First Singapore Eye Research Institute International Meeting

28 Sep 2001

By Mr Lim Hng Kiang

Prof Arthur Lim, Chairman, Singapore Eye Research Institute

A/Prof Donald Tan, Director, Singapore Eye Research Institute

Distinguished guests

Ladies and gentlemen

Introduction

It is a pleasure for me to be here this morning at the Opening Ceremony of the First Singapore Eye Research Institute International Meeting. This meeting, which is being held in conjunction with the 3^rd Singapore National Eye Research Meeting and the inaugural meeting of the Asia-Pacific Society of Eye Genetics, has brought together clinical and scientific researchers from over ten countries. I am happy to see the enthusiasm and the progress we have made in ophthalmology research.

Development of research in ophthalmology

Research in ophthalmology in Singapore has come a long way since 1934, when ophthalmology was first set up as a speciality at the then General Hospital. More than a few important discoveries have been made along the way. In the 1940s, the recognition that many disorders of the eye were due to deficiencies in vitamins A and B led to the enactment of legislation requiring the fortifying of all condensed milk with vitamin A. In the early 1970s, an epidemic eye infection that swept across Africa and Asia led Singapore researchers to isolate two distinct viruses that caused the epidemic. As we enter into the 21^st century, eye research will expand increasingly into the realms of genomics and stem cell research.

Importance of research

It is important that we establish strong research teams in our hospitals and centres. Clinicians and researchers must also aim to be internationally competitive by working closely together in selected niche areas where we have research strengths. The focus on biomedical and clinical research will provide us with a better understanding of diseases which are common and important in Singapore and the region. It would also keep our clinicians up to date with the rapid developments in their areas of expertise. Together, these should translate into improved care for our patients and better preventive public health programmes. In some cases, we also hope that there would be discoveries which may have commercial value in the form of better diagnostic tests or more effective treatments.

Increasingly, medical institutions are also being benchmarked by the research which they do and not just the number of patients seen or the number of procedures performed. The quality of research produced by an institution often distinguishes an excellent institution from a good one. Internationally, research data is being used to assess and compare centres. To be a regional and world-class ophthalmology hub, we need to ensure that our institutions are innovative and produce high quality research. To do so, it is very important that our hospitals and research institutions collaborate closely because Singapore is too small for our different institutions to go separate ways.

We have made significant strides in the area of ophthalmology research. This has been possible through the hard work of our researchers, the prudent allocation of human resources, the development of research facilities and the collaboration of our research institutes. Let me elaborate.

Human resources

Firstly, human resources. Today, we have adequate numbers of very well-trained ophthalmologists and we are continuing to train more. Our institutions are also committed to the training of researchers. The proposed formal affiliation of the Singapore Eye Research Institute (SERI) with the National University of Singapore (NUS) will not only augment the research infrastructure of both institutions, but also enhance the training capabilities of the NUS Department of Ophthalmology. Similarly, the proposed SERI Clinical Scientist Programme will enable ophthalmology registrars undergoing Advanced Specialist Training to combine clinical training in ophthalmology with a structured research programme.

Research infrastructure

Secondly, research infrastructure. Human talent is the critical factor for a successful research enterprise. However, good research environment and infrastructure are also very important. In 1997, my Ministry allocated a five-year grant of $24 million for the development of the Singapore Eye Research Institute. SERI has grown and I am happy to note that today also marks the official opening of SERI's new facilities on two floors of the new Singapore National Eye Centre building. As SERI grows, produces more high quality research and recruits and nurtures more top researchers, it should be able to compete for greater research funding from the National Medical Research Council and Biomedical Research Council.

Collaboration

Thirdly, collaboration. Given Singapore's small critical mass of clinicians and researchers, it is crucial that the ophthalmology community here work very closely together, in order that Singapore as a whole will succeed. I am happy that SERI is working on developing a formal linkage with the National University of Singapore. SERI already has close research collaborations not only with NUS, but also with the Defence Military Research Institute (DMRI), and the Singapore Polytechnic. It is also heartening that stronger research collaborations are being developed between ophthalmologists in SNEC, NUH and TTSH through SERI. I would encourage SERI to do more in this regard.

It is also very important for our local researchers to have strong linkages and collaboration with internationally renowned centres. It has done so with the Lions Eye Institute in Australia, the Moorsfields Eye Hospital in London and Johns Hopkins University in the United States. These areas of cooperation will greatly strengthen our own research capabilities.

Key concerns

Next, I would like to highlight two key challenges facing ophthalmology in Singapore. The challenges are in the areas of myopia and blindness in the elderly.

Myopia

Myopia is an area of public health concern in Singapore. Firstly, the prevalence of myopia in Singapore is one of the highest in the world. It is a problem that affects all ages. 15% of our preschoolers, 33% of our primary one students and more than 70% of our youths who are completing their university education are myopic. Secondly, a large proportion of Singaporeans have high myopia - about 10% of Singapore adults compared to less than 2% in most Western populations. Thirdly, both the prevalence and severity of myopia have increased significantly over the past two decades. Nearly 40% of our adults aged 40 and older, are myopic. But now, the incidence is much higher with each new cohort and generation.

The underlying causes for the high prevalence and severity of myopia in Singapore is still not well understood. It is likely that complex and multiple factors, both genetic and environmental, are involved. We need to carry out more basic research, epidemiological studies and clinical trials in myopia. Research which would enable us to ultimately modify the biological course of the condition and ideally to prevent the onset of myopia altogether. SERI has an active and productive epidemiological, clinical and basic research programme in myopia. This is one of the priority areas of research for SERI.

To address the problem of myopia, the Health Promotion Board, the Ministry of Education and the Ministry of Health launched the National Myopia Prevention Programme (NMPP) last month. The NMPP will provide for vision screening, health education programmes and the establishment of the Singapore Myopia Registry.

The Singapore Myopia Registry is a national myopia registry that will be set up to collect and provide information on myopia for the purpose of health planning, clinical quality assurance, benchmarking and clinical research. With participation from all the hospitals, DMRI and NUS, the registry will track children with high myopia and assist in the monitoring of outcomes of interventional programmes. The database will allow us to determine the changing trends in the incidence and severity of myopia. The Singapore Myopia Registry will support the NMPP by providing relevant information and assisting in the tracking of schoolchildren with suboptimal vision and visual disability to ensure that they receive adequate treatment.

Reducing blindness in the elderly

Besides the problem of myopia in our younger population, we also face the problem of blindness in the elderly. I would like to take this opportunity to announce a pilot project which will examine the cost-effectiveness of a programme aimed at reducing Blindness in the Elderly through Comprehensive Eye Screening. This pilot project is being funded by the Health Services Development Programme of my Ministry. The aim of the project is to examine the utility of screening for the early detection of conditions such as glaucoma, cataracts and refractive errors which can affect the vision of the elderly. Patients found to have glaucoma or cataracts will be referred to the ophthalmologists for treatment while patients with refractive error will be advised to visit the optometrist. The programme aims to screen 28,000 patients over 2 years. By improving vision for the visually impaired in the elderly, their quality of life will be improved.

Glaucoma and cataracts are common conditions affecting our elderly. This is significant as Singapore has an aging population. Today, we have 220,000 people aged 65 years and above making up 7% of our population. By 2030, we will have 800,000 elderly persons, comprising 18% of the population.

Cataracts and glaucoma are preventable causes of poor vision amongst the elderly. The progression may be insidious and silent, and patients may be unaware of its seriousness until it is very advanced. The pilot project will examine the feasibility and usefulness of screening for these conditions and through treatment, to prevent blindness in our elderly.

Conclusion

There will be many emerging issues and new challenges that lie ahead in ophthalmology. Our local researchers have done well over the years and I am confident that they will do more in the future.

In conclusion, let me congratulate the Singapore Eye Research Institute for organising this meeting. I wish all participants a fruitful and successful meeting. It is my pleasure now to declare the 1^st Singapore Eye Research Institute International Meeting open.