Distinction and Gold Medal in Medical Ethics. She was the was the first and only female in the world to receive the highly coveted 1-year William H Ross Vitreoretinal Surgery Fellowship at the University of British Columbia in Vancouver, Canada.
With more than 13 years of experience, her forte is in cataract surgery, myopia prevention, macular and retinal diseases. She is a firm believer in eye wellness which embodies treatment of dry eyes symptoms and preventative eye care.
Cataract surgery is the most common surgery that Singaporeans encounter in our adult life due to ageing. Surgery is usually advised when the poor vision caused by cataracts cannot be corrected with glasses and interferes with one's daily activities.
Dr Claudine answered questions from readers on:
- Types of cataract surgery in Singapore
- Cost of cataract surgery in Singapore
- Risk and complications
- What to expect after a cataract surgery
- Cataract surgery recovery process
The average cost of cataract surgery per eye in Singapore can range between is $1500 – $8000. Wow, that’s a wide range, you may say.
That’s because the average cost of the cataract surgery procedure alone (without the cost of the lens implant) is approximately $3000 – 5000. The out-of-pocket cost to you then depends on the following factors:
- Whether patient is eligible for government subsidy:
If you are able to get special government subsidy, this cost can be brought down to as low as $1500. Government subsidies such as Community Health Assist Scheme (CHAS) and Pioneer Generation Package are only offered in public hospitals, not in private hospitals.
Patients under such subsidies will not be able to choose their cataract surgeon nor the type of intraocular lens.
- Whether surgery is done in private or public hospital:
While it is a general assumption that private hospital fees are higher than public hospital fees, it is not always the case. You may be surprised to know that a non-subsidised (private) patient at a public hospital may end up paying as much or more than a patient in a private hospital.
This is especially so if patients at a public hospital choose a particular surgeon, femtosecond-laser assisted cataract surgery and premium intraocular lens.
How safe is a cataract surgery, and what are the main risks of going for cataract removal in Singapore?
Cataract surgery in Singapore is a very safe procedure, with more than 99% success rate. Having said that, any kind of surgery carries some risk even if very low. The risk of blindness is quoted at 0.0001% (approximately 1 in 10,000).
The main complications that may arise during cataract surgery are:
- Infection – First of all, this complication is very rare (1 in 1000). Even with the best precautions including copious antibiotic coverage before, during and after surgery, there is still a small risk of eye infection. The infection could come about from unclean surroundings, microbial contamination or a lowered immune system. Your eye doctor will be able to advise you on how to boost your eye health and general well-being after surgery.
- Bleeding – Again, this complication is very rare. During any surgery there is always a risk of excessive bleeding in or at the back of the eye. This occurs especially in those who have uncontrolled high blood pressure or are on pre-existing blood thinning medication. It is important to inform your doctor about the medicines you are taking so that they can be stopped prior.
When choosing an eye surgeon, you will want to know the following:
- Surgeon’s qualifications – In Singapore ALL eye doctors or ophthalmologists are certified to perform cataract surgery. There is no additional training needed to perform cataract removal.Although additional training or subspecialization in certain surgical fields such as retina, glaucoma and anterior segment surgery may put the surgeon in a better position to perform more complicated cataract cases. When considering how good the ‘extra’ training your doctor received in these areas of subspecialty is, you may want to know the duration of his/her training overseas and which eye hospital in which country was it done. This will allow you to have an idea of how much surgical hands-on experience your doctor has accumulated.
- Surgeon’s characteristics – A few essential characteristics you should look for in your doctor is patience, meticulousness and genuine concern. Your eye doctor should be patient enough to explain to you the procedure, risks and what to expect. If he/she is meticulous enough in your eye examination and consultation, he/she will likely do a meticulous job during surgery. Your eye surgeon should also take extra time to find out your daily activities and personal preferences. In doing so, it shows his/her genuine concern and care towards you and in wanting to get your lens implant fitted to your exact visual needs.
- Other patients' experiences – It would be ideal if you had a relative or friend who has had a good experience undergoing cataract surgery with a particular doctor. However, if you have not, you can search for relevant patient reviews on the internet.
Most importantly, you must feel comfortable with your surgeon and feel safe enough to trust him/her with our eyes.
Yes, cataract surgery is covered by Medishield and other insurance policies in Singapore. In fact, many of my patients have managed to claim the entire cost of their bill from Medishield and other personal or company insurance policies.
Clinics that are Medisave accredited will be able to check your mother’s extent of coverage very easily using her full name and NRIC number through a nation-wide electronic registry which holds all the information about every citizens insurance coverage. Simply ask your eye clinic to assist you to check your exact coverage.
Yes, cataract surgery is a procedure that can be claimed in Singapore. The most common claim made is through Medisave. Every Singaporean and Permanent Resident can claim up to $2450 for cataract surgery from their Medisave account or an account of their next-of-kin, be it spouse or child.
What’s more, if you have a Medishield plan, depending on your coverage, you could claim your cataract surgery cost in full, for both private and public hospitals.
Lastly, if you qualify for special government subsidies such as Community Health Assist Scheme (CHAS) and Pioneer Generation Package, you will be able to receive further subsidy at a public hospital.
Why are cataract surgery costs in Johor Bahru cheaper, and what are the risks of going abroad for cataract removal?
As with the cost of everything else, it is not surprising to pay double the amount for a similar service or product in Singapore compared to in Malaysia. This is largely due to the currency exchange rate. The other factors that could lower cost of cataract surgery in Malaysia would be the lower cost of surgical supplies, medical staff, rental or facility fee and medication in Malaysia.
It is generally not recommended to have surgery done overseas as you may need unforeseen close monitoring or post-surgery care which would not be convenient if you need to travel for long hours so frequently. It is also less ideal since you would require proper rest in comfortable and familiar surroundings, with good support from family and/or friends present.
There is no dedicated cataract eye surgery clinic in Singapore because all eye doctors in Singapore can treat cataracts as well as other eye conditions. In fact, I would be worried about an eye clinic that only treats cataracts and not anything else.
We must remember to treat the eye as a ‘whole’ and not treat only the cataract while neglecting the other parts of the eye. If you had glaucoma or retinal problems but only had your cataract treated, that would not improve your vision.
I have seen multiple cases of patients who had their cataract surgery done elsewhere without any visual improvement. They saw me for a second opinion and was found to have pre-existing glaucoma and retinal problems that were not detected before. They had to undergo a second surgery to fix the problem when it could have been fixed at the same time as the cataract surgery.
Most importantly, choose an eye doctor who can handle complicated cataract cases as he/she will be able to handle simple cataract cases as well.
Firstly, it is preferable for you to be completely well when going for surgery. Hence, take more vitamin C-rich foods or supplements to boost your immune system. Vitamin C is also known to help tissue healing. If you have any flu, viral-like illness or fever, it may be advisable to postpone the surgery till you are well. This is to prevent any spread of infection to your eye.
Secondly, avoid taking any foods or medication that are known to cause blood-thinning as this may cause more excessive or easy bleeding during surgery. Examples of such foods include cordyceps, lingzhi and gingko; and medications would include Aspirin, Plavix, Warfarin and Ticlopidine.
The most recent advancement in cataract surgery is the use of a femtosecond-laser to assist in the cataract surgery. This is called Femtosecond Laser-Assisted Cataract Surgery (FLACS).
To understand what FLACS is, you first need to understand the 3 essential steps of cataract surgery:
- Create a 2mm incisional wound for the insertion of instruments
- Create an opening at the top of the capsule or bag which holds the lens
- Use phacoemulsification energy to break up the lens
Normally, these steps are performed manually in standard phacoemulsification, however with the advent of femtosecond laser, these steps can be aided with the use of laser energy instead. This allows for the wound opening and capsule opening to be done more precisely.
Which is the most common cataract surgery in Singapore between femtosecond laser versus phacoemulsification cataract surgery, and why?
Between the two methods, the most common cataract surgery remains the standard phacoemulsification cataract surgery. This is because after the advent of femtosecond laser assisted cataract surgery, many studies have been performed to show that there is no improvement of visual outcome or success rate with the use of femtosecond laser.
Hence, given its higher cost to the patient and no added benefit to the patient’s visual outcome, most surgeons choose to use phacoemulsification and only opt for femtosecond laser if patient’s eye condition truly requires it.
Briefly, the various types of lenses available include:
1. Monofocal lens — targets good vision at a chosen distance
2. Toric lens — corrects astigmatism
3. Multifocal lens — targets far and near vision
4. Trifocal lens — targets far, intermediate and near vision
5. Extended depth of focus (EDOF) lens — gives an extended range of vision
It is true that there is NO such thing as a best lens when comparing all of the above.
There is however, a best choice for each individual, depending on the individual’s visual requirements, daily activities and personal