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IN AU IS GU SU R E AL J U L - S E P TEInsight INSIDE DELIVERING THE FINEST QUALITY EYECARE 2 0 0 5 A publication of MITA (P) 107/02/2005 IN THE SPOTLIGHT Refractive Surgery and Oculoplastics 2 3 6 4 Oculoplastics Iris Tracking Aesthetic Eye Surgery Artifical Eye Service 6 Test Your EyeQ A growing field in ophthalmology Customised ocular prostheses in under 10 hours A world’s first for TEI P U L L O U T 7 What’s On 8 TEI Profile INTRALASE - Safer LASIK HOW INTRALASE IS DONE BEFORE Mechanised surgical blade Cornea In the standard method, the surgeon does a circular cut using a mechanical surgical blade on the surface of the cornea and folds back the flap. Conventional LASIK LASIK is currently the most commonly performed laser procedure to correct myopia, astigmatism and hyperopia (far-sightedness) worldwide, as well as in Singapore. It has been proven to be safe, predictable and effective. 1 Traditionally, LASIK involves 2 steps: 1. An automated mechanical surgical blade is used to cut a thin hinged corneal flap which is then folded aside; 2. A computer-controlled laser beam is then applied onto the underlying corneal bed to change the shape and thickness of the cornea, thereby eliminating myopia, astigmatism or far-sightedness. The corneal flap is then flipped back into place. While results remain excellent and complications rare, some of them may be related to how precisely and uniformly the corneal flap is made by the blade. Blade-less, All-Laser LASIK with Intralase With Intralase, there is no need for surgical blades. Instead, the computercontrolled Intralase machine emits very short wavelengths of laser energy (femto-seconds or 10-15 seconds) to precisely and uniformly fashion the corneal flap. This converts the partial-laser approach to the new all-laser approach, thus bringing LASIK to an even higher level of safety. The shape and size of the flap can be precisely pre-determined and created with this all-laser approach. Furthermore, with such precision, an even thinner 100 micron corneal flap can be fashioned, instead of the conventional 160 microns. This makes it possible to treat people with high degrees of myopia but thin corneas, who were previously excluded from LASIK. Intralase was approved by the US Food & Drug Administration (FDA) for use in LASIK three years ago. Since then, more than 100,000 Intralase procedures have been successfully and safely performed worldwide. By Dr Lee Hung Ming In Intralase, a computercontrolled machine uses a laser to create microscopic cavities within the cornea and, by connecting these areas into a single plane, a very precise flap is created. Corneal Flap 2 Computer-controlled laser beams then reshape the underlying tissue of the cornea. The flap is flipped back into place. No stitching is needed as the flap will adhere naturally to the cornea and will re-attach itself within months. Illustration: [email protected] B reakthrough technology that has made LASIK surgery even safer and more precise is now available at TEI. In fact, TEI @ Tan Tock Seng Hospital remains the first and only restructured hospital to offer Intralase for myopia and astigmatism correction in Singapore. Since the introduction of Intralase last year, more than 1000 myopic eyes have been successfully corrected with this all-laser approach. REFRACTIVE SURGERY It gives me great pleasure to present to you the inaugural issue of TEInsight – the official publication of The Eye Institute, National Healthcare Group, Singapore. As we would all agree, keeping abreast of the latest investigations and treatment is of paramount importance in providing our patients with the best care possible. Unfortunately, browsing through peer review journals can be very time-consuming. Most articles are heavy on research but may not be directly applicable in our day-to-day clinical practice. With TEInsight, we aim to provide regular updates of what is considered latest standard care in ophthalmology today. For the benefit of the busy practitioner, these updates are kept intentionally concise. These articles are dedicated to family physicians, optometrists and non-ophthalmic physicians. Future issues will feature a growing emphasis on practical diagnostic approaches, differential diagnoses, pitfalls and referral criteria. These articles complement TEI’s disease flipchart, entitled “Practical Approaches to Common Problems in Ophthalmology”, which you may have already received. We have also decided to focus on 2 subspecialties per issue, so that our readers get exposed to an even spread of subject matter. In this, our maiden effort, the spotlight falls on refractive surgery and oculoplastics. It is our ultimate goal that this newsletter proves to be a useful tool to our readers and we hope it will be a helpful guide in your practice. I wish you and your family good health and a productive year ahead. Dr Lim Tock Han Director, The Eye Institute National Healthcare Group 2 TEInsight JUL-SEP05 TEInsight Editorial Team Dr Wong Hon Tym (Chief Editor) Mr Christopher Koh (Secretariat) Dr Gangadhara Sundar Dr Christopher Khng Dr Ronald Chung Iris Tracking A World’s First for TEI: Iris tracking technology and the promise of even better LASIK outcomes T he TEI Refractive Surgery team launched the world’s first iris tracking technology that promises to bring the safety and precision of Laser Assisted In-Situ Keratomileusis (LASIK) to a new level. LASIK is currently the most common method of correcting myopia and astigmatism worldwide. During wavefront-guided LASIK, patients have their corneas mapped prior to the operation. However, lying down may cause their eyes to cyclotort (rotate), misaligning the mapping and thereby reducing the accuracy of the procedure. In some patients, the centre of the pupil may also shift, depending on whether it is dilated or miosed. Iris recognition and tracking can compensate for these misalignments. Dr Lee Hung Ming, head of TEI’s Refractive Surgery division, was the principal investigator of a landmark study which was the first in the world to utilise iris recognition and tracking technology to compensate for eye cyclotorsions and pupillary shifts that may occur during the laser treatment. This multi-dimensional and multi-directional tracker ensures that all the laser pulses are precisely applied on the cornea. The trial was carried out using 60 eyes of 30 patients and resulted in almost 90 per cent of them achieving 20/20 or better vision without glasses or contact lenses. A predictable improvement within 1 dioptre of the target refraction was also found in 97 per cent of all eyes. SPOTLIGHT ON TEI’s Refractive Surgery Team Many firsts mark TEI’s Refractive Surgery team: first in the world to perform LASIK with iris recognition technology, first in Asia to study the Optical Coherence Pachymetry (OCP) for real-time measurement of corneal thickness in LASIK, and first in Singapore to embrace Femtosecond Intralase, and to implant iris-fixated intra-ocular lenses as well as implantable contact lenses for high myopia. Aesthetic Eye Surgery A growing field in Ophthalmology T he eyes are the centre of attraction of the face. However, aging changes around the eyes can lead to a less appealing and haggard look, which may be amenable to correction by aesthetic eye surgery. TEI’s Oculoplastic Surgeons have garnered considerable collective experience in this emerging field and are increasingly being called upon by patients to manage changes in their eyebrows, eyelids and midface, restoring a youthful appearance and confidence. The four most common areas of concern are eye bags, sagging upper lids and eyebrows, droopy eyelids and wrinkles. Eye Bags can be due to any or all of the following causes: • Orbital fat prolapse can be improved with lower blepharoplasty using hidden sutureless conjunctival incisions. (Fig 1) Ptosis can be identified easily by torch light illumination of the cornea to observe the distance between the upper eyelid margin and the corneal light reflex (normal: 3-4mm). Ptosis surgery is achieved via an external approach through the blepharoplasty skin incision. (Fig 1), or via a posterior route (trans-conjunctivally) with no cutaneous incision. Wrinkles around the eyes The aging skin around the eye often manifests as pigment changes and wrinkles. A good skin care regime is recommended, and this can be augmented with chemical peels, Botox injections, dermal fillers and lasers, all office-based procedures. Aging changes around the eyes are disturbing problems that can be addressed by the Oculoplastic surgeon who is in a unique position, with the training and knowledge of the eye, to specifically manage these concerns. By Dr Yip Chee Chew All clinical photographs are the property of TEI @ TTSH Fig 1. Before and after bilateral ptosis correction, with upper & lower blepharoplasty • Fluid Festoons are areas of fluid accumulation along the lower eyelids that are managed with fluid-salt restriction and/or heat therapy (sponge thermoplasty). • Prominent orbicularis oculi muscles lead to bulging of the lower eyelids when smiling. It can be effectively relaxed with Botox injections (Fig 2). SPOTLIGHT ON TEI’s Oculoplastics Team The Ophthalmic Plastic & Reconstructive Surgery Service of The Eye Institute, located at all three centres of the National Healthcare Group, offers the full spectrum of treatment for disorders of the eyelid, lacrimal and orbits. The TEI Oculoplastics fellowship is emerging as one of the most sought after in the region, attracting surgeons from Myanmar, China, Indonesia, India and the Philippines. Fig 2. Prominent obicularis oculi muscles, before and after Botox injections Sagging upper eyelids (dermatochalasis) or eyebrows (eyebrow ptosis) may result in problems such as blocked vision and a tired, sleepy look. Dr Lee Hung Ming Senior Consultant, Head, Refractive Surgery Service Dr Fam Han Bor Senior Consultant, Head, Cataract, Implant & Anterior Segment Service Dr Heng Wee Jin Consultant, Head, Cornea Service and Training & Education Dr Voon Li Wern Consultant Dr Lee Sao Bing Associate Consultant Dr Lee has performed thousands of refractive procedures and continues to lead this field, involving himself in many research projects such as wavefrontguided ablation, iris-recognition, optical coherence pachymetry for LASIK and phakic IOLs. He has also been an invited speaker to numerous regional and international conferences on refractive and cataract surgery. Dr Fam completed his 15-month fellowship in Cornea & Refractive Surgery at the University of British Columbia, Vancouver, Canada. He is currently Head of Cataract & Implant Services at TTSH. Also a Senior Consultant in Refractive Surgery at TEI, Dr Fam is actively involved in the teaching of refractive and cataract surgery in the region, with a particular interest in corneal topography, visual optics and wavefront sciences. Dr Heng is a highly experienced cataract and refractive surgeon, and is involved in many research projects in this field. He has also been an instructor in LASIK and microsurgical courses, and trained international fellows in cornea and refractive surgery. He is co-author of the book “Colour Atlas & Synopsis of Clinical Ophthalmology Cornea”. With a fellowship at Oxford Eye Hospital under her belt, Dr Voon has been extensively trained in cornea, contact lenses and refractive surgery, encompassing LASIK, phakic IOLs, dry eyes and corneal transplants. Dr Voon is actively involved in training and education and has conducted numerous talks in the above topics. The winner of four Young Investigator Awards, Dr Lee had his fellowship training at Bascom Palmer Eye Institute in USA where he performed laboratory and clinical research in ocular surface reconstruction and stem cell biology of the eye. • Dermatochalasis results from lax upper eyelid skin and can be treated with upper blepharoplasty. • Eyebrow ptosis is often confused with dermatochalasis, which frequently co-exists. The normal eyebrow position should rest at the superior orbital rim for males and slightly above it for females. Mild degrees can be elevated with Botox injections to the brow depressors. Moderate to severe cases require endoscopic eyebrow lift from beneath the hairline. Fig 3. A patient with Crow’s feet wrinkles, improved dramatically with Botox injection. Dr Shantha Amrith Senior Consultant, Head of Oculoplastic Service Dr Yip Chee Chew Consultant Dr Gangadhara Sundar Consultant Obtained her FRCS from the Royal College of Surgeons, Edinburgh in 1979, followed by two Ophthalmic Plastic and Reconstructive Surgery fellowships in Sydney Eye Hospital, Australia and University of Cincinnati Hospitals, USA. Now Dr Shantha heads TEI’s Oculoplastic Service. She possesses a breadth of experience in managing lid, lacrimal and orbital pathologies for reconstructive as well as cosmetic surgery. Dr Yip underwent a two-year Ministry of Health scholarship at the University of Cincinnati and the University of California, Los Angeles. He publishes widely and is also a reviewer for the American Journal of Ophthalmology as well as a course instructor at the Americam Academy of Ophthalmology Annual Meeting. Dr Yip has a special interest in aesthetic surgery of the eyes. Dr Ganga underwent a dedicated 2 year fellowship in Ophthalmic Plastic & Reconstructive Surgery at Henry Ford Hospital in Detroit, USA. He is also active in furthering the cause of the specialty in the South and East Asian region. His special interests include pediatric oculoplastics, anophthalmic sockets and orbital reconstruction. Visiting Consultant Dr Liew Geok Cheng TEI @ TTSH 3 TEInsight JUL-SEP05 A Message from Our Director OCULOPLASTICS D R R U O A Y O B R O E F IC T T U O N O LL IC U C LI N P Reconstructive & Plastic Surgery for the Eye R econstructive and plastic surgery is a growing area in eye care. Specialists known as oculoplastic surgeons are skilled in treating certain eye deformities (which may be inborn or caused by injury). They also treat sightthreatening infections and even tumours of the surrounding tissues, such as the eyelids, bone and muscle. Parts of the Eye Treated by Oculoplastic Surgeons The Eyelids protect the eyeball and may be abnormally turned in (entropion) or out (ectropion). This results in irritation, tearing and infections. Strokes or weakness of certain nerves can lead to an inability to fully close the eyes (lagophthalmos), thus putting the cornea, also known as the windscreen of the eye, at great risk of infection. Eyelid surgery can correct this problem. Epiblepharon is a condition where the lower eyelashes turn towards the eye, occurring in children who have an extra-thick fold of skin and muscle on the lower eyelids. These children rub their eyes frequently because of the irritation. They often have wet, teary eyes as well. This can be surgically corrected by an oculoplastic surgeon. Droopy eyelids (Ptosis, Fig 1 & 2) could occur at birth or with age. In children, they may cause a Fig 1 & 2. Congenital ptosis – before (above) and after surgery child to develop lazy eyes (amblyopia), where the brain does not properly learn to interpret signals sent by the eyes. In adults, droopy eyelids could be due to aging, injury or rare nerve and muscle diseases. Surgery helps not only to correct this and improve the person’s sight, but generally improves the person’s appearance as well. Fig 3. Lacrimal abscess from chronic The Tear Drainage nasolacrimal duct obstruction System Excessive tearing can affect a patient’s quality of life, causing blurred vision due to pooling of tears. In some cases, blocked tear ducts near the nose can become Fig 4. Child with congenital severely infected (Fig 3). nasolacrimal duct obstruction Infants with tearing problems (Fig 4) should be seen early by an oculoplastic surgeon to ensure that this does not worsen. There are many methods to treat the blockage of the tear drainage system without surgery, but stubborn cases may require an operation. The Eye Socket (also called the orbit) is the bony cavity in the skull that protects the eyeball and other vital structures Fig 5. Orbital cellulitis from like nerves, blood vessels chronic sinusitis and muscle. Diseases of the orbit could be both sight- and life-threatening. Patients with orbital cellulitis, a severe infection that rapidly spreads within the orbit (Fig 5), if not properly Fig 6. Orbital fracture treated, may develop blindness, meningitis and even find their lives at risk. Orbital fractures (Fig 6) are common, especially in motorcycle accidents. If treated early, sight loss and facial deformity can be prevented. Tumours of the orbit may be removed safely through minimally-invasive approaches to visually and cosmetically rehabilitate patients. ...and Beyond Because of their expert knowledge of diseases of the eye and methods of protecting the underlying vital structures, oculoplastic surgeons also have a special advantage to offer reconstructive and cosmetic procedures of the face, including the forehead, the eyebrows, the upper and lower eyelids (including the creation of “double” eyelids), and the midface. The territory continues to expand everyday for this group of eye specialists. All clinical material and photographs are the property of TEI @ NUH TEInsight J U L - S E P 2 0 0 5 Public Education Material with compliments of PROFILE WHAT’S ON Express Artificial Eye Service at TEI IN UNDER 10 HOURS Dr Low has developed a technique in the fabrication of customised ocular prostheses, allowing a patient to receive an artificial eye replacement in under 10 hours within the same day. > > EYEQ This 10 year-old boy presented with double vision and vomiting after accidentally bumping his head and face forcefully against his friend while playing in school. His vision was 6/6 in each eye, with normal pupils, slit lamp and fundus examination for both eyes. The MRCS/MMed exam was held at TEI @ NUH in April, with examiners (front row, left to right): Dr Caroline Chee, A/Prof Paul Chew, Dr Alistair Adams, Dr Brian Fleck, Clin/Prof Ang Chong Lye, Dr Sharon Tow, Dr Shantha Amrith. Adjunct A/Prof Au Eong Kah Guan, TEI Deputy Director (Clinical Quality) and Head of Research attending the AMD Alliance International Scientific Advisory Board meeting in Florence, Italy in May 2005. Adjunct A/Prof Au Eong gives a talk "Eye on Vision Health" with NewsRadio FM 93.8. Conditions and treatment of cataracts and age-related macular degeneration were discussed. TEI Doctors in the Research Journals 1. Han-Bor Fam, E-Shawn Goh, Hung-Ming Lee, Kooi-Ling Lim Post-LASIK myopic shift after a trek in the North Pole Journal of Cataract & Refractive Surgery. 2005 Jan: 31: 198 - 201 2. Ronaldo R Jarin, Teoh SCB, Lim ATH “Resolution of Severe Macular Oedema in Adult Coat’s Syndrome Treated with High-dose Intravitreal Triamcinolone” Eye, Feb 11 2005. Epub ahead of print 3. Tan CSH, Au Eong KG. Surgical drainage of submacular haemorrhage from ruptured retinal arterial macroaneurysm. Acta Ophthalmologica Scandinavica Apr 2005; 83(2):240-241. What do the photographs demonstrate? 4. Yip CC, Gonzalez-Candial M, Jain A, Goldberg RA, McCann JD. "Lagophthalmos in enophthalmic eyes."British Journal of Ophthalmology. 2005 Jun;89(6):676-8. 7. Yip LW, Yong VK, Hoh ST, Wong HT. Optical coherence tomography of optic disc swelling in acute primary angle-closure glaucoma. Archives of Ophthalmology. 2005 Apr;123(4):567-9. 5. Teoh SCB, Thean LSY, Koay ESC “Cytomegalovirus in Aetiology of Posner-Schlossman Syndrome: Evidence from Quantitative Polymerase Chain Reaction” Eye, Oct 29 2004. Epub ahead of print. 8. Khng C. Pupil Dilatation Methods. Ophthalmology. May 2005; 112(5): 949-950 6. Teoh SCB, Lim JWK, Koh AHC, Lim ATH, Fu ERY Abnormalities on the Multifocal Electroretinogram may Precede Clinical Signs of Hydroxychloroquine Retinotoxicity Eye, Feb 25 2005. Epub ahead of print. 11. Wagle AA, Wagle AM, Eong KG. Pulmonary embolism following ocular surgery. Journal of Anesthesia. 2005;19(1):91. 12. Shabana N, Cornilleau-Peres V, Droulez J, Goh JCh, Lee GS, Chew PT. "Postural stability in primary open angle glaucoma." Clinical Experiment Ophthalmology. 2005 Jun;33(3):264-73. Upcoming Events What are the appropriate steps to take in the initial management? Date A CT Scan was subsequently ordered - what does it show? For GPs 30 Jul Venue Contact Tan Tock Seng Hospital Theatrette Ms Lalitha K / Ms Annie Liew T: 6357 7648 / 7726, F: 6357 7718 [email protected] For Optometrists 9:00am - 11:00am Continuing Optometric Education 14 Sept 9:00am - 11:00am Continuing Optometric Education 16 Nov Alexandra Hospital, Seminar Room Alexandra Hospital, Seminar Room Ms Alice How T: 6379 3741, F: 6379 3540 [email protected] For Ophthalmologists 23 Jul 8:30am - 5:30pm National University Hospital Ms Jennifer Dodd T: 6772 5391, F: 6777 7161 [email protected] Time Title 12:30pm - 4:30pm GP Symposium: Eye Needs – Everything You Ever Need for the Family Physician What is the recommended treatment? Quiz master: Dr Gangadhara Sundar 3. A fractured left orbital floor (blow-out fracture) with herniation of orbital contents into the maxillary sinus. Air is also seen in the orbit. 2. Initial management a. Consider admitting under Neurosurgery for observation (vomiting after head injury) b. Arrange for urgent CT of orbits and brain (axial and coronal if possible) c. Prescribe a short course of steroids and antibiotic drops 1. A sunken left eye (enophthalmos) and limitation of upgaze in the same eye – signs of typical ‘white-eyed’ blowout in children. ANSWERS 4. Urgent referral to an ophthalmologist for fracture repair to prevent permanent ocular mobility disorder. The child should also be advised not to blow his nose, otherwise orbital emphysema may occur. 6 TEInsight JUL-SEP05 Dr Inez Wong, TEI Registrar at the 31st Annual Meeting of American Association for Pediatric Ophthalmology and Strabismus, Orlando, Florida, USA in March 2005 with her poster, "Surgical Treatment of Myopic Strasbismus Fixus". An ocular prosthesis being fitted (below). YOU MAKE THE DIAGNOSIS! 1 2 3 4 Dr Michael Ramirez Munoz, TEI Oculoplastics Fellow at the Asia Pacific Academy of Ophthalmology Congress in Kuala Lumpur, Malaysia in March 2005 with his poster, "Levator Muscle Biopsy: Is it necessary?’ > TEST YOUR QUIZ Dr Christopher Khng (right), TEI Consultant, received a Best Paper of the Session Award for his presentation "Predicting Capsular Size from Limbus Dimensions" in Washington DC, USA, May 2005. With him is Dr John Polansky, a surgeon and good friend from Oregon. Glaucoma Symposium Combined Scientific Meeting 2005 On 4 - 6 November at the Raffles City Convention Centre, the first Combined Scientific Meeting 2005 of Singapore Health Service (SingHealth), the National Healthcare Group (NHG) and the National University of Singapore (NUS) will bring together Singapore's leading medical institutions on a shared platform to showcase the best in our medical research and teaching. We invite you to be part of this exciting inaugural event. See you at CSM05!www.csmsingapore.com 7 TEInsight JUL-SEP05 F or the unfortunate few of our patients who have experienced the loss of an eye, the psychological distress can linger long after, with lifelong social and functional problems, not to mention the impact on their families. Dr Low Huey Moon is responding to the tragic plight of this group with her distinctive skill. She has developed a technique in the fabrication of customised ocular prostheses, allowing a patient to receive an artificial eye replacement in under 10 hours. This speedy response is of particular benefit to patients from overseas, saving them both time, travel and lodging costs. Dr Low is a Senior Consultant at TEI @ Alexandra Hospital and National University Hospital. She is also a Visiting Consultant at the Singapore National Eye Centre. Dr Low is a highly respected authority in maxillo-facial prothodontics, and has over 15 years of working experience with eye patients. She has been actively involved in the field following her fellowship at the MD Anderson Cancer Center, University of Texas in USA. By collaborating with TEI eye surgeons, Dr Low has been providing artificial eye services for infants and adults who have eye socket complexities. She provides them with ocular prostheses that are customised for maximum comfort and mobility, with a natural appearance. The pictures here are testimony to the dramatically positive effect that this service can have on our patients’ lives. TEI Doctors in the Limelight INTRODUCING The Eye Institute TEI brings together the Ophthalmology Departments from three National Healthcare Group hospitals (from left): Alexandra Hospital, National University Hospital and Tan Tock Seng Hospital. To serve our patients better and meet the rising demand for quality eye services, The Eye Institute was established to oversee the provision of eye care throughout the National Healthcare Group. All existing eye units and services from Alexandra Hospital, National University Hospital and Tan Tock Seng Hospital have merged horizontally across the cluster, and are vertically integrated with primary and community units under one umbrella. As a result, patients can now travel to the hospital nearest their homes for any eye services. The Eye Institute allows for medical cross-accreditation between departments, continuing medical education, training, quality benchmarking and research. Harnessing the experience and expertise of 34 trained ophthalmologists, ably supported by our team of optometrists, technicians and nurses, TEI is more than capable of handling the entire spectrum of eye diseases. A: Alexandra Hospital N: National University Hospital T: Tan Tock Seng Hospital Our Doctors by Subspecialty Cataract, Implant & Anterior Segment Service Dr Fam Han Bor (Head) N,T Dr Christopher Khng Yen Wei T All other TEI Consultants & Associate Consultants Refractive Surgery Service Dr Lee Hung Ming (Head) N,T Dr Fam Han Bor N,T Dr Heng Wee Jin N,T Dr Lee Sao Bing N Dr Voon Li Wern T Cornea Service Dr Heng Wee Jin (Head) N,T Dr Fam Han Bor N,T Dr Lee Hung Ming N,T Dr Lee Sao Bing N Dr James Pan T Dr Voon Li Wern T Dr Wang Jenn Chyuan N Glaucoma Service Assoc. Prof Paul Chew Tec Kuan (Head) N Dr Lim Boon Ang T Dr Loon Seng Chee N Dr Jovina See Li Shuen N Dr Lennard Thean N Dr Wong Hon Tym T Dr Leonard Yip Wei Leon T Dr Vernon Yong Khet Yau T Oculoplastics Service Dr Shantha Amrith (Head) N,T Dr Gangadhara Sundar N Dr Yip Chee Chew A,T Paediatric Ophthalmology & Adult Strabismus Service Dr Khoo Boo Kian (Head) T Dr Leo Seo Wei T Dr Gangadhara Sundar N Uveitis Service Dr Lennard Thean N Neuro-Ophthalmology Service Dr Goh Kong Yong (Head) T Dr Lim Su Ann T Dr Clement Tan Woon Teck N Surgical and Medical Retina Service Dr Billy Tan Ban Hock (Head, Surgical Retina) T Dr Chee Ka Lin, Caroline (Head, Medical Retina) N Adjunct Assoc Prof Au Eong Kah Guan A,T Dr Lee Jong Jian T Dr Lim Tock Han T Dr Nikolle Tan Wan Hui T Dr Zaw Minn-Din N,T Our Clinics 8 TEInsight JUL-SEP05 Alexandra Hospital Ophthalmology and Visual Sciences GP Hotline: 9369 3912 OVS Line: 6379 3500 OVS Fax: 6379 6292 National University Hospital Eye Clinic GP Hotline: 6772 2000 Clinic Line: 6772 5408 Clinic Fax: 6772 5508 Tan Tock Seng Hospital Eye Centre GP Hotline: 6357 8383 Centre Line: 6357 8000 Centre Fax: 6357 8675 General Enquiries by E-mail: [email protected] In our quest to constantly improve ourselves, we would appreciate your frank feedback on any part of this newsletter, be it on the format or content. Please email your comments to [email protected] or mail to Ms Izyani Ayik, The Eye Institute, National Healthcare Group, 6 Commonwealth Lane, Level 6, GMTI Building, Singapore 149547. Please indicate if you would grant us the permission to publish your letter. If you would like to receive our upcoming quarterly e-newsletter, please send an e-mail with your name to [email protected] with the subject heading ‘TEInsight Subscribe’.