Gaps in eye health

by | May 26, 2015

Awareness of the importance of vision and eye health is relatively low among elderly Singaporeans according to recent national SNEC survey.

BY:Eleanor Yap

The SNEC survey found that while 67 percent of those surveyed felt that it was important to go for annual eye screening, only 38 percent actually attended screening at least once a year.

A recent study commissioned by the Singapore National Eye Centre (SNEC) has revealed significant gaps in knowledge and practices around eye health. The findings, which was announced at SNEC’s 25th anniversary international meeting, showed that 45 percent of respondents thought that being able to see clearly meant that their eyes are healthy, and that nine in 10 assumed there is no need to have regular eye checks if they can see well.

This could be a potential problem if one has a history of glaucoma, diabetes or hypertension, as their risks would be higher for eye diseases. As such the recommendation for persons with such conditions is to get screened as early as possible to detect any problems so they can be dealt with in a timely manner. Shared Professor Ecosse Lamoureux, director of Population Health at the Singapore Eye Research Institute (SERI) and principal author of the study, if the results are negative, they may need only to come in every two years for screening. 

He added: “Blinding eye diseases such as glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy can start with no symptoms. You need to get tested early and you shouldn’t rely on your vision being clear as an indication of your eye health.”

For instance, damage done by glaucoma is irreversible and can lead to blindness in advanced cases. This eye disease, where high fluid pressure within your eye damages the delicate fibres of the optic nerve which are responsible for carrying visual impulses from the eye to the brain, accounts for 40 percent of blindness in Singapore.

And blindness isn’t the only concern when it comes to vision impairment. Minister for Health Gan Kim Yong said in his opening address at the SNEC’s 25th anniversary international meeting: “Vision impairment is a significant burden with an ageing population. Studies by SNEC show that Singaporeans with vision impairment are three times more likely to have problems in mobility and in conducting activities of daily living and also two times more likely to be anxious or depressed than those with normal vision.”


Understanding the community’s needs

The SNEC study was conducted among 517 Singaporeans and permanent residents aged 50 to 79 years. There were 50 questions conducted through door-to-door interviews for one month starting in January this year. “Being a national eye centre, we wanted to find out about the needs of the population – their attitudes and knowledge, and their thinking about eye health. The survey has provided us with some good insights, as we had never asked these questions before,” said Professor Wong Tien Yin, medical director of SNEC.

Other study findings:

  • Seventy-seven percent of respondents felt that vision loss was a normal part of ageing and there is nothing they can do about it.
  • Vision loss was the source of concern for the respondents and 21 percent ranked blindness as the third most worrying aspect of ageing, after cancer (29 percent) and stroke (26 percent).
  • Six in 10 thought that cataract, which is highly treatable, was the main trigger for vision impairment, compared to more serious conditions such as diabetic retinopathy, AMD and glaucoma.

Another worrying point in the survey is that while 67 percent of those surveyed felt that it was important to go for annual eye screening, only 38 percent actually attended screening at least once a year. Said Prof Wong, “If glaucoma is detected in its early stages, we are able to check the eye pressure and stop the disease from progressing.

“We can treat early-stage glaucoma with eye drops. If that doesn’t work, the patient may need laser treatment or surgery. Early treatment could prevent the need for surgery, which is more costly.”

And with diabetic retinopathy, a digital diabetic retinal photography can detect the condition. Through the Singapore Integrated Diabetic Retinopathy Programme (SiDRP), an initiative by SERI, the photography can cost S$10.50 at a polyclinic to S$16 at a community health centres (where a patient is referred to by general practitioners).

There was also low awareness among chronic disease sufferers. The study found that 41 percent had been diagnosed with hypertension, while 18 percent had diabetes. Though their risks are higher to have eye problems, only 36 percent of diabetics and 38 percent of those with hypertension had not been diagnosed with eye conditions such as diabetic retinopathy.

In addition, one in five diabetics have not heard of diabetic retinopathy before and four in 10 diabetics did not adhere to the recommended eye screening interval of once a year.


Socioeconomic status is a factor

SNEC shared that the respondents’ monthly household income, housing type, education and employment status play a part in their health and their attitudes towards eye health. Hypertension and diabetes were more prevalent among those living in one- to three-room flats, with secondary school education and lower, and monthly household income lower than S$4,000. The survey found that 47 percent of all respondents living in one- to two-room flats had never had their eyes checked.

Also, respondents living in private property were more likely to seek immediate treatment if they developed an eye problem. In comparison, those living in one- to three-room flats with a monthly household income below S$4,000 were more likely to go within a week.


What’s next?

SNEC’s Prof Wong shared that currently there are no guidelines on what age to screen for eye diseases, unlike mammography for breast cancer and the Pap smear for cervical cancer. Currently, eye screening guidelines are only applicable to patients with diabetes. “It is timely to look at implementing guidelines for Singapore, based on the threshold of onset of the top eye diseases in Singapore and the cost-effectiveness of population-based screening.”

He shared that SNEC will explore such guidelines within the year and might involve other eye professionals to the screenings as well. SNEC will also continue its various initiatives including the National Eye Care Day which offers underprivileged elderly Singaporeans free eye screenings and advice on maintaining their eye health and the new Vision Fund, which will help needy patients and raise awareness of eye care.





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