image: Launch of the NUS Medicine Centre for Innovation and Precision Eye Health. From left to right: • Assistant Professor Su Xinyi, Co-Director of the Centre; • Professor Cheng Ching-Yu, Director of the Centre; • Professor Yeoh Khay Guan, Chief Executive of National University Health System; • Dr Vivian Balakhrishnan, Minister for Foreign Affairs, Guest-of-Honour; • Professor Chen Tsuhan, Deputy President (Research and Technology), NUS; • Associate Professor Victor Koh, Lead of Community Eye Care at the Centre, and Head, Department of Ophthalmology, NUS Medicine. view more
Credit: NUS Yong Loo Lin School of Medicine
As Singaporeans age, the increasing incidence of eye disease calls for community-based eye healthcare to more effectively prevent, detect and treat vision problems in the population.
Such an approach would draw on large scale population health metrics to proactively and pre-emptively spot patterns and trends in Singaporeans’ general eye health. These metrics, powered by novel medical devices, artificial intelligence (AI) and drawing on population-based data, will help doctors and health care planners to marshal and site the necessary resources where they are needed.
At the same time, the comprehensive picture provided by the database will help guide research work that is aimed at bringing the most effective screening and treatment options for patients, according to disease severity and the risk of developing chronic eye conditions. These are the aims of the newly established Centre for Innovation and Precision Eye Health that is being set up by the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine), and the National University Health System (NUHS).
Said Dean of NUS Medicine, Professor Chong Yap Seng, Lien Ying Chow Professor in Medicine, “This Centre is an example of the translational research work that we believe will help to transform the current healthcare ecosystem in Singapore to one that prioritises preventive care. We want to do this by detecting and identifying early stages of eye diseases, particularly when the population of Singapore is rapidly ageing and more are at risk of developing chronic diseases. Through the use of evidence-based innovation, AI-powered digital infrastructure and scalable community-based care models, this Centre will help to meet the increasing demands of eye care in our ageing population.”
Creating greater accessibility to community-based eye health care
Currently, the early detection and identification of eye diseases means that patients will require access to tertiary ophthalmic care—which is typically available in acute or specialist care centres like the National University Hospital (NUH). In addition, the costliness and bulkiness of the gold-standard diagnostic eye equipment typically used in hospitals or specialist eye clinics poses another difficulty for efficient eye disease screening.
To address this, the Centre has introduced the development of novel, portable eye screening and monitoring medical devices for people to get eye check-ups more regularly and conveniently in the primary care settings such as polyclinics or optometrists at the optical shops in the future.
These medical devices are AVAT or Automated Visual Acuity, which measures eye ability to distinguish shapes at a distance, SUPRA or Smart, User-friendly Portable Reliable Automated perimetry device which tests visual fields, and STOP or Self-Tonometry device for monitoring of Intra-ocular pressure that measures eye pressure through the eyelids. These devices address the unmet needs of increasing demand to decentralise the current care model of conducting eye screening and monitoring of eye diseases, and scale up the testing phase with minimal costs and manpower resources.
Funded by Temasek Foundation, these portable medical eye screening devices were developed by the Department of Ophthalmology at NUS Medicine and have undergone multiple refinements at NUH. Currently, there is an ongoing pilot programme that conducts community-based eye screening using these novel devices in Pioneer Polyclinic, with plans underway to scale up to more polyclinics. To date, there are more than 230 elderly participants involved in this pilot programme. Compared to conventional screening, these eye screening devices are able to detect the major chronic eye diseases affecting the elderly population, and streamline the evaluation process to increase efficiency. Importantly, these novel devices bring the assurance that detection and close monitoring of the onset of eye diseases can now be done outside the hospital setting, at the primary care level.
A key part of these new initiatives is the involvement of optometrists in the community, who are an important group of eye care professionals that can work together with ophthalmologists to provide primary eye care for our elderly population. As such, the new Centre will also focus its efforts in providing certified standardised training and promoting continuous learning opportunities for community-based optometrists. Associate Professor Victor Koh, Head of Department of Ophthalmology, NUS Medicine, said, “Through upskilling courses and pathways, optometrists will be equipped with the necessary skill sets to detect early signs of eye diseases as first responders in the community.”
Developing new models for detecting eye diseases via AI-powered Research
In addition to new portable devices, the Centre will leverage state-of-art big data analytics and AI technologies to develop more cost-effective algorithms to screen and detect eye diseases. Professor Cheng Ching-Yu, the Centre’s Director and his team have developed retinal photo-based AI algorithms to detect visual impairment and cataract and to predict biological age and the risks of cardiovascular diseases. The Centre will be conducting clinical trials in the community to evaluate the real-world performance of these AI models. “We aim to deliver precision population health for major age-related eye diseases by providing the right intervention to the right population at the right time. With advances in AI and digital technology, we now have better capabilities and infrastructure to devise and adopt AI algorithms which will bring about important insights into the hidden pattern of diseases, that may otherwise be obscured by limitations of traditional analytic tools,” said Prof Cheng.
Introducing precision gene and cell therapy for blinding retinal diseases
At the same time, research at the Centre will draw on genomic data to develop precision gene and cell therapy for currently untreatable and blinding retinal degenerative eye diseases. Over one billion people globally suffer from visual impairment, making it a major health burden. The World Health Organization (WHO) identifies age-related macular degeneration (AMD) and Inherited retinal dystrophies (IRDs) as the most critical retinal eye diseases, which affects an estimated 196 million people and two million people per year respectively.
“Visual impairment is ranked as one of the top disease burdens, aside from obesity, diabetes and hypertension. We hope to introduce new collaborations and create ground-breaking advancement in precision medicine, specifically gene and cell therapies to provide effective treatments for those suffering from visual impairment to recover their sight, and regain their independence and confidence again,” said Assistant Professor Su Xinyi, Co-Director of the new Centre and consultant ophthalmologist at NUH. Asst Prof Su also actively works on stem cell therapeutics in the treatment of degenerative eye diseases.
There are limited treatments for advanced AMD and IRD currently. This presents a significant opportunity to introduce new gene and cell therapies to patients in Singapore, fostering a thriving research ecosystem through partnerships with industry and other research organisations. The Centre has an established partnership with RxCell, a United States biotech company that utilises stem cell regenerative technologies to improve health outcomes. This partnership offers potential for vision restoration in patients with end-stage retinal disease. “To benefit Singapore patients, we have plans to conduct the first-in-man clinical trial using stem cell regenerative technologies,” added Asst Prof Su.