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Common Vision Problems and Low Vision

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How Does The Normal Eye Sees

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The eye functions like a camera.

Light rays enter the eye through the cornea (the clear window in front), pass through the pupil (the central opening in the iris), and are then focused through the lens before reaching the retina at the back of the eye. The retina is analogous to the film of a camera. When light rays land on the retina, they form an inverted image. The retina transforms this image into impulses that travel along the optic nerves to the brain, where they are translated into upright visual images.

Vision is clear only if the cornea and lens correctly bend or "refract" light rays, focuing them precisely on the retina's point called the fovea. In the normal eye, the cornea's focusing power aligns with the eye's length Blurry vision may be due to a "refractive error", indicating a failure of the cornea and lens to properly focus light. Prescription eye glasses, contact lenses and refractive surgery correct are used to correct or reduce refractive errors by focusing light rays closer to or directly onto the retina.

Watch the video to learn about the causes and treatments of myopia, hyperopia and presbyopia:

Myopia (Near-Sightedness)

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What is Myopia?

Myopia, or short-sightedness, is a refractive error where distant objects appear blur but near objects can be seen clearly.

Myopia arises when the cornea is excessively curved (focusing power is too high) or the eyeball is too long. This causes images of distant objects to be focused in front of the retina instead of on it. The resultant blurred image on the retina is due to the spreading apart of light rays after passing the focal point.

Singapore has one of the highest rates of myopia in the world, with an estimated 28% of Primary 1 students, 65% of Primary 6 students and 80 %of young adults experiencing myopia.

To learn more about myopia in children and the treatment options, please refer to Myopia Management For Children. Read the Paediatric Cataract for Children here.

What Are the Treatment Options?

Myopia can be corrected with corrective lenses such as glasses, contact lenses and refractive surgery such as LASIK.

Contact Lenses

Contact lenses provide a safe and effective way to correct vision as they allow light to be focused more precisely on the retina.

(Learn more about contact lenses and their associated problems here).

Refractive Surgery (LASIK)

Refractive surgery, such as LASIK, is a common surgical procedure that uses laser to correct myopia.

(Learn more about the different refractive surgery treatments at NUH LASIK Centre here)

Astigmatism

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What Is Astigmatism?

Astigmatism is a refractive error characterized by the irregular curvature of the cornea, which may be more pronounced in one direction, resembling the shape of a rugby ball or the back of a spoon. This irregularity prevents light rays from converging to a single focal point, leading to a blurred image dispersed over multiple points.

Astigmatism frequently coexists with near-sightedness or far-sightedness.

What Are the Symptoms?

Common signs and symptoms include blurred and distorted vision, eye strains and headaches.

What Are the Treatment Options?

Astigmatism can be corrected with corrective lenses such as glasses and contact lenses, or refractive surgery (LASIK).

Contact Lenses

Contact lenses provide a safe and effective way to correct vision as they allow light to be focused more precisely on the retina.

(Learn more about contact lenses and their associated problems here).

Refractive Surgery (LASIK)

Refractive surgery, such as LASIK, is a common surgical procedure that uses laser to correct astigmatism.

(Learn more about the different refractive surgery treatments at NUH LASIK Centre here)

Hyperopia (Far-Sightedness)

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What is Hyperopia?

Hyperopia, or far-sightedness, is a refractive error where distant objects can be seen clearly but near objects appear blur.

This condition arises when the cornea of the eye is insufficiently curved (resulting in a lower focusing power) or when the eyeball is too short. This combination leads to the focal point falling behind the retina, causing a blurred image as light rays haven't yet converged when reaching the retina.

What Are the Treatment Options?

Hyperopia can be corrected with corrective lenses such as glasses and contact lenses, or refractive surgery (LASIK).

Contact Lenses

Contact lenses provide a safe and effective way to correct vision as they allow light to be focused more precisely on the retina.

(Learn more about contact lenses and their associated problems here).

Refractive Surgery (LASIK)

Refractive surgery, such as LASIK, is a common surgical procedure that uses laser to correct hyperopia.

(Learn more about the different refractive surgery treatments at NUH LASIK Centre here)

Presbyopia (Old-Sightedness)

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What is Presbyopia?

Presbyopia, commonly referred to as old-sightedness or "Lao Hua", is a refractive error caused by the eye's natural ageing process, resulting in an inability to focus on near objects.

As the normal eye ages, the lens loses elasticity and the ability to change its shape. This results in a need for assistance, such as reading glasses, for near tasks like reading, typically becoming noticeable around the age of 40.

What Are the Treatment Options?

Presbyopia can be corrected with bifocal contact lenses and glasses, or refractive surgery (LASIK, PRK or PRESBYOND).

Contact Lenses

Contact lenses provide a safe and effective way to correct vision as they allow light to be focused more precisely on the retina.

(Learn more about contact lenses and their associated problems here).

Refractive Surgery

Presbyopia can also be treated with either LASIK or PRK. One eye can be corrected to see far and the other eye corrected to see near. A technique known as monovision corrects one eye for distance vision and the other for near vision, eliminating the need for glasses or contact lenses. This adjustment is easily adapted by the brain within one to two weeks, and there are no issues with activities like driving or playing sports. The blending of vision between the two eyes can be further enhanced using aspherical treatment to increase the depth of focus of both eyes.

(Learn more about the different refractive surgery treatments at NUH LASIK

(Learn more about the different refractive surgery treatments at NUH LASIK Centre here)

Low Vision Rehabilitation

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What is Low Vision?

Low vision refers to visual impairment that cannot be corrected with standard glasses, contact lenses, medical treatment or surgery. Individuals with low vision experience severely reduced visual acuity, contrast sensitivity and/or significantly obstructed field of view.

Low vision may affect daily activities such as recognising faces, reading small prints and large signs, identifying obstacles and reduced independent mobility.

What Causes Low Vision?

Common causes of low vision include age-related macular degeneration, diabetic retinopathy, glaucoma, neurological conditions and trauma.

How Does NUH Help Persons with Low Vision?

NUH has established a Low Vision Enabling Programme, featuring a multidisciplinary team of optometrists and occupational therapists specialising in low vision rehabilitation. The team works closely with patients and their families to help regain lost function due to visual impairment. The approach encompasses a comprehensive strategy addressing visual and functional challenges related to reading, safety, daily activities, community participation, and psychological adjustment to vision loss.

What is Low Vision Rehabilitation?

Low vision rehabilitation aims to reduce the functional impediments imposed by vision loss. It begins with a low vision consultation, which involves optometric low vision evaluation and occupational therapy assessment. This may be followed by prescription and dispensing of low vision optical devices such as magnifiers, telescopes, assistive technology and sensorial adaptive devices as appropriate. In addition, visual skills trainings and adaptive therapies may be provided to maximise function, safety and independence. This comprehensive rehabilitation service can be conducted at home and/or in the clinic.

NUH Vision Care Services in the Community

NUH Vision Care Services, comprising the Eye Care for Empowered Community (EC2) and Seniors' Eye Rehabilitation Programme (SEER) <*HYPERLINK TO PAGE 1 ACCORDION 7 / COMMUNITY ENGAGEMENT AND OUTREACH SECTION>, was established in 2015 to identify seniors with poor or low vision, providing early intervention and teaching strategies for safe functioning within the limitations of their low vision.

Low Vision Consultation and Rehabilitation Are Provided By:

Mr Danial Bohan

Dip Optom (Merit), BSc (Hons), MSc

Senior Optometrist

Ms Chen Xuanyu

BHSc (Occ Therapy), PG Cert Low Vision Rehab

Senior Occupational Therapist

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2023/12/26