About Dr Brian Ang

Your Questions

Your questions and comments about any aspect of your eye health not covered in this website are most welcome. To submit your question or comment, please click here.

July 2023

Anonymous from Halifax, Canada comments:
Hello, I am writing this in regards to let people know about how to get some possible help for eye nerve pain. I will briefly share my situation and the research and info I came across over the years below, in a step by step basis.

– I had pterygium surgery on my left eye in 2014, it’s pronounced Ter-ig-e-um the “p” is silent, a pterygium is a growth of flesh on the surface of the eyeball that was surgically removed. The recovery process has not gone well still almost 9 full years later, it’s still bothering me. I have had aching/throbbing pain, soreness and a general dry eye discomfort over the years.

– Trying to get help is not easy because alot of eye doctors use the Slit Lamp and that won’t necessarily show nerve damage. What is needed to detect and display a nerve damaged eye is something called the In-Vivo Confocal Micropscopy, this is a higher resolution optical imaging that is much more detailed and can show the damaged amputated nerves from eye surgery or whatever may have caused it. The patients who go to eye doctors and complain of eye pain are often dismissed because most eye doctors use the Slit Lamp which is over a century old and that won’t show nerve damage, the In-Vivo Confocal Microscopy is needed if you could hypothetically attain that type of imaging.

– Once an eye is examined with the In-Vivo Confocal Microscopy which can show the damaged amputated nerves a patient could then get a proper diagnosis for eye pain which is called Corneal Neuralgia or Corneal Neuropathy. Corneal Neuralgia can happen after eye surgery when the nerves are amputated and won’t regenerate themselves like their supposed too.

– Treatment for Corneal Neuralgia that I came across can potentially be attained with Autologous Serum Eye Drops or Endoret Serum Eye Drops which are supposedly similar as told to me by an ophthalmologist recently when I inquired about the Autologous Eye Drops.

– Autologous/Endoret Serum Eye Drops are made up of the patients own blood/DNA and formulated with a solution that create a eye drop that hopefully will work in harmony with the patient’s body and regenerate those nerves that were amputated by eye surgery. These special eye drops are made in a lab and have to be refrigerated once attained by the patient to my knowledge. A prescription from a eye doctor or physician is probably needed and they may also have to facilitate this process or the patient may have to make effort as well, that’s how it’s for me in Canada anyhow as i’m trying to make contact about the Endoret drops personally that a ophthalmologist recently told me about and wrote down some info for me.

– I hope this was helpful, as I continue on my journey to get help for my post surgical left eye, I wanted to share some information I learned over the years. Please share this with anyone or any support groups or eye doctors it may help as alot is still not known about Corneal Neuralgia and some eye doctors may not be trained or know how to detect it.

Thank You.

Brian replies:
Dear Anonymous,

Thank you for your in depth commentary about corneal neuralgia. I think it is an important area that perhaps doesn’t get the attention that it deserves, so well done in trying to create awareness for this.

May 2023

Rita from Townsville, Australia asks:
I have ocular albinism and would like to know if you have any support groups or know of any? I’m almost 50 and would love to know how others navigate life / family/ work

Brian replies:
Dear Rita, thank you for your query.

The only support group I know of for albinism is the Albinism Fellowship of Australia.

It looks like quite an active and friendly group, so do give them a call and see if they can provide you with the support you need.

Good luck!

October 2022

Medina from Miami, United States of America asks:
My Mother needs to have an eye injected due to a shadow the Doctor saw, but she had contact implants a long time ago, and she can see very well until she started to notice a shadow on the corner of her right eye, but now the shadow moves along with her eye wherever she looks at. The Doctor wants to give her an injection on her cornea. Would she lose the implant if they give her an injection?

Brian replies:
Dear Medina, thank you for your query.

Unfortunately it is not clear from your question as to what implants your mother had and what kind of injection her ophthalmologist has recommended her to have.

Apologies, I am therefore not able to provide any opinion on this.

May 2022

Anil from Melbourne, Australia asks:
My name is Anil and I am trying to order the PEA supplement and am unable to locate this on your website. May I please request your assistance.

Brian replies:
Dear Anil, thank you for your query. Please click on: Palmitoylethanolamide (PEA) as a glaucoma treatment

Hope this helps and good luck!

April 2022

Abhishek from Lucknow, India asks:
Does the Gloeye tablet help in the treatment of macula edema?

Brian replies:
Dear Abhishek, thank you for your query.

Gloeye is a supplement manufactured in India. Its active ingredients are bilberry extract and pine bark extract.

Bilberry is an antioxidant that helps to protect against retinal degeneration. Pine bark extract is beneficial in diabetes and can reduce retinal edema.

However both have not demonstrated a benefit specifically for macular edema, whether used individually or as a combination.

What has been shown is that when taken together, they can reduce eye pressure. This is very helpful for glaucoma patients. The combination of bilberry and pine bark is also marketed as Mirtogenol.

If you have macular edema, please consult your ophthalmologist for diagnosis and appropriate treatment.

March 2021

Lin from Green Lane, United States of America, asks:
Why do I see double images when I move my head after second cataract surgery?

Brian replies:
Dear Lin, thank you for your query. Seeing double images after second cataract surgery may be the result of posterior capsular opacification or residual astigmatism.

It is best to be examined by your ophthalmologist if the double vision persists.

February 2021

Nick from Lake Stevens, United States of America, asks:
Can two XEN gel stents be placed in one eye? What would be the reason if the doctor chooses to place a second XEN gel stent when the 1st one was being placed?

Brian replies:
Dear Nick, thank you for your query. The answer is yes, two XEN gel stents can be implanted in the eye as a surgical procedure for glaucoma.

This is not common. The main reason for implanting a second XEN gel stent is if there is uncertainty as to the positioning of the first XEN gel stent.

Hope this is of help.

June 2020

Luigi from Montreal, Canada, asks:
I was injected with Anti-VEGF and was completely blinded by the procedure, my vision was 20/50, to complete darkness and all they can tell me is learn to live with it. Then they wanted to start on the other eye, that in accordance to another doctor is fine, but they will keep an eye on it.

Brian replies:
Dear Luigi, thank you for your query. I am sorry to hear that the anti-VEGF injection resulted in complete blindness in one eye. Anti-VEGF injections are now the gold standard treatment for AMD (age-related macular degeneration) and DMO (diabetic macular oedema), among others. Without the injections, the disease will cause progressive loss of vision. Unfortunately the injections are not without risks. The risk of blindness from a severe complication is less than 0.1%, but it can still happen.

If your ophthalmologist has recommended injections in the other eye, it is because the risk of not injecting outweigh the risk of injecting. I would follow the advice of your ophthalmologist, especially since you have also already obtained a second opinion which confirms the same.

I hope this helps.

February 2020

Melissa from Lincolnwood, United States of America, asks:
I have very difficult vision. I had contact lenses that corrected my issues fully for 15 years. The company stopped making my lenses and I have had six months of misery ever since. My family and my friends are tired of listening to me. I am currently working through every lens out there and experiencing double vision, nausea and plan ol blurriness. I am at my third specialist. But I seem to have a very “tight” visual field and see very small change. Do you know of a support group for something like this. I am getting so depressed. Thank you.

Brian replies:
Dear Melissa, thank you for your query. I am sorry to hear about your predicament. There are usually support groups for most eye conditions. I am not sure what your diagnosis is, but it sounds like you may have keratoconus. I believe there should be a keratoconus support group in your area. Your specialist or local optometrist should be able to provide you with further information about this.

I hope this is of help, and good luck!

October 2019

Pauline from Milton Keynes, United Kingdom, asks:
Four months ago, I had consecutive lens replacement with cataract surgery to correct long distance vision. My post op distance prescription for my left eye is +1.25, and my right eye is +0.75. Is this the best I could have expected?  I am worried about my left eye as I can see a white ‘cloud’ at the top, centre of my eye. No one can give me an explanation that I understand. Also my eyes have been red rimmed from just after the 2nd op. My GP says It’s not blepharitis. Both eyes look as if I have red eye shadows surrounding them. I would be grateful for any comments. Thank you.

Brian replies:
Dear Pauline, thank you for your queries which I will answer in turn.

1. Is a post op distance prescription of +1.25 in the left eye and +0.75 in the right eye the best that you could have expected? This is difficult to answer without knowing the condition of your eye beforehand. Generally speaking, I aim for my patients undergoing cataract surgery to have a post op distance prescription of between -0.10 to -0.50, so your current post op prescription is not the most ideal.

2. A white ‘cloud’ could be due to posterior capsular opacification (cloudiness behind the intraocular lens implant) or posterior vitreous detachment.Posterior capsular opacification can easily be treated in 5 minutes with an office-based procedure called laser capsulotomy. Usually, no treatment is indicated for posterior vitreous detachment. However if the symptoms are very bothersome, this can be treated with an operation called vitrectomy, which is similar to surgery to repair a detached retina.

3. There are many causes for eyes to be red. Some of the common reasons include dry eyeblepharitis, and irritation to eye drops. Unfortunately it is not possible to say what your red eyes are due to without examination at the slit lamp.

I hope this helps, and good luck!

July 2019

Judy from Melbourne, Australia, asks:
Hello Brian, my husband has a cataract on the eye that sustained a blunt impact injury 20 years ago. He has seen an ophthalmologist who has diagnosed zonular dialysis. The report is scary actually. Can you please explain this condition in layman’s language? The specialist he saw did not fully explain the risks involved removing the cataract with this prevailing injury. Many thanks.

Brian replies:
Dear Judy, thank you for your query. A cataract is the natural lens that has become cloudy. Cataracts mostly develop with age, but can also develop as a result of trauma.

In the normal eye, the natural lens is held in place inside the eyeball by zonules. Think of the zonules as cobwebs, supporting the lens in the middle. The zonules (cobwebs) keep the lens suspended in the correct position within the eye.

Following trauma, the zonules can be damaged just as cobwebs can. When this happens, this is called zonular dialysis or zonular dehiscence. If too many zonules are damaged, there won’t be enough zonules to support the lens in the correct position.

In normal cataract surgery, intact zonules are needed for the  intraocular lens implant to be implanted successfully in the ideal position (this is called “in-the-bag implantation”). The lack of zonules in your husband’s case means less support for the lens during surgery, thus making the operation more tricky and time-consuming to perform.

There is a risk that a second operation may be required to fix any problems caused by the zonular dehiscence. This may include a vitrectomy procedure, when the lens/cataract loses all zonular support and drops to the back of the eye instead of being suspended in the eyeball. This may also include a secondary lens implant, when the intraocular lens implant has to be stabilized using a technique that does not require support from the zonules (this is called “out-of-the-bag implantation”).

I hope this helps. Good luck and all the best.

Disclaimer: Replies to your questions are only general in nature, and in no way are to be considered as replacement for a proper ophthalmology consultation and examination. If you require a more specific evaluation, please consult your ophthalmologist for a full eye examination.

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