Every day, Sarah (not her real name) sets multiple alarms. These are not for work or family commitments, but for her eye drops.
The 62-year-old has glaucoma, a condition that requires strict, lifelong management. Missing a dose is not just forgetfulness – it can mean losing vision over time.
Keeping up is harder than it sounds. The drops leave her eyes red and itchy. They sting. Over time, they have even darkened the skin around her eyes.
Sarah’s experience is common among fellow glaucoma patients, notes Dr David Goh, medical director and glaucoma specialist at Novena Bladeless Cataract Surgery and Eye Specialist Centre.
According to the World Glaucoma Association, glaucoma is a leading cause of irreversible blindness with around 80 million people affected globally. Approximately half of those with glaucoma are unaware they have the disease, as it is asymptomatic in its early stages.
The condition develops when fluid pressure inside the eye builds up, gradually damaging the optic nerve that sends visual information to the brain.
Dr Goh likens glaucoma to “the silent thief of sight”. He explains: “In Singapore, glaucoma affects up to 5 per cent of the population over 50 years old. It’s an age-related condition.”
Regular screening is recommended from the age of 40 for those with a family history of glaucoma.
PHOTO: NOVENA BLADELESS CATARACT SURGERY AND EYE SPECIALIST CENTRE
Other risk factors include high myopia (short-sightedness) of more than 600 degrees, steroid use and eye trauma or surgery. Those with a family history of glaucoma are three times more likely to develop it and should begin annual screening from their 40s, he adds.
According to Dr Goh, who cites studies reporting that up to 40 per cent of patients do not use their eye drops as prescribed: “Compliance with medication is a huge thing, whether it’s because of the side effects, forgetfulness or inability to administer them on their own.”
Without regular use, the drops become less effective, and vision loss can progress quietly over time.
Managing glaucoma typically begins with medicated eye drops to reduce pressure in the eye. But over time, maintaining this routine can become increasingly difficult.
“It’s not just about prescribing the medication,” says Dr Goh. “It’s about whether patients can realistically keep up with it every single day.”
For glaucoma patients like Sarah, a procedure could free them from the daily eye drops.
She was referred to Dr Goh’s clinic to undergo minimally invasive glaucoma surgery, where microscopic stents were implanted in her eye.
The technology, called iStent, has been available since 2012. It started with a single tiny stent; now in its third generation – iStent Infinite, which has been available in Singapore since 2024 – it comprises three stents.
These tiny titanium stents create extra channels to drain excess fluid in the eye, relieving pressure by up to 30 per cent or 7.5mmHg, says Dr Goh.
“Initially, we could only treat mild to moderate glaucoma. Now with iStent Infinite, we can treat moderate to severe cases because of the triple stents in place for increased drainage.”
The iStent Infinite comprises three microscopic titanium stents, implanted through a 2.5mm incision.
PHOTO: PHOTO: NOVENA BLADELESS CATARACT SURGERY AND EYE SPECIALIST CENTRE
This 15-minute procedure can also be performed alongside cataract removal, says Dr Goh. “It can be done through the same two micro incisions of 2.5mm made during cataract surgery, without requiring a separate procedure.”
A US study found that up to 63 per cent of patients with mild to moderate glaucoma who underwent the iStent Infinite procedure no longer needed eye drops, though results may vary. Sarah was among those people who responded well – her glaucoma stabilised and side effects subsided within a week.
The stents are made of implant-grade, heparin-coated titanium designed to prevent rejection by the body, and the data shows they remain effective for up to 10 years.
Recovery takes 24 to 48 hours before patients regain normal vision. “Because it’s so small and microinvasive, the only side effect is minimal internal micro-bleeding for one or two days – which is normal – that settles quickly.”
Patients can resume most activities immediately — gym, yoga, driving, jogging — but should avoid swimming for up to a month due to the risk of infection.
For Sarah, the change has been significant.
After undergoing the procedure, her eye pressure stabilised, and she no longer needs her daily drops. And the constant reminders are no longer part of her day.
Visit Novena Bladeless Cataract Surgery & Eye Specialist Centre for more information on glaucoma surgery.
