PART B - LIGHT AT THE END OF THE TUNNEL

A wild-goose chase can be simply defined as a waste of time, effort and money in pursuing something unsuccessfully. My failed attempt from mid February to end of October to find a medical solution to my vision and dizziness problem is a perfect example of a wild-goose chase. During the initial period of more than four months I had sought consultation and treatment from more than half a dozen medical practitioners and specialists, including a Chinese Sinseh, but all to no avail. And worst of all I suffered liver damage due to consumption of medications prescribed by the Chinese Sinseh. I was finally advised by a very experienced eye specialist in Singapore to wear a pair of multi-focal glasses to correct my vision. I was also told that I would take sometime to get adapted to them. I did for the next four months, but my vision and dizziness problem persisted. It deteriorated during the second half of October when the vision of my left eye was completely blurred if I were to lie down to read. Also when I awoke early in the morning, I could see a dark ring floating in my left eye which would disappear when I got out of bed.

On 30th Oct 08, I decided to see an optician (not my usual one) to examine my eyes and test the multi-focal eye glasses. After going through the normal ocular examination of my eyes, the optician was quite alarmed and told me straight “Your left eye’s intraocular lens (IOL) implant was off-centre and you need to have a more thorough examination by an ophthalmologist soonest possible”. I was completely taken aback by his finding as I had been emphatically assured by the eye specialist in Singapore that both my IOL implants would last beyond my lifespan. After regaining my composure I asked him “Can you recommend a good and experienced eye specialist?”  He said “Many of my customers have consulted Dr Choong, one of the eye specialists from the Centre For Sight in Taman Sea, PJ” and advised me to go there for tests as soon as possible. I thanked him for the tests and recommendation and assured him that I would be back to his shop to replace my eye glasses when required.        

I left for home to think over my next course of action: to see Dr Choong in Centre For Sight or Prof Lim in Singapore. After a light lunch of home-grown durian and a short nap I decided to go to the Centre For Sight to have my eyes examined. I chose Centre For Sight because of the seriousness of the problem that needed immediate attention and also I had somewhat lost confidence in Prof Lim when he had told me earlier about my IOL implants. Also, depending on the test results, I could still go to Singapore for treatment if necessary.

In that afternoon I went to register at Centre For Sight. After some tests were carried out by the medical attendants, I was referred to Dr Choong who conducted further examination of both my eyes with a binocular slit-lamp instrument. Dr Choong confirmed that the IOL of my left eye was dislodged and was “dancing” inside the eye! A stereoscopic magnified image of both the IOL implants in my eyes in striking detail was captured in a computer monitor and was shown to me. I was completely taken aback to see the condition of my left eye in comparison with that of the right one. I didn’t have to be an ophthalmologist to know that something was seriously amiss with the IOL of my left eye.

                                                                      Displaced IOL

Dr Choong further told me that the displaced IOL might risk dislocation at any time and advised me that it would be prudent to replace it soonest possible. Also the intra-ocular pressure of my left eye was high. Without any hesitation, I agreed to an immediate surgery to replace the displaced IOL as I had already planned to travel to Huangshan in China in less than two weeks’ time. Also I was given to understand that if the dislocated IOL were to drop into the vitreous cavity of the eye it might cause the development of intra-ocular inflammation and increase in intra-ocular pressure. Arrangement was then made for my eye surgery to be carried out the next day (31st Oct) in the late morning.

I was not at all concerned about the coming eye surgery as I had experienced it twice about twenty years ago in Singapore. The first was in 1987 when my right extra-capsular cataract was extracted and an IOL was implanted. The second surgery was done in 1989 for my left eye. Both were carried out by Dr Arthur Lim (now Prof Lim) in Mt Elizabeth Medical Centre in Singapore. At that time the conventional method was used in which a large incision (10-12mm) was made in the cornea and almost the entire lens was removed while the elastic posterior capsule was left intact to allow implantation of an IOL. This conventional method not only requires a large incision but also the use of stitches. The IOLs then available were fixed-focal lenses which left the patient to wear bifocal or reading glasses. In my case I had one long-focal IOL and one medium-focal IOL. With these implants I only need reading glasses.

The newer technique is one called Phaco Technique. This technique requires smaller incision to enter the cornea. The surgeon then inserts a small probe into the lens capsule which emits ultrasonic waves that soften and break up the cloudy lens so it can be removed by suction. The removed lens is replaced by an IOL which is made of flexible material allowing it to be folded for implantation. The new IOL can be multi-focal which allow patients to see near or far without glasses. 

As my left eye’s IOL had to be removed, the conventional technique had to be adopted.

I was at Centre For Sight at the appointed time. Without much ado, my left was dilated and soon I was let into the operation theatre. Dr Choong was in command with a couple of assistants to assist him. After applying local aesthesia to my left eye, Dr Choong told me that I might feel a bit of irritation and slight pain, but I would remain fully awake during the procedure.

During the whole operation I closed my right eye and tried to remain calm and relaxed. I could hear voices, particularly from Dr Choong when he asked his assistants for the various types of surgical instruments he needed for the operation. During the early part of the operation he told me that my displaced IOL had dislocated and dropped. I asked him “Drop onto the floor?”  “No, inside the eye, but it would take a while to locate and extract it” Dr Choong replied. I requested him not to throw away the dislocated IOL as I would like to take a look later. The surgery was smooth-sailing thereafter and was satisfactorily completed after slightly more than half an hour.

After the surgery I was shown the extracted IOL. It was a small crystal clear plastic lens and now I fully understand what precisely the eye specialist in Singapore told me that it would last well past my lifespan. But had it being  properly installed in my eye to last more than twenty years? 

                                                                        Explanted IOL

I closed my bloated left eye and was let out of the surgical room to rest in a lounge. I was given two types of eye drops to apply to my left eye and some diamox tablets to reduce its pressure. The nurse also attached an eye goggle to my left eye and told me not to splash it with water during shower or washing. For less than two hours in the Centre For Sight, I was allowed to go home to recuperate.

For a day or so after the surgery I either closed my left eye or covered it with soft tissue paper and used only my right eye to see or read. Two days after the surgery, I removed the cover to my left eye and was pleased that though it was still red, swollen, and blurry and had a slight pain when moving, my vision was more stable and my dizziness gone! A week after the surgery I went back to see Dr Choong for a follow-up check and was again pleased to learn that my left eye was recovering well. A magnified image of the new IOL was taken and it was in vast contrast to that I saw earlier before the surgery.

Anterior Chamber – New IOL

 After the surgery I refrained from many of my planned/normal activities. The first was the cancellation of my travel to Huangshan, China with my wife on 10th Nov. This was the second time that I had to abandon this trip; the first was in May when I was in the midst of my wild-goose chase for a medical cure of my dizziness and vision problem.

Though I was advised not to lift heavy goods, I also voluntarily refrained from the following activities for at least two weeks:

• Going to the pubs with my pub kakis as I did not want my healing left eye to expose to cigarette smoke;

• Driving to my oil-palm plantation in Pagoh, Johor as safe driving would require concentration which could cause a great strain to my eyes;

• Golfing with my regular kakis as executing a hit would require rapid eye movement which might put unnecessary strain on my left eye and

• Cutting down on reading, writing and surfing the internet so as not to strain my eyes.

I resumed all the above activities and started writing this episode three weeks after the surgery when I felt my left eye had sufficiently healed and after receiving the medical report and photographs from Dr Choong.

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