Prof. Dr. Louis Tong from Singapore National Eye Centre (SNEC)

1. What is dry eye disease?

Dry eye disease is a common condition that occurs when your eyes do not produce enough tears or when the quality of tears is poor and they evaporate too quickly. Tears are essential to keep the surface of the eye healthy, comfortable, and vision clear. When tear balance is disrupted, patients may experience dryness, irritation, redness, burning, fluctuating vision, excessive tearing, or a gritty “sand-like” sensation. Dry eye can be temporary or long-term, and its severity can vary from mild discomfort to symptoms that significantly affect daily life, work, and screen use.

2. Why is it important to treat dry eye early and consistently?

Dry eye is often a chronic condition, meaning it usually requires ongoing care rather than a one-time treatment. If left untreated, dry eye can lead to persistent discomfort, unstable vision, inflammation, and damage to the eye surface.

Regular treatment helps to:

• Improve eye comfort
• Stabilize vision
• Protect the ocular surface
• Prevent worsening of symptoms over time
• Consistency is important; treatments work best when eyedrops are used as prescribed by your eye doctor, even when symptoms feel better.

3. What are artificial tears and how do they help?

Artificial tears are lubricating eye drops designed to supplement your natural tears.

They help to:

• Moisten the eye surface
• Reduce irritation and dryness
• Improve visual clarity
• Support healing of the ocular surface

They are often the first-line treatment for dry eye and are safe for long-term use when used appropriately.

4. Why are there so many types of artificial tears in the market?

Not all dry eyes are the same. This is why there are many different formulations of artificial tears available. They may differ in:

• Thickness (viscosity):
  Thinner drops feel lighter and are suitable for mild dry eye or frequent use, while thicker gels or ointments provide longer relief but may blur vision temporarily
• Ingredients:
  Some focus on water replacement, others improve tear stability or reduce evaporation, while certain drops support the healing of the eye surface. For instance, formulations with sodium hyaluronate are hydrating and help promote ocular surface repair, making them especially useful for moderate to severe dry eye or tear instability.
• Preservative vs preservative-free:
  Preservative-free drops are often recommended for frequent use or sensitive eyes while preserved drops may be suitable for occasional use. Multi-dose preservative-free (MDPF) formulations like Evolve HA stay sterile for 90 days after opening and are suitable for sensitive eyes and post-procedure care.

Because dry eye can involve tear deficiency, tear instability, inflammation, or eyelid gland dysfunction, your doctor may recommend a specific type of artificial tear that best matches your condition.

5. Why does my eye doctor recommend a particular eye drop for me?

Your eye doctor’s recommendation is based on:

• The type and severity of your dry eye
• Your symptoms and examination findings
• How often you need to use the drops
• Your lifestyle (screen use, contact lenses, work environment)

Using the recommended drop correctly and consistently gives you the best chance of symptom relief. If a drop causes discomfort, blurring, or does not seem effective, it is important to inform your doctor rather than stopping it on your own.

6. Do you provide specialized care for dry eye?

Yes, for severe dry eye cases with other complications, we offer comprehensive assessment and personalized management through our dedicated Dry Eye Clinic services at Singapore National Eye Centre. Our approach focuses on identifying the underlying causes of dry eye and tailoring treatment plans that may include eye drops and advanced therapies when needed. Whereas for the mild and moderate types of dry eye with no other complications, you can be taken care by your regular eye care professionals like Optometrists and general ophthalmologists.

7. What is the key message for patients with dry eye?

Dry eye is common, manageable, and treatable. With the right diagnosis, appropriate eye drops, regular warm compresses, and ongoing education, most patients can achieve good symptom control and improved quality of life. Staying informed, consistent with treatment, and engaged in shared learning makes a meaningful difference.

8. Is there a platform where I can learn more and connect with other dry eye patients?

Yes. Patients with dry eye are encouraged to join our education and patient-sharing platform on the Friends of the Dry Eye Service Substack page here.

On this platform, patients can:

• Learn more about dry eye and available treatments
• Read educational articles written for patients
• Participate in constructive discussions
• Share real-life experiences and coping strategies
• Share your stories dealing with various types of treatment for dry eye

Melatonin is one of the most commonly used over-the-counter sleep aids worldwide. Marketed as a “natural” solution for insomnia, jet lag, and poor sleep quality, it has become a go-to option for adults and even children.But is melatonin really harmless? And is it even effective?

Here’s what you need to know before reaching for that next tablet.

What Is Melatonin?

Melatonin is a hormone naturally produced by the pineal gland in the brain. Its main job is to regulate the sleep–wake cycle, rising in the evening to signal that it’s time to wind down and dropping in the morning to help you wake up.

Synthetic Melatonin Supplements

The melatonin sold in pharmacies is a synthetic version of this hormone. Unlike prescription sleep medications, melatonin is often unregulated in dosage and purity in many countries, making its effects unpredictable.

Why Do People Take Melatonin?

Most people use melatonin for:

• Difficulty falling asleep
• Jet lag
• Shift-work sleep rhythm problems
• Stress-related insomnia
• Screen-related sleep disruption

While melatonin can help in certain cases, especially for circadian rhythm issues, many people use it incorrectly or unnecessarily.

Why Melatonin May Not Be Good for You

1. Your Body Can Become Dependent on It (Psychologically)

Melatonin doesn’t cause physical addiction, but people can quickly develop a mental dependence, feeling they cannot sleep without it—especially if used nightly.

2. Dosages Are Often Too High

The body naturally produces about 0.3 mg of melatonin per night. Most supplements sold are 3–10 mg—up to 30 times what your body needs.

High doses can:

• Disrupt your natural hormone rhythms
• Cause next-day grogginess
• Lead to vivid dreams or nightmares
• Affect mood and hormonal balance

3. Quality and Purity Are Unpredictable

Studies found that many melatonin supplements contain:

• Far more melatonin than the label claims
• Contaminants like serotonin, which is unsafe

Because it’s not strictly regulated, the actual dose you’re taking may be completely different from what’s printed.

4. Side Effects Are More Common Than People Think

Melatonin may cause:

• Morning sleepiness
• Headaches
• Dizziness
• Nausea
• Irritability
• Lower body temperature

In children and teens, long-term use may even affect puberty and hormonal development.

5. It Doesn’t Treat the Root Cause of Insomnia

If your sleep issues are due to:

• Stress
• Anxiety
• Irregular schedule
• Excess screen time
• Caffeine
• Hormonal changes
• Poor sleep habits

Melatonin won’t fix those problems. It may simply mask symptoms while the underlying issue continues.

6. Not Suitable for Certain People

Melatonin should be avoided or used cautiously if you have:

• Autoimmune disorders
• Depression
• Epilepsy
• Diabetes
• High blood pressure
• Are pregnant or breastfeeding

It can also interact with medications such as:

• Antidepressants
• Blood thinners
• Blood pressure medication
• Anti-seizure drugs

When Melatonin Can Be Helpful

Melatonin can be useful short-term, especially for:

• Jet lag
• Shift-work adjustments
• Circadian rhythm disorders
• Sleep pattern resetting after travel or illness

In these cases, low doses (0.5–1 mg) taken at the right time may help.

Better Alternatives to Improve Sleep

Instead of relying on melatonin, try improving your sleep hygiene:

1. Keep a regular sleep schedule

Go to bed and wake up at the same time daily.

2. Reduce screen time

Avoid phones and tablets 1 hour before bedtime.

3. Create a sleep-friendly environment

Cool, dark, quiet rooms help your body wind down.

4. Limit caffeine and heavy meals at night

5. Manage stress

Deep breathing, meditation, or gentle stretching can help.

6. Get natural sunlight

Daylight exposure helps regulate your internal clock.

If insomnia persists, it’s best to consult a doctor to evaluate underlying causes.

Conclusion

Melatonin is often thought of as a harmless, natural sleep aid—but the truth is more complicated. While it may help in specific, short-term situations, long-term or excessive use can disrupt your natural hormone balance, cause side effects, and create psychological dependence.

Before relying on melatonin nightly, consider addressing lifestyle factors, improving sleep habits, and seeking professional guidance if sleep problems persist. Understanding the root cause of your sleep difficulties not only leads to safer, more sustainable solutions, but also supports healthier sleep rhythms in the long run.

Why is an Eye doctor worried about Sleep?

Because Sleep Is Important for Preventing Dry Eyes

• During sleep, there are corneal cells that are important for retaining fluid that regenerate.
• Poor sleep reduces tear production and increases inflammation
• Lack of REM sleep can worsen eye fatigue, redness, and light sensitivity
• People with insomnia or irregular sleep cycles have higher rates of dry eye disease

Better sleep → Better tears → Happier eyes.

You may experience eye twitches or spasms when you have not had enough sleep. Your eyes may even be more sensitive to light, or you may have blurry vision. Sleep deprivation could lead to serious eye problems, such as glaucoma, over time. Research has shown that sleep helps clear out toxins that accumulate in the retina during the day.

Patients who see me know that I believe in the holistic approach and to manage the root cause of the problem. If sleep is the cause of the eye issues, I would work on the sleep and in meantime start on a supplement that is not a sleeping pill to help regulate the sleep cycle. I have had wonderful results with a supplement called Deeper Sleep. You can read more about it here.

Read the full article on THE EYECLINIC

Dr Tan Shi Ming, Senior Consultant Orthopaedic Surgeon
Centurion Orthopaedic Centre

KNEE PAIN ON THE RISE

Osteoarthritis is the most common musculoskeletal condition affecting joints, particularly in the lower limb joints – including hips, knees and ankles. Knee osteoarthritis prevalence has increased significantly over the past few decades that up to 250 million people worldwide are affected. This prevalence is expected to rise in part due to obesity and other risk factors such as increasing age, prior knee injuries such as fractures, ligament and meniscal tears as well as the participation in endurance and high impact sports such as marathon running, football, basketball and racquet games.

WHAT IS CARTILAGE?

Joint cartilage (also referred to as articular cartilage) is a tissue made up of cells known as chondrocytes and extracellular matrix (ECM, the environment around cells). This matrix is composed of water (more than 70%) and organic components such as hyaluronic acid, collagen and other components. The composition of the ECM is important to maintain nutrition and health of the articular cartilage. Chondrocytes play a key role in keeping the joint environment healthy by producing both the building blocks of cartilage (ECM components) and the enzymes that break down old or damaged components. This balance helps the body maintain homeostasis — its way of keeping everything in check and working properly. This symbiotic relationship between the cells and its matrix is essential in ensuring the overall health and function of the articular cartilage, allowing it to withstand forces across the joint both in motion and at rest.

WHAT HAPPENS IN OSTEOARTHRITIS?

Osteoarthritis is a medical condition in which there is inflammation of the joint tissues, characterized by the degeneration of chondrocytes. This is usually precipitated by excessive mechanical loading or a prior knee injury such as ligament, meniscal or chondral injury.

Osteoarthritis often presents with symptoms of joint pain, swelling, stiffness in the early stages and joint deformities and loss of range of motion in the late stages. In advanced stages, the joint will develop contractures and impede the ability to walk.

In the early stages of osteoarthritis, too much stress on the joint or past injuries cause chondrocytes to produce more enzymes that break down cartilage. This leads to a loss of important ECM components and a decline in its quality. . In a bid to maintain the ECM, chondrocytes continue to produce increased quantities of the various ECM components — but over time, they struggle to keep up.

In the later stages of osteoarthritis, the balance between production of ECM components and degradation enzymes becomes disrupted continually. With continued wear of the chondrocytes and an altered environment, inflammation sets in — creating a vicious cycle where inflammation causes more chondrocyte damage, and the damage in turn fuels more inflammation.

WHAT IS VISCOSUPPLEMENTATION?

Various non-surgical therapeutic modalities have been used to treat osteoarthritis, each having its role and efficacy. Viscosupplementation is a non-operative, intra-articular treatment option that is based on the physiologic importance of hyaluronic acid within the ECM of articular cartilage. It usually comes in the form of hyaluronic acid injections.

The goal of this treatment is to restore the viscoelasticity of the joint. It’s similar to restoring the engine oil and shock absorbers of a car. This would reduce pain, improve mobility and restore the natural protective functions of hyaluronic acid in the joint. In the short term, patients would experience the pain relief benefits from viscosupplementation. The long-term effects are to restore joint mobility and improve joint lubrication, shock absorption and the ability to reduce mechanical stress on cartilage. Additionally, viscosupplementation provides anti-inflammatory effects, reducing symptoms produced from joint inflammation such as pain, swelling and reduced motion.

Viscosupplementation is a simple, short and highly effective treatment option for osteoarthritis of major joints such as the knee, ankle, hip and shoulder. It can be performed in a clinic or day surgery setting, under local anaesthesia, with or without mild sedation. The joint is first cleansed well with antiseptic solution, which is followed by the administration of local anaesthetic to the site of injection. Hyaluronic acid injection is then injected into the joint, followed by the placement of a comfortable bandage.

WHO SHOULD CONSIDER VISCOSUPPLEMENTATION?

Whilst viscosupplementation is an effective treatment option for joint osteoarthritis, it is important to undergo a proper and comprehensive evaluation of your joint condition by a trained musculoskeletal doctor before undergoing the procedure. This may entail a careful understanding of your symptoms, a confirmation of your condition and its severity with a physical assessment and tests.

Patients who have mild to moderate osteoarthritis would benefit most from viscosupplementation. These patients usually exhibit a good range of joint motion, have minimal bony deformities and exhibit early symptoms such as joint pain, swelling and stiffness.

Other patients who have been shown to respond well to this treatment include patients who have had meniscal or ligamentous injuries or previous surgeries such as menisectomy, meniscal repair and/or ligament reconstruction. Another group of patients who would benefit are patients who cannot tolerate anti-inflammatory pain agents (due to drug allergies, medication side effects and co-morbidities) and those who are seeking to delay surgeries.

WHY CHOOSE CINGAL?

Various formulations of viscosupplementation are available in the market. These are broadly categorized into low and high molecular formulations, with the latter being favoured in terms of stronger and longer-lasting effects.

Cingal is the first and only approved combination viscosupplement, formulated to provide combined benefits of both cross-linked high molecular hyaluronic acid and a premium corticosteroid (triamcinolone hexacetonide). This gives it its edge as a fast-acting and long-lasting pain reliever from joint osteoarthritis. It is administered as a convenient single injection with a strong safety profile due to its non-avian bio-fermented source of hyaluronic acid, making it suitable for patients who are sensitive to avian proteins.

Cingal is available across major hospitals, orthopaedic centres, and GP clinics throughout Singapore — speak to your doctor today to find out which treatment best suits your lifestyle and take the first step toward lasting relief from knee pain.

FAQ’S ON VISCOSUPPLEMENTATION

1. What is the downtime after a viscosupplementation procedure?
   There is minimal downtime after an intra-articular injection of hyaluronic acid. Minimal pain and swelling are experienced for a short period and patients are allowed to weight-bear on the injected joint immediately.
2. How long do the effects of viscosupplementation last?
   The length of effects varies amongst individuals. The majority of patients will have some improvement in their pain as soon as days after the intra-articular procedure. These effects have been shown to last up to 6 months in individuals.
3. Are there any side-effects from viscosupplementation?
   Low incidences of increased pain and swelling, joint infections, or injury to nerve and blood vessels have been reported. These can be further reduced by choosing experienced medical professionals in administering the procedures.

To view the full article, head over to Centurion Orthopaedic Centre