Opening Address by Mr Gan Kim Yong, Minister for Health, at the Singapore National Eye Centre 25th Anniversary International Meeting, 23 May 2015

Professor Ivy Ng, Group CEO, SingHealth
SingHealth Board Members,
Professor Wong Tien Yin, Medical Director, Singapore National Eye Centre
Members of the local and international ophthalmology community
Ladies and Gentlemen,

Introduction

1.           I am delighted to join you here today to commemorate the 25^th anniversary of the Singapore National Eye Centre (SNEC).

2.           To our guests from abroad, a very warm welcome to Singapore. 

3.           This year, Singapore is also celebrating its 50^th anniversary. As we commemorate the key milestone in our journey of nation-building, we also recognise the accomplishments of our healthcare system and our healthcare professionals. Our specialist centres, such as SNEC, play a critical role in our healthcare system.  Whilst our general hospitals provide good, affordable care covering a wide range of healthcare conditions, our specialist centres have developed highly specialised capabilities and deep skills to look after patients with more complex clinical conditions.

Tribute to Prof Arthur Lim and Progress of SNEC

4.           Building a centre of excellence is not just about the hardware or equipment, but also about its people.  SNEC’s founding Medical Director, the late Professor Arthur Lim, had the vision to establish a major eye centre of international reputation.  Like Singapore’s pioneer generation who has built Singapore to where it is today, Prof Lim’s foresight, determination and hard work laid the foundation for SNEC, and I am pleased to note that SNEC’s achievements over the past 25 years have mirrored Singapore’s nation building and healthcare sector’s development to become one which we can be proud of.

5.           The national centres play three key roles. Firstly, to deliver high quality specialist care to patients. SNEC manages close to 300,000 patient visits and more than 27,000 surgeries annually, many of these are tertiary and complex in nature. SNEC is among a select few where every single major operation is recorded for teaching and monitoring of outcomes. This helps to maintain high standards resulting in excellent surgical quality and outcomes for all patients.

6.           Secondly, training and education of our healthcare professionals is a core component of our national centres’ mission. Over the last 25 years, SNEC has trained more than 130 local ophthalmologists in Singapore as well as many from around the region, including nursing and ophthalmic allied health professionals.  SNEC must continue to contribute to nurturing the next generation of professionals.

7.           Thirdly, our specialist centres act as leaders in research and innovation to spearhead transformation and break new grounds to deliver better treatments to our patients. Under Professor Lim’s leadership, the Singapore Eye Research Institute (SERI) was set up which has since established an outstanding track record in conducting clinical and translational research in eye diseases that ultimately benefits patients. 

SNEC’s New National Survey on Eye Health of the Elderly

8.           We have been preparing for the impact of an ageing population and the rise of chronic disease, and eye health is no exception. Vision impairment is a significant burden with an aging population. Studies by SNEC show that Singaporeans with vision impairment are three times more likely to have problems in mobility and in conducting activities of daily living and also two times more likely to be anxious or depressed than those with normal vision[1]. But the awareness of the importance of vision and eye health is relatively low among elderly Singaporeans. In a recent national survey² by SNEC on our elderly’s attitude and behaviour towards eye health, it was observed that elderly people do not have a good understanding of eye health.  Nine in ten assumed that there is no need to have regular eye checks if they can see well.  Some viewed eye diseases as a normal part of aging and that there is nothing they can do about it.  Clearly, more needs to be done for public education to increase awareness and promote regular vision and eye checks.

9.           In recognition of these needs, SNEC and the National Healthcare Group Eye Institute (or NHGEI) have each a Primary Eye Care models in the community.

10.       In SNEC’s model, stable patients are transferred from Singapore General Hospital campus to its Primary Eyecare Clinic (or PEC) at Balestier. With further training and development, ophthalmic allied health professionals such as optometrists are able to provide good quality care for stable patients with diabetic retinopathy and glaucoma at the PEC, equivalent to that provided at the SGH clinic in terms of assessment, management and outcomes.

11.        In NHGEI’s model, their Primary Eye Care Units which are sited in selected polyclinics are run by specially-trained optometrists and are tele-linked back to NHGEI@TTSH’s eye doctors for final diagnosis and counselling. This arrangement reduces unnecessary patient trips to the hospitals by over 40%. In both models, patients benefit from easier access to eye care, and free the specialist clinics to manage the more complex conditions.   

12.       Another initiative is the Singapore Integrated Diabetic Retinopathy Screening Programme (or SIDRP). A major condition affecting Singaporeans is diabetes. More than 10% of our adults have diabetes and diabetic eye disease is a major complication of diabetes. Regular screening for diabetic retinopathy will identify cases which need appropriate treatment to prevent vision loss. Twenty years ago, a technician would rotate through various polyclinics with a portable diabetic eye screening camera to screen the eyes of diabetics. Today, all 18 polyclinics are fitted with modern retinal screening cameras run by well-trained nurses.

13.       Since 2011, SNEC worked collaboratively with NHGEI and the polyclinics to conceptualise and implement the SIDRP which is a telemedicine-based screening of diabetic retinopathy. In this collaboration, the images are sent to centralised centres to be read by trained grader. Initial results from the first few polyclinics participating in the SIDRP suggest that referral of patients is now more accurate and many patients can be managed within primary care. The initiative will be fully rolled out to all 18 polyclinics by early next year.  When fully operational, it is anticipated that more than 110,000 Singaporean patients with diabetes at the polyclinics will benefit from this programme.

Multi-Pronged Approach to Improving Accessibility to Eye Care

14.       The private sector also has an important role to play as eighty per cent of the primary healthcare services in Singapore are provided by private general practitioners (GPs). SNEC has already started its engagement with the Singapore Medical Association and other professional bodies to understand the issues and barriers to good eye care in general practice to enhance awareness and accessibility for good eye care.

Research to Benefit Patient

15.       Finally, I encourage SNEC and SERI to continue to push for innovative ways to improve our treatment of eye diseases through their translational and clinical research programs. Their clinical trials on myopia treatment with low dose atropine eye drops are one example in which we develop effective ways to prevent progression of myopia in children. With research, we can find better ways to care for our patients in the future.

Conclusion

16.       In closing, I would like to thank the local and international ophthalmic community for helping to make this event and our celebration of SNEC’s 25^th year milestone meaningful and memorable.

My best wishes for a successful conference.

Thank you.

[1]^{, 2} Wang X, Lamoureux E, Zheng Y, Ang M, Wong TY, Luo N. Health burden associated with visual impairment in Singapore: the Singapore epidemiology of eye disease study. Ophthalmology. 2014 Sep;121(9):1837-42.