The windows to the soul—and the body

The eye is so much more than a small ball in the face, says Dr Tara George, an ophthalmologist at Sunway Medical Centre in Kuala Lumpur. If you look into the eye, you can get an idea of what’s happening in the whole body.

“It’s the only place where you can actually look into the blood vessels of your body without having to do anything invasive,” she explains. “And it tells you a lot.”

Medical retina practitioners do not just deal with vision; they also look at the person as a whole. Diabetes, for example, might be a disease that affects other parts of the body, but it can be picked up by looking for changes in the eye.

It is also a disease which ophthalmologists like Dr Tara are seeing more often following an alarming increase in the number of patients diagnosed with the disease both in Malaysia and across Asia.

“In Malaysia, the latest surveys show an almost 40 percent rise in diabetic patients. The country also has one of the highest rates of diagnosis of diabetic retinopathy in the world,” says Dr Tara.

“The kidneys and the eyes are related, so diabetic nephropathy is linked to diabetic retinopathy. There is a correlation because the same type of blood vessels are damaged.”

Among the diabetic population, some 30 to 50 percent will have some form of retinopathy, including sight-threatening and proliferative retinopathy, where patients get bleeding in the eye.

There are treatments that can help these patients maintain or improve their vision that were not available just a decade ago.

Sunway Medical Centre has a diabetic retinopathy screening service whereby an optometrist will use a special camera to examine a patient’s retina and take their eye pressure. The eye does not need to be dilated these days, compared to in the past when drops were administered and vision would be blurred for three to four hours.

SunMed’s technology now gives a wide field view of the retina that allows doctors to analyse changes to the eye. If anything is found to be abnormal, the patient is directed to an ophthalmologist for further examination.

The longer a patient has had diabetes, the higher the risk of a complication involving the eye. Those who have had diabetes for 15 years or more have a 90 percent chance of getting retinopathy, though it doesn’t have to be sight threatening.

“If you are well controlled, you may not have sight-threatening retinopathy, but you will have some mild form of the condition,” says Dr Tara, who stresses the need for diabetics to control their blood sugar.

While diabetes is a growing area of her practice, the same goes for age-related macular degeneration (AMD), largely due to a growing older population and a lack of awareness among Malaysian patients that poor eyesight does not have to follow old age.

The science for macular degeneration has been mainly moving towards restoring the eye cells that have died and preventing scarring after abnormal blood vessels grow under the retina and leak.

New drugs in their final stage of trials can limit the amount of leakage and scarring from these blood vessels. Stem-cell therapy, which can regenerate the retinal cells that are dead, has also been undergoing successful trials, with some patients having responded quite well to the treatment.

In Malaysia, many patients “accept that losing your eyesight is part of getting older, and they don’t take it very seriously,” says Dr Tara. Yet there are now health campaigns designed to teach the public how to detect slight visual symptoms in the early stages of AMD.

Sunway Medical Centre has gained a widespread reputation for the treatment of AMD and has invested heavily in the latest equipment for this purpose. Dr Tara now sees referrals from across Malaysia as well as other neighbouring countries.

“We have a specific subtype in Asia called PCV or polypoidal choroidal vasculopathy which is diagnosed by an indocyanine green (ICG) angiogram, and the scanning laser ophthalmoscope angiographic camera is used to diagnose this condition accurately here at Sunway Medical Centre. Some cases of PCV require Photodynamic therapy (PDT) laser for optimal treatment outcomes and this option of treatment is available here in Sunway Medical,” she says.

“For other forms of AMD, just giving an anti VEGF injection in the eye would be sufficient, but for this subtype, we need the ICG angiogram and PDT laser. The test and the treatment do help the patient achieve better outcomes, so we get referrals from Malaysia and abroad.”

She adds that for AMD and diabetic retinopathy, the treatment lends itself to medical tourism, especially for Indonesian patients, who make up most of her international patients. They can fly into Kuala Lumpur in the morning, do the treatment, then return home in the evening, she says.

Dr Tara Joseph is a retina specialist and eye surgeon at Sunway Medical Centre. Her areas of expertise include ocular motility assessment, phacoemulsification cataract surgery, retinal antipathy and photodynamic therapy.

Sunway Medical Centre
5 Jalan Lagoon Selatan, Bandar Sunway
46150 Petaling Jaya, Selangor, Malaysia
Tel: +60 (0) 3 7491 9191
sunwaymedical.com