International Eminence in Ophthalmology
Project Manager:Callam Waller
In the middle of Singapore’s transition from a manufacturing-based economy to a knowledge-based “value creation” hub in 1990, the Singapore National Eye Centre (SNEC) was established.
At that time, cataract was the major cause of blindness. Over time, this was compounded by an epidemic of myopia in young schoolchildren, leading to visual problems later in life. Concurrently, with an ageing population, glaucoma and age-related macular degeneration (AMD) were becoming major problems.
Fortunately, at the same time, the practice of ophthalmology was experiencing a revolution enabled by new technology. A prime example of this was eye doctors’ transition from standard extracapsular cataract extraction (ECCE) to small incision “sutureless” phacoemulsification, a method which gave both positive and predictable clinical outcomes in a faster recovery time.
“We saw the gradual transition from in-patient surgeries into day surgeries and the gradual replacement of general with local anaesthesia during procedures,” begins Professor Wong, the 5th Medical Director at Singapore National Eye Centre. “These changes provided the foundations for a standalone ambulatory eye centre, giving birth to the true concept of SNEC.”
Undoubtedly, the establishment of SNEC as the national specialist centre for eye care that would be independent from the Singapore General Hospital (SGH) was one of the most profound changes for ophthalmology in Singapore, a change which would subsequently accelerate many other changes in the practice of eye care.
Ahead of its time
Beginning with a team of only nine, Professor Arthur Lim, the founding Medical Director of SNEC, experienced considerable resistance as a number felt uncomfortable leaving SGH as they were unsure if SNEC would be a viable entity.
“Of course, for many eye surgeons at that time, joining a new start-up standalone centre, separate from the 100-year old ‘mothership of SGH’ was a very risky move. Shortly after Professor Lim mooted the idea of creating a research institute within SNEC,” explains Wong. “This led to the development of the new Singapore Eye Research Institute (SERI). The bravery to build a research institute within a new healthcare institution was way ahead of its time. Research in a healthcare setting at that time was seen as counter to the primary mission of hospitals, which was to provide care.”
Times have changed considerably since that point in the Centre’s history, now fully embracing its role as a major academic eye centre in Asia and globally, with a triple and integrated mission of clinical care, research and education.
Wong adds: “As part of delivering better care to our patients, SNEC encourages its younger residents to have diverse training and to gain experience in innovation, conducting research projects, and becoming part of its teaching faculty. SNEC now partners with Duke-NUS Medical School Singapore to train future clinicians, clinician-educators and clinician-scientists as part of the massive uptake in biomedical sciences that are now recognised as the fourth pillar of Singapore’s economy.
“27 years after SNEC was conceptualised, Singapore’s population has almost doubled and now stands close to 5.5 million; this means we now face new challenges in eye care, particularly with an ageing population,” pointed out Wong who is also Chairman of SERI and Vice-Dean of Clinical Sciences at Duke-NUS Medical School.
Today the Singapore National Eye Centre receives 340,000 outpatient visits annually, meaning that more than 1,000 patients are coming through its doors daily, while performing 42,000 major eye surgeries and laser procedures. With its level of expertise in the industry, SNEC also receives tertiary referrals for complex eye conditions from overseas, such as advanced retinal conditions, corneal transplants and paediatric eye conditions.
“In the 1990s, SNEC was also among the first centres worldwide to video-tape and record all surgical procedures to use in clinical audit and teaching,” continues Wong. “This is still practiced today and we have a specialist team that audits the outcomes of procedures and this is presented to all doctors in a forum among their peers annually.”
For the research institute, SERI is now Singapore’s national research institute for ophthalmic and vision research, with a mission to conduct high impact eye research with the aim to prevent blindness, low vision and major eye diseases common to Singaporeans and Asians. SERI has the unique distinction of being among the first research clinics to be located and embedded in a hospital
“During the past decade or so, SERI has conducted landmark research that has led to tangible outcomes, continuous patient benefit and success stories,” Wong describes. “It has paved the way for significant improvements in the way in which eye diseases are treated and prevented, not just for Singaporeans or Asians, but on a global scale.”
SERI has now published 2,700 scientific journal papers as of January, 2017, alongside securing 252 external peer-reviewed competitive grants worth more than $227 million and being awarded more than 400 national and international prizes.
With the tremendous growth that has been achieved since SNEC’s inception, the plans for a new-phase two-wing Centre were conceived as early as 1992. Completed in October, 2001 at a total cost of $50 million, SNEC’s new purpose-built, eight-storey phase-two facility provides an additional 15,000 square metres to the already existing area of 6,500 square metres.
“Today our facility features a full array of consultation clinics, well-integrated diagnostic, imaging and laser systems, modern operating theatres, day recovery suites, sophisticated training and education facilities as well as a dedicated floor to house the SERI’s trial clinics and comprehensive ancillary and support facilities,” Wong describes. “On top of that SNEC has 80 consultation suites and nine operating theatres.”
All of the above enhances SNEC’s capabilities in the healthcare sector to deliver cost-effective and quality eye care to meet increasing demand and expand its role in ophthalmic education and research.
In 2014, SNEC developed the Retina Centre, complementing the services of the adjacent new Diabetes and Metabolism Centre on the campus. Then SERI started operations in the Academia Building which opened in 2013. There are four levels of basic and advanced eye research facilities such as corneal tissue engineering and stem cell, ocular genetics, ocular therapeutics, drug delivery as well as a retinal reading centre and research administration office.
“The new building is able to offer a more conducive environment for greater synergies in pathology, medical research and education to raise the benchmarks for better healthcare,” clarifies Wong. “Located within the vicinity of the clinical services at SNEC and Duke-NUS Medical School, this is a key milestone in academic medicine with a vibrant environment for networking and professional collaborations to advance diagnosis, treatment and innovative care for patients.”
SNEC is actively involved in local and multi-centre clinical trials and research into the causes and treatment of major eye conditions such as myopia, AMD, diabetic eye disease, glaucoma and corneal conditions, with hundreds of ophthalmologists from neighbouring countries. The Centre has been privy to thousands of ophthalmologists from neighbouring countries and beyond participating in the Centre’s teaching courses and international meetings which are organised annually.
In order to advance ophthalmic science and service, and to increase opportunities for professional interactions and collaboration, SNEC has also fostered strategic links with leading eye institutions the world over. Not only is the institution as a whole well-respected, but it has also selected the top talent to take it forwards successfully.
Wong continues: “Three of our top clinicians from the Singapore National Eye Centre and the Singapore Eye Research Institute were awarded the prestigious President’s Science and Technology Award in 2009, 2010 and 2014 for their outstanding contributions in translational, clinical and epidemiological research in cornea, retina and glaucoma.
"Apart from retaining this top level of talent, the other challenge we face is in continually providing good service, and even with an ever-increasing workload, we saw 250,000 annual visits in 2007, compared to close-to 340,000 today.”
An issue for the Centre is the time in which it takes to increase its manpower, due to the many years - up to 12 - that it takes to train a specialist, and at present it is challenging to keep up with the increasing population demands. However, SNEC is now working closely with the Ministry of Health with the overall aim to transform eye care, bringing eye care to the community, while enhancing quality and value for the patients.
Over the next five-10 years, SNEC and SERI hope to develop new innovation in areas of deep learning technology or artificial intelligence for diabetic retinopathy screening, telemedicine for remote diagnosis and monitoring, step-down community eye care for patients with mild or stable eye disease, and new surgical treatments such as minimally invasive glaucoma surgery and stem cell therapy for retinal diseases.