Category Archives: Eye Chat

Column by Dr Dr Lee Mun Wai

Eye Chat – Eating for Diabetes

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease
Dr Lee Mun Wai

Diabetes is fast becoming an epidemic around the world and in Malaysia, an estimated 15 per cent of our population have diabetes!! This number is projected to continue on an upward trend and before we know it, 1 in 5 Malaysians could become diabetic! That is a scary statistic!

Our population really does not know very much at all about diabetes. This is a chronic disease with a whole plethora of life threatening complications not to mention sight threatening ones as well. What I have found with my patients is also their complete lack of knowledge about how to eat properly when they have been diagnosed with diabetes. It is very common to think that taking less sugar is good enough but in reality, there is a lot more to it.

Striking a Balance

Eating for diabetes isn’t about going on a diet – it’s about making changes to your eating habits to create a healthier balance. Diabetes doesn’t change the kinds of food you can eat. The focus should be on making smart food choices to lead a healthier life; that is, eating less fat, less sugary foods, a variety of fresh fruits, vegetables, lean meats and fish. Basically, having a balanced diet.

Diabetics should work closely with their physician and dietitian to come up with meal plans. There is no one special diabetic diet – the meal plan has to be personalised to meet the unique requirements of each diabetic individual. The meal plan should aim at keeping the blood glucose levels as near to normal levels as possible – it is those large swings in blood glucose levels which do the most damage to the organs. I have lost count of the number of times I have heard my patients tell me that the reason their sugar levels have been so high is because they just had something to eat! If eating properly, the levels should not fluctuate so wildly. It is therefore, important to monitor your own blood glucose levels as well.

The Food Groups

Protein – A healthy diet should consist of 10-20% of calories from protein and sources of protein include poultry, fish, dairy and vegetable sources.

Fat – A healthy intake of fat should be less than 30% of daily calories. You should take less of saturated fats (meat and dairy products) and more of polyunsaturated fats (fish and other seafood).

Carbohydrates – the remainder of daily calories should come from carbohydrates (fruits, vegetables, beans, rice, noodles, etc.).

Steps to Eating Well

  1. Eat regular meals at consistent times. Consider having smaller meals more frequently.
  2. Cut down on the fat you eat (especially saturated fats).
  3. Eat more fruit and vegetables – at least 5 servings a day.
  4. Aim for at least 2 servings of fish a week. Omega 3 fatty acids in oily fish are good for the heart and eyes.
  5. Limit sugar and sugary drinks.
  6. Reduce salt in your diet – limit the amount of processed foods.
  7. Drink alcohol in moderation.
  8. Don’t be tempted by diabetic foods or drinks – they are often expensive with no added benefit and will still affect blood glucose levels.

Staying healthy with diabetes is a challenge but not totally unachievable. Eating right is but one aspect of living with diabetes; it is important to maintain a healthy weight and to exercise regularly as well. It is vital that you set health goals for yourself and work together with your health-care professionals to achieve these goals. Eating a balanced diet, managing your weight, and following a healthy lifestyle, together with taking any prescribed medication and monitoring where appropriate will ensure that you can prevent or delay the side effects of diabetes!

For more information about this topic or other eye health subjects, call Lee Eye Centre: 05-254 0095.

Omega 3 fatty acids and Macular Degeneration

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease
Dr Lee Mun Wai

Eye Chat – From a Retinal Surgeon’s Perspective

Previously, I had talked about nutritional supplements for age related macular degeneration (AMD) and further research is now ongoing to look at the benefits of omega 3 fatty acids as well as lutein and zeaxanthin in a large clinical trial known as AREDS 2 (Age Related Eye Diseases Study).

What are Omega 3 fatty acids?

These polyunsaturated fats are essential nutrients as they cannot be synthesized in our body. The omega 3 fatty acids are made up of short chain alpha-linolenic acid and the long chain docosahexanoic acid (DHA) and eicosapentanoic acid (EPA). Examples of foods rich in omega 3 fatty acids are fish, shellfish, flaxseed, walnuts and soy bean.

Importance to the retina?

The brain and eye are highly enriched with omega 3 fatty acids which accumulate in these tissues during early neonatal life. DHA is a major structural lipid in the retina particularly the disc membranes of the photoreceptor outer segments. The photoreceptors are very metabolically active as they are responsible for converting light energy into electrical impulses to be transmitted to the brain for interpretation of images. Consequently, a steady supply of DHA is required for normal retinal function. The complete function of omega 3 fatty acids in the retina is still not fully understood but it is postulated that they have other neuroprotective and anti-angiogenic effects.

Omega 3 and Omega 6 fatty acids imbalance

Humans evolved on a diet with a 1:1 ratio of omega 6:omega 3 but in the industrialized countries nowadays, our diets are more like 12:1 or even 18:1! This hugely disproportionate intake of omega 6 fatty acids has been contributory in the observed increased incidence of heart disease, cancer and other inflammatory disorders. Basically, omega 6 fatty acids exert pro-inflammatory effects whereas omega 3 fatty acids exert anti-inflammatory effects but both are required by our body (in proportionate amounts) for normal functioning.


Omega 3 and AMD

Age Related Macular Degeneration is the leading cause of blindness in developed nations and intense research into the treatment and prevention of this disease has led to observational studies showing evidence supporting the association between omega 3 fatty acids and AMD. A high intake of individual fatty acids such as linoleic acid and a high cholesterol intake could lead to an increased risk of AMD. In contrast, epidemiological studies have shown that an increased intake of omega 3 fatty acids could have a protective role especially in wet AMD.

Historically, low incidences of AMD have been reported in Japan and Iceland where fish consumption is high but in recent times, more and more of this disease have been seen in these countries which could reflect a change in the dietary behavior towards a more “western diet”.

Striking a Balance – Making a Difference

It is therefore, very important to have the correct balance of omega 6 and omega 3 fatty acids in our diet. In our current food environment, it is very difficult to get away from the omega 6 overload as almost all our food is cooked with sunflower oil or corn oil or other vegetable oils and all these are laden with omega 6. A lot of food manufacturers of health foods in specialty stores will also coat their products with vegetable oil to improve the texture and taste and unwitting consumers who believe they are taking the healthy option, are in fact tipping the scales towards the omega 6 imbalance.

We are currently victims of modern society and of our lifestyles. Knowing that a lot of these “lifestyle diseases” such as high blood pressure, diabetes, heart disease, etc can be prevented with modified behaviour and habits, we should make an effort to change our ways. For some more information on how to “tip the balance in your favour” visit my blog on

For more information about this topic or other eye health subjects, please visit my blog at: Or call Lee Eye Centre : 05-254 0095.

Nutritional Supplements for Macular Degeneration

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease
Dr Lee Mun Wai

Eye Chat – From A Retinal Surgeon’s Perspective

Age-related Macular Degeneration (AMD) is the leading cause of blindness in developed nations. A lot of research has been carried out to identify the cause and possible risk factors for AMD and as with many other diseases, the development of AMD is a consequence of the interplay between genetic and environmental factors.

There is of course little we can do to alter our genetic makeup (for now) but the identification of different genes associated with this disease only allows further development of therapeutic options in the future. Environmental influences such as smoking and diet have also been strongly linked with AMD, and unlike our genes, we can directly impact on the disease by changing our behaviour or habits.

The identification of specific nutrients which may be beneficial for AMD came from the Age Related Eye Diseases Study (AREDS). From this study, the importance of anti-oxidants and zinc in preventing the progression of AMD was discovered.

Dr Lee Mun WaiWhat are Anti-oxidants?

To understand how anti-oxidants are beneficial, one must first understand how our body works. Our body’s cells are constantly at work and particularly in our eyes (where the photo transduction process which converts light into electrical impulses uses large amounts of energy), a lot of free radicals are generated. These free radicals are reactive oxygen particles and can be damaging to our cells. Anti-oxidants in effect ‘neutralise’ these oxygen particles and prevent further damage.

Anti-oxidants which were found to be beneficial for AMD are Vitamins A (beta-carotene), C and E and zinc. The study showed beneficial effects of these anti-oxidants only in individuals at high risk of developing advanced AMD – there was a risk reduction of 25% in these individuals. In people with no AMD or early AMD however, there was no apparent benefit.

The AREDS Formulation

As a result of the findings of this study, there have been a flood of these ‘eye supplements’ into the market since 2001. The formulation used in the study was 500mg of Vitamin C, 400 IU of Vitamin E, 15mg of beta-carotene, 80mg of zinc and 2mg of copper (copper was added to prevent copper deficiency which could be associated with high doses of zinc supplementation). With aggressive marketing from the pharmaceutical companies, many consumers have started using these supplements ‘to protect their eyes’!

I’ve been asked by many of my patients about taking different varieties of supplements and my advice to them is always to look at the evidence. As a doctor, I can only base my recommendations on scientific evidence and strong scientific evidence can only be achieved by doing very large controlled trials. There are always claims by companies selling these supplements about the “proven” effects of their product. Even the scientific journals which I read can sometimes be misleading – it is therefore important that we be cautious about information we read or hear about.

As for the AREDS formulation, it is indeed an important addition to our armamentarium for the battle against AMD but we must be mindful that it is currently proven to be beneficial only to people at high risk of developing advanced AMD. Moreover, smokers who take the AREDS formulation may be at increased risk of lung cancer due to the interaction with beta-carotene so my advice would be to discuss with your physician before ‘popping more pills’.

Other Nutrients?

You may have read about other substances with potential benefits to the eye such as lutein or zeaxanthin and omega fatty acids. There is currently an ongoing AREDS 2 study which will investigate the impact of these other supplements on AMD and more definite information will be available in the next 1 to 2 years.I shall write more about lutein, zeaxanthin and omega fatty acids in subsequent posts. Meanwhile, “pop by” to read my blog at for the latest on eye diseases and eye care tips.

For more information about this topic or other eye health subjects, call Lee Eye Centre: 05-254 0095.

Eye Chat – Eye injections for the treatment of retinal diseases

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease
Dr Lee Mun Wai

From a Retinal Surgeon’s Perspective

Intravitreal injections are a very effective way of delivering drugs for treatment of certain serious diseases in the eye and particularly the retina. This has been done for many years when used to treat severe infections or inflammation of the eye but it was not until recently that a ‘revolution’ in the treatment of age related macular degeneration (AMD) led to the very routine use of these injections and has now become a very important part of the armamentarium of a retinal surgeon.

What exactly is an intravitreal injection?

Lee Eye Centre Ipoh - Dr Lee Mun WaiAs shown in this image, it involves “sticking a needle” into the eye and releasing specific drugs into the vitreous cavity. It is used for the treatment of a variety of eye diseases but in recent years, it has revolutionized the management of retinal diseases and has a significant impact not just on affected patients but also on retinal surgeons’ lives!!

The “Revolution”

The rise of intravitreal injections started in 2004 when intravitreal Macugen was first used in the management of AMD. This drug was developed to inhibit vascular endothelial growth factor (VEGF) which is a growth factor involved in the development of blood vessels. This had modest effect on the disease but the following year when Avastin (another inhibitor of VEGF) was first used to treat AMD, the revolution truly took off!

This was the first time there was any treatment that could actually improve vision in people with wet AMD. From Avastin, another drug came into the market in 2006 – Lucentis. This was a designer drug specifically manufactured to treat VEGF driven eye diseases as compared to Avastin (which was a cancer drug for metastatic bowel cancer).

The impact of this ‘revolution’ extended beyond its positive effects on patients but also the increased workload for retinal surgeons as these injections had to be given every month in order to maintain its efficacy. There were also far reaching consequences for healthcare services in some countries as reimbursement for this very expensive drug burned very large holes in the healthcare budget!

What conditions are treated with intravitreal injections?

The anti-VEGF drugs (Avastin & Lucentis) were initially used to treat wet AMD. However, it’s use has extended to many other retinal diseases which all have a common association; i.e. the blockade of VEGF would result in a positive impact on the disease. Aside from wet AMD, other diseases would include diabetic retinopathy, retinal vein occlusions (or eye stroke), neovascular glaucoma and even retinopathy of prematurity.

So far, I have mentioned only anti-VEGF drugs which have resulted in an exponential increase in the number of intravitreal injections in recent years. In actual fact, this technique of drug delivery is not at all new. We have been giving antibiotics (in cases of severe eye infections), anti-virals (in patients with AIDS) and steroids (for inflammatory eye diseases) for a long time. This mode of drug delivery allows for a good amount of drug getting to the intended target without having large amounts in the body (when taken orally or through a vein) and giving unwanted side effects.

The Future of intravitreal injections?

More drugs are being developed to treat these retinal diseases – some which can last longer and would therefore, reduce the frequency of injection. Other techniques are being researched i.e. different ways of storing and releasing the active drug in a gradual and controlled manner could mean even less frequent injections. Safe to say however, intravitreal injections will continue to play a big role in the treatment of retinal diseases in the near future or until the next “revolution”. I leave you with a link to a nice video clip which describes the intravitreal injection process from a lay person’s point of view.

For more information about this topic or other eye health subjects, please visit my blog at: Or call Lee Eye Centre: 05-254 0095.

Retinopathy a sign of Cognitive Decline

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease
Dr Lee Mun Wai

Eye Chat – From A Retinal Surgeon’s Perspective

The eye is often described as the “windows to our souls” and in the medical sense, they are indeed the “windows” through which  eye doctors can observe a lot of disease processes going on!

The retina is a particularly common place to look when there are other systemic diseases (like diabetes) as there is a wealth of information that can be obtained by looking at the blood vessels in the retina.

What is retinopathy?

ipoh echo issue 142, Retinopathy, Dr Lee Mun WaiRetinopathy refers to a group of conditions whereby the common feature would be dysfunction of the retinal blood vessels. In the case of diabetic retinopathy, the presence of excessive levels of sugar in the blood has an adverse effect on the retinal vessels causing them to be more “leaky’ and consequently, blood and proteins can leak out causing retinal swelling and reduced vision. There is also insufficient oxygenation of tissue and this results in abnormal “growth” of new blood vessels which are prone to bleeding.

Hypertension can also be associated with retinopathy – blood vessels harden with age and progressive narrowing of vessels and reduced oxygenation can lead to bleeding, swelling and strokes in the eye. Other conditions which may be associated with retinopathy include anaemia, leukaemia, lupus and radiation.

Retinopathy and cognitive decline

There has been a recent study which reported a possible link between the presence of retinopathy and worsening cognitive function in older women. This study looked at over 500 healthy older women (over 65 years of age) as part of the Women’s Health Initiative Memory Study and they used retinal photography to assess the eyes of these women, the Mini-Mental State Examination to assess cognitive function over time and also Magnetic Resonance Imaging (MRI) of the brain to look for specific changes.

What they found was that the presence of retinopathy was associated with poorer scores on the mental state test as well as a greater volume of ischemic (oxygen-starved) areas in the brain.

What it means?

The findings of this study add to a growing body of evidence that diseases of blood vessels have a role in the decline of cognitive function in people. Retinopathy may therefore, be an early marker of small vessel disease in the brain and this could imply that screening the eyes for retinopathy could help detect early vessel disease in the brain and cognitive impairment (dementia). Conditions such as Alzheimer’s have far-reaching consequences and if detected early by means of eye screening, could be treated earlier with better outcomes.

But of course these are still early days and further research and studies will be required to evaluate the true relationship between retinopathy and cognitive function. Again another case of “watch this space”. But meanwhile, take care of the “window to your soul”…

For more information about this topic or other eye health subjects, please visit my blog at: Or call Lee Eye Centre: 05-254 0095.

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease

Eye Chat: Stem Cells in Retinal Disease

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease
Dr Lee Mun Wai

Eye Chat – From A Retinal Surgeon’s Perspective

Stem cell treatment has been a ‘headline grabber’ for many years now and in fact, since its discovery 13 years ago, we have all been aware of talk about treatment for cancer, Alzheimer’s disease, diabetes and so on.

In ophthalmology (particularly in retinal circles), stem cell treatment is a very hot topic as there are many retinal diseases which could be potential targets for development of a viable stem cell treatment. Most recently, there has been a research paper published in the well-known medical journal The Lancet ( which described the use of human embryonic stem cells (hESCs) to help patients with age-related macular degeneration (AMD) and Stargardt’s macular dystrophy (another degenerative disease of the macula which has no available treatment as yet).

Introduction to Stem Cells

What are they? – Stem cells have the potential to develop into any type of cell in the body and can serve as an internal repair system to replenish other cells. Stem cells can, under specific conditions, develop into a cell type which is specific for a particular organ.

The Retina? – The retina is a tissue of many layers and it lines the inside of the eye. There are 10 layers in the retina but for simplicity, it can be divided into the neurosensory retina and the retinal pigment epithelium (RPE). The neurosensory retina is responsible for transmitting information to the brain for us to get the perception of vision and the RPE is a pigmented layer whose functions are mainly related to nutrition of the retina as well as transporting of ‘waste material’ out of the retina. In conditions such as AMD or Stargardt’s disease, it is the RPE which is sick or dysfunctional.

ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal DiseaseWhy should the RPE become sick? It could be genetic or environmental influence (e.g., sun or smoking). Unfortunately, the damaged RPE cells cannot regenerate and as more and more cells die, the disease gets worse and the vision deteriorates further. There has been intense interest in research to find ways to replace these RPE cells and using stem cells is one way to do it.


What the future holds?

There is still much work to be done and many more questions to be answered. This most recent study has shown encouraging results in that there have been no complications observed in transplanting these stem cells into the retina of patients with AMD and Stargardt’s disease. Aside from the technical challenges of the procedure, there was no abnormal growth of the stem cells or no “rejection” observed.

This study has been touted as a major breakthrough in the use of stem cells for the treatment of retinal diseases and if longer term and larger studies in future should show similarly encouraging results, we may be looking at another step towards the prevention of blindness!

For more information about this topic or other eye health subjects,
please visit my blog at:
Or call Lee Eye Centre :

Dr Lee Mun Wai - Glaucoma and Erectile Dysfunction

Glaucoma and Erectile Dysfunction

Dr Lee Mun Wai - Retinal Surgeon’s Perspective
Dr Lee Mun Wai

Eye Chat – From A Retinal Surgeon’s Perspective

What has an eye disease like glaucoma have to do with a condition which is so physically remote from the eyes (you might ask)? A recent study was published ( which described a possible link between glaucoma and erectile dysfunction (impotence) and has reported an almost 3 FOLD increased risk of glaucoma in individuals suffering from erectile dysfunction (ED).

Dr Lee Mun Wai - Glaucoma and Erectile DysfunctionWhat is glaucoma?

As World Glaucoma week nears (March 11-17), there has been much information put out there about how glaucoma is the 2nd leading cause of blindness worldwide and how the symptoms do not present themselves until a very advanced stage. There are many different types of glaucoma and I shall not elaborate too much into the diagnosis and treatment of this disease but suffice to say that glaucoma is a group of diseases characterised by progressive damage to the optic nerve and associated with pressure inside the eye.

What is erectile dysfunction (ED)?

Dr Lee Mun Wai - Glaucoma and Erectile DysfunctionThis is a particularly taboo subject (amongst the men at least) and not often discussed in the context of our society as well. It is defined as the inability to develop or maintain an erection for satisfactory sexual intercourse.

Causes of ED – Public education about this condition is very poor and there are many men who “suffer in silence” for fear of the stigma associated with this diagnosis. The main causes are divided into two main categories; psychological and physical. Little do people know that the physical causes account for over 50% of ED and these would include hypertension, diabetes, high cholesterol and heart disease just to name a few. All these diseases have a common ‘theme’ in that they are vascular disorders (i.e., problems with blood vessels). In actual fact, treatment of these vascular problems would also treat ED in such individuals.

What is the link between glaucoma and ED?

This study looked at data from over 4,600 men with ED and found that there was an increased risk of these men having glaucoma compared with a “control” group of men without ED. There has been evidence to show that vascular problems (as mentioned above) can lead to ED as there is chronic damage to the blood vessels throughout the body. Similarly, problems with vascular tone and blood flow have been implicated in glaucoma and it would not be surprising if the two conditions had common causative mechanisms.

What are the implications?

The results of this study have to be taken into context of course – a lot more research has to be done to evaluate this association between glaucoma and ED. Is there a true link or is this a chance finding?

What it would mean for physicians is that there is another aspect to look out for when managing a patient with ED – getting their eyes checked as well! For the layman, being armed with good health information is always a good start towards leading a normal life in spite of these problems. Nevertheless, this paper has raised some eyebrows and we shall continue to look hard for more information about these two conditions.

More about Viagra and risk of blindness in coming issues.


For more information about this topic or other eye health subjects, please visit my blog at: Or call Lee Eye Centre : 05-254 0095

Eye Chat – From A Retinal Surgeon’s Perspective

Dr Lee Mun Wai - Retinal Surgeon’s Perspective
Dr Lee Mun Wai

Happy New Year everyone – I’d like to start the New Year by talking about conditions which affect the macula – the most important part of our retina.

What Is The Macula?

The macula is the most sensitive part of our retina responsible for 90% of our functional vision. If you remember, I had previously written about Age Related Macular Degeneration. There are other conditions which can cause similar loss of central vision which can have significant impact on our daily activities such as reading, driving and computer work.

Macular Pucker/Epiretinal Membrane

This is the formation of a “membrane” on the surface of the macula which is formed from the presence of scar tissue. There is gradual proliferation and contraction of the cells resulting in folds at the macula. Initially, affected individuals may not have any symptoms at all but as the condition worsens, one might notice visual disturbances ranging from generalised blurring of central vision, lines appearing wavy or distortion of central vision altogether.

This epiretinal membrane can be associated with retinal vascular diseases (e.g., diabetic retinopathy), retinal tears or detachment, eye injury, inflammation of the eye, after excessive laser treatment (to the retina for diabetic retinopathy) or eye surgery. They can also develop in persons over 50 years old with no apparent predisposing factors.

Macula Hole

This is a retinal break involving the macula. This condition is related to aging and usually occurs in persons over 50 years of age. As we age, the vitreous gel in the eye shrinks and pulls away from the retina. In some cases, when the gel pulls away, it can tear the retina. If this tear occurs in the peripheral retina, a retinal detachment can result. If this tear occurs at the macula, a hole is then formed. Macular holes can also result from eye injury, macular pucker, high myopia and diabetic retinopathy.

The symptoms of a macular hole would include distortion of central vision, loss of central vision and in rare cases, if a retinal detachment ensues, total loss of vision.


Macular pucker and macula holes can be easily diagnosed by your ophthalmologist if he/she performs a retinal examination after dilating your pupils. Not every case requires treatment as it is usually not a rapidly progressive condition and to monitor this, a scan of the macula area with an Optical Coherence Tomography (OCT) machine is often necessary. This scan provides very detailed information about the different structures at the macula and shows the extent and size of the macular pucker/hole.


Treatment of these conditions is surgical. A procedure called a vitrectomy would have to be performed by a retinal specialist and the “offending” membrane peeled off. This surgery is somewhat more complex than cataract surgery, different instrumentation is required, surgical time is longer and recovery is not as quick as in cataract surgery. Nevertheless, it is necessary in many cases and is the only treatment available up to now.

For more information about retinal diseases or other aspects of eye care, please visit my blog at


For more information, contact:  Lee Eye Centre Ipoh

Tel: 05-254 0095 or email: Website:

What is Age Related Macular Degeneration?

Dr Lee Mun Wai

Eye Chat – from a Retinal Surgeon’s Perspective

Most people are aware of cataract as a cause of blindness but not so many know about retinal diseases.

The leading cause of blindness in developed nations is a condition called age related macular degeneration (AMD). It is a disease of the macula (the most important part of the retina) and tends to affect individuals over the age of 55 years. Symptoms would include distortion or blurring of central vision (see below).

There are 2 types of AMD – wet and dry. The more common form (90%) is dry AMD which is slowly progressive and less aggressive whereas wet AMD can cause abrupt, devastating loss of central vision. I shall focus on wet AMD in this article.

What is the cause of AMD?

Wet AMD is characterized by bleeding from abnormal blood vessel(s) underneath the retina. These abnormal vessels are stimulated to “grow” by the presence of a signal protein called VEGF.

The cause remains unknown but risk factors for this disease include age, heredity as well as hypertension and heart disease which have been shown to have mild association with AMD. Smoking has been found to be the most important modifiable risk factor.

Studies have shown that up to 15% of people aged 55 to 74 years have some form of AMD and the risk goes up to 30% in people over 75 years old.

Treatment of wet AMD

Before the turn of the century, there weren’t any effective treatment options for wet AMD and eye doctors would be helpless as their affected patients progressed to blindness.

A “revolution” occurred in 2005 when a new form of treatment became available and it came about when a very innovative retinal specialist from USA decided to use a drug normally used to treat bowel cancer, and inject it into eyes with wet AMD. This drug, Avastin, is an anti-VEGF i.e. it blocks the action of VEGF and thus, stops these abnormal vessels from growing and bleeding.

Whilst Avastin was used in this “off label” manner to treat wet AMD, research was carried out to design a drug to specifically treat this disease – so Lucentis was born in 2006. Large clinical trials were done and it’s efficacy and safety was proven without a doubt. For the first time, retinal specialists had a treatment which could stabilize and halt the disease process in wet AMD in over 90% and even improve vision in up to 40% of patients – something which was never before possible!

The only drawbacks with this treatment (besides needing an injection into the eye), is the frequency and cost of treatment. Lucentis was proven to be effective if injected at monthly intervals and this could go on indefinitely! In USA, Lucentis costs more than $2000 per injection whereas Avastin costs $150. This huge price difference has led to a real dilemma for the patients as well as the retinal doctors

The latest “head to head” study comparing Lucentis and Avastin has shown that both drugs are almost equal in efficacy and safety. The safety of Avastin remains “inconclusive” and we await further reports about this.

The experiences of retinal specialists throughout the world have been very similar in terms of the use of Avastin or Lucentis for the treatment of wet AMD. Both drugs work well in properly selected patients and with proper monitoring and informed consent. This will remain the primary form of treatment for wet AMD until better options become available in the future. Rest assured, more research is ongoing for better alternative therapies.

For more information, contact:  Lee Eye Centre Ipoh
Tel: 05-254 0095 or email: Website:

Surgical Management of Retinal Diseases

Dr Lee Mun Wai

‘Eye Chat’ – from a Retinal Surgeon’s Perspective

World Sight Day is upon us again and this annual advocacy event for “The Right to Sight” marks the coming together of all ophthalmic care providers to increase public awareness of blinding eye diseases. Retinal diseases make up a significant portion of the blinding diseases and with this article, I hope to provide an overview of the surgical management of these diseases.

Retinal Surgery

Schematic diagram of Vitrectomy

Vitrectomy is a specialized microsurgical procedure which is used to treat retinal disorders. The surgeon uses an operating microscope with a specialized viewing system and a highly sophisticated vitrectomy machine together with very fine instruments to perform the surgery. This is usually performed under local anaesthesia and is often a day case procedure.


Diabetic eye disease

Diabetes is a fast growing worldwide ‘epidemic’ and eye complications from diabetes are the leading cause of blindness in the working age group. Diabetes causes leakage of blood and protein from the blood vessels of the retina (retinopathy). Advanced diabetic retinopathy requires aggressive laser treatment to prevent progression to blindness but in severe cases, surgery is often required.

Symptoms of eye problems from diabetes may not be obvious until a very late stage. It is therefore very important for diabetics to have regular eye checkups to monitor for retinopathy. The longer the duration of diabetes, the higher the risk of developing retinopathy.

Retinal detachment

This refers to a separation of the retina from the back wall of the eye. The retina will degenerate and lose its ability to function when detached. The most common form of retinal detachment occurs following a break or tear in the retina.

Symptoms of retinal detachment include floaters, flashing lights or blurred vision particularly described by patients as ‘a curtain hanging over their vision’. The prognosis for retinal detachment depends a lot on the extent and duration of detachment. Therefore, it is important that patients present early when they have visual disturbances as described above.

Macular diseases

The macula is the most sensitive part of the retina responsible for high quality vision necessary for tasks such as reading, driving or watching television. In the aging eye, abnormal changes in the macula can lead to formation of scar tissue known as macular pucker or epiretinal membrane. In some cases, a hole in the macula can form. Typically, patients will describe ‘straight lines appearing crooked’ or even a ‘missing portion’ in their central vision. A vitrectomy combined with peeling of this scar tissue would be required to close this hole and restore vision.

Other conditions

Cataract surgery can sometimes be complicated when the cataract dislocates to the back of the eye or in other cases where the intraocular lens implant itself dislocates. Vitrectomy would then be required to retrieve the dislocated lens material.

Other serious conditions which require vitrectomy would include endophthalmitis (intraocular infections) and serious injuries to the eye including intraocular foreign bodies.


Vitrectomy has been a major advance for ophthalmology as retinal specialists are now able to treat certain retinal diseases and prevent significant visual loss in patients where previously they may have gone blind. There have been further improvements made in the instrumentation for modern vitrectomy and the advantages to the patient include shorter operating times, less discomfort and quicker healing.

For more information, contact:  Lee Eye Centre Ipoh Tel: 05-254 0095 or email: Website: