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MESSAGES TO

Cataract Surgery

A DxD Session with Dr Claudine Pang


Ended on Wed Nov 14 2018
Ended

Top Answers


Dear Anonymous, 

There’s a fine balance when it comes to deciding the perfect timing for cataract surgery. 

You are right that we shouldn’t delay too long because in some cases, if the cataract progresses too rapidly, it will become too dense or hard; and may make the surgery more complicated or difficult, which in turn may affect visual outcome.

Having said that, very often if the cataract is progressing rapidly, it will likely affect your vision significantly, and you would be able to sense it. 

On the other hand, we do not want to rush into having surgery when your vision is hardly affected.

A key consideration before surgery is how much of your vision is affected by the cataract. Remember that every surgery has some risks albeit low, so we do weigh the benefits of doing surgery against any potential risks.

I would definitely encourage surgery if your diminished vision is affecting your quality of life; however if you are functioning very well and happily at the moment, then there would be no need to rush into surgery. 

In your case, because you mentioned that your vision is not affected much yet, it would be reasonable to monitor your cataracts for now.

You should visit your eye doctor regularly at least 6-monthly to check on the cataract progression.

In addition, visit your eye doctor immediately if you should experience any noticeable deterioration in your vision. 

I hope this was helpful to you.

Yours truly

8 Feb 2018

Dear Sfw,

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 preferences.

A detailed consultation with the eye doctor will be able to elucidate which lens is best for your grandmom. 

At the same time, each type of lens has their pros and cons; these should also be discussed before considering which lens is best for her. I hope this was helpful to you. 

Yours truly,

Dr. Claudine Pang

13 Feb 2018

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 follow factors: 

  1. 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. 

  1. 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.

  1. Who your surgeon is:

In public hospitals, your surgeon may range from resident trainee to senior consultant level. Subsidised patients do not get a choice on their surgeon and may see a different doctor at every visit, while private patients will be able to choose their surgeon.

Other than surgical skill, it is important to choose a surgeon whom you are comfortable with and feel safe enough to trust your eyes with.

  1. Type of cataract surgery – phaco or femtosecond-laser assisted

The 2 most common cataract surgery procedures are phacoemulsification (phaco) and the femtosecond-laser assisted cataract surgery. Both methods are equally safe and yield equally good visual results under the right hands.

The decision on which method is used depends on your eye condition and your surgeon’s judgement. The laser assisted cataract surgery cost is higher due to the additional cost of the laser machine. 

  1. Type of intraocular lens implant

The cost of the intraocular lens alone ranges from $600 to $3500, depending on the type. A premium intraocular lens (toric or multifocal) will cost more and contribute to the total cost of the surgery.

  1. Whether patient has Medisave, Medishield or insurance coverage

All Singaporean or Permanent Resident patients (at public or private hospitals) are further eligible to claim up to $2450 from their Medisave for cataract surgery.

In addition, if you have Medishield Life and/or personal insurance coverage, you may able to claim the FULL COST of the surgery and lens implant, hence the ‘out of pocket’ cost to you could be zero. The clinic or hospital may be able to facilitate this claim for you by doing direct electronic filing of your claim.

16 Aug 2018

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: 

  1. 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.
  1. 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.
  1. Posterior Capsular Rupture – This describes a tear or break in the bag which holds the lens during the cataract removal. Without getting too technical, this complication makes the whole surgical procedure longer, surgery cost higher and visual recovery slower. Depending on the severity of the tear, some surgeons will be able to manage independently during surgery, while other surgeons may need to call in a retinal specialist for their expertise in this area. Although this complication occurs rather uncommonly, it is ideal to have a surgeon who is competent enough to handle it if and when it occurs.
  1. Retinal tears or detachment – Due to turbulence created within the eyeball during surgery, rarely a retina tear or detachment can occur. If detected early, it can be fixed by a retinal specialist without any permanent damage to the vision. It is important to have an eye doctor who pays attention to your retina during cataract surgery as well.
  1. Injury to the surrounding tissue such as the eyelid, cornea and iris can occur during cataract surgery. This is uncommon especially in the hands of a skillful surgeon.
  1. Anaesthetic Risk – There is always a small risk of any kind of anaesthesia to your brain, heart and lungs. It is important to have the surgery done with the support of a good anaesthetist who will be there to take care of your brain, heart and lungs while your eye surgeon is operating on your eyes.

During the recovery period, it is usual for the eye to experience inflammation which may result in transient eye redness, eye swelling, changes in eye pressure or transient retinal swelling. These temporary effects can be treated easily with eyedrops or medication if detected early by your surgeon. Hence, it is important to continue regular follow-up checks after surgery. 

In the long run, it is usual for the intraocular lens to accumulate tissue cells or opacification with time (1 to 5 years later). This is can managed with a simple office laser procedure which ‘polishes’ the lens to its original clear condition again.

16 Aug 2018

When choosing an eye surgeon, you will want to know the following:

  1. 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.

  2. 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.

  3. Other patient’s 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.

16 Aug 2018

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.

16 Aug 2018

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.

16 Aug 2018

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.

It is also difficult to get reliable doctor recommendations in Malaysia compared to Singapore. In Singapore, most doctors (even in different fields) would have heard or worked with one another at some point in our careers. It is easy to get referrals, recommendations or find out more about your eye doctor by asking another doctor in Singapore.

16 Aug 2018

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.

16 Aug 2018

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.

Thirdly, we know that how dry your eyes are will affect how good your vision is after cataract surgery. This is especially so if you are getting a premium intraocular lens (toric or multifocal). So, in order to optimize your visual outcome, it is important to keep your eyes well lubricated with natural tears or to treat any underlying pathological dry eyes. Your eye doctor will be able to assess whether you need any special dry eye treatment.

16 Aug 2018

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:

  1. Create a 2mm incisional wound for the insertion of instruments
  2. Create an opening at the top of the capsule or bag which holds the lens
  3. 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.

In the last few years, many large studies have been done to compare the success rates between the standard phacoemulsification and the FLACS and the results have been unanimous. There is NO significant difference in visual outcome and success rates between either method.

In the light of those findings, many surgeons see no benefit at this point in time in opting for FLACS which turns out to be more costly and yet NOT more beneficial to the patient.

As there are pros and cons of each method, the ultimate choice between the two methods is still debatable and largely dependent on the surgeon after assessment of the patient’s eye condition.

16 Aug 2018

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.

16 Aug 2018

Hi Revee, 

The most common causes of cataracts are:

  • Age – We will all develop a cataract when we get older. It’s a matter of how severe the cataract is and whether our vision is impaired by it, that determines whether or not we need surgery.
  • Excessive sunlight exposure – We know that ultraviolet rays from sunlight exposure is a major risk factor for cataract formation. Hence, with cumulative exposure to sunlight without proper UV protection, we will need cataract surgery sooner than most.
  • Improper or prolonged steroid use – Steroid medication in any form can lead to early cataract formation. This includes steroid eyedrops, steroid inhalers and nasal sprays.
  • Diabetes mellitus – Elevated blood sugar level can lead changes in the lens proteins which bring about early cataract.
  • High myopia – People with higher degrees of myopia or short-sightedness are more like to get cataract earlier in life.
6 Sep 2018

Hi Justina, 

Cataract surgery is not always an elective procedure. Occasionally, a cataract may progress very rapidly to cause severe visual impairment, as well as acute glaucoma.

In these situations, the cataract needs to be removed urgently. In most other cases, cataract surgery is elective because cataract progression is usually very gradual.

You should choose to have your cataracts removed when your vision deteriorates to a stage that it affects your quality of life. This is very dependent on each individual, your occupation and activities you like to do.

If you experience blurring of vision, doubling of vision, dimming of vision or decrease in contrast, especially in low-light conditions, that is preventing you from enjoying your favourite hobbies or sports, you should get your eyes assessed for the need for cataract removal.

If your cataracts are not removed, you will suffer from increasingly poorer vision and in the most severe scenario, the cataract may ‘explode’ to cause an acute glaucoma, which leads to eye redness and pain.

Another important point to note is that cataract removal of a very mature or ‘hard’ cataract is more difficult and complicated than cataract removal of a less dense cataract. Hence, it is ideal to remove it before it gets too ‘hard’.

6 Sep 2018

Hi Cecilia,

The best treatments for cataract include:

Eyedrops – There are eyedrops which are said to slow down the progression of a cataract. This is only effective in the case of mild cataracts that are not yet affecting your vision.

New pair of spectacles – Sometimes, a simple change of your spectacle prescription could be all you need to do to improve your vision. This is because cataracts can bring about either an increase or decrease in your existing power. Again, this is only effective in the case of a mild cataract.

Surgery – Cataract removal with intraocular lens implantation is the most effective method to get rid of your cataracts and restore your vision. Nowadays, the most commonly used technique is phacoemulsification with or without femtosecond laser assistance. The method of choice is very dependent on each individual’s cataract and eye condition as well as the surgeon’s judgement. It is best to discuss the most appropriate method for yourself with your eye surgeon.

6 Sep 2018

Hi Letty, 

Yes, it is possible to delay the progression of cataract by using eyedrops. This is reserved for people with mild cataracts only. These eyedrops need to be used 3-4 times daily.

At the same time, you may update your spectacle prescription to improve your visual blurring if possible. However, using the eyedrops will not be able to reverse or take away your cataracts completely. Ultimately, cataract surgery is still the only definitive way to remove your cataracts.

6 Sep 2018

Hi Kartini, 

All of my patients whom I’ve operated on for cataract surgery experience no pain whatsoever. This is because the wound is very small (less than 2 mm in size) and the incision is performed where there are no pain (nerve) fibres. It is also important for your eye surgeon to be extra gentle and careful during the surgery.

During the surgery, my patients do not experience any pain because they will be sedated comfortably. What they experience is a short nap, and upon waking up, the surgery is over.

While I do know of other eye surgeons who choose to perform cataract surgery with patients completely awake, I personally believe that patients have the most comfortable experience when they are sleeping and unaware of the surgery. In my experience, patients can get rather anxious about being awake and this anxiety may increase their blood pressure and affect the surgery outcome.

After surgery, my patients do not complain of any pain and usually do not need any painkillers whatsoever. If you are worried about pain, you may take Panadol or any other painkillers for 2-3 days after surgery as a ‘just-in-case’, however this is most usually not necessary.

6 Sep 2018

Hi Luke, 

I prefer to perform cataract surgery with my patients under monitored sedation (this is different from general anaesthesia or GA). Monitored sedation is when patients are completely asleep (without the need for GA) and under the close monitoring of an anaesthetist.

Monitored sedation (unlike GA) is very safe, even for patients who have pre-existing medical conditions. I believe that patients have the best experience and are most comfortable when they are completely unaware of the ongoings of the surgery. My patients like the fact that they experience taking a short nap and upon waking, the surgery is all over.

Having the patient completely asleep means that the surgeon and anaesthetist need to be very good at controlling the patient’s eye and body movements during surgery. This is one of the reasons why other surgeons may choose to perform the surgery when the patient is awake and cooperative. They rely on the patient to keep their eye and body still and straight during the surgery. 

In my experience, patients can get rather anxious about being awake during surgery and this anxiety may increase their blood pressure and affect their surgical outcome. What’s more, as expected, it may be difficult for patients to cooperate fully with the surgeon’s instructions during surgery through no fault of theirs.

As an experienced eye surgeon who strives for a perfect result, I prefer to be in total control of the surgery and not to rely on my patient’s cooperation for the perfect surgery outcome. 

6 Sep 2018

Hi Ginny,

Before your cataract surgery, your eye doctor would have discussed with you at length the type of intraocular lens that will be implanted in your eye.

In addition, your eye doctor would have made detailed measurements and calculations of your eye in order to determine the best power for your lens implant.

Leading up to cataract surgery, your eye doctor will prescribe some eyedrops for you to put in your operated eye 2-3 days before surgery. These eyedrops include antibiotics and anti-inflammatory eyedrops to prep your eye before surgery.

Cataract surgery in Singapore is performed as a day surgery procedure. You would need to fast for 6 hours before the procedure and you should arrive to the day surgery ward about 3 hours before the surgery time to prepare. You would need to get changed and receive eyedrops to dilate your pupils in that time.

If you are my patient, you would be having a good nap and sweet dreams during the entire surgery and by the time you are awake, the surgery would be over.

After the surgery is over, you will be kept in observation for 1-2 hours. Depending on well you feel, you may start eating your meal as per normal and you will be ready to go home soon after. That makes the entire duration of your stay in the day surgery ward approximately 6 hours from the time you arrive to the time you leave.

6 Sep 2018

Hi Nurshahida, 

All my patients after cataract surgery see very well (6/6) on the first day after surgery. Although I tell my patients that they can expect a further improvement in their vision in the first week, most of them already do see very well from day 1.

Most patients feel completely normal in the first week after cataract surgery. They can resume most of their normal activities except for strenuous sports and swimming with their head underwater. Complete recovery is 1 month after surgery as the wound takes time to heal.

6 Sep 2018

Hi Ke Xin, 

Yes, the results after cataract surgery are permanent. This is because we do not expect the eye to change much in adulthood.

However, if there are external factors that cause the eyeball to grow or develop astigmatism, such as excessive eye rubbing or prolonged near work, there may be changes in the cornea or eyeball length that bring about a change in the spectacle power. This can easily be correct with a new spectacle prescription.

Another change which can occur to the lens implant is that it may develop lens opacification or ‘clouding’. This does not occur in everyone but approximately 50% of all post-cataract surgery patients. It normally develops within 1 to 5 years and it will appear as a ‘clouding’ of your vision.

Why it appears is because our lens proteins or cells proliferate to form a hazy film on the posterior capsule of the lens. This problem can be easily rectified by undergoing a simple laser procedure that is painless, takes 5 minutes with no downtime and can be done in the clinic.

You can think of it as a ‘polishing’ of the lens that has gotten ‘dirty’ over time. The good news is that you will only need to ‘polish’ your lens once, and it will be clean forever.

6 Sep 2018

Dear Helen, 

Poor night vision can be brought about by either cataracts or retinal problems! If you have not already seen an eye doctor, you should see one to get checked for whether any cataract or retinal condition is present. A useful clue would be ask if any of your family members also have poor night vision. If it seems that your parents or siblings also have poor night vision, it could indicate a hereditary retinal condition. 

If your retina is all healthy and you are suffering from an increasing cataract, then yes, cataract surgery will most definitely improve your night vision. In fact, alot of my patients with cataracts come in complaining of poor night time vision and difficulty seeing when the lighting is dim. This is because, as cataracts progress, they change colour and tend to get darker (from green to yellow to brown to black). So the more advanced your cataract, the darker everything will appear. Once the cataract is removed and replaced with a clear intraocular lens, all my patients experience the return of vibrant colors and drastic improvement in their night vision!

Did you know that the famous artist Monet suffered from cataracts at the end of his life? That is why if you observe the trend in his impressionistic paintings of the scenery around him, you will be able to note that he chose cooler colors like blue and green early on in life and as the years progressed, he painted with warmer colors like red and yellow. That is how he saw the world through his cataracts. Interesting story!  

Hope that helps!

Dr Claudine Pang

16 Oct 2018