Understanding of treatment and prevention of eye disease lacking among Singaporean elderly

Singapore — A recent study commissioned by the Singapore National Eye Centre (SNEC) has revealed significant gaps in knowledge and practices around eye health.

The nationally-representative study was conducted among 517 Singaporeans and permanent residents aged 50 to 79 years, in conjunction with SNEC’s 25th anniversary. It aimed to shed light on the current awareness level of various eye diseases and their risk factors, and understand the perceptions and attitudes of the public towards eye health.

“SNEC through the Singapore Eye Research Institute (SERI) already has a deep understanding of population eye health issues through our research in various areas of ophthalmology. This survey provides a current view of what Singaporeans aged 50 years and above know and understand about eye health. These individuals are at a time of their life when age-related changes in the eye take place, and the incidence of eye health problems rises. An understanding of their perceptions and attitudes will help us formulate outreach and care strategies that will help preserve and maintain their vision for as long as possible,” said Professor Wong Tien Yin, Medical Director, SNEC.

Vision impairment in Singapore is associated with substantial health burden among Singaporeans, affecting quality of life more than chronic disease. For every 100,000 people in Singapore, the burden of vision impairment is equivalent to 512 healthy Chinese, 707 Malay and 609 Indian people who are dying every year . People with vision problems are more likely to be depressed and suffer from higher mortality in general.

Respondents’ awareness and understanding of eye health
The findings showed that 45 per cent of respondents thought that being able to see clearly meant that their eyes are healthy, and that eye checks were needed only if they noticed a problem. 77 per cent of respondents felt that vision loss was a normal part of ageing. While 67 per cent of those surveyed felt that it was important to go for annual eye screening, only 38 per cent actually attended screening at least once a year.

Vision loss was a source of concern for the respondents, 21 per cent of whom ranked blindness as the third most worrying aspect of ageing, after cancer (29 per cent) and stroke (26 per cent). 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, age-related macular degeneration and glaucoma.

Eye screening practices among chronic disease sufferers
A significant proportion of respondents reported that they had been diagnosed with hypertension (41 per cent) and diabetes (18 per cent). They were more likely to have eye problems – only 36 per cent of diabetics and 38 per cent of those with hypertension had not been diagnosed with eye conditions such as diabetic retinopathy. However, one in five diabetics had not heard of the condition before, and four in 10 diabetics did not adhere to the recommended eye screening interval of once a year. The findings show that more needs be done to improve Singaporeans’ knowledge and understanding of eye diseases, particularly diabetic eye diseases.

The International Diabetes Federation recommends that people with Type 2 diabetes undergo eye screening annually to assess visual acuity and retinopathy.

The impact of socioeconomic status
Monthly household income, housing type, education and employment status were factors in respondents’ health status and help-seeking behaviour. Hypertension and diabetes were more prevalent among those living in 1- to 3-room flats, with secondary school education and lower, and monthly household income below S$4,000. 47 per cent of all respondents living in 1- and 2-room flats had never had their eyes checked.

Socioeconomic status also influenced treatment-seeking behaviour. Respondents living in private property were more likely to seek immediate treatment if they developed an eye problem. In comparison, those living in 1- to 3-room flats with a monthly household income below S$4,000 were more likely to go within a week.

“These findings show that there are eye health inequalities in Singapore and underscore the initiatives undertaken by SNEC to improve access to eye screening and care to the underprivileged. Respondents’ knowledge of the impact of chronic disease on eye health is of particular significance as it highlights a possible gap in the care of patients with chronic disease,” said Professor Ecosse Lamoureux, Director of Population Health at SERI.

Primary care partnerships to reach chronic disease patients
Research shows that perceived barriers to obtaining an eye examination predict adherence to annual eye examination among adults with diabetes . To facilitate eye screening, SNEC/SERI introduced the Singapore Integrated Diabetic Retinopathy Programme (SiDRP) in 2010. The programme enables remote reading of eye scans done at a screening centre, by a centralised team of qualified technicians at SNEC.

SiDRP is currently available at 16 screening centres islandwide. The programme has expanded to include Tampines, Bedok South, Tiong Bahru and SATA Community Health Centres (CHCs), as well as a mobile van CHC operated by the National Healthcare Group from the first quarter of this year. Participating general practitioners (GPs) can refer patients using CHC referral forms or written memos. Once patients have attended screening at the CHC, their reports and results will be sent to the referring GPs within one week for further follow-up.

SNEC’s Primary Eyecare Clinic right-sites stable and well-managed patients with diabetic retinopathy, glaucoma, and mild cataracts that do not need surgery. The clinic provides care equivalent to SNEC’s clinics on the Singapore General Hospital campus, but offers patients shorter waiting times for appointments and consultations while optimising manpower resources. Since its launch, the PEC’s load has grown steadily. It now sees 450 patients monthly.

SNEC is holding dialogue sessions with the Singapore Medical Association (SMA) and GPs to understand the issues that GPs face in managing chronic disease patients and explore ways to enhance access to eye screening services. The centre is also working on strategies to improve the referral uptake at SNEC.

Sharpened focus on the needy
SNEC will redouble its efforts to reach Singaporeans of lower socioeconomic status through outreach activities such as National Eye Care Day. This year’s event will reach underprivileged elderly Singaporeans, offering them free eye screening and advice on maintaining their eye health. 

A new Vision Fund is also being set up to support community outreach, education and research activities. The fund will help needy patients and raise public awareness of eye care. SNEC hopes to raise S$25 million towards this new fund over the next five years.

For media queries and clarifications, please contact:
Ms Jean Angus
Golin Singapore
Tel: +65 6880 5951
Email: jangus@golin.com

Mr Ravi Chandran
Corporate Communications
Singapore National Eye Centre
Tel: +65 6322 8394
Email: ravi.chandran@snec.com.sg

About the Singapore National Eye Centre

Singapore National Eye Centre (SNEC) is the designated national centre within Singapore’s public sector healthcare network.  It spearheads and co-ordinates the provision of specialised ophthalmological services with emphasis on high quality ophthalmic clinical services, education and research.  The Singapore Eye Research Institute (SERI) being the research arm of SNEC is the national institute for eye and vision research.

SNEC manages more than 300,000 patient visits and more than 27,000 surgeries annually, many of these are tertiary and complex in nature.  The centre’s full spectrum of subspecialties addressing every part of the eye – Cataract, Corneal and External Eye Disease, General Cataract & Comprehensive Ophthalmology, Glaucoma, Neuro-Ophthalmology, Ocular Inflammation and Immunology, Oculoplastic, Paediatric Ophthalmology and Adult Strabismus, Refractive Surgery, Surgical and Medical Retina. The centre’s one-stop multi-subspecialty approach to treatment of complex eye conditions, a quality assurance programme that is backed by 100% video recording of major surgeries and dedicated audit of outcomes as well as the pursuit of high-impact translational research have placed SNEC as one of the premier eye centres in the world.

For more information about SNEC, visit www.snec.com.sg

About the Singapore Eye Research Institute

Established in 1997, SERI is Singapore’s national research institute for ophthalmic and vision research. SERI’s mission is to conduct high impact eye research with the aim to prevent blindness, low vision and major eye diseases common to Singaporeans and Asians. Serving as the research institute of the Singapore National Eye Centre, and directly affiliated to the Yong Loo Lin School of Medicine, National University of Singapore, as well the Duke-NUS Graduate Medical School, SERI undertakes vision research in collaboration with local clinical ophthalmic centres and biomedical research institutions, as well as major eye centres and research institutes throughout the world.

SERI has grown from a founding team of five in 1997 to a faculty of 220, encompassing clinician scientists, scientists, research fellows, PhD students and support staff. This makes SERI one of the largest research institutes in Singapore and the largest eye research institute in Asia-Pacific. The institute has amassed an impressive array of publications totalling 2,100 scientific papers as of November 2014, and has secured 212 external peer-reviewed competitive grants worth $197 million. As of November 2014, SERI’s faculty has been awarded over 300 national and international prizes and filed over 90 patents.

For more information about SERI, visit www.seri.com.sg