Speech by Dr Lam Pin Min, Senior Minister of State for Health, at the Opening Ceremony of the National Healthcare Group 8th International Ophthalmology Congress

Professor Philip Choo, Chief Executive Officer, National Healthcare Group
Professor Lim Tock Han, Deputy Chief Executive Officer, National Healthcare Group
Associate Professor Wong Hon Tym, Chairman of the Organising Committee
Distinguished Speakers and Guests

INTRODUCTION 

      Good morning. It is my pleasure to join you here at the 8^th International Ophthalmology Congress, organised by the National Healthcare Group Eye Institute. To all the international speakers, a warm welcome to Singapore. 

TRANSFORMING OUR CURRENT MODEL OF CARE

2.    Vision disorders are the fourth leading cause of disease burden in Singapore, with cataract, uncorrected refractive error, diabetic retinopathy, age-related macular degeneration, and glaucoma as the top causes of visual impairment. As our population continues to age, the prevalence of these conditions is projected to increase. The prevalence for diabetic retinopathy, for example, is estimated to more than double from 2015 to 2040.

3.    Singapore’s current eye care model is heavily reliant on specialist care. To ensure long-term sustainability in the provision of eye care, it is essential that we enhance our efforts on prevention and early detection, as well as shift the provision of eye care towards non-specialist and community-based settings.

4.    Our healthcare clusters have made good strides in this direction through various primary eye care initiatives. For example, in 2014, the National Healthcare Group Eye Institute (NHGEI) piloted Tele-Ophthalmology Primary Eye Care units where optometrists in polyclinics are tele-linked to ophthalmologists in Tan Tock Seng Hospital (TTSH) to triage and manage stable, non-complex eye cases in the community. This has strengthened the ability of primary care to hold and anchor such cases, and reduces unnecessary referrals to specialist outpatient clinics.

5.    More recently, NHGEI and the other two healthcare clusters – SingHealth and National University Health System – with the support from the Ministry of Health (MOH), jointly developed a harmonised Singapore National PRImary Eyecare Clinical Service (PRIME) pilot model to facilitate the right-siting of stable, non-complex eye patients in the community. The Community Eye Care Clinic (CEC) under PRIME focuses on the upskilling of non-specialist physicians and optometrists to provide comprehensive examination and management of selected stable, non-complex eye conditions. With the CECs, patients can access eye care in the community in a timelier manner.

PREVENTION, EDUCATION AND EARLY DECTECTION

6.    Even as we enhance eye care capabilities in the community, it is important that we go further upstream and encourage evidence-based case detection. While there is currently no good evidence to support population-wide screening for conditions such as glaucoma and age-related macular degeneration, there are benefits to assessing visual acuity among the elderly. MOH, in partnership with Temasek Foundation Cares, recently launched Project Silver Screen to bring functional screening to more seniors aged 60 and above in the community. This programme aims to detect age-related decline in the domains of vision, hearing, and oral health early. In the domain of vision, seniors who are found to have visual abnormalities such as refractive errors will be referred appropriately for management.

7.    Annual screening is also done for our children, under Singapore’s National Myopia Prevention Programme (NMPP) for early detection of defective vision. This is complemented by public education programmes organised by the Health Promotion Board (HPB) such as the annual Eye Care Week and Roving Carnival for children and their family.
RESEARCH AND INNOVATION8.    The theme of today’s congress, “Dilemmas in Ophthalmology”, highlights the current diagnostic and therapeutic challenges that eye specialists face, against the backdrop of a rising number and increasing complexity of chronic eye conditions. Research and innovation can help to address these challenges by reducing the disease burden of eye diseases, and bring about better health outcomes for patients through the improvement of disease diagnosis, delay of disease progression and development of new healthcare solutions.
9.    Neurological and Sense Disorders (including eye diseases) has been identified as one of the five therapeutic areas of focus under the health and biomedical sciences domain in the Research, Innovation and Enterprise 2020 (RIE2020) plan. To support research discoveries that can be translated into knowledge, products or services that improve health outcomes for Singaporeans, MOH’s National Medical Research Council (NMRC) has funded various research projects, such as the Translational Asian Age-related macular degeneration Programme (TAAP), a multi-institutional collaboration amongst the local medical schools and hospitals which aims to reduce vision loss and blindness resulting from age-related macular degeneration. TAAP was awarded an Open Fund-Large Collaborative Grant in April 2018. 

10.   In addition, NHGEI is embarking on a project involving Artificial Intelligence, known as the Computer-aided Diagnostic classification of Retinal Images (CARE), which could potentially assist clinicians in diagnosing common age-related eye conditions such as diabetic retinopathy, age-related macular degeneration and glaucoma.I am pleased to hear that there are similar collaborative efforts at the Singapore National Eye Centre, in conjunction with the Singapore Integrated Diabetic Retinopathy Programme. I am hopeful that in the near future, we will get to see a user-friendly application that performs automated classification and image correction on retinal images, which will benefit our patients through faster diagnoses and cost savings.CONCLUSION11.   In closing, we recognise the need to enhance eye care in Singapore, particularly to strengthen the capabilities of primary eye care and develop its links with specialist care. This will support our goal to anchor the management of eye conditions in the community and allow eye specialists to focus on more complex cases and surgical procedures. In line with the theme of the Congress – “Dilemmas in Ophthalmology” – I hope that you will find the Congress a good platform for the exchange of ideas, and be able to challenge and debate the practices in the profession through rigorous panel discussions, case presentations and networking.12.   I would like to thank the organising committee for putting together an insightful and enriching programme, and I wish all of you a fruitful conference ahead. Thank you.