Eye Discoveries: Towards more Holistic Glaucoma Care

By Dr Owen Hee, Consultant, National Healthcare Group Eye Institute, Tan Tock Seng Hospital

Since its inception in 2001, the NHG Eye Institute has continued to address the increasing demand for eye care services, and areas of its research and training.

It incorporates Tan Tock Seng Hospital’s Department of Ophthalmology as its flagship clinical unit, and delivers quality tertiary and primary eye care to patients in Singapore and the region. With more than 32 fellowship-trained consultants on-board, the Institute covers the entire spectrum of ophthalmic subspecialties, providing comprehensive diagnosis and advanced treatment for both common and complex eye diseases.

In part two of the ‘Eye Discoveries’ series by the NHG Eye Institute, we will be taking a look at the introduction of a new Glaucoma Nurse-Led Service, and how the initiative has successfully added a holistic facet to the process of Glaucoma Care.

I bring out the visual field test results. There are quite a few black spots amidst the white background. And I begin to tell my patient: “The test results confirm you have glaucoma.”

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The experience is not entirely satisfactory; for me, nor for the patient. Why? Because I wish I had more time to explain the diagnosis. Often, time does not permit and doctors are not always very good at explaining in understandable terms.

The news of a diagnosis like glaucoma represents a significant turning point in a patient’s life. Glaucoma comes with some heavy connotations. Blindness. No cure. Pain. These perceptions often occupy the public’s imagination when it comes to glaucoma; and need to be addressed adequately. Then there is treatment and monitoring. Up to 50% of patients are non-adherent to their medications. The visual field test that is the gold standard for monitoring is notoriously challenging to perform. This then gives inconclusive results because patients can struggle to perform them properly.

The recognition of these issues started a “movement” to improve patient education so that they understand their disease better, understand how to properly instil their eyedrops and learn how to perform visual field tests reliably. From 2012 to 2015, Assistant Nurse Clinician Soo-Hoo Wai Cheng was earmarked, and underwent vigorous training for the role of Glaucoma Nurse.

With the introduction of dedicated consultation slots with Nurse Wai Cheng, our glaucoma patients can now find out more about their diagnosis, treatment and tests.

But more than that, these sessions have given us valuable insights into each patient. I had a patient whom I sent to Nurse Wai Cheng to educate on the use of his eyedrops because his intraocular pressure was poorly controlled. After seeing him, Nurse Wai Cheng came to see me and informed me that this patient had dementia and in spite of a 45-minute session, was still confused about how to use his eyedrops. This added information prompted me to consider glaucoma surgery for him so he no longer needed to instil glaucoma eyedrops; and his pressure has now improved.


Nurse Wai Cheng explaining the condition to a glaucoma patient. 

We often talk about treating the patient, not just the disease. I think this example aptly brings home the point.

The introduction of the Glaucoma Nurse-Led Service has “closed the loop” in the glaucoma care we deliver, and brought about more holistic care for our patients in a tangible way.