The SNEC has 80 eye specialists who are trained to deal with difficult and complicated cases that other hospitals cannot handle

WHEN the beer bottle smashed straight into Mr Tan Chee Siong’s eye, he felt little pain as his retina — a light-sensitive tissue — silently floated out, detached from the back wall of his eye.

To bystanders, the impact of the broken glass had cut open his eyelid and eye globe, sending parts of the retina flying onto the bar floor.

He was wheeled into the Singapore National Eye Centre (SNEC) as an emergency trauma case, and multiple sub-specialists took turns to treat Mr Tan’s injury.

“The surgeon-on-call that night repaired the torn outer wall of the eye. The oculoplastic surgeon worked on his eyelid, while the retina specialists worked on the inside and the back of the eye,” says Dr Doric Wong, a senior consultant and head of the Vitreo-Retinal Service at SNEC who took the case.

Miraculously, even with the missing part of the retina, after multiple operations, the patient regained his vision of mid-sized objects.

All kinds of eye ailments, particularly the complicated cases, are being referred to SNEC, which houses 80 eye specialists under one roof.

“You can’t call yourself a complete eye centre without having all the sub-specialty expertise,” says Dr Wong. “And to do so, each sub-specialist has to be able to concentrate on doing over and over again what he is sub-specialising in so that he or she becomes good at it.”

This means having enough complex cases to work on and a critical mass of doctors to develop expertise in all the different areas.

“At the vitreo-retina service alone, we have about eight full-time specialists. This allows the surgeons to exchange ideas and knowledge on a wide range of cases within the sub-specialty,” says Dr Wong.

The eye sub-specialisation list includes cataract, refractive surgeries such as Lasik and Kamra, cornea issues such as transplants, contact lens complications and glaucoma.

There are also paediatric or children’s eye problems such as squints, lazy eyes and inborn malformations, oculoplastics such as ptosis (drooping eyelids), and neuro-ophthalmology, for patients in which eye problems are linked to brain or nerve disease.

“Advancement in ophthalmology expertise is not something that is a dramatic paradigm shift but something that is built up over the years,” says Dr Wong.

“In most instances, advancement is incremental — instruments get finer and faster each year, and as a surgeon, you strive to become better at each case that you operate on.”

To ensure that each specialist is doing what he or she is best at, SNEC runs an annual audit of all its surgery cases.

“Nothing is done in secret here. The official audit of surgery success rates helps heads of departments guide trainee specialists towards the skill they are best able to handle and alerts us if there are problems,”
says Dr Wong.

Some 60 per cent of the vitreo-retinal surgeries conducted at SNEC comprise subsidised patients like Mr Chua Pek Meng, 50.

Mr Chua was referred to SNEC for an emergency rescue after an operation to remove the blood vessels at the back of his eye went astray at another hospital. “By then, I had a pool of blood blocking my vision. “I was told that when the blood dries up, my vision will come back, but a few months passed and I became really nervous; my eyesight was becoming worse each day… I couldn’t drive and I had to ask my wife to take me to the hospital,” Mr Chua recounts.

Dr Wong repaired Mr Chua’s right eye and he checked his left eye as well. “It was really difficult for me to accept the fact that my left eye also had a problem,” says Mr Chua.

Using computer simulation, Dr Wong explained to him in Mandarin and Hokkien how he would work out the best and safest angle to penetrate the eye so that the potential risk could be reduced to less than 5 per cent.

“He not only convinced me to go back to the operation theatre, but also during the operation, I was not worried at all,” says Mr Chua.

“The doctor really looked after us patients as if we were his own parents.”

Today, Mr Chua’s vision is good enough for him to work at the computer and he is back at work, although he still needs to go for regular check-ups.

The queues are long but he does not mind. He says: “We chat among ourselves while waiting and we often end up talking about how good the doctor is to us.

“You know they say if the top management is good, the junior staff will be good, and that’s very true here,” says Mr Chua.

“The doctors and nurses I meet here are all doing their best to help us. They are good because the one training them is good.