From left: Khaw, Fong and Mano (Photo: SooPhye)
Three ophthalmologists who started in government service before going into private practice now call themselves “accidental entrepreneurs”. Dr Khaw Hoon Hoon, Dr Kenneth Fong Choong Sian and
Dr Manoharan Shunmugam were often asked why they traded established clinics for worries about investment and risk to open OasisEye Specialists on Jan 2, 2020. Two months later, Covid struck — something even the savviest business mind could not have foreseen.
Khaw remembers those uncertain early days. “If you think about the cost, you cannot sleep at night. So, you don’t think too much, just carry on day to day and hope things will be okay.”
“We had the funds but still, it was personal money,” Fong adds.
Clearly, a mindset centred on their vision, a sound business model, decades-long experience and loyal patients who had been seeing them for years pulled these partners through. On hindsight, the lockdowns were “a true measure of a business’ resilience”, says Fong. “It allowed us to be focused, to streamline our work and be very efficient. To be honest, after the pandemic, we just expanded because of this.”
OasisEye’s management is practically the trio, with each having separate roles but working in parallel. Khaw is in charge of operations side of things, including administration and licensing; Fong handles business development and marketing; and Mano takes care of clinical services.
They met as colleagues and became friends who socialised frequently. Having served in the public and private sectors, they could compare the differences between both. What was missing, it struck them, were sub-speciality services in the latter, to treat more complicated cases such as retinopathy of prematurity (ROP) and paediatric retinal detachment, or carry out oculoplastic and related oculofacial procedures.
In 2018, they mulled over the idea of a doctor-led practice where specialists, particularly those dealing with more complex situations, could work as a group. Ownership would give them control of technology and equipment without interference by management, as happens in private hospitals. After all, they knew the business like the back of their hand.
A lot of the time, Fong shares, the decision-making is very straightforward.
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“We know what to buy, which staff to hire. We also have an idea of how to design an eye centre, the flow of patients and, more importantly, how to deal with them and their complaints, insurance companies and big corporations that want to send their staff to us. We can manage all these directly ourselves, so there is some cost-saving, which we pass on to the patient.”
The setup enables multiple practitioners to share facilities, cross-covering and referring cases to each other should the need arise. Also, with investment in equipment astronomically high nowadays, no doctor can afford these “expensive toys”. The only way is to pack the best tools under one roof, and make them accessible to a group.
Entrepreneurship came about “by accident” but they have learnt each others’ roles and cross-cover when necessary. “Of course, we have a very able administration team assisting us,” Fong says. “When I became a doctor, I never imagined I would invest my money to set up a centre.” It is not unusual for ophthalmologists to do that, though. In India, it is common to see multi-generations of whole families running such set-ups.
Owning and helming OasisEye takes Khaw back to her student days of loving mathematics. There were options like science and IT to pursue, but medicine came up. “It is in my character; I can do all these things.”
Having helped her husband manage a fertility centre was grounding for her current role too, although there is lots of learning on the spot from contractors, engineers, architects, lawyers and more. “We found we could actually do it. And I think we’ve been doing it well, the way we want.”
With things quiet in their first year, they took the opportunity to provide Covid-19 vaccinations, conduct internal training and run Mandarin classes for staff so they would be familiar with the terms of different eye conditions.
Why the eye and not, say, a bigger organ in the body?
“Eyecare involves the best combination of medicine and surgery and we can make a huge impact in people’s lives with just one operation,” Fong says. Take cataracts, a common ailment: Patients can see well the very next day.
From speaking to them, he finds many would rather lose a limb than their sight. “Those who have gone blind are often depressed because they lose a lot of their independence.”
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Surgery is exacting as there is a very small margin for error. “Surgeons cannot afford to make any mistakes because they are dealing with such a tiny organ. So, we have to be very good at what we do.”
Mano, among a handful of specialists who treats childhood eye disorders in the country, is up for the challenges involved. “I was just telling someone I did orthopaedics for six months and found it a bit boring. Ophthalmology is more interesting because of how fine the work is.”
Khaw, who loves handicrafts, views the science related to the diagnosis and treatment of ocular disorders with the eye of an artist. She sees the organ as “the moon or the sun, the mountains, valleys and river flowing around. Every day, I just enjoy looking into the windows of life — that’s how I imagine the eye. Everything you do with the retina, all the corrections, are so beautiful.”
In reality, the picture is darker. With the precedence of the myopia (nearsightedness) epidemic, things are quite pressing actually. A lot of pre-schoolers are having problems with their vision because of this, Mano says.
Childhood onset myopia tends to progress as eyes continue to grow until a kid is about 12. Higher levels increase the risk of disease in adulthood, research shows.
About 80% of Asia’s population will become myopic, a major public health problem, Fong warns. In Singapore, 90% of children are at risk. Already, one billion people in the world will be short-sighted by 2040, and of that number, maybe 200 million will have very high myopia.
Pathologically, myopic patients are at much higher risk of problems such as glaucoma, cataracts, retinal detachment and macular degeneration.
Worldwide, there is a big push to reduce the incidence of this vision condition and prevent the common causes of blindness.
But there is a bright ray of hope: Two of the easiest ways to fight myopia are to reduce gadget use and get children outdoors.
Last September, the US’ National Academies of Sciences, Engineering and Medicine released a new report recommending that myopia be classified as a disease — so stakeholders will invest in its prevention and management — and policies be implemented to encourage children to spend one to two hours outdoors each day. There is unequivocal evidence that more time outdoors slows excessive eye growth in kids and therefore reduces the risk of their developing myopia, the report adds.
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“People are indoors more now and then gadgets come in. This trend the world is moving into has badly affected the eye and our vision,” Khaw says.
“We find that of all the organs in our body, the eye is one of the most important structures [impacted] by our lifestyle, and consequently the most at risk.”
Even newborns are not spared eye problems. In the neonatal ICUs, doctors are getting better at keeping babies born too early alive. But they develop scarring and then retinal detachment, says Mano, who is seeing a third epidemic of ROP-related blindness in pre-term births.
The reassuring part is, 90% of cases do well with treatments such as laser and injections into the eye from birth. “What Manu is doing is so special, we hardly see it — saving small little babies,” Khaw adds, proudly.
OasisEye, whose logo is a stylised view of the pupil surrounded by a flora formation of eight ren (people in Chinese), has 11 outlets today, each with a doctor in charge. Staff strength has grown from 30 to 200, with half the number based at its Kuala Lumpur headquarters in Nexus Bangsar South. It started with seven specialists and now has 40.
At 25,000 sq ft and with four operating theatres, the KL base is as big as it gets. If demand grows, they should build new outlets in other parts of the Klang Valley, where the need is, Fong reckons. “That way, you bring the care closer to patients as well.”
Growth has been organic, with medical colleagues wanting to join every year. “But we don’t have a corporate mindset or target of how many centres and where to open. It’s more like we want to attract doctors with the right mindset.
“I think the culture of this organisation is very important. A lot of the time, there’s debate about healthcare costs. We’re trying to look beyond this: aim for high quality because every patient deserves the best treatment and focus on that. Along the way, because you do high volumes of a specific thing, you can reduce costs because of economies of scale.”
Khaw believes that when one creates a brand, it is crucial to have a sense of exclusivity. Specialisation is the way to go, evident from the growing number of centres dedicated to the heart, gut and other parts of the anatomy. “You decentralise but become very specialised. You gather the services of good people who share facilities, and it becomes more cost-effective to deliver better care.”
Looking back on their first year, Fong says they “survived” with the support of local patients. “Our doctors were well-known but OasisEye wasn’t then.
“So, it’s important we get the best specialists, who have their own reputation among patients. It’s like, if I want a certain thing done, I would look for the doctor first, right? Then where he practises just follows.”
It helped, too, that with the lockdowns, people had time to sort out their health issues. The economy was not great, but many were not spending and had disposable income. Interestingly, those who would usually head overseas to seek treatment turned to local clinics. “They realised that, actually, Malaysia has very good healthcare.”
With travel curbs a thing of the past, they are seeing an influx of tourists, particularly from Indonesia, who make up a sizeable percentage of their clientele. This is not surprising, because medical tourism is mushrooming in the region.
Like Malaysians, Indonesian patients are savvy too, going online to check reviews, Fong observes. “They’ve been to Singapore and Penang and when they come here, they’re quite certain they want us to look after their eyesight.” Often, their whole family tags along and stay because language is not an issue and the culture is similar.
Fong expresses surprise that eye treatment costs in KL are about half of that in Jakarta’s top hospitals and centres. That aside, the doctors there are swamped. As for Singapore, “we are one-third the cost there”. He lauds the government’s emphasis on medical healthcare tourism because “we can serve the region and there is economic spillover for the country”.
Keeping on one’s toes with eyes open wide is vital in ophthalmology’s competitive space. But these partners have begun to look further ahead, to when they hang up their white coats.
Every OasisEye centre has a person in charge who is younger. “That’s important because when I retire, there will be someone to look after my patients,” Fong reasons.
Having a succession plan ensures the next generation of sub-specialists can continue to provide the care patients have come to expect. “Of course, the younger doctors are happy to join because we are an established group with mature patients and an interesting caseload. They will learn a lot too, so it becomes a positive cycle,” adds Khaw.
“I train them in exactly what I know, passing down the knowledge. Never be stingy with that. Tell and teach everyone everything and when they eventually take over, patients will be comfortable.”
The centre welcomes optometry and medical students from local private universities who join for clinical attachments, and students from overseas doing electives. It is developing a paramedical programme for SPM school leavers keen on a job in the industry but do not have a place to get the qualifications to perform eye checks or learn to handle patients.
Long term, they want to do more doctor training. Already, on an informal basis, there are weekly postgraduate tutorials for students in the public sector preparing to be eye doctors.
Gathering all these efforts together and viewing them from a personal perspective, Fong says: “I generally do not operate on my own family members. But I would want a colleague I trust who can do it.
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“We approach training and succession from this simple level,” adds the specialist who, in 2012, co-wrote Food For Your Eyes with his wife, Goo Chui Hoong. It highlights how diet can boost eye health and plays a role in preventing age-related macular degeneration, the leading cause of blindness in developed countries.
Available as an e-book now, it won Best Cookbook in the World (Health category) at the annual Gourmand Cookbook Awards in Paris. Among its eye-friendly recipes is one for healthy nasi lemak, which patients love, Fong says. Supplements may have better bioavailability but only about 20% gets absorbed and the rest is passed out. “Evidence shows the best way to get nutrients is through cooked, natural ingredients.”
Even after 20-plus years of focusing on the eye, “we’re all still very passionate about it”, he says. In many parts of the world, including Malaysia, ophthalmology is the most competitive speciality to join. In the UK, for example, there are 1,000 people applying for 100 places every year, and they are all graduate doctors. Sub-speciality training is another two to three years, by which time the candidate can easily be 35. It is a long journey patients may not always understand.
But he and his cohorts do. “That’s why we want to build centres where specialists can give 100%, without management meddling. We feel this is a much easier way to run a practice. All those who join us are like shareholders; they feel invested and part of the family.”
This article first appeared on Jan 27, 2025 in The Edge Malaysia.
