Other than prescribing spectacles and contact lenses, one of the main roles of the Optometrist is to detect eye conditions such as cataracts, dry eyes, squints in children and more sight-threatening eye diseases such as glaucoma, diabetic retinopathy, and age-related macular degeneration for early intervention.
Optometrist who graduated from degree programs are actually well trained for the above role. Even though the role of the optometrist is recognized by TTSH and the Optometrist and optician’s Board as a primary eye care provider , the skills and knowledge of the Optometrist are not fully utilized due to regulations in Singapore . Optometrists in Singapore are not allowed to use diagnostic drugs such as those that dilates the pupil for thorough examination of the inside of the eye. Even so, well trained Optometrist are still able to carry out their job effectively in the detection of eye diseases and prevention of blindness.
Diabetic retinopathy and blindness
Just last week, someone in his early 40s came in complaining of distant blur, especially in one eye. When someone complains of blurred vision, the first thing that they think of is that there is a change in prescription (if they are wearing glasses) and came in asking us to get them new glasses.
After checking the customer’s prescription, I found that there was no significant change in prescription but the vision in the right eye was poorer than the left eye. He mentioned that he is a diabetic for many years and had recently seen an eye specialist in a government hospital. We thought that since he was seen by an eye specialist, all was well. He was also due for a follow up with the eye specialist in a few weeks time.
In cases like this, he would have been given a pair of glasses while he wait for his appointment in the hospital in a few weeks time. But i decided to take a look inside his eyes with a slit lamp biomicroscope . Without dilating eye drops to make the pupil bigger, it’s not easy to examine the inside and back of the eye properly. However, with careful examination, I was able to find out the cause of poor vision in his right eye. I took a fundus photo and showed it to him.
Haemorrhage and leakage very near the macular (circled part)
As it is affecting his central vision, it’s somewhat urgent that he should see an eye specialist for further check / treatment. This is because if the condition got worse, his eyesight could have become worse if it affects his central vision and he could go blind. Treatment at that stage would not have restored his vision. I was glad that he took my advice and visited our trusted eye specialist for further examination and gave him prompt treatment so that his vision does not deteriorate further.
Double vision and brain tumor
Few years ago, we had a customer came in to make a pair of glasses after seeing an eye specialist in a private hospital. The customer was in her 80s and had seen the eye specialist because she was experiencing double vision. After the examination by the eye doctor, he gave her a prescription with a lot of prism to correct her double vision. As she had a prescription from the doctor, I could have made a pair of glasses based on the prescription given.
As the amount of prism given was too high to be made into a pair of glasses, I decided to check her eyes again to see if the prescription given will work for her. It turned out that the prescription will not solve her double vision during the testing.
Double vision (which happens recently) that occurs to adults , especially if it’s very bad, is not normal. I was not sure why the customer was simply given a prescription. I thought she should seek a second opinion and referred her to another eye specialist who deals with double vision and squint.
The eye specialist ordered an MRI scan and they found out that she has a brain tumor which was pressing onto the nerves that control eye movements. I was not sure how the first eye specialist had miss the diagnosis. If we had simply given her a pair of glasses, the brain tumor would probably not have been detected, which could lead to death. I was not sure if she had the tumor removed and if she had, what is the outcome as I didn’t receive any updates from the eye specialist . i hope she is well and is still enjoying her life.
Eye infection can cause blindness
There were also occasion where blindness could not be prevented. There was this customer who is in his 50s or 60s who often came to make glasses because he often loses them. One day , he came in with a visibly scarred cornea on his left eye.
It’s most likely due to in infection which was not promptly treated. Some people just ignore a red eye and hoping that it will go away. For this case, I am sure it’s must have been quite painful. I wasn’t sure why he did not seek medical attention. But one likely reason could be due to financial constraint. On another note, sometimes infection and corneal scarring can happen very fast
It’s quite sad to see cases like this because it can be prevented as we have the best eye doctors and medical facilities in Singapore.
Even though he has lost his vision in one eye, he is still quite cheerful . If I see him again, I will persuade him to seek medical attention and hopefully something can be done to help him see clearly again with both eyes.