Your Life. Live it well.

MC

I (P)

073

/02/

2014

THURSDAY / OCTOBER 30 2014

5

14

17

RECOVERY AFTER CANCER

APPLE OF YOUR EYE

How herbs can boost your immunity

Satisfy your sweet tooth with this apple rice pudding

A new laser eye procedure, Relex Smile, is in town. How does it match up

to Lasik?

PAGES 10-12

SMILE,YOU’VE GOT

PERFECTEYESIGHT

EXERCISE IS NO CHOREFun and trendy fitness routines to try out

10 THE STRAITS TIMES OCTOBER 30 2014

Fans on regaining perfect vision

Fitness coach Fay Hokulani, 27, wore contact lensesfor more than a decade, sometimes up to 15 hours ata stretch.

From time to time, irritants such as dust would getinto her eyes when she conducted training sessionsoutdoors. She had to either excuse herself to remove

and wash her lenses or bear with the discomfort until the endof the session.

Despite the hassle, she simply could not do without them.Her refractive error was a high -7.25 dioptres (commonly knownas 725 degrees) and -5.50 dioptres in her right and left eyerespectively.

Besides myopia, she also had mild astigmatism of-1.00 dioptres, which occurs when the shape of the eye’scurvature is irregular.

Spectacles were not useful for her job, she said, as theywould slip down her nose when she perspired. Last month, sheunderwent a relatively new procedure known as Relex Smile,which stands for refractive lenticule extraction, small incisionlenticule extraction, to be free of visual aids for good.

In this technique, a small piece of corneal tissue is cut withlaser and removed through a tiny incision.

It is a variation of refractive lenticule extraction, which hasthe European Union’s CE Mark, but has yet to be approved bythe United States Food and Drug Administration.

QUEST FOR PERFECT VISIONMs Hokulani is one of close to 50 patients at the SingaporeMedical Group’s (SMG) The Lasik Surgery Clinic to haveundergone the procedure in the last three months.

A day after thesurgery, she wasable to read thesecond last line onthe eye chart, whichhad the secondsmallest font for itstext. A week and amonth later, shecould read the lastline, a testament toher new-foundperfect vision.

The SingaporeNational Eye Centre(SNEC) is the onlyother medicalinstitution here thatoffers Relex Smile toits patients. It hasdone so sinceFebruary 2012.

Assistant Professor Mohamad Rosman, head of its refractivesurgery service and Laser Vision Centre at SNEC, said about5 per cent of the 2,000 to 3,000 refractive eye proceduresdone at SNEC yearly is the Smile procedure.

Most patients still opt for Laser-assisted in-situkeratomileusis (Lasik) as it has a longer track record and ischeaper, he said.

At SNEC, one can expect to pay at least $4,682 for theSmile procedure, compared with $2,996 for bladeless Lasik.

People who are suitable for Lasik would likely be able toundergo Smile as well, say doctors.

However, unlike Lasik, Smile cannot treat myopia of morethan -10.00 dioptres and hyperopia (long-sightedness).

Ms Hokulani said she was not keen on Lasik because herelder sister suffered post-operative discomfort from dry eyes

when she had the surgery six years ago. This is a commonproblem patients experience after undergoing the procedure.

A critical step of the Lasik procedure is the creation of a thinflap on the top layer of the cornea – the transparent portion ofthe eye which lets light through.

This flap of about 20mm in diameter is created with eitherthe mechanical microkeratome (a blade) or the femtosecondlaser.

Once the flap is lifted, another machine known as theexcimer laser vaporises the corneal tissue underneath toreshape the cornea and correct the vision.

Smile, on the other hand, uses only one laser for the entireprocedure and requires no flap, which is believed to weaken thecornea’s biomechanical strength.

Instead, the femtosecond laser is used to cut a small piece

of corneal tissue, called a lenticule, as well as make anincision of no more than 4mm in the cornea through which thelenticule is removed (see graphic).

THE GOOD AND THE BADA smaller cut means fewer corneal nerves are damaged duringthe treatment and, subsequently, dry eyes would be less of aproblem after the surgery, said Dr Eugene Tay, a consultantophthalmologist at SMG’s The Lasik Surgery Clinic.

The absence of a flap also reduces the risk of opticalaberrations (distortions), which can cause significant nightvision problems such as glare, haze and haloes, he explained.

The patient does not risk having the flap displaced ordislodged too.

This is especially useful for people whose occupations put

them at high risk of eye trauma, such as policemen or soldiers,said Prof Rosman. The same goes for people who play contactsports.

At SNEC, doctors first learn to remove the lenticule through aflap similar to that created in Lasik. They then learn to do thesame thing through a small area of the flap, but without liftingthe flap completely. This pseudo Smile procedure, as the eyecentre calls it, provides the doctor an option to revert to aneasier method if he needs to.

Early studies show promise. Last month, results of all threesurgical techniques (femtosecond lenticule extraction, Smileand pseudo Smile) published in the Journal Of Cataract AndRefractive Surgery showed that patients’ vision were stillholding up well 12 months later.

Another study in the same journal reported that people whohad their vision corrected with the refractive lenticule extractiontechnique had better eyesight years later, compared to thosewho had Lasik. Their vision regressed by only 0.07 dioptresafter five years. But the Lasik group’s eyesight worsened by0.63 to 0.97 dioptres six to seven years later.

Yet, doctors cannot repeat a Smile procedure on the sameperson to make any adjustments, or perform Lasik on eyes thathad undergone Smile to make further corrections. Thetechnology does not allow doctors to do so, said Dr Tay.

Advanced surface ablation would therefore be the onlyrecourse if one is not satisfied with his vision after the Smileprocedure. This involves removing the superficial surface of thecornea, followed by laser treatment.

LASIK AS GOLD STANDARDDr Jerry Tan, who performed the first Lasik surgery inSouth-east Asia in 1996, recognises the potential of the Smileprocedure. But he thinks the new technology has a long way togo before it can rival Lasik, which took 25 years to reach itscurrent stage.

Dr Tan, who has studied the Smile technique, believes thatLasik is still the gold standard in refractive eye surgery. Tens ofthousands of people have undergone it since it was introducedhere in 1996.

A drawback of Smile, he said, is that the laser cannotcompensate for the rotation of the eye when the person is lyingflat on his back, as a suction force is applied to hold theeyeball in place.

If the laser deviates more than 0.2mm from the initialcorrection – which is done with the patient seated down – orthe eyeball rotates more than 2 degrees, there can beinaccuracies in vision correction.

Jerry Tan Eye Surgery at Camden Medical Centre has lasereye trackers which monitor eyeball movements in sevendirections and compensate for microscopic eye movementsduring surgery.

Today’s technology has also allowed Lasik flaps to becreated with a dovetail design that wedges the flap edge in,reducing the risk of flap displacements, he said.

He recalled a former patient who lost her eyebrows andeyelashes after a gas explosion in her kitchen, but her Lasikflaps stayed firmly intact.

joanchew@sph.com.sg

Turn to page 12 to see a comparisonof the different vision correction procedures

Smile forclear vision JOAN CHEW

It felt like areally fastprocedure,as if Isteppedout assoon as Istepped in.There was no pain at all,just a weird,uncomfortable feeling.

Ms Fay Hokulani,on her Relex Smile procedure. She

was back at work three days later

I had myopia since I was in Primary 2. The degree of mymyopia was quite high and I also had the problem of dryeyes when wearing contact lenses, so I decided to undergoLasik surgery four years ago. Except for dry eyes in the firstthree months, it went well.

I love looking at the beautiful world and my family withmy naked eyes.Poh Heok Joyce Choo

I went for Lasik surgery two or three years ago. It was thebest decision I ever made.

The degree of myopia for both my eyes was about 800and I also had astigmatism. After wearing contact lensesfor 10 years, I had developed dry eyes and had scratcheson my pupils. I had to switch back to wearing spectacles,which I hated.

My recovery after Lasik was quick: I had only sometearing for a day and dry eyes for a few months. I used aneye lubricant for about a month.Meg Tan

Turn to page 12 for more Facebook comments

SOURCE: SINGAPORE MEDICAL GROUP

PHOTOS: CARL ZEISS MEDITEC ST GRAPHICS

How Relex Smile is done

■ Numbing eye drops are applied. The patient is asked to stare at a blinking green target. ■ A gentle, comfortable suction device is then used to ensure proper contact with the eye before laser treatment starts.■ It takes about 30 seconds to create a small, thin, disc-shaped piece of corneal tissue called the refractive lenticule. This is the precise amount of tissue that has to be removed to change the shape of the cornea for the patient to see more clearly.

■ A special surgical instrument is inserted into the micro-incision to loosen the refractive lenticule within the cornea. The lenticule is pulled out of the eye using forceps.

■ The micro-incision will heal naturally without any stitches.

■ The same machine makes a micro-incision measuring 2mm to 4mm on the selected area of the cornea surface.

1

22 33

Refractivelenticule

Laser

Forceps

Incision

PHOTOS: SINGAPORE MEDICAL GROUP, LIANHE WANBAO FILEDr Eugene Tay, a consultant ophthalmologist at SMG’s The Lasik Surgery Clinic, performing the Relex Smile procedure. During the procedure,he will wash the patient’s eye (right) after removing a small piece of corneal tissue via a micro-incision that is no more than 4mm.

Cover Story

Move over Lasik, Relex Smile is thelatest vision correction procedurewhich promises less post-operativediscomfort and fewer side effects

12 THE STRAITS TIMES OCTOBER 30 2014

Different types of corrective proceduresAdvanced surface ablation Implantable contact lens Lasik Relex Smile

How it works

The outermost surface of the cornea, knownas the corneal epithelium, is removed beforea laser is used to reshape the cornea toallow light entering the eye to be focusedaccurately.

There are three types of surface ablationprocedures. They differ only in the method ofepithelium removal.

Photorefractive keratectomy removes thecorneal epithelium manually with a bluntinstrument. Laser-assisted sub-epithelialkeratectomy (Lasek) uses dilute alcoholsolution, and epithelial laser in-situkeratomileusis (Epi-Lasik) uses a bluntautomated blade called an epitome.

These are like permanent contactlenses. They are implanted,through a small incision of about3.2mm, behind the iris and infront of the natural lens of theeye.

A flap of about 20mm incircumference is made on thecornea with either a rapidlyoscillating blade known as amicrokeratome or with afemtosecond laser (bladelessLasik). This flap is opened toexpose the underlying cornealbed. An excimer laser thenremoves tissue from the centreof the cornea to reshape it,correcting the patient’s refractiveerror. Finally, the flap ispositioned back in place.

A femtosecond laser is used tocut a small piece of cornealtissue called a refractivelenticule, as well as make anincision of no more than 4mm toremove the lenticule.

Duration 10 to 15min per eye 30min per eye 15 to 30min per eye 10 to 15min per eye

For thosewith...

Myopia: Up to -8.00 dioptres*Astigmatism: Less than 3.00 dioptresCorneal thickness: At least 450 microns.Those whose corneas are too thin in relationto their degree of refractive error, whichrules them out for Lasik or Relex Smile, canopt for this.

Myopia: Up to -18.00 dioptresHyperopia: Up to+10.00 dioptresAstigmatism: Up to-4.50 dioptresCorneal thickness: Notapplicable

Myopia: Up to -15.00 dioptresHyperopia: Up to +5.00 dioptresAstigmatisim: Up to-5.00 dioptresCorneal thickness: At least500 microns

Myopia: Between -2.00 and-10.00 dioptresAstigmatisim: Up to-5.00 dioptresCorneal thickness: At least500 microns

Recovery

Three to five days for healing.Blurred vision, pain and discomfort may beexperienced during this time. Antibiotic orsteroid eye drops may be used for a periodof one to several months.

A person can go back to work five toseven days after the surgery and participatein contact sports a month later. Full visualrecovery can be expected in three to sixmonths.

Clear vision is possible withinone or two days, though theremay be slight eye discomfort onthe day of the surgery. One wouldneed to use antibiotic eye dropsand medication for four to sixweeks.

The patient can return to workafter one to two days and takepart in contact sports four to sixweeks later. Swimming should beavoided for six weeks. Fullrecovery takes one or twomonths.

Clear vision is possible within24 hours or up to a week later.The procedure is relativelypainless, but expect slightdiscomfort for a day after thesurgery. One can resume workwithin two days. Antibiotic orsteroid eye drops may be usedfor a week.

One should not rub his eyesfor two weeks to prevent flapwrinkles. Plus, no swimming forthree weeks and no contactsports for a month. Full recoverytakes one or two months.

Clear vision is possible within afew weeks. The procedure isrelatively painless, though theremay be slight discomfort after thetreatment. One can resume workone or two days after the surgery.

Antibiotic or steroid eye dropsmay be used for two weeks andartificial tears for one month.Avoid swimming or contact sportsfor three weeks. Full recoverytakes one to several months.

ProsNo flap-related complications and thecorneal structure is maintained. Goodoutcomes for lower degrees of myopia andastigmatism.

Fewer after-effects, such as dryeyes, haloes (rings around lightsources) and starbursts,compared with Lasik. Theprocedure is reversible, so thelenses can be removed.

Quick visual recovery, littlepost-operative discomfort.

No flap-related complications andcorneal structure is maintained.

Cons

Slower visual recovery and use of eyemedication. There is also an increased riskof corneal scarring and corneal infectionsduring the healing phase. This risk isheightened for patients with high myopiaand astigmatism. The outcomes for thosewith higher degrees are less predictable.

The most invasive of all refractiveeye procedures, as surgery isdone inside the eye.

Flap-related complications suchas folds, inflammation, epithelialingrowth and traumaticdislodgement; though these arerare.

If there is a need to make furthercorrections, advanced surfaceablation is the patient’s onlyrecourse.

Cost fortwo eyes

From $3,518 at Singapore Medical Group’sThe Lasik Surgery Clinic; from $3,852 at theSingapore National Eye Centre (SNEC).

From $11,000 at Pacific EyeCentre; from $9,523 at SNEC.

From $2,199 at SingaporeMedical Group’s The LasikSurgery Clinic; from $2,364 atSNEC.

From $5,659 at SingaporeMedical Group’s The LasikSurgery Clinic; from $4,682 atSNEC.

I found that I had myopia (of about700 degrees) at the age of 11 and have beenwearing glasses since then. Contact lensesare not a consideration as my eyes get itchyeasily and painful at times.

Furthermore, I tend to doze off any time,anywhere, which is very dangerous if I have mycontact lenses on and this could lead to eyeinfections.

After much consideration, I have decided tocontinue to wear glasses, which are safe andless costly.James Young

I have been wearing glasses since I was sevenyears old, with my myopia degree climbing upsteadily until I was 12, when it remained atabout 600 degrees in each eye.

I started to wear contact lenses when I wasabout 14 years old and continued doing so tillI decided to have Lasik surgery when I was

30 years old. I had theusual side effects of dryeyes, but this went awayafter a few weeks.

I have since loved every moment of livingwith perfect eyesight for the past eight years.Furthermore, I don’t have to worry aboutpacking contact lens solutions when I travel,plus I can engage in all of my favourite sportswithout glasses slipping off my sweaty face.Cindy Angelique Chia

WINNERCindy Angelique Chia wins a $50 shoppingvoucher for the best post. The winner shoulde-mail her full name, address, e-mail address,identity card number and contact details tosthealth@sph.com.sg by next Wednesday.

Specify “ST MYB Facebook” as the subject.

www.facebook.com/STMindYourBody

Sources: Consultant ophthalmologists Eugene Tay and Marc Tay, The Lasik Surgery Clinic*One dioptre is 100 degrees

By CAROLYN KHEW

THE first government-industryscholarship dedicated to thepower sector has been awarded tofour tertiary students.

Mr S. Iswaran, Minister in thePrime Minister’s Office, gave outthe scholarship awards yesterdayat the In Dialogue With Youthforum, which was part of theSingapore International EnergyWeek and attended by more than300 students.

The Energy-Industry Scholar-ship was launched in January tohelp nurture talent for the sector,which was reported last year tohave workers with a median ageof 48. The industry would need2,400 more technical profession-als in the next decade, the EnergyMarket Authority (EMA) had said.

Open to Singaporeans and per-manent residents, the scholarshipcovers hostel and tuition fees, andprovides a monthly allowance.

This year’s recipients will joinSingapore LNG Corporation, Sin-gapore Power and YTL Pow-erSeraya once they graduate.

To keep the energy sector com-petitive, there must be good peo-ple joining the sector at different

levels, said Mr Iswaran, who is al-so Second Minister for Home Af-fairs and Trade and Industry.

Singapore Polytechnic studentNoor Nashriyah Jalil, 19, is one ofthe scholarship winners and isstudying for a diploma in electri-cal and electronic engineering.

“Engineering has always been a‘man’s field’. I hope to prove tomyself and society that womancan do the job just as well, if notbetter,” she said.

The other recipients are Nation-al University of Singapore under-graduate Tay Wei Jia, 23, Instituteof Technical Education CollegeWest student Muhammad Rafiud-din Samsudien, 17, and SingaporePolytechnic student Teo WenXuan, 18.

The next scholarship applica-tion period starts in December.

Seven companies in the sector,including Sembcorp Industriesand Keppel Infrastructure Hold-ings, will come on board.

Yesterday, Singapore Powerand EMA also unveiled initiatives,including a mobile exhibition anda short film contest, to reach outto 16,000 primary and secondaryschool students from next year.

kcarolyn@sph.com.sg

By FENG ZENGKUNENVIRONMENT CORRESPONDENT

MANUFACTURING companies in Singapore, espe-cially power-guzzling ones like semiconductorfirms, are likely to benefit more from installing so-lar panels to save on electricity costs, a study herehas found.

These companies operate throughout the week,even on weekends, and heavy-duty production com-panies are also likely to have large roofs which canaccommodate more panels for economies of scale,according to the study by solar energy firm RECand the Solar Energy Research Institute of Singa-pore (Seris).

In contrast, commerce and trade companiessuch as warehouses and distribution centres usuallydo not operate on weekends, which limits the sizeof their solar power systems, said the researchers.

“Making the system larger would reduce the con-sumption from the (power) grid during the week,but the excess electricity on the weekend would bewasted,” they explained.

REC, with Seris’ help, had looked at commerceand trade, manufacturing and heavy-duty produc-tion companies here to see whether and how theycould profit from installing solar panels on-site andusing the energy generated from the sun.

The study did not include condominiums, Hous-ing Board flats and industrial estates where compa-nies share a building, as the rooftop space in theseplaces is smaller and shared.

The researchers said their projections showedthe companies could recoup investments in suchsystems in eight to nine years.

The electricity generated for the rest of thesystems’ typical 25- to 30-year lifespan would be al-most free.

This is even as Singapore’s retail electricity pric-es rose by 9 cents for a kilowatt hour from 2005 tolast year, while the average cost of a solar powersystem fell by almost 40 per cent between 2011 andthis year, they noted.

For companies that cannot afford or baulk at thelong recoupment period, REC senior vice-presidentof operations and technology Ter Soon Kim saidthey can make use of power-purchasing agree-ments, where companies such as REC pay for andoperate solar panels on their roofs.

In return, the companies with the panels on theirroofs buy electricity from the solar panel providersat an agreed rate that is usually lower than thatcharged by utilities.

But Mr Ter said more can be done to boost solarpower adoption in Singapore.

For instance, “buildings should be designed tobe able to accommodate multiple green featuressuch as water tanks, gardens and solar panels ontheir roofs, as it is more costly to retrofit the build-ings”, he said.

zengkun@sph.com.sg

Energy-Industry Scholarship recipients (from left) Tay Wei Jia, Teo Wen Xuan, Noor Nashriyah Jaliland Muhammad Rafiuddin Samsudien. The scholarship, which is open to Singaporeans and permanentresidents, was launched in January to help nurture talent for the sector. ST PHOTO: DESMOND LIM

MOVE over, Lasik. A new vision-correction proce-dure is in town, and it promises less discomfort andfewer side effects.

Called Relex Smile, it gives a person clearer vi-sion by removing a disc-shaped piece of his corneathrough a tiny cut. There is no flap created and novaporising of tissue like in Lasik.

Today’s Mind Your Body examines how the lat-est technique measures up to the popular option ofLasik, as well as other existing options such as im-plantable contact lenses.

We also round up popular and trendy fitness rou-tines that you can opt for to inject some fun intoyour workout regime.

Cancer patients who want to seek traditionalChinese medicine to boost their recovery and immu-nity after chemotherapy can get tips in today’s is-sue.

Plus, learn how to transform a rich Indian ricepudding into a less sinful one by using apples as thecore ingredient.

Four awarded newscholarship dedicatedto energy industry

Your Life. Live it well.

MC

I (P)

073

/02/

2014

THURSDAY / OCTOBER 30 2014

5

1417

RECOVERY AFTER CANCER

APPLE OF YOUR EYE

How herbs can boost your immunity

Satisfy your sweet tooth with this apple rice pudding

A new laser eye procedure, Relex Smile, is in town. How does it match up to Lasik? PAGES 10-12

SMILE,YOU’VE GOTPERFECT

EYESIGHT

EXERCISE IS NO CHOREFun and trendy fitness routines to try out

Factories‘suitable’to tapsun’s raysBig roofs, 7-day operationallow them to benefit morefrom solar panels: Study

New way to getbetter vision

B2 HHOOMMEE T H U R S D A Y , O C T O B E R 3 0 , 2 0 1 4