SingVision Issue 2, 2024

TOMORROW’S EYE CARE, TODAY

ISSUE 2 | 2024

Diabetic Retinopathy 101: What You Need To Know

Also In This Issue:

SNEC-SERI ranked World No. 2 in Ophthalmology

Preventing Blindness, Improving Sight

Editor’s Note

EDITORIAL COMMITTEE EDITOR-IN-CHIEF Assoc Prof Audrey Chia

SingVision has undergone a design makeover, prioritising readability, and visual acuity for a better reading experience.

We have enhanced the spacing, colours, and font type to make reading easier on the eyes.

The cover story of this issue explores diabetic retinopathy, an eye condition that causes retina damage and vision loss in people who have long standing diabetes. You can learn more about the causes, symptoms, and treatment of this eye condition.

We are very happy to share that SNEC-SERI was ranked 2nd in the 2024 SCImago rankings for Ophthalmology institutions worldwide.

SCImago rankings evaluate institutions based on research performance, innovation outputs, and societal impact.

In addition, SNEC has now partnered the World Health Organisation (WHO) in the first collaboration of its kind in Southeast Asia. This collaboration was officially announced at the SERI and IAPB 3rd International Myopia Summit and held in conjunction with the 37th Singapore-Malaysia Joint Meeting in Ophthalmology.

For parents of little ones, our SNEC-SERI study has released reassuring findings on the long-term safety of Atropine eye drops to slow down myopia progression. You will also learn how a simple, non-invasive eye scan can show how the changes in the retina are linked to cognitive impairment and Alzheimer’s disease.

Lastly, we chatted with our colleagues from the SNEC Ocular Reading Centre on their daily job roles where some of them work in a darkened room to scrutinise retinal images carefully on a screen. Definitely not an easy job!

CO-EDITOR-IN-CHIEF Dr Loh Kai-Lyn EDITOR Ravi Chandran CO-EDITORS Wong Cui Yan Jaclyn Tan MEMBERS Dr Rachel Chong Dr Shweta Singhal Dr Tay Su Ann Dr Chan Hiok Hong Dr Tan Peng Yi Joanna Chia Goh Hui Jin Shirlyn Sam Wendy Tsai Dr Ryan Man DESIGN Fuse Creative (Singapore) WITH ADDITIONAL CONTRIBUTIONS BY Lin Peishan Lyer Laxmi Ravi Rachel Lee Zi Xin

We hope you’ll enjoy reading our stories!

Singapore National Eye Centre is the designated national centre within the public sector healthcare network. It spearheads and coordinates the provision of specialised ophthalmological services, with emphasis on quality education and research.

Connect With Us www.snec.com.sg www.seri.com.sg

@snec.seri

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SINGVISION is a publication of Singapore National Eye Centre and Singapore Eye Research Institute. No material may be reproduced in part or in whole without prior written consent from the Publishers. Views and opinions expressed in SINGVISION are not necessarily those of the Publishers or the Editors. Although reasonable care has been taken to ensure the accuracy and objectivity of the information provided in this publication, neither the Publishers, Editors or their employees or agents can be held liable for any errors or omissions, nor any action taken based on the views expressed or information provided within this publication.

MCI (P) 085/10/2023

Contents

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Cover Story

4

Diabetic Retinopathy 101: What You Need To Know

7

Engaging GPs for Better Patient Care

8 8

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At The Forefront

SNEC Collaborates With WHO to Build Eye Care Capability in South-East Asia Welcoming Back Our Alumni

10 SNEC-SERI Ranked Second Amongst Global Ophthalmology Institutions 11 International Summit on Myopia 12 Shedding Light on Alzheimer’s: How Retina Scans Can Help 13 Ageing Gracefully with “Lao Hua Yan” (Presbyopia)

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All About Eyes

14 Slowing Down Myopia Safely 16 What an OCT Scan Reveals About Your Eyes

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Caring For Our Community

18 Volunteering With Compassion 19 Overcoming Blindness With Strength and Positivity

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14

Did You Know?

20 Celebrating Nurses’ Strength: Inspiring Stories from the Frontline 22 A Peek Behind-the-Scenes at the SNEC Ocular Reading Centre

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Cover Story

DIABETIC RETINOPATHY 101:

WHAT YOU NEED TO KNOW Diabetic retinopathy is an eye condition that causes retina damage and vision loss in people who have long standing diabetes.

It occurs when diabetes damages the small blood vessels in the retina, the light-sensing nerve layer at the back of the eye.

More than 400,000 people in Singapore live with diabetes, with the number projected to rise to one million by 2050. As diabetes is a chronic condition, it is important for us to take proactive steps to manage our health to prevent the onset of chronic diseases as aligned with Healthier SG, a national initiative by the Ministry of Health (MOH) focusing on preventive health.

Early onset diabetic retinopathy often has no warning signs. Sight may not be affected until it becomes severe.

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Symptoms may include: • Loss of central vision when reading or driving • Loss of the ability to see colour and • Mild blurring vision In most cases treatment will consist of laser surgery as it can prevent significant vision loss associated with diabetic retinopathy. While in other cases, medicines may be injected into the eye to control swelling or new vessel growth. Other surgical procedures such as vitrectomy may be required in advanced cases where there is bleeding in the eye, scar tissue formation and retinal detachment. Surgery is the last resort to save the eye.

However, while diabetic retinopathy cannot be completely prevented, vision loss can be prevented with early detection. People with diabetes (diabetics) should get their eyes checked yearly even if they experience none of the symptoms. Your doctor can SingVision | Issue 2 • 2024

Cover Story diagnose diabetic retinopathy by examining your eyes and taking a photo of the back of your eye.

eye examination annually even if you have no eye symptoms.

Diabetes, when poorly-controlled, results in multiple complications. Diabetes is a leading cause of kidney failure, blindness, limb amputation, heart attack (myocardial infarction) and stroke. Diabetes complications can be broadly divided into those affecting the small blood vessels (microvascular) and those affecting the large blood vessels (macrovascular).

If you develop a gradual blurring of vision or hazy vision, please see your doctor immediately.

Eye checks can be done by taking a photo of the back of your eye, in a process known as retinal photography, at SingHealth polyclinics and hospitals.

If further consultation with an eye specialist is required, you will be referred to an eye specialist at SNEC.

What Puts You At Risk of Diabetic Retinopathy?

All individuals with diabetes are at risk of developing diabetic retinopathy. After 20 years, most people will develop this complication to some degree. Those who have poorly-controlled diabetes are at higher risk of developing diabetic retinopathy earlier and at more severe stages.

Treatments Available At SNEC In most cases, laser surgery can prevent significant vision loss associated with diabetic retinopathy.

What You Can Do To Protect Your Eyes Reduce your risk of diabetic retinopathy by: 1. Keeping your blood glucose levels in check 2. Treating and keeping other medical conditions such as high blood pressure, high cholesterol and heart disease under control 3. Quitting smoking (if you haven’t) and exercising regularly Although you cannot completely prevent diabetic retinopathy, vision loss can be prevented with early detection. Diabetic retinopathy often has no warning signs, hence it is important to get a comprehensive

Laser photocoagulation can be performed to seal or destroy growing or leaking blood vessels in the retina.

Procedures include: • Panretinal photocoagulation (PRP) – to treat the peripheral retina to prevent or stop the growth of abnormal new vessels • Focal laser – to treat the macular oedema to reduce swelling In general, each eye requires 2-3 sessions for a PRP to be completed. You will be expected to go for regular treatments over a period of 6-12 months before diabetic retinopathy is controlled adequately.

In patients with loss of central vision due to diabetic macular oedema, intravitreal injections of medication into the centre of the eye can reduce the macular swelling and improve vision.

Medications which are injected into the eye for diabetic macular oedema include Anti-Vascular Endothelial Growth Factor (VEGF) drugs such as Avastin, Lucentis and Eylea, as well as steroids.

Your vision may look like this with diabetic retinopathy.

Often, multiple injections at intervals of 1 month or longer are required to achieve resolution of the swelling. Repeated injections at longer intervals may also be required to maintain the visual improvement.

In some people with diabetic retinopathy, the abnormal blood vessels in the retina may also result in massive bleeding into the centre of the eye (vitreous humor), causing sudden severe loss of vision. A surgical procedure called a vitrectomy can be performed to remove the blood that has leaked into this part of the eye.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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Cover Story

Dr Andrew Tsai, Senior Consultant from the Surgical Retina Department at SNEC, answers your questions on the causes, symptoms and treatment of Diabetic Retinopathy.

Menon: I have been diagnosed with type 2 diabetes for over 20 years and have encountered three episodes of diabetes-related retina nerve issues.

Kamani: My mother is 87 years old and has had diabetes for over 55 years. Is her condition due to a rise in blood sugar levels or low sugar levels?

Two years ago, I did an endoscopy and had been struggling with IBS-D. I had to switch to a low FODMAP diet, which complicates managing my diabetes.

Is diabetic retinopathy the same as CRV (Occlusion)?

I’m concerned about the impact IBS-D management has on my eyes. Should I be given a more indepth re-assessment of my eyes?

Dr Andrew Tsai: In general IBS-D does not affect the eye. The eye checks at the polyclinic will usually entail taking photos of the retina. If there are any retina issues on the photos the polyclinic will refer you to an eye specialist.

Dr Andrew Tsai: Diabetic retinopathy is not the same condition as central retinal vein occlusion. However, having diabetes puts one at risk of central retinal vein occlusion.

Maintaining blood sugar levels at normal levels will help to keep the diabetic retinopathy in check and reduce the risk of central retinal vein occlusion.

Siew Poh: Is it true that if diabetes is well-controlled with HbA1C at around 6-6.5, the risk of DM retinopathy is minimum and therefore, there is no need for DM eye screening even if the disease has been long-standing in a patient?

Dr Andrew Tsai: Good control of diabetes is very important to prevent eye complications.

However, we do see patients with diabetic retinopathy even with good levels of HbA1C. Therefore, all patients with diabetes should receive eye checks at the polyclinic.

If there is an issue the polyclinic will then refer the patient to an eye specialist for further evaluation.

However, if you have any other eye symptoms such as reduced vision or double vision, please highlight this to your polyclinic doctor who can then make a decision of whether to refer you to an eye specialist for further evaluation.

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SingVision | Issue 2 • 2024

Cover Story

Engaging GPs for Better Patient Care

and leading cause of blindness in working adults.

He highlighted that the condition can result in irreversible vision loss and blindness in the late stages but is often asymptomatic until vision loss occurs, and emphasised on the importance of yearly eye screening for diabetics.

As Singapore embarks on its Healthier SG implementation journey, integrated care for the population is fundamental to ensure care continuation. GP clinics serve about 80% of the population’s primary care needs. As part of national efforts to strengthen primary care, the Ministry of Health introduced the Primary Care Network (PCN) scheme to encourage GP clinics to organise themselves into networks that support holistic and team-based care in the community. To date, 10 PCNs have been formed nationwide, including the SingHealth Partners PCN, which is the largest with 143 GP clinics.

On 6 April 2024, over 100 GPs attended the inaugural SingHealth’s GP Symposium ‘Partners in Care for Complex Chronic Diseases’ held at Academia to get insights from specialists on treatment protocols for care escalation beyond the community.

At the event, Associate Prof Gavin Tan, Head & Senior Consultant, Surgical Retina Department and Head of the Ocular Diagnostics Department, SNEC, shared insights on Diabetic Retinopathy, the most common microvascular complication of diabetes

Associate Prof Gavin Tan shared insights on Diabetic Retinopathy, the most common microvascular complication of diabetes and leading cause of blindness in working adults.

Specialists from other SingHealth institutions such as Singapore General Hospital, National Cancer Centre Singapore, National Heart Centre Singapore and National Neuroscience Institute, also discussed prevention and management of stroke and kidney disease caused by diabetes, the use of technology in heart health and screening for breast and cervical cancers.

Prof Ng Wai Hoe, Group CEO, SingHealth in his welcome address said, “GPs play a critical role in bridging patients with relevant specialist care, ensuring that patients have access to appropriate and timely care for more complex medical conditions.

After their condition stabilises, GPs then have the important responsibility of following up closely with their patients to ensure that their health does not take a turn for the worse.”

Prof Ng also announced that SingHealth is extending its Specialist Outpatient Clinic (SOC) Fast Track Referral Process arrangements for specialist care to our GP partners. While the existing Partners Buddy platform already allows GPs to easily make SOC appointments for patients, the SOC Fast Track Referral Process will significantly reduce the waiting time for an appointment with the relevant specialist.

Panel of specialists from SNEC and other SingHealth institutions shared with over 100 GPs on treatment protocols for care escalation beyond the community.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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At The Forefront

SNEC Collaborates With WHO to Build Eye Care Capability in South-East Asia As its purpose is to prevent blindness and improve sight, SNEC has now partnered the World Health Organisation (WHO) in the first collaboration of its kind in South-east Asia. Through this tie-up, SNEC Global Ophthalmology (GO) unit has been designated as the Collaborating Centre for the Prevention of Blindness and Vision Impairment, where it will support in building capacity of the eye care workforce in Southeast Asia and provide safe and accessible ophthalmic and optometry services. It will also build the region’s capacity to conduct research on blinding eye diseases.

“SNEC is honoured to be designated as the first WHO Collaborating Centre for the Prevention of Blindness and Vision Impairment in the region. This is a testament to the strengths of our clinicians and faculty, who have dedicated their lives to improving eye care and furthering research in eye health, in particular myopia, which affects most Singaporeans.

We look forward to working together with our counterparts from the WHO and hope that our contributions will positively impact the lives of many in the region who are in need of eye care,” said Professor Aung Tin, Chief Executive Officer, SNEC. WHO Collaborating Centres are selected based on the past contributions to the objectives of the WHO.

SNEC-SERI has been working with the WHO for various activities such as providing expert guidance in WHO think tank workgroups, reviewing WHO policy and guides related to evidence-based eye care related reports, developing the diabetic retinopathy management guide, and organising the International Myopia Summit.

This collaboration was officially announced on 20 January 2024 at the SERI and IAPB 3rd International Myopia Summit and held in conjunction with the 37th Singapore-Malaysia Joint Meeting in Ophthalmology.

Gracing the event’s opening ceremony was Minister for Foreign Affairs and former SNEC Medical Director Dr Vivian Balakrishnan who made the announcement.

The event was attended by over 600 delegates from around 39 countries. It was organised by the Singapore Society of Ophthalmology (SSO), which marked its 60th anniversary in 2023.

First organised in 1981, this annual meeting is held with the aim of increasing collaboration and partnerships among ophthalmologists and eye care professionals from both countries. This year, the theme ‘Transforming Paradigms in Ophthalmology’, examined how scientific innovation is evolving to change clinical practices in eye care in Asia and around the world.

Minister for Foreign Affairs, Dr Vivian Balakrishnan, announcing the designation of SNEC as the first WHO Collaborating Centre for the Prevention of Blindness and Vision Impairment in the region.

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SingVision | Issue 2 • 2024

At The Forefront

Since 2023, a team of doctors, nurses, optometrists, engineers, researchers and administrators have embarked on several missions in Laos as part of the SNEC Global Eye Health Initiative.

As a WHO Collaboration Centre, SNEC worked closely with the Fred Hollows Foundation, the International Agency for the Prevention of Blindness (IAPB) and WHO, with one goal in mind: to uplift, train, and pave the way for sustainable, quality eye care in Laos.

March 2024 marked a milestone as the SNEC team screened over 500 patients, including 19 children impacted by Type 1 Diabetes, thanks to a referral from Action4Diabetes. They conducted 147 lifechanging cataract surgeries at Laos’ National Ophthalmology Centre (NOC) during a brief but impactful 5-day stay. NOC’s health workers also received hands-on training from SNEC, and best practices and knowledge were shared amongst teams.

The success of the pilot phase was celebrated during the opening ceremony on 21st March, which was graced by the presence of Ambassador Sudesh Maniar from the Singapore Embassy to Laos, alongside representatives from NOC, the Laos Ministry of Health, and our sponsors.

SNEC team screened more than 500 patients in Laos as part of the SNEC Global Eye Health Initiative.

Welcoming Back Our Alumni Over the past 33 years, SNEC-SERI has trained over 500 clinicians, scientists, and fellows, not just from Singapore but from more than 30 countries around the world including Malaysia, Indonesia, China, India, Mexico and the UK. On 20 January 2024, SNECSERI launched our very first alumni group and celebrated the event with a get-together lunch hosted

by CEO of SNEC, Prof Aung Tin. In SNEC-SERI launched its first alumni group in January 2024. attendance were more than 50 local and international alumni of SNEC-SERI, including past and Moorfields Eye Hospital and Assoc Prof Adrian fellows, colleagues, and researchers.

Koh, Founding Partner and Senior Consultant at the Eye & Retina Surgeons, Camden Medical respectively.

During the reception, Prof Aung Tin shared that the goal of the alumni group is to strengthen ties, foster It was a joyous and exciting time where the SNEC-SERI lasting and meaningful relationships and enable Alumni was successfully launched with impromptu networking opportunities between all SNEC-SERI heartful speeches from various alumni members alumni and faculty both local and international. He reminiscing about the past and envisioning for the also introduced the appointed chairpersons of the future. The sunny afternoon was spent as a time of international and local alumni groups, Prof Paul reconnecting, and enjoying the company of friends Foster, Professor of Ophthalmic Epidemiology and and colleagues, both old and new over lunch.

Glaucoma Studies, UCL Institute of Ophthalmology

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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At The Forefront

SNEC-SERI Ranked Second Amongst Global Ophthalmology Institutions

SNEC-SERI was ranked second in the latest SCImago rankings for ophthalmology institutions worldwide.

The SCImago Institutions Rankings (SIR) is a classification of academic and research-related institutions ranked by a composite indicator that combines three different sets of indicators based on research performance, innovation outputs and societal impact measured by their web visibility.

These rankings provide a vital tool for institutions, policymakers for the analysis, evaluation and improvement of their activities and outcomes.

One of the criteria is that institutions must have published at least 100 works in the SCOPUS database during the last year of the selected time period.

Also, the citable documents such as Article, Chapter, Conference Paper, Review and Short Survey, must represent at least 75% of total documents published by the institution.

Since 2009, SIR has published its international ranking in the SIR World Report. This report is the work of the SCImago Research Group, a Spain-based research organisation consisting of members from the Spanish National Research Council (CSIC), University of Granada, Charles III University of Madrid, University of Alcalá, University of Extremadura and other education institutions.

Many thanks to all the stakeholders who have contributed to this recognition as we continue to strive towards our goal in preventing blindness and improving sight.

Rank Institution

Country

1

Moorfields Eye Hospital NHS Trust

UK

2

Singapore National Eye Centre*

SG

3

University of Miami Health System

USA

*includes all SNEC and SERI publications

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SingVision | Issue 2 • 2024

At The Forefront

International Summit on Myopia The latest International Myopia Summit (IMS) convened from 19 to 21 January 2024 at Singapore Eye Research Institute (SERI), to discuss tackling myopia as a public health concern worldwide.

Over 30 invited speakers as well as 30 public and private sector representatives from around the AsiaPacific and beyond participated in this year’s summit, providing diverse international and cross-sector perspectives.

Through a series of presentations followed by roundtable discussions, the summit set collective priorities for clinicians, academia, NGOs, and industry in the global treatment of myopia. These include increasing advocacy to healthcare policymakers, developing research on the socioeconomic impacts of myopia, and determining standards for myopia prevention and treatment.

Associate Professor Marcus Ang, Advisor, Myopia Centre, SNEC and Head & Senior Consultant, Corneal & External Eye Disease and Refractive Surgery Departments, SNEC, and Amanda Davis, Chair of the International Agency for the Prevention of Blindness (IAPB) Western Pacific Region, led the meeting.

More than 30 speakers from Asia-Pacific participated in the Myopia Summit.

IMS 2024 was jointly organised by IAPB, SERI with the support of SNEC and SNEC Myopia Centre. It marked the first meeting of the IMS since the COVID pandemic and the third overall summit following two meetings in 2018 and 2019.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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At The Forefront

Shedding Light on Alzheimer’s: How Retina Scans Can Help

The variance observed in these scans has empowered researchers to pinpoint early signs of Alzheimer’s, paving the way for early intervention strategies. Dr Jacqueline Chua, a clinician scientist at SERI, explained the connection between the eye and the brain: health issues affecting one could mirror in the other.

Brain scans employing MRI technology stand tall for their precision, yet the process can be expensive and time-consuming. Eye screenings, in contrast, are not only quicker and more cost-effective but also multifunctional.

The eyes are not only the windows to the soul; they can also reveal our cognitive health. Did you know? A simple, non-invasive eye scan can show how the changes in the retina are linked to cognitive impairment and Alzheimer’s disease.

They have the potential to uncover a range of diseases including, but not limited to, kidney disease, diabetes, cardiovascular disease, and multiple sclerosis. For example, patients with Alzheimer’s also have increased odds of having moderate to severe diabetic retinopathy.

Alzheimer’s is a type of dementia that slowly destroys memory and cognition.

Initial symptoms of this disease may include difficulties in handling money and getting lost. By 2030, it’s anticipated that Singapore will see its dementia patient numbers rise to 152,000, highlighting an increasing need for caregiving services, awareness and intervention.

Alzheimer’s disease has no definitive cure, and cases are expected to rise with an increasing aging population. Eye screenings offer a cost-effective means to identify diseases in susceptible individuals, leading to better social support, and perhaps, a brighter outlook to caring for the vulnerable in our community.

Researchers at the Singapore Eye Research Institute (SERI) have utilised technology such as optical coherence tomography (OCT), a non-invasive, detailed scan that uses light waves to take cross-section pictures of our retina, and its angiography counterpart (OCTA), which can take pictures of the blood vessels in and under the retina, to examine and measure the thickness of optic and macular nerves, alongside the density of blood vessels.

Their fascinating findings? Individuals battling Alzheimer’s tend to have considerably less vessel density and much thinner nerves compared to those without the disease. The study group comprised 90 volunteers over the age of 50, of which 30% serve as a impairment-free control group.

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An OCT scan comparing an individual with normal nerve thickness and an individual with much thinner nerves (an indicator of Alzheimer’s disease). A green color code indicates normal limits while the red color code indicates the nerve measurement was outside normal limits.

SingVision | Issue 2 • 2024

At The Forefront

Ageing Gracefully with “Lao Hua Yan” (Presbyopia) Presbyopia, often referred to as “Lao Hua Yan” in Mandarin, is an age-related condition typically occuring in your 40s and nearly universal by 50. Presbyopia blurs our near vision due to the eye’s diminished ability to focus on close objects.

Thankfully, it’s correctable with reading glasses, multifocal contact lenses, or even refractive surgery.

Traditionally associated with those over 40, recent research suggests that individuals as young as 30, particularly women and those of Malay descent, may also be prone to presbyopia. They may encounter difficulties reading from their mobile phones, books, and tablets, and have to hold these further away to be able to see clearly.

Adopting simple eye-care practices, such as taking regular breaks to look at something 20 feet away for at least 20 seconds, can alleviate eye strain and preserve vision.

Uncorrected presbyopia has consequences on quality of life. This was shared by Professor Ecosse Lamoureux, Director, Population Research and Clinical Epidemiology platform at the Singapore Eye Research Institute (SERI) in a Straits Times opinion piece.

Published on 1 February 2024, the news article shared compelling research findings from the Population Health and Eye Disease Profile (Pioneer) study by SERI and Duke-NUS, which highlighted that 30% of

Singaporean adults with presbyopia have yet to seek correction for their deteriorating close-up vision, posing challenges for functional independence in their daily lives. This oversight is particularly pronounced in older individuals, women and the Malay community.

Without correction, however, presbyopia can significantly disrupt daily life, making tasks like reading, writing, and cooking challenging, not to mention its impact on productivity in today’s digital age.

As retirement and re-employment ages are set to increase to 64 and 69 by 2026, this will become a major public health concern in a rapidly ageing Singapore. With projections showing that a quarter of Singapore’s population will be over 65 by 2030, fostering good visual health is crucial for enabling active, independent, and meaningful later years.

Advocating good personal habits, targeted eye screening and educational programmes play a vital role in identifying and supporting those at higher risk of presbyopia.

Promoting awareness and proactive management of visual health is essential for all of us as we age.

By understanding presbyopia and taking steps to correct it, we can all look forward to maintaining our independence and enjoying a high quality of life, well into our later years.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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All About Eyes

Slowing Down Myopia Safely SNEC-SERI study gives assurance on long-term safety of atropine eye drops to slow down myopia progression.

Atropine eye drops have been used to treat myopia in children since the 1990s. However, concerns on its long-term effects and sustained benefits remained in question.

complications 10 to 20 years after treatment. This research builds upon two earlier studies, Atom 1 and Atom 2, which involved 400 children each and laid the foundation for Atlas.

Now, parents can feel more assured. SNEC-SERI have published the Atropine Treatment Long-Term Assessment Study (Atlas) in the medical journal Jama Ophthalmology in November 2023, the first study of its kind on the long-term safety of atropine eye drops.

The Atlas study found that even after 20 years, there was no difference in incidences of complications such as cataracts or myopic macular degeneration between those treated with the one per cent concentration atropine eye drops and those given the placebo.

The study shows that the atropine eye drops slow down the progress of myopia in children and teenagers in Singapore and is safe with no

Associate Professor Audrey Chia, Head of Paediatric Ophthalmology and Adult Strabismus department, shared that the Atlas findings showed that atropine

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SingVision | Issue 2 • 2024

All About Eyes

Myopia Treatment Apart from spectacles and contact lenses, there are other treatments to treat myopia or slow its progression.

Atropine Eye Drops These work by blocking the muscarinic receptors in the eye, which control how the eye changes focus. This in turn helps reduce the strain myopia places on the eyes. The drops are typically prescribed to children and teenagers.

Laser Refractive Surgery This refers to several types of procedures which use lasers to alter the shape of the cornea to correct errors of refraction resulting in myopia. The most well-known of these is laser assisted in-situ keratomileusis (Lasik), which was approved by the US Food and Drug Administration in 1999. The surgery is typically recommended for those aged 21 and above.

Implantable Collamer Lens (ICL) The surgery, involving placing a permanent contact lens in the eye, can be used to correct myopia, hyperopia or farsightedness, and astigmatism, a disorder which causes distorted or blurred vision. It is suitable for those who are aged at least 21, with myopia of up to 1,900 degrees, though patients should not have glaucoma or diabetic eye disease.

eye drops was safe to use, with no long-term adverse effects. Adverse effects appeared to be related more to the degree of the participant’s myopia, rather than the treatment the person received.

Atlas’ Principal Investigator, Associate Professor Marcus Ang, Head of Corneal and External Eye Disease as well as Refractive Surgery departments, pointed out that many still have questions about the long-term effects of atropine eye drops.

The study noted that questions remained about the effectiveness of atropine eye drops in slowing down myopia. There were no differences in spherical equivalent or axial length of the eye ball – which are indicators of myopia – or the prevalence of high myopia among the different groups of participants.

This could be due to reasons such as there being no benefit from short-term treatment or rebound effects following the abrupt stoppage of atropine eye drops.

It was also noted that atropine eye drops were more effective in Asian children suggesting that the difference in results due to difference in myopia progression among the different ethnicities.

Singapore’s myopia rates are high with 9 in 10 adults expected to be myopic by 2050 and up to a quarter of them may have high myopia. Results from atropine eye drops may take time to show therefore it will require close monitoring half yearly. Commercially available in Singapore, China, Malaysia, Japan, and other parts of the world, it slows down the progression of myopia, with minimal side effects in children.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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All About Eyes

What an OCT Scan Reveals About Your Eyes

Dr Charles Ong, Associate Consultant, Cataract & Comprehensive Ophthalmology explains how this technology gives eye doctors a detailed look at your retina.

What Is An OCT Scan? How Can It Save Your Vision?

OCT stands for Optical Coherence Tomography. OCT scans are non-invasive and allows a detailed look at different parts of the eye. It is commonly used to diagnose and monitor conditions of the back of the eye (i.e. the retina). These retinal conditions include age related macular degeneration, diabetic retinopathy, retinal vein occlusions, epiretinal membranes and macular holes.

The OCT scan provides an added depth to the assessment of retinal conditions beyond traditional

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examination techniques by your eye doctor. It is routinely used in the clinical practice of retinal physicians and is crucial to the decisions made on the treatment for a patient’s retinal condition.

How Is An OCT Scan Performed?

OCT scans are fast, safe, and painless. A technician will guide you through the process. The patient sits in front of the OCT scanner and places his chin on the chin rest. The machine scans the eyes and takes images of the retina. The entire process is complete within a few minutes. The images are then

SingVision | Issue 2 • 2024

All About Eyes

An OCT scan showing a normal retina

Before treatment: an abnormal OCT scan showing retina swelling (macula edema) from a retinal blood vessel blockage (retinal vein occlusion)

After treatment: same patient after undergoing treatment with injection of medications into the eye (intravitreal anti-VEGF injections)

Before treatment: an abnormal OCT scan showing a retina with a macula hole before surgery

After treatment: same patient after undergoing surgery to close the macula hole

transmitted almost instantaneously to the eye doctor.

OCT scans play a very important role in determining the diagnosis and treatment decisions of retinal conditions.

What’s Next For OCT? There is constant research looking into how to improve OCT technology and finding better ways to use this technology to benefit patients. With each new generation of OCT scanners, we are seeing higher scan resolutions and imaging of wider areas of tissue that was previously unimaginable. OCT-

Angiography (OCTA) is a recent advancement that has revolutionised the way patients with retinal conditions are assessed. In the past, retinal physicians relied heavily on dye-based angiography (fundus fluorescein and indocyanine green angiography) that involves a needle prick to allow injection of dye to light up the vessels of the back of the eye. OCTA now allows imaging of the vessels of the back of the eye without a needle prick and need for dye. The use of OCTA is still evolving and has not completely replaced the role of dye-based angiography but it is certainly a very promising development.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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Caring For Our Community

When myopia robbed Dr Allan Fong of his ambition to become a fighter pilot, he decided to become an ophthalmologist to fight eye conditions instead.

The former Senior Consultant of Cataract & Comprehensive Ophthalmology Department at SNEC, specialises in cataract surgery and refractive surgery. He volunteers regularly with non-profit organisations to provide free eye screenings to the needy and seniors.

In recognition of his outstanding contributions to healthcare, he received the Superstar Award in the Exemplar Leader-Clinician Category at the Singapore Health Quality Service Awards (SHQSA) 2024. This is also the first time SNEC received this prestigious Superstar award, and there were 94 SNEC-SERI recipients of the SHQSA this year.

Since 2011, the SingHealth Duke-NUS Academic Medical Centre has been organising the SHQSA to recognise outstanding healthcare professionals who provide quality care and excellent service to patients.

With an eye and a heart for the community, Dr Fong is in-charge of an on-going voluntary eye screening project called “Project I-Care”, a collaboration between the Singapore Society of Ophthalmology and the North-West CDC. This project screens seniors for eye conditions such as cataract, glaucoma, and diabetic retinopathy. The team also reaches out to the needy in nursing homes and Senior Activity Centres. Dr Fong serves as Vice-Chairman of Lions SaveSight Centre which promotes eye care and prevention of blindness among the underprivileged and vulnerable members of society.

These programmes are also offered in nursing homes and community centres, where volunteer eye specialists screen patients who have not had eye checks before and make referrals for cataract surgeries and other treatments. Quite a number of elderly patients are bed-ridden or are wheelchairbound and have difficulty travelling. With early detection, we can treat eye conditions before they worsen and save their sight,” Dr Fong shared.

Dr Fong constantly seeks to collaborate to enhance care through process improvement and innovation.

He embraces cutting-edge technologies and engages eye care industry partners to provide feedback on emerging technologies to ensure that they are relevant and optimise treatment outcomes.

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SingVision | Issue 2 • 2024

Caring For Our Community

Overcoming Blindness with Strength and Positivity Adrian’s Journey from Darkness to Light As someone who loves reading, losing his vision was a cruel blow to Adrian Chan. This life-altering event occurred when the dedicated teacher was just 33 years old. Yet, his unwavering strength and determination to overcome his eyesight problems is what earned him the SingHealth Inspirational Patient Award 2024.

In 2009, Adrian was diagnosed with Stevens-Johnson syndrome, an autoimmune disease that caused him to lose vision in his right eye overnight. At the time, Adrian had been teaching English and Literature at secondary and junior college levels for over a decade.

Despite the sudden loss of vision in one eye, he continued teaching for another four years before the strain of marking essays eventually became too taxing.

Adrian adapted by switching to part-time work, including tutoring, running enrichment programs, and serving as an oral examiner. Although the partial loss of vision left him feeling depressed, he found pride in helping students grow and excel. Adrian also learned to become self-reliant through his part-time income.

In 2022, Adrian underwent a corneal transplant procedure, which initially restored his vision in the right eye after ten long years. Unfortunately, his joy was short-lived as an infection caused his vision to fade again. Compounding this, his left eye suffered from glaucoma and cataracts, which led to further vision loss. Within a year, Adrian became medically unfit to work.

Unable to manage household tasks on his own, Adrian bravely reached out for help. His family and friends responded with overwhelming support, assisting with chores, food preparation, and errands.

Despite these immense challenges, Adrian has shown incredible strength and adaptability. He now listens to

Adrian Chan (in blue shirt) standing proud with his family, SNEC COO, Lee Jiun Kee (third from left), Nurse Clinician Soh Wee Wee (second from left) and SNEC staff from the Office of Patient Experience at the IPCA award ceremony.

Regardless of the prognosis, Adrian possesses a can-do spirit.

His patient and persevering spirit is inspiring to both patients and staff.

Soh Wee Wee, Nurse Clinician, SNEC

audiobooks instead of reading and has learned to be patient with his limitations.

“I believe that the way you face challenges is a choice.

As a blind person, I can either choose to feel ashamed or feel grateful for the love and support of the people around me. I choose the latter,” Adrian shared.

Adrian is one of the 56 outstanding award recipients at the 2024 SingHealth Inspirational Patient and Caregiver Awards (IPCA). His journey inspires us all to face our challenges with courage and gratitude.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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Did You Know?

Celebrating Nurses’ Strength:

1B Clinic 3

Inspiring Stories from the Frontline Did you know Singapore is home to over 40,000 dedicated nurses? That’s only eight nurses for every 1,000 residents! Nurses are the ones who provide comfort, compassion and support to our patients, often in a challenging, fast-paced and demanding environment.

This Nurses’ Day, August 1st, let’s take the time to appreciate our SNEC healthcare heroes. Join us in celebrating the care our nurses provide, as we share heartwarming stories and compliments from patients whose lives they’ve touched.

Next time when you visit a doctor, remember to show your appreciation for the nurses too. A little gratitude goes a long way in making their day just a bit brighter.

My mother was blessed to be treated with patience and care by nurse Jasmine. The doctors and nurses have given us utmost understanding especially in allocating consultation slots at a convenient time for us. We are very happy that they have been very professional and showered my mother with so much patience, concern, helpful tips, guidance, and care.

Mdm Tan

Day Ward

Happy Nurses’ Day to all the wonderful nurses out there!

Most patients are nervous and afraid to proceed with eye surgery. As nurses, our job is to assure and comfort them. The beaming smiles seen on the post operation patients’ faces are simply indescribable.

Staff Nurse, Valerie A/P Varugeesu

Nurse Valerie projects the essential skills that every nurse should have. Her explanation is very clear and thorough. Even though I had a simple operation, she assured me that everything is going to be alright, thus eliminating the fear in me. I don’t mind going for a cataract operation every month if nurse Valerie is around.

Mr Sahar

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SingVision | Issue 2 • 2024

Did You Know?

3B Clinic F

Being able to see those beautiful smiles on my patients’ faces, is part of my satisfaction and daily achievement!

Enrolled Nurse, Jasmine Seat

Operating Theatre

On pre-assessment day, nurses at the counter really impressed us with their detailed explanation and cleared our doubts. We were also impressed that once they found my condition to be complex and challenging, they quickly arranged for Dr Gavin Tan to handle our case ASAP. We waited a long time since the polyclinic’s referral and it’s really worth the wait.

Mdm Leow I had a left eye cataract [surgery] this year and had no confidence at all. But ALL the theatre staff (Dr Woo Jyh Haur’s Team) are so friendly, joyful and caring. This made the difference for me. When the nurse pushed me to the operating theatre, I was TOTALLY changed. I was happy, confident and had no fear at all. What a PROFESSIONAL team!!

Mrs Toon

We are driven by intellectual curiosity and ensuring that we can always provide quality care to all patients. We are also committed to keeping up with the latest practices and standards.

I firmly believe that giving our patients the best care is not just about providing them treatment, but also offering our patients spiritual support and empathy. Putting the patient first to value their medical, emotional, and cultural needs is the best quality care.

Senior Staff Nurse, Li Hongyan (left)

(Left to right) Senior Staff Nurse, Phang Tse Wei, Staff Nurse, Evelyn Wee, Claris Lim and Abel Kwan (not in photo)

I am motivated by the knowledge that my actions and decisions can significantly influence a patient’s health and well-being. Ultimately, seeing patients recover and knowing I played a part in their healing process is incredibly rewarding and inspires me to strive for excellence in every aspect of patient care.

Staff Nurse, Ray Chiang (right)

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

21

Did You Know?

A Peek Behind-theScenes at the SNEC Ocular Reading Centre Started as a research unit in 2006, SNEC Ocular Reading Centre (SORC) at Bedok has evolved into a clinical service and serves as a tele-ophthalmic ocular reading centre. Their clients include public hospitals, GP clinics, SingHealth Polyclinics, Family Medicine Centres, Community Health Centres and Voluntary Welfare Organisations. With the focus on academic medicine, SORC also performs grading for investigator-initiated research studies and conducts trainings for healthcare professionals locally and internationally.

Haslina Hamzah, Deputy Director of SORC, oversees a team of 19 staff including doctors, scientific advisors, ophthalmic specialists and technicians, who are trained to perform accurate interpretation of retinal fundus and other eye images.

On average, the centre receives about 200-250 images per day and they come from SingHealth polyclinics and public hospitals, community health clinics as well as General Practitioners - all of which need to be processed by four staff who grade eye conditions within a day.

Such analysis of the images is part of the Singapore Integrated Diabetic Retinopathy Programme (SiDRP), which is offered by SORC to conduct eye screening of diabetic patients.

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These graders sit in a darkened room where they scrutinise retinal images carefully on a screen, to scan for abnormalities. The images currently go through up to three levels of checks. Primary graders are the first to analyse an image after it has been sent to SORC. Most of the images at this level typically have no abnormalities.

The remaining images with abnormalities are then sent to a group of secondary graders. If the primary and secondary graders disagree in their analysis of an image, it will be sent to an ophthalmologist.

Leveraging on the graders’ technical skills in detecting eye diseases, SORC expanded their job role to set up the Retinal Observational Clinic (ROC), where they perform imaging and preliminary assessment for patients with stable retina conditions.

When asked on how does one become a trained grader, Haslina shared, “Having a background in the biosciences will have an added advantage. Most importantly, one needs to appreciate and enjoy looking at these eye images. And of course, the grader needs to have an eye for detail.”

“We are also mindful that our graders need to stare at the screen to analyse the images. Hence, we will take turns to grade the eye conditions so that everyone has sufficient eye rest.”

SingVision | Issue 2 • 2024

Did You Know?

SingVision interviewed two Ophthalmic Grading Specialists to find out more about their job roles.

Raudhah Hanim Bte Mohamed Yusof Ophthalmic Grading Specialist How has the journey been from being a primary grader to now, an ophthalmic grading specialist?

The journey has been rewarding and I am thankful for the opportunities provided for my career development and personal growth. I am proud that SIDRP has grown from three polyclinics in 2010 to become the national screening programme for diabetic retinopathy.

It is also personally fulfilling as I have close family members who have been diagnosed with diabetes.

Through my work, I can save our patients’ vision through early detection.

Lee Lin Jun Ophthalmic Grading Specialist I Can you describe your job role?

As lead for Retina Observation Clinic (ROC), I manage daily operations, which is dedicated to monitoring patients with stable retina conditions.

For each patient, I capture Fundus scans (retina images) and examine the scans to detect changes which may be new or clinically significant. Patients who are categorised as urgent will be scheduled to see the doctor as soon as possible.

What do you look out for in these scans?

I look for signs of Diabetic Retinopathy or Agerelated Macular Degeneration. In cases with disease progression, an Ophthalmologist will do a further assessment to see if an intravitreal injection is required. In addition to these diseases, I also check for other eye conditions such as occlusion in patients with Diabetic Retinopathy.

What are some of the important qualities you need to be working in this field?

It is important to be meticulous to ensure that we do not miss any subtle features in the images.

Attention to detail is crucial, as it impacts how we categorise the severity of a condition, which affects the timeframe for a patient’s referral.

What challenges do you face in your role?

The ROC allows patients to reduce their waiting time as patients used to spend up to three hours doing their tests with a physical review. With ROC, there is no need to see an ophthalmologist if a patient’s scans are normal.

Any advice for those who want to join the Allied Health Profession?

Our graders have a science background. They undergo rigorous training to learn grading using ocular imaging techniques, and standardised protocols to ensure consistency. They must attain their first accreditation within six months.

As ROC is a new model of care, some patients may be unwilling to be monitored through ROC as they are used to seeing an ophthalmologist. I will reassure them that their eyes will be checked thoroughly and that an ophthalmologist will also review their scans. Once patients have experienced that the ROC process is faster, they are more than happy to be part of that process.

If you are keen to join the Allied Health Profession, find out what is your motivation. Is it to make a difference in people’s lives? Saving people’s eyes is like saving lives; you need your eyes for quality living. That’s the reason I took the plunge.

What’s the most important thing you’ve learned at work?

Communication is key in every aspect of my role in SORC. I must communicate clearly with patients so that they fully understand the results of their scans. I do the same with my team to ensure they understand the tasks assigned.

A Publication of Singapore National Eye Centre & Singapore Eye Research Institute

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SNEC Branches and Affiliated Clinics

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CENTRAL

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Singapore National Eye Centre 11 Third Hospital Avenue Singapore 168751 Tel: 6227 7255

EAST

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SNEC Eye Clinic @ NHCS National Heart Centre Singapore 5 Hospital Drive, Level 4, 4C Singapore 169609 Tel: 6227 7255 SNEC Retina Centre Diabetes & Metabolism Centre (DMC), Singapore General Hospital 17 Third Hospital Avenue #02-00 Singapore 168752 Tel: 6227 7255 KK Eye Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Level 1, Children’s Tower Singapore 229899 Tel: 6394 1930 / 6394 1931

SNEC Community Eye Clinic @ HPB Building 3 Second Hospital Avenue #03-04 Health Promotion Board Building Singapore 168937 Tel: 6227 7255

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SNEC Eye Clinic @ SKH Sengkang General Hospital Medical Centre, Level 8 110 Sengkang East Way Singapore 544886 Tel: 6227 7255 SNEC Community Eye Clinic @ Punggol Polyclinic Blk 681 Punggol Drive Oasis Terraces #04-12 Singapore 820681 Tel: 6227 7255

Email: appointments@snec.com.sg

GP Hotline:

Website: www.snec.com.sg

6322 9399

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NORTH EAST

Consultation by appointment:

6227 7266

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SNEC Eye Clinic @ Bedok Blk 212 Bedok North Street 1 #03-147 Singapore 460212 Tel: 6227 7255 Myopia Centre Blk 212 Bedok North Street 1 #03-147 Singapore 460212 (Located at SNEC Eye Clinic @ Bedok) Tel: 6227 7255 SNEC Eye Clinic @ CGH Changi General Hospital 2 Simei Street 3 Medical Centre, Level 1 Singapore 529889 Tel: 6850 3333