Made-in-Singapore treatment for glaucoma more effective, has fewer side effects: NUH

An eye afflicted with glaucoma. Glaucoma patients who underwent the new and faster treatment by the National University Hospital reported almost no side effects.PHOTO: MOHAMAD ROSMAN OTHMAN

SINGAPORE - A relatively new laser treatment that was developed in Singapore for glaucoma patients has been shown to be more effective at treating the debilitating eye condition. It also caused less pain and side effects, according to data released by the National University Hospital (NUH).

The treatment, micropulse transscleral cyclophototherapy (MPTCP), involves shooting small lasers into the patient's eyes, as opposed to the conventional treatment of transscleral cyclophotocoagulation (TCP) which uses a high-intensity laser.

Since 2016, 300 patients have successfully undergone the treatment at the NUH Eye Surgery Centre. Within 12 months, 75 per cent of patients who had undergone MCTCP had their eye pressure reduced, compared to 20 per cent for the conventional treatment, according to figures released by NUH on Wednesday (May 24).

While 30 to 40 per cent of patients who undergo TCP suffer from side effects such as inflammation and shrinkage of the eye, there are almost no side effects reported by patients who received the new treatment. It takes 100 seconds to complete, half the time needed for conventional laser treatment.

The latest treatment was developed by Associate Professor Paul Chew, who is a senior consultant with NUH's department of ophthalmology, and patented in 2015. In the past two years, it has been used on 45,000 patients in other countries, such as the United States, the United Kingdom and the Philippines.

"Patients with advanced glaucoma can now look forward to a treatment which enhances their quality of life," said Professor Chew in a statement.

Glaucoma results in gradual loss of one's vision and can lead to blindness. It is caused by improper drainage of fluid from the eye, leading to increasing eye pressure that damages the optic nerve.

While glaucoma is incurable, it can be delayed through eye drops and oral medication. In advanced stages of glaucoma, laser treatment is only recommended after invasive surgery fails to reduce eye pressure.

Prof Chew had been treating glaucoma since the 1980s and saw the potential of micropulse technology to treat glaucoma to avoid the damaging side effects associated with conventional treatment. Previously, micropulse treatments had only been used to treat diabetic retinal disease.

The maximum temperature of the laser in the new treatment is 35 deg C, compared to 550 deg C in the conventional treatment. The laser probe used for the new treatment was also developed to better fit the shape of the eye, preventing the pain that is commonly reported by patients who have undergone TCP, Prof Chew said.

Development of the MPTCP treatment began in 2007. Studies and experiments were conducted until 2015. The technology for the micropulse treatment is currently being manufactured by American-based company IRIDEX.

One of the patients who has benefitted from the new treatment is Mr Chee Chean Shyong. The 64-year-old retiree discovered during a check-up in March that the glaucoma in his left eye, diagnosed over eight years ago, had worsened significantly. He then consulted Prof Chew at NUH.

He underwent the treatment in April after being told the pressure in his eye was too high for regular surgery. "Knowing that if I don't get treatment, my eye will get worse, I was psychologically prepared," he said about the new laser treatment.

"The only pain was when they did the injection for the painkiller into my eye," he recalled. "I could feel the pressure (of the laser probe), but it was very fast." He said that his condition has improved since the treatment.

The treatment was originally developed to combat advanced glaucoma, and there are plans to expand the scope of the treatment to treat patients with a less responsive form of the disease. "There is a lot of potential for the treatment to be used in primary treatment or early treatment in third-world countries," said Prof Chew at a media conference.

He added that the treatment could potentially help patients save more money in the long run, compared with using eyedrops. While glaucoma patients may have to spend up to $1,800 a year on two to three different types of eyedrops to control their condition, each laser treatment costs between $1,200 to $1,600 and has longer-lasting positive effects. This could result in patients not having to go for additional surgery and reduce the number of eyedrops they require.

According to figures from the Singapore National Eye Centre, three per cent of all Singapore residents aged 50 and above have glaucoma. This increases to 10 per cent for those aged 70 and above.