Singapore National Eye Centre (SNEC) was incorporated on 3 March 1989and commenced operations in October the following year. The Centre has achievedremarkable growth in the short span of time. From the original team of nine staff,to the present force of more than 350 medical, paramedical and administrativestaff; from the retrofitted surgical A & B blocks in the Singapore General Hospital(SGH) campus to the completion of its Phase 2 wing, SNEC has expanded into aS$50 million ultra modern facility. The 8-storey complex features a full array ofsubspecialty clinics, well integrated diagnostic, imaging and laser systems,state-of-the-art operating theatres, day recovery suites, sophisticated training andeducational facilities as well as two floors of dedicated space to support bothclinical and laboratory research.

As the designated national eye centre within the public healthcare network,SNEC provides specialist eye care to 70 percent of patients in the public sector.It now attends to 250,000 outpatient visits and performs 12,000 major eye surgeriesand 11,000 laser procedures annually. The high quality and volume of SNEC’sservices place the institution as a leading eye centre in the Asia-Pacific regionand beyond.

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F A C I L I T I E S

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The elegant and distinctive design with the clean-lined metal-and-glass façade is abold expression of the Singapore National Eye Centre (SNEC) reflecting the Centre’sstate-of-the-art technologies.

With the recent completion of the new 8-storey extension which more than doubledthe Centre’s operating capacity, the entire SNEC complex now occupies a totalgross floor area of 21,100 sq m (227,000 sq ft). The newly glazed extensionfeatures a central atrium, the design focus. It is a naturally lit space that improvesthe aesthetic quality of the interior and facilitates circulation.

Two entire floors in the expanded facility are assigned for specialist outpatientclinics to serve the nine subspecialties of Cataract & Comprehensive Ophthalmology,Cornea & External Eye Disease, Glaucoma, Neuro-Ophthalmology,

Ocular Inflammation & Immunology, Oculoplastic/Aesthetic Eyeplastic, PaediatricOphthalmology & Strabismus, Refractive Surgery and Vitreo-Retina.

The clinics are well supported by integrated diagnostic and imaging facilitiesfeaturing the latest ultrasound equipment, digital ImageNet for FFA, computerizedvisual field and nerve fibre analysers, confocal scanning laser ophthalmoscopeand other specialised equipment.

Nine operating theatres and the day recovery ward are located on the Centre’ssecond floor with an observation room for viewing of live surgery transmitteddirectly to the overhead panel of plasma monitors. Audio-visual links enable furthertransmission to a separate audience in the 150-seat auditorium. There are additionaltraining rooms for conducting wet-labs and teaching courses, a resource libraryand a staff lounge that overlooks the open roof garden creating a green andrestful ambience for staff to relax in and socialise.

The Singapore Eye Research Institute is housed within the SNEC complex occupying twofloors with dedicated space for research clinics and basic research laboratories.The unique design for the close proximity of research facilities in the heart of highvolume clinical activities has enhanced both research opportunities and synergies.

1. Advanced Optical Coherent Tomography system capturingcross-sections of the retina

2. Digitised ImageNet System with full colour fundal photography andICG/FFA capabilities

3. Reception area at the specialist outpatient clinics

4. Live Surgery Viewing Room featuring simultaneous transmission ofsurgery from four operating theatres. All major operations in theSNEC are videotaped for quality assurance and teaching

5. SNEC operating theatres manage 12,000 major eye operations annually

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C L I N I C A L S E R V I C E

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Quality is the most important tenet of SNEC’s promise to its patients. In SNEC,the highest standard of service is achieved through strict quality assurance andclinical audit.

This institution is one of the few in the world that videotapes and recordsevery major operation for quality assurance as well as for teaching purposes.The surgical skills of every eye surgeon at the SNEC are regularly evaluated.A dedicated Clinical Audit Department reviews outcomes of all major operationsdone in the Centre and maintains a comprehensive database. For instance, thesuccess rate of each and every of the 68,355 cases of cataract operations performed

CATARACT AND COMPREHENSIVEOPHTHALMOLOGY SERVICE

Head and Senior ConsultantDr Peter Tseng

Senior ConsultantsClin Assoc Prof Ang Chong Lye

Dr Chan Wing KwongAssoc Prof Chee Soon Phaik

Dr Chia Swee CheongDr Choo Chai TeckDr Goh Kong Yong

Dr Aliza JapDr Yvonne LingDr Francis Oen

Dr Ong Sze GuanDr Seah Lay Leng

Dr Steve SeahAssoc Prof Donald Tan

Dr Doric WongDr Yeo Kim TeckDr Ronald Yeoh

ConsultantsDr Sharifah Zainah Alsagoff

Dr Aung TinDr Chan Tat Keong

Dr Sonal FarzavandiDr Fong Kee Siew

Dr Jon GohDr Ho Ching Lin

Dr Adrian KohDr Lim Li

Dr Ng Sok HoonDr Quah Boon Long

Dr Julian ThengDr Ti Seng Ei

Dr Sharon TowDr Wee Tze Lin

Dr Edmund WongDr Wong Tien Yin

Associate ConsultantsDr Leonard Ang

Dr Bobby ChengDr Audrey Chia

Dr Chuah Chin TekDr Hoh Sek TienDr Lee Shu Yen

Dr Lim Wee KiakDr Audrey Looi

Dr Ranjana MathurDr Ian Yeo

1. Patient undergoing clinical examination at the slit lamp

2. SNEC performs 8,000 cataract operations with intraocular lensimplantation each year

3. Day Ward nursing staff providing post-op care to patient

4. Nurse attending to patient in the outpatient specialist clinic with careand professionalism

in the last 10 years is maintained in the Centre’s database. Such meticulous andstrict quality assurance allows SNEC to maintain high surgical standards and achievesuperior outcomes year after year.

Over the years, SNEC has built a team of highly specialised and experienced eyesurgeons to provide secondary, tertiary and quaternary care in nine distinctsubspecialty services.

CATARACT AND COMPREHENSIVE OPHTHALMOLOGY SERVICE

The Service provides diagnosis and management of simple and complex cataractsand general ophthalmic problems. Cataract surgery remains the most commonlyperformed major surgery in the SNEC.

Phacoemulsification, no stitch small incision techniques, topical anaesthesia, foldableintraocular lens implantation, the use of multifocal lenses and refractive cataractsurgery are some of the developments that have made cataract surgery a verysatisfying operation to both the patient and the surgeon.

The SNEC attends to 8,000 cataract surgeries annually. With its strict qualityassurance programme, patients are assured of excellent results comparable toother world-class eye institutions.

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CORNEAL AND EXTERNAL EYE DISEASE SERVICE

The Service delivers medical and surgical treatment to a wide variety of corneal,external eye disease and anterior segment eye disorders. The Service is managedby a team of corneal subspecialist ophthalmologists providing tertiary referralconsultation on cases such as corneal trauma and infections, inherited cornealdisorders, ocular surface disorders. The Service has introduced the breakthroughtechnique in the use of a patient’s own conjunctival stem cells to treat chemicalburns to the eye, acute corneal infections as well as in pterygium surgery to correcta common conjunctival disorder with significantly better results.

The Corneal Transplantation Programme under the Corneal Service collaboratesclosely with the Singapore Eye Bank which is instrumental in securing a largenumber of high quality donor corneas. Each year, over 150 transplants areperformed in the programme with an overall transplant survival rate exceeding90%. Other new technologies introduced include human amniotic membranetransplantation and the development of the artificial cornea.

The Service also provides specialised contact lens fitting for keratoconus, paediatricand adult aphakia, corneal perforations and ocular surface disease.

GLAUCOMA SERVICE

Glaucoma is rapidly becoming the second major cause of mass blindness in Asiaand accounts for about 20 percent of blindness in Singapore. The Service providessecondary and tertiary care to glaucoma patients both locally and regionally. Thespectrum of cases ranges from opinions on early detection of glaucoma tocomplicated and refractory glaucoma cases. The Service attends to about 17,000clinical visits annually.

The Glaucoma Service is well equipped with the latest technologies includingVisual Field Analysers, Frequency Doubling Perimeter, Stereodisc Camera, theGDx Nerve Fibre Analyser, anterior segment Ultrasound Biomicroscope, ConfocalScanning Laser Ophthalmoscope, Optical Coherent Tomograph and HeidelbergRetinal Tomograph (HRT II) for effective evaluation of various glaucoma conditionsand implementation of appropriate treatment strategies for the patients.

The Service offers wide ranging therapeutic and surgical treatment from topicalanti-glaucoma medications, laser treatment for angle closure glaucomas, to surgicaloptions including antimetabolite augmented filtration surgery, combinedphacoemulsification and trabeculectomy and Seton implants for complicated andrefractory glaucomas. The service performs in excess of 750 of such glaucomaprocedures annually and is also actively involved in various research projectsincluding multi-centre trials and large-scale epidemiological studies.

CORNEAL ANDEXTERNAL EYE DISEASE SERVICE

Head and Senior ConsultantAssoc Prof Donald Tan

Senior ConsultantsDr Chan Wing KwongDr Peter Tseng

ConsultantsDr Chan Tat KeongDr Lim LiDr Julian ThengDr Ti Seng EiDr Wee Tze Lin

Associate ConsultantDr Leonard Ang

GLAUCOMA SERVICE

Head and Senior ConsultantDr Steve Seah

Senior ConsultantsDr Aliza JapDr Francis Oen

ConsultantsDr Aung TinDr Ho Ching Lin

Associate ConsultantDr Hoh Sek Tien

5. Corneal transplant patients enjoy an overall transplant success rate exceeding 90%

6. Scleral lenses are fitted for patients with special medical conditions

7. The Heidelberg Retina Tomograph (HRT II) offers sophisticated assessment of the optic disc and retinal nervefibre layer, important to the detection and management of glaucoma

8. MRI scan (saggital cut) showing a suprasellar cystic mass – craniopharyngioma

9. Acute Retinal Necrosis

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NEURO-OPHTHALMOLOGY SERVICE

This specialised service provides evaluation and treatment of patients with ophthalmiccomplaints related to neurologic disorders. These include disorders of the visualpathway, for example the optic nerve, conditions involving the extraocular muscles,cranial nerves and the orbit.

Patients with such disorders typically have complaints of blurring of vision or doublevision. They may also have neurological disorders associated with brain tumours,strokes and pupil abnormalities. The neuro-ophthalmic consultation consists of an in-depth clinical examination followed by the appropriate investigations which includecomputerised visual field testing or the Goldman Perimetry as well as access toneurophysiologic investigations.

These specialists at SNEC work closely with the neurology, neurosurgery andneuroradiology specialists to provide effective and coordinated treatment forpatients.

OCULAR INFLAMMATION AND IMMUNOLOGY SERVICE

The Service provides investigations, diagnosis and management of a wide rangeof uveitic and ocular immunological disorders ranging from ocular surface problemslike Mooren’s ulcer, episcleritis/scleritis etc to posterior segment inflammations.

These ocular inflammatory conditions are estimated to account for 5-15% ofblindness. Common ocular inflammations seen include HLA-B27 related anterioruveitis, Fuch’s Heterochromic iridocyclitis, Posner Schlossman Syndrome,Intermediate uveitis, Behcet’s disease, Vogt-Koyanagi-Harada Syndrome, ocularinfections such as acute and chronic endophthalmitis, toxoplasmosis chorioretinitisand Tuberculosis uveitis, and rarely, ocular malignancies such as ocular lymphoma.

The Service is a tertiary service that receives referral from local and regionalophthalmologists and provides advanced diagnostic and therapeutic options whichinclude polymerase chain reaction (PCR) for microbes, HLA phenotyping,radiological and angiographic investigations, and a wide range of biochemistryand immunology serology. Therapeutic options range from topical steroids, NSAIDS,periocular injections, systemic steroids and immunosuppressants/modulators, tothe more advanced intraocular drug delivery systems like Surodex.

Major research projects undertaken include HLA-B27 related anterior uveitis, Intermediate,posterior and pan-uveitis therapy with systemic immunosuppressants, Uveitis epidemiologyand multi-centre trials on new intraocular drug delivery systems.

NEURO-OPHTHALMOLOGY SERVICE

Ag Head and Visiting Senior ConsultantDr James F Cullen

Senior ConsultantDr Goh Kong Yong

ConsultantDr Sharon Tow

OCULAR INFLAMMATIONAND IMMUNOLOGY SERVICE

Head and Senior ConsultantAssoc Prof Chee Soon Phaik

Associate ConsultantDr Lim Wee Kiak

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OCULOPLASTIC / AESTHETIC EYEPLASTIC SERVICE

The Oculoplastic Service is a specialised area of ophthalmology dealing withplastic and reconstructive surgery of the periorbital and facial tissues which includethe eyelids, orbit and lacrimal system.

The scope of service includes management of abnormal eyelid position (entropion,ptosis), removal of eyelid tumors, lid reconstruction, lacrimal surgery, orbitaldecompression for thyroid eye disease, orbitotomy, repair of orbital fractures aswell as rehabilitation of an ophthalmic socket. An average of 750 oculoplasticoperations are performed a year.

Aesthetic Eyeplastic

Many advances and revolutionary techniques in Aesthetic Eyeplastic Surgery haveevolved in the last decade. Aesthetic ophthalmic plastic surgeons deal with periorbitaland the whole face surgically because of the principle in anatomical lid/face continuum.

Common procedures available in the service are: Blepharoplasty (double eyelidsurgery) to improve appearance and some times visual function. Eyebrowliftprocedure corrects the unstable/sagging eyebrow which can affect visual functionand a person’s facial expression. Traditional coronal incision has been taken overby the current mini incision endoscopic approach which is the second most commonprocedure done by the service. Midface Lift is performed to correct agingappearance and sometimes lower lid decent using transconjunctival or endoscopicapproach. Other available periorbital rejuvenation procedures are CO2 resurfacingand Botox injections.

PAEDIATRIC OPHTHALMOLOGY AND STRABISMUS SERVICE

Strabismus, or squints, occurs in both children and adults, and can be managedby spectacles, or in more severe cases, surgery.

This Service also treats a wide range of eye disorders in children, such as lazyeye, congenital cataracts, glaucoma, and malformations of the eye. In addition,SNEC eye specialists also manage the paediatric eye department of KK Women’sand Children’s Hospital and attend to the largest portion of paediatric patients inSingapore. Our eye specialists also regularly perform eye screening for prematurelyborn babies at the neonatal departments of major hospitals.

The Service collaborates with the Singapore Eye Research Institute on variousclinical trials for treating myopia in children such as the use of atropine eye drops,multifocal spectacles and other new modalities.

PAEDIATRIC OPHTHALMOLOGYAND STRABISMUS SERVICE

Head and Senior ConsultantDr Yvonne Ling

ConsultantsDr Sonal FarzavandiDr Quah Boon Long

Associate ConsultantDr Audrey Chia

OCULOPLASTIC / AESTHETIC EYEPLASTICSERVICE

Head and Senior Consultant(Oculoplastic)Dr Seah Lay Leng

Head and Senior Consultant(Aesthetic Eyeplastic)Dr Choo Chai Teck

Senior ConsultantAssoc Prof Chee Soon Phaik

ConsultantDr Fong Kee Siew

Associate ConsultantsDr Chuah Chin TekDr Audrey Looi

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It also spearheaded the wavefront guided LASIK for customised ablations as wellas phakic intraocular lenses for the correction of extremely high myopia. The SNECRefractive Surgery Centre continues to be the regional reference centre for clinicalevaluations and trials involving the latest advances in LASIK technology.

The Centre is the only facility in Singapore and in the neighbouring region to beequipped with two top-of-the-line LASIK systems. It is the centre of choice for LASIKprocedures, performing 3,000 laser refractive surgery procedures annually.

The SNEC refractive surgeons have given top priority to their initiative in theeducation of ophthalmologists, doctors and the public in refractive surgery inSingapore. They have run training courses in LASIK and PRK for all ophthalmologistsin Singapore and the surrounding region and trained several other LASIK surgeonsin Singapore as well as surgeons in Malaysia, Indonesia, Thailand, Philippines,India, Hong Kong, Taiwan, Korea, Japan and China. Regular educational forumshave also been conducted for family and general practitioners as well as thepublic.

REFRACTIVE SURGERY SERVICE

SNEC performed the first excimer laser refractive surgery in Singapore and SouthEast Asia in January 1992. By 2000, the total number of laser refractive surgeryprocedures performed in SNEC stood at more than 10,000 of which half wereLASIK (laser in-situ keratomileusis) procedures and half were PRK (photorefractivekeratectomy) placing SNEC as one of the established high volume refractivesurgery centres in the Asia-Pacific region.

The Service has achieved excellent growth and constantly upgrades its capabilitiesto treat broad ranges of myopia (short-sightedness), hyperopia (long-sightedness)and astigmatism utilising the latest laser refractive surgery technologies.

Besides excimer laser PRK and LASIK procedures, the Service conducted the firstclinical trial in Asia using the intrastromal corneal rings (Intacs®) for the correctionof myopia in 1998 – 1999.

REFRACTIVE SURGERY SERVICE

Head and Senior ConsultantDr Chan Wing Kwong

Senior ConsultantsAssoc Prof Donald Tan

Dr Peter Tseng

ConsultantsDr Sharifah Zainah Alsagoff

Dr Chan Tat KeongDr Jon Goh

Dr Lim LiDr Julian Theng

Dr Ti Seng EiDr Wee Tze Lin

10. Oculoplastic surgery in progress using the latest mini incision endoscopic technique

11. SNEC Paediatric Ophthalmology Service treats a wide range of eye disorders in children

12. Orbscan for computerised mapping of the cornea

13. The Refractive Surgery Service performs 3,000 laser refractive surgery procedures annually with excellent results

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VITREO-RETINAL SERVICE

The Vitreo-Retinal Service provides diagnosis and treatment of diseases of theretina, vitreous and choroid.

Commonly encountered conditions include retinal detachment, diabetic retinopathy,age-related macular degeneration, retinal problems related to myopia, retinalvascular occlusion, ocular trauma, ocular infections, retinitis pigmentosa and otherheredofamilial retinal conditions.

Surgical Retina

Over 500 vitreo-retinal surgeries are performed annually in the Centre.Among them, retinal detachment is the most commonly encountered sight-threateningcondition requiring surgery.

The Service has the capabilities to treat retinal detachment, using various treatmenttechniques, including the traditional scleral buckle to pneumatic retinopexy andprimary vitrectomy. The Service also manages complex retinal conditions includingproliferative vitreoretinopathy (PVR) management, giant retinal tears, etc. Oursurgical armamentarium includes intraoperative laser, microsurgical wide-fieldviewing capabilities, the use of various intraocular tamponade agents, includinglong-acting gases like perfluoropropane and silicone oil and the use of “heavy liquids”.

Other surgical vitreo-retinal capabilities include macular surgery, peeling ofepiretinal membranes and macular hole surgery.

In ocular trauma, the subspecialty manages complex posterior segment trauma,including intraocular foreign body management, and the treatment of penetratingand perforating eye injuries with the use of temporary keratoprosthesis for complexanterior and posterior segment injuries.

Complex glaucoma problems, including the placement of Seton implants into thevitreous cavity via the pars plana are co-managed with the glaucoma faculty.

VITREO-RETINAL SERVICE

Head and Senior ConsultantClin Assoc Prof Ang Chong Lye

Senior ConsultantsDr Ong Sze GuanDr Doric WongDr Yeo Kim TeckDr Ronald Yeoh

ConsultantsDr Adrian KohDr Edmund WongDr Wong Tien Yin

Associate ConsultantsDr Bobby ChengDr Lee Shu YenDr Ranjana MathurDr Ian Yeo

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Medical Retina

The SNEC Diabetic Retinopathy Service consists of teams of eye surgeons led byretinal specialists dedicated to the care of patients with diabetic retinopathy. They areinvolved in the assessment, health education and management of these patients. TheCentre is also involved in a collaborative effort with primary healthcare polyclinics indiabetic retinopathy screening using fundal photography.

Laser photocoagulation is the main mode of treatment for diabetic retinopathy.In certain situations, vitreous surgery may also be required. Other retinal diseasessuch as retinal vascular occlusions, including central retinal and branch retinal veinocclusions are also encountered.

The Service also treats patients with macular diseases including age-related maculardegeneration, choroidal neovascularisation and central serous retinopathy. Some ofthese conditions may be amenable to laser photocoagulation treatment. The Serviceparticipated in a leading trial and now provides photodynamic therapy for subfovealchoroidal neovascularisation using Verteporfin. Electrodiagnostic tests and geneticcounselling are available to patients suffering from inherited retinal conditionssuch as retinitis pigmentosa and Stargardt’s disease.

The Service is supported by a fully equipped imaging department, able to performthe array of fundal photography, fluorescein and indocyanine green angiographyusing advanced digital imaging systems.

Analysis for gene mutations responsible for certain inherited retinal conditions isperformed by the research laboratories in Singapore Eye Research Institute (SERI).The Low Vision Clinic in the Centre offers visual counselling and rehabilitation.Through collaboration with the Singapore Association for the Visually Handicapped(SAVH), the low vision optometrist is able to tailor management plan for individualpatients with low vision, and assists patients in activities of daily living, job placementand psychological counselling.

The Service is actively involved in training and education. It is responsible forundergraduate, residency and advanced training in the management of diseasesof the vitreous and retina. Local and foreign retinal fellowship positions are offeredon a regular basis.

Major research projects include myopia, diabetic retinopathy, photodynamictherapy, polypoidal choroidal vasculopathy and retinitis pigmentosa.

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14. Patient undergoing retinal examination

15. Fundal photography showing haemorrhages due to diabetic eye disease which will require laser treatment

16. Optical Coherent Tomograph (OCT) photograph of the retina

17. Vitreous surgery in progress

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