LASIK : A Success in Singapore - It's Not Too Risky

No, LASIK surgery is not 'too risky'. In fact, almost all the operations carried out at government institutions Singapore have been safe and successful, said the Health Ministry in December 7.

The success rate among the 6,000 patients who had the procedure done at the Singapore National Eye Centre (SNEC) and the National Healthcare Group's The Eye Institute between November last year and October this year is between 95 per cent and 97 per cent, it said. In addition, doctors contacted here said the potential for long-term complications due to the surgery was significantly reduced because of stringent pre-operative screening procedures. They were responding to a British report that said Lasik was deemed 'too risky' and did not justify widespread use.

The report from the British government's watchdog on medical matters, the National Institute for Clinical Excellence, questioned the long-term safety of the procedure. It said the chances of damage during Lasik treatment did not justify widespread use, and recommended that the government reject a move to make the surgery available in subsidised hospitals. Laser surgery is currently available only in the private sector in Britain. When contacted by The Straits Times, the Ministry of Health here said its success rates were 'on par with international standards' - between 86 per cent and 100 per cent.

The ministry also identified two main criteria for judging the success of the procedure: Three months after the surgery, patients should be able to achieve at least 6/12 vision without glasses or contact lenses. Those with 6/12 vision are legally allowed to drive a car without glasses on. Patients' vision should have been corrected to within 100 degrees of the estimated 'target' set before the operation. The ministry, however, added that it did not have data on the long-term safety rates of the operation, since Lasik has been available here only since 1996. In Lasik surgery, a laser is used to reshape the cornea, the transparent protective covering of the eye's lens, to correct sight problems such as myopia.

The technique leads to thinning of the cornea, which the British report expressed concern about. It said doctors are concerned about the long-term effects of thinning of the cornea. This could include corneal ectasia, where an excessively thin cornea begins to bulge forward, causing loss of vision. But doctors here said good pre-operative screening procedures help to reduce significantly the potential for such complications. Associate Professor Donald Tan, deputy director of SNEC, said the risk of corneal ectasia can be detected easily by screening.

He said: 'Our institute routinely turns away about 10 per cent of potential patients, mainly because their corneas are already too thin for them to be operated upon.' He added that there was 'emerging evidence' that corneal ectasia was more common in Caucasians. Added Dr Lee Hung Ming, head of refractive surgery at The Eye Institute: 'Lasik is safe as long as the stringent pre-operative criteria are met, and enough corneal tissue is left behind as a precaution.'

Eye surgeon Jerry Tan, who conducted the first Lasik surgery here in 1996, said doctors have been reshaping corneas to improve vision since 1939, in a procedure known as myopic keratomileusis. Back then, doctors used a blade rather than laser to cut the cornea. 'If there were any long-term ill effects, we would have definitely known by now,' said Dr Tan. All three doctors averred that if you choose a good surgeon, go to a reputed institute and take good post-operative care, chances of complications are near zero.

NUS Team to Develop Drugs from Snake Venom

Researchers from the National University of Singapore (NUS) are planning to form a company to develop and market drugs derived from snake venom. Professor R. Manjunatha Kini and Associate Professor Ge Ruowen - both from the department of biological sciences - as well as Associate Professor Peter Wong from the department of pharmacology, have been in talks with interested parties for the past year and are close to sealing a deal.

Prof Kini said there is a potential 'multibillion-dollar market' for the drugs. One of his latest discoveries is an anti-clotting protein derived from the venom of the rough-scaled snake, found in Australia. He hopes the protein can be used as long-term medication for patients suffering from coronary heart disease and stroke. The researchers said it could be potentially more effective and has fewer side effects than current anti-coagulants.

The venom from the rough-scaled snake slows down the formation of thrombin - an enzyme that causes blood to clot - between 500,000 to one million times more effectively than other drugs that prevent thrombin from forming. Other medications the NUS team has developed include a painkiller stronger than morphine and an anti-hypertensive to lower high-blood pressure. To make the drugs, certain useful proteins in snake venom are identified and separated from the toxic elements that are harmful to humans.

Synthetic copies of these proteins are then produced. Snake venom proteins have been the basis for many drugs, including Integrilin, an anti-platelet drug derived from rattlesnake venom that has been used for heart surgery since 2001. As it is very expensive, it is used at the National University Hospital on about one in 10 heart patients who undergo procedures to clear clogged arteries, said its cardiac chief, Dr Tan Huay Cheem. Once the NUS team has formed the company, it will take another two to three years of further laboratory tests before clinical trials can be conducted.

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