They call me "Dr. Shan."
Tel: 604-730-8869
Fax: 604-730-0556
COVID-19
MASKS ARE OPTIONAL
We can supply one for you if wish to wear one.
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Please do not arrive more than 5 minutes early for your appointment as we have limited space in our waiting room.
PATIENT INFORMATION LITERATURE
This page is under construction, but you will find some information about common eye disorders, like glaucoma, cataracts, diabetic retinopathy, and macular degeneration.
Diabetic Retinopathy
It is recommended to have regular eye exams (typically annually) if you have diabetes. Your eyes will be assessed for any sign of the effect of diabetes. The most common ocular side-effect of diabetes is diabetic retinopathy. The longer you have diabetes, especially if the blood sugar is not well controlled, the more likely it is for diabetic retinopathy to develop. It is important to understand that while we can easily see the damage inside the eye, blood vessels in other organs, such as the kidneys, are likely suffering the same damage. Good blood sugar control is very important for the eyes and the rest of the body.
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There are two types of diabetic retinopathy: Non-proliferative and proliferative. Most cases of non-proliferative diabetic retinopathy do not require treatment, but the damage to the retina and blood vessels is a warning sign that the blood sugar level may require better control. There are some cases of non-proliferative diabetic retinopathy (e.g., diabetic macular edema) that may require injection of drugs into the eye or laser therapy. Proliferative diabetic retinopathy involves the growth of new blood vessels to replace the damaged ones. These new vessels often leak. Injection of an anti-vascular growth drug into the eye, and/or laser therapy is usually recommended to limit the damage.
Cataracts
The human eye has a lens located just behind the iris (coloured part of the eye). This lens is responsible for about one-third of the focusing power of the eye. A cataract is an opacity in the lens. While some people can be born with cataracts, the most common cause is aging. It is believed that everyone would get a cataract if they live long enough. Like grey hairs and wrinkles, it happens at different ages for different people.
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Once a cataract develops, it can cause blurred vision, halos around lights, and glare. Most cataracts develop fairly slowly (taking years tfrom the first detection to the time it interferes with one's lifestyle. In less common cases, a cataract can progress quickly and require surgery earlier. Many years ago, it was necessary for the cataract to 'ripen' (get quite dense) before surgery was performed. Now, surgery is recommended when the cataract reduces vision to the point that daily tasks are impacted.
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Prior to surgery, various parameters of your eyes will be measured to determine the lens power to be used. The surgery involves removing your natural lens and replacing it with an intraocular lens implant. If the lens is not replaced, thick glasses or contact lenses would be required after the surgery.
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When scheduling surgery, Dr. Shan will discuss intraocular lens implant options. The government medical services plan covers the basic lens which will give good quality vision. Glasses would be required, at least part-time. Optional lenses can improve vision without glasses (in the case of astigmatism), and may also provide the ability to see distance and near without glasses. Not everyone is a candidate for the optional lenses.
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Surgery is done in an operating room (not at the office). Surgery takes less than 15 minutes in most cases. You will be required to use drops in your eyes for up to four weeks following the surgery. You will also need to limit your activities for the first week after surgery, especially those activities that involve heavy lifting. You will return to the office one day and one week after the surgery for follow-up exams.
Macular Degeneration
The macular is a small part of the retina that is responsible for being able to see fine detail. If the macular is damaged, it will be difficult or impossible to see detail, making tasks like reading to be a challenge or not possible.
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Most cases of macular degeneration are caused by the aging process. It is kind of like getting wrinkled skin in this delicate area of the retina. There are types of age-related macular degeneration: Dry and wet. The dry form of macular degeneration is typically a slow-progressing version. Unfortunately, there is no treatment for this variety. Taking supplements meant for macular degeneration may slow down the progression. The wet kind of macular degeneration can cause quick changes to one's vision. Once macular degeneration progresses to the wet variety, injections of drugs into the eyes can help to arrest the progression and can sometimes restore some of the lost vision. These injections are done at regular intervals for a period of time that is decided by the retinal specialist.
Glaucoma
The eye produces a fluid, called aqueous, to provide nutrients to the parts of the eye that do not have blood vessels. The aqueous needs to drain out of the eye at the same rate as it's being produced. If the drainage is restricted, the fluid accumulates in the eye and causes the pressure in the eye to increase. In almost all cases, this does not provide any symptoms to alert the person of any problem. For this reason, regular eye exams (more often as one ages) are required.
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If the pressure in the eye rises too high, a condition known as glaucoma develops. In the early stages, it will cause an undetectable loss of peripheral vision. As the disease progresses, more vision is lost and will become noticeable. In the end-stages, blindness may occur.
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Treatment of glaucoma is usually in the form of eye drops. While it will seem like the drops are not doing any good, it is important to continue to use them as directed. You will be asked to get your eye pressure checked regularly. Please use the drops on your regular schedule leading up to any eye exam, unless directed otherwise. If treatment with drops is not successful, there are surgical methods that can be utilized. Surgery is usually done only if medical therapy has been unsuccessful.
Hydroxychloroquine (aka Plaquenil) and the eye
Hydroxychloroquine (and chloroquine) is used to treat various diseases, including rheumatoid arthritis, Sjogren's disease, and lupus. While damage to the eye is rare, it is important to be screen annually for any sign of toxicity from the drug. In the early stages, most people have no symptoms. It is only possible to detect damage through special testing such as visual field tests and optical coherence tomography (OCT). The probability of developing toxicity increases with higher doses, prolonged use (especially more than 20 years), and in individuals over 60 years of age.
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If toxicity is detected, the patient is referred to a retinal specialist. In most cases, discontinuation of the drug is recommended. Even after the drug has been stopped, the damage to the eye may continue to progress.