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The “Underdog” of Healthcare: Important facts on Primary Eye Care less known to the public in Singapore.

The Situation
The increasing standard of living in Singapore is gradually affecting the types of diseases diagnosed among the workforce population. In particular, the following table shows the 3 most common chronic diseases in Singapore1:

Disease Prevalence (2010) Aged
Hypertension 23.5% 30 – 69
High Cholesterol 17.4% 18 - 69
Diabetes 11.3% 18 – 69


The prevalence of these chronic diseases are expected to rise, and the corresponding healthcare costs are expected to increase. The Singapore National Eye Centre reported that among patients who are diagnosed with Diabetes, 80% of them will develop Diabetic Retinopathy (DR)2 , which is an eye condition resulting from diabetes. This is particularly alarming, especially when Diabetes ranked as the third most common chronic disease.

Treatment for diabetes costs $7,600 and is expected to rise to $10,500 by 20503. Part of the cost incurred is for the treating of DR, which cost $240 - $1250 per injection per eye during each visit and this excludes the Specialist’s fees4. Notably, the cost of treatment for diabetes and its related conditions only is already a hefty amount by itself.

In order to prevent such high healthcare costs and offer better treatment options, Health Promotion Board (HPB) is actively promoting and endorsing regular health screening5.

Health screening is important, but research have also shown that using health screening alone as a preventive measure is ineffective and may in fact increase healthcare costs in the long term6. Hence, to prevent escalating medical issues, it is imperative to adopt a complementary approach to ensure a good health status. An effective health programme should consist of surveillance, public education and a combination of screening, examination and treatment7.


The “Underdog”: Importance and Impact of Primary Eye Care
The public need to recognise that primary eye care plays a crucial part to ensure an effective and cost-saving healthcare ecosystem. Quoting the American Optometrist Association, eye and vision care serve as an important point of entry into the healthcare system8. This is a key reason why eye examination should be positioned as an essential component in a health and wellness programme. But sadly, eye care is rarely promoted as an important aspect of the healthcare ecosystem in Singapore because eye care is perceived as a want more than a need. In addition, people can easily get “free” eye checks offered at retail optical shops as part of their marketing technique to attract customers. However, these “free” eye checks are just vision checks to diagnose the prescription for spectacles and contact lenses, and are unable to detect eye and chronic diseases.

In fact, a comprehensive eye examination involves analysis of the front and back structures of your eye, as well as vision and other eye-related checks. These checks can only be conducted using sophisticated equipment by an Optometrist or Ophthalmologist. Through these thorough checks, signs and symptoms of eye and chronic diseases can be detected. If surgery and medication are required for an eye condition, a visit to the Ophthalmologist is necessary.

The cost of a comprehensive eye examination starts from $128 at a government hospital9 and at least $200 at a private clinic. With this price tag and the expected waiting time at the hospital or clinic, it is not surprising that people are not inclined to get their eyes examined regularly as part of their health screening.


The Role Differentiation
The eye care family is made up of three main pillars comprising the Ophthalmologist, Optometrist and Optician. Ophthalmologist is a medical doctor that provides Secondary and Tertiary eye care services, while Optometrist and Optician provide Primary eye care services. The following table shows the differences between these three professions in Singapore:

Ophthalmologist Optometrist Optician

Trained in Medical School and specialises in Ophthalmology

Trained in Optometry School

Trained in Dispensing of Optical Appliances

Conduct Eye Examination

Conduct Eye Examination

Provide basic eye care advises

Diagnose, monitor and treat eye diseases

Diagnose and monitor eye diseases; and refers patients to an Ophthalmologist if necessary

Dispense optical appliances

Prescribe medication, contact lenses and eye treatment

Prescribe contact lenses and some eye treatment

Perform surgery


When faced with any eye conditions, most people generally visit a General Practitioner (GP) or go directly to an Ophthalmologist. However, visiting a GP may delay treatment and incur additional cost since the GP will ultimately refer the patient to an Ophthalmologist10. On the other hand, a visit directly to the Ophthalmologist will usually mean incurring higher medical cost, possibly for a minor condition.

Optometrists’ services would thus come in as a middle ground solution. People can visit an Optometrist at any optical shop to receive a comprehensive eye examination, even if they did not experience any eye problems. However, one needs to ensure that the shop is equipped with the right equipment to offer such services and be prepared to pay for the consultation, which will be cheaper compared to the hospital/clinic rates. An optometrist will then be able to carry out diagnosis of eye and chronic diseases, if any, and direct referral to an appropriate ophthalmologist.


The Holistic Approach
In summary, public education is the first step to achieve a holistic approach for an effective healthcare ecosystem. This should be followed by the combination of screening, examination and treatment. Primary eye care, as the “Underdog”, needs to be included as part of this holistic approach as soon as possible to enhance our health and wellness programme. This Underdog definitely has a great potential to help everyone stay healthy while their wallets remain happy!


Article by:

Jeffrey Tan
Director
Senior Optometrist
Eyecare 24/7 Pte. Ltd.

Email: jeffrey@eyecare247.co
Website: www.eyecare247.co
Contact: 98477446

Copyright©2016 Eyecare 24/7. No part of this document may be reproduced or transmitted in any form or by any means without written permission. All the content herein remains the sole property of Eyecare 24/7.


1 https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Disease_Burden.html

2 Donald Tan. 2011. Eye Check: A look at common eye conditions. Singapore National Eye Centre

3 http://www.straitstimes.com/singapore/health/study-cost-of-diabetes-to-singapore-to-soar-beyond-25b

4 http://www.snec.com.sg/about/newsroom/news-articles/Pages/Stoppingdiabeticsfromgoingblind.aspx

5 http://www.hpb.gov.sg/HOPPortal/health-article/HPBSUEXTAPP1_4022026

6 Hackl F. et. al. 2012. The effectiveness of Health Screening. Institute for the Study of Labor. Discussion paper no. 6310.

7 Au Eong K.G, Yip C. C. 2007. Prevention of Blindness in Singapore: No Room for Complacency. Annals Academy of Medicine. 36: 10.

8 American Optometrist Association, Optometric Clinical Practice Guidelines – Reference Guide for Clinicians – 2nd Edition 2005

9 https://www.ktph.com.sg/eye-screening

10 Klin Oczna.Oczna K. 1999. Possibilities of diagnosis and treatment by General Practitioner. Pubmed. 101(5):397-400