Singapore Eye Feb 2017

EYE

NEWSLETTER • ISSUE 1, 2017

ACADEMIC MEDICINE Perspectives and Activities featuring the EYE ACP and the Duke Eye Center

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The Importance of Academic Medicine

ICES V R

ACADEMIC MEDICINE

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CH EAR ES

CLINICAL S E

Academic medicine is a symbiotic cycle of clinical care, leveraging on research and education with the ultimate aim of ensuring better patient outcomes.

ED UCATI ON

It advocates the recognition, mutual respect and support of the three pillars of clinical services, education and research to purposefully come together in order to achieve our collective and aligned objective, which is to attain better outcomes for our patients and improve their quality of life.

Importantly, academic medicine recognises that clinical service is integral as the primary conduit to our patients, and thus clinicians serve to underpin the foundation of academic medicine.

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C O N T E N T S 04 CLINICAL SERVICES

05 06 RESEARCH

07 08 EDUCATION

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Eye Care on the Road Touch Surgery

Innovative Macular Surgery Defies Expectations Expanding Ocular Oncology

The Future of Glaucoma Treatment Singapore – Global Leader in Ophthalmology Research Duke Spearheads Trials in Age-related Macular Degeneration Searching for Causes of Glaucoma in Africa Developing the Next Generation of Eye Care Workforce Delivering Resident-led Teaching Duke Fellows Make a Difference Ophthalmic Medical Technician (OpTech) Program

Singapore Celebrity Dick Lee Saving Sight with VisionSave

PHILANTHROPY

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EVENTS

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EYE Ball 2016 – A Sight to Behold

AWARDS

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EYE ACP Awards 2016

Monitoring Intraocular Pressure (IOP) at Home with Duke’s ‘Lending Library’

eYe-P Time-out

Contact Us

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CLINICAL SERVICES EYE ACP

Eye Care on the Road – by Dr Wong Chee Wai A “clinic on wheels” is providing free eye screening to needy elderly people. Organised by the Singapore Society of Ophthalmology (SSO) and Standard Chartered Bank, and supported by the Singapore National Eye Centre (SNEC), the Mobile Eye Clinic (MEC) implements screening and referral to tertiary institutions.

Patients requiring further followup are linked with medical social services. This follow-up system has significantly increased attendance rates from 39% to 65%.

We have screened over 1,800 elderly people and monitored more than 100 patients with severe visual impairment.

In the Spotlight

Dr Wong Chee Wai is Associate Consultant of SNEC and Executive Committee Member of SSO. He is involved in international clinical trials as well as charity work, including the MEC.

Touch Surgery – by Adj. A/Prof. Shamira Perera The SNEC-authored cataract module on the mobile application Touch Surgery (TS) (Kinosis Ltd) represents an evolution in cataract training. TS, free to download on Android and Apple devices, digitises operations to help trainees rehearse procedures.

Join the two lines on each side with a horizontal incision at the same depth to create the outline of a rectangle.

In the Spotlight Congratulations to Adj. A/Prof. Shamira Perera and team who won the Programme Innovation Award (Medical) at the AM•EI Golden Apple Awards 2016 for their work on the cataract module.

Insert the I & A probe through the main port into the anterior chamber.

Adj. A/Prof. Shamira Perera

The SNEC cataract module on TS

The module, developed by Adj. A/Prof. Shamira Perera and Dr Sameer Trikha, was launched in 2015.

TS breaks down each simulated operation into detailed animated explanations and reinforces learning through testing. This module was downloaded over 20,000 times across 60 countries in the first 6 months.

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Sameer Trikha

Shamira Perera

This module provides trainees readily available, out-of-theatre training.

Senior Consultant at SNEC, Adjunct Associate Professor at DukeNUS, and Co-Head of the Bioengineering and Devices Research Group at Singapore Eye Research Institute (SERI).

Dr Sameer Trikha Consultant Ophthalmic Surgeon at King’s College Hospital NHS Foundation Trust, London, UK and a joint Senior Clinical Research Fellow at SERI.

DUKE EYE CENTER CLINICAL SERVICES

Innovative Macular Surgery Defies Expectations Duke Vitreoretinal surgeon Dr Tamer Mahmoud performed the first autologous retinal transplant on patient Virginia Hall using a piece of her peripheral retina to plug the macular hole affecting her vision.

Dr Tamer Mahmoud with patient Virginia Hall

A month after surgery, the large black spot at the centre of Ms Hall’s vision became less dense. Three months later, Ms Hall’s retinal sensitivity increased and her vision improved to 20/80. In another surprise, Dr Mahmoud found that the peripheral tissue that plugged the hole “started developing layers that you can only see in retinal tissue at the centre of the vision!” Six months post-surgery, Ms Hall’s vision remained at 20/80 and her retinal sensitivity continued to improve.

This unanticipated functional improvement in retinal sensitivity and vision may have applications for other types of retinal diseases where the central vision is lost.

Dr Tamer Mahmoud

Expanding Ocular Oncology Assistant Professor of Ophthalmology Dr Gargi Vora has big plans for ocular oncology at Duke. Dr Vora is gathering information to create a tumour registry for ocular surface tumours.

Dr Vora is also tailoring imaging to improve diagnosis of ocular tumours.

While surgical biopsy remains the gold standard, Duke is investigating using a pump-probe laser to characterise pigmented conjunctival tumours.

A tumour registry like this one would serve as an excellent resource that would improve prevention and early diagnosis.

Dr Gargi Vora

Benign tumour

Conjunctival melanoma

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RESEARCH EYE ACP

The Future of Glaucoma Treatment – by Adj. A/Prof. Shamira Perera Poor patient compliance with hypotensive eye drops, the current mainstay in glaucoma treatment, is linked with progressive vision loss.

Sustained-release (SR) ocular drug delivery systems may improve patient outcomes by simplifying treatment regimes.

In our cross-sectional study – involving Singaporean Chinese patients recruited from outpatient glaucoma clinics at the SNEC – most patients were willing to accept the three routes of SR drug delivery as an alternative to daily dosing. Among the SR routes, patients preferred punctal plug placement followed by the subconjunctival and intracameral routes.

Males, nonsubsidised patients and those with bilateral glaucoma, who are more severely affected, were more likely to accept all three routes.

Additionally, most patients who accepted SR delivery were willing to pay an equal or higher price than their current eye drops for these alternatives.

While these systems are promising and show better tolerability than topical drops, several questions remain unanswered. These include comparing SR to selective laser trabeculoplasty, combining SR systems, and understanding the interaction between SR drugs and topical medications.

For more information, see: Chan HH et al. J Glaucoma 2015;24:485–92.

Singapore – Global Leader in Ophthalmology Research 2nd Mean 5-year impact factor

4th Based on the 5-year impact factor gross domestic product index

Among the top 20 in total number of eye publications

Singapore at a glance: 2010−2014

550 articles

2nd Based on the 5-year impact factor population index

An independent paper by a team of French researchers established that Singapore ranks second globally and first in the Asia-Pacific region for research on eye diseases in terms of mean 5-year impact factor per article as well as per capita.1 1. Boudry C et al. PeerJ 2016;4:e1557.

90% Articles affiliated with the SNEC and/or SERI

These rankings reflect Singapore’s scientific productivity and effective utilisation of resources in eye research.

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DUKE EYE CENTER RESEARCH

Duke Spearheads Trials in Age-related Macular Degeneration The Duke Center for Macular Diseases is advancing care for patients with age-related macular degeneration (AMD) through clinical trials of cuttingedge therapies, leading to patented new medications for dry AMD and treatment-resistant wet AMD. Studies investigating novel clinical trial endpoints that measure potential therapeutic efficacy are also under way.

For more information, visit http://dukeeyecenter.duke.edu/research/ clinical-trials

From left: Mike Allingham, MD, PhD; Scott Cousins, MD; Eleonora Lad, MD, PhD; and Prithu Mettu, MD

Searching for Causes of Glaucoma in Africa The Duke team led by Prof. Rand Allingham is creating the world’s largest glaucoma genetics database of African ancestry. To identify genes that will enable early diagnosis and treatment, the team is collecting samples across Africa to obtain a full genetic spectrum of glaucoma.

Duke has also partnered with ophthalmic genetics experts, Prof. Tin Aung from the SERI and Dr C.C. Khor from the Genome Institute of Singapore. A major accomplishment of this initiative has been the discovery of genetic variants associated with exfoliation syndrome, an aggressive form of glaucoma.

From left: Tin Aung, MD, PhD; Michael Hauser, PhD; Rand Allingham, MD; and C.C. Khor, MD, PhD

We have a strong foundation in African genetics, and our Singaporean colleagues have the expertise and infrastructure to analyse massive global genetic datasets.

Prof. Rand Allingham ISSUE NO. 1, 2017 | 7

EDUCATION EYE ACP

Developing the Next Generation of Eye Care Workforce Research indicates that the global ophthalmic workforce will face significant challenges by 2020. With the establishment of the Ophthalmology & Visual Sciences Academic Clinical Program (EYE ACP), SNEC embarked on an initiative to develop novel educational programmes to train ophthalmic assistants (OAs) and ophthalmic technicians (OTs), riding on the ACP framework to secure Duke-NUS joint affiliation. The OA/OT curriculum provides competency-based on-the-job training and is the first in the Asia-Pacific region to be accredited by the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO).

Congratulations to the team comprising of Imaging, Ophthalmic investigations, Nursing, HR and T&E personnel, for winning the 10th AHIP GEM Award 2017, for their efforts in addressing the manpower capacity development!

To further expand the profile and recognition of Allied Ophthalmic professionals, the EYE ACP has embarked on the following initiatives: • Part of the JCAHPO Global Allied Ophthalmology Workforce training development efforts.

• Working towards JCAHPO recognition of SNEC as a regional examination centre for international OA/OT certifications.

• Partnering with other institutions to develop a postgraduate certification in ophthalmic nursing.

Delivering Resident-led Teaching Transitioning from medical student to intern is inherently challenging for students with limited exposure to the clinic. The Singapore Health Services Student Internship Programme Bootcamp, a resident-led, large-group teaching initiative for final-year medical students, intends to alleviate these challenges while honing the teaching skills of residents.

Dr Daniel Ting, Associate Consultant at SNEC, describes the programme.1 This programme covers general surgery, obstetrics and gynaecology, orthopaedics, and paediatric medicine. Resident educators deliver lectures combined with interactive, case-based question-and-answer sessions. Students interpret test results, and present diagnosis and management plans.

Our inaugural bootcamp was well-received by the students, who found the sessions to be relevant and of high quality. Future bootcamps may include small-group discussions and practical surgical sessions for various specialties. We also hope to recruit more students and residents.

1. Ting DS et al. Singapore Med J 2016;57:233–7. https://doi.org/10.11622/smedj.2016092

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DUKE EYE CENTER EDUCATION

Duke Fellows Make a Difference Fellowship programmes at the Duke Eye Center aim to develop future leaders in ophthalmology.

“Duke has one of the strongest imaging-focused biomedical engineering departments. We have outstanding specialists developing innovative imaging tools, which we can directly utilise on patients.

During my fellowship, I have helped evaluate a new biomarker for uveitic

cystoid macular oedema and have also gained insights into the postsurgery recovery of the retina.

Additionally, I have been involved in developing novel surgical techniques and have used realtime optical coherence tomography imaging. Several projects are ongoing, and we hope to improve diagnostic and therapeutic options for our patients.”

Inter-disciplinary collaboration has made Duke Eye Center a leader in research and patient care.

Dr Dilraj Grewal Fellow in Vitreoretinal Surgery

Ophthalmic Medical Technician (OpTech) Program The OpTech Program offers accelerated, affordable, accessible and accredited learning in state-of-the-art facilities, with opportunities for an expanded curriculum and greater development opportunities.

By the time I graduated, I felt completely prepared to begin my career, and it opened up a door for me to a job that I enjoy coming to every day.

Lindsay Lawter, Certified Ophthalmic Technician, 2015 graduate For more information on the Duke OpTech Program, visit www.dukeeyecenter.duke.edu/optech

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PHILANTHROPY

Singapore Celebrity Dick Lee Saving Sight with VisionSave His personal struggle with vision problems, including almost going blind at the age of 21, made Dick Lee acutely aware of the fragility of vision. He thus readily agreed to serve as an Ambassador for VisionSave – SNEC/SERI’s inaugural campaign to leverage on philanthropic investment to innovate medicine in the most impactful manner to ensure optimal outcome for every patient.

I have learned to appreciate every sunrise and sunset and prepare myself for the possibility of blindness.

VisionSave aims to: • SAVE VISION by preventing avoidable blindness.

• RESTORE VISION by helping those already experiencing vision loss.

• PROTECT VISION by addressing people at risk of sight loss.

Donate at www.visionsave.sg/donate/

“VisionSave is a great initiative to raise funds towards enhanced eye care delivery, and I encourage everyone to donate to this worthy cause.”

Monitoring Intraocular Pressure (IOP) at Home with Duke’s ‘Lending Library’ Working with Duke Eye Center’s Dr Sharon Freedman, 13-year-old glaucoma patient Sarah Smale raised over $40,000 for a ‘Lending Library’ that provides Icare tonometers to select paediatric patients. Patients share their IOP with Dr Freedman, who uses the data to manage the patient, as well as for research towards improving outcomes.

Dr Freedman using the Icare on Quinn

Sarah with 4-year-old Quinn, who has benefitted from the Icare library

Icare is really catching on, and it’s exciting to be on the forefront of something that can be really enabling.

Dr Sharon Freedman ISSUE NO. 1, 2017 | 10

EYE ACP EVENTS

EYE Ball 2016 – A Sight to Behold Almost $3.7 million was raised towards VisionSave at the EYE Ball 2016, a charity event organised by the EYE ACP to raise awareness of vision and the fragility of sight.

Conceptualised by celebrity extraordinaire, Dick Lee, with strong support from the Singapore Tatler, the event saw the ballroom at the St Regis filled to capacity with some of SNEC/SERI’s strongest supporters.

Professor Tommy Koh, Singapore’s Ambassador-at-large, was honoured with the inaugural Visionary Award, which recognises individuals who have contributed to societal benefit in Singapore and beyond.

The EYE Ball was held at the St Regis on 19 November 2016

Professor Tommy Koh receiving the inaugural Visionary Award

eYe-P Time-out eYe-P Timeout, organised by the EYE ACP, is a chill-out informal gathering where clinicians and scientists can meet and mingle, share ideas, network and have an enjoyable music-filled evening, with good company.

At the eYe-P Time-out 2016, the EYE ACP faculty enjoyed a night of wine, tapas and music from our Residents and staff

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AWARDS EYE ACP

EYE ACP Awards 2016 3RD INTERNATIONAL CONFERENCE OF PATHOLOGIC MYOPIA Poster Session Award Dr Wong Chee Wai

10TH WORLD BIOMATERIALS CONGRESS Trainee Award Mr Andri Kartasasmita Riau

THE ASSOCIATION FOR RESEARCH IN VISION AND OPHTHALMOLOGY (ARVO) 2016 Travel Grant Dr Tin Aung Tun Dr Baskaran Mani Dr Shi Yuan

ARVO Silver Fellow Award Prof. Aung Tin

INC RESEARCH 2016 ASIAN FORUM ON MODERN RESEARCH OF TRADITIONAL CHINESE MEDICINES Outstanding Oral Presentation Dr Koh Jun Jie

ACADEMIC MEDICINE•EDUCATION INSTITUTE (AM•EI) GOLDEN APPLE AWARDS 2016 Programme Innovation Award (Medical Category) Adj. A/Prof. Shamira Perera

ACADEMY OF ASIA-PACIFIC PROFESSORS OF OPHTHALMOLOGY

Clinical Research Site Award SERI and SNEC

JOINT RESEARCH DAY ON CLINICAL TISSUE ENGINEERING AND REGENERATIVE MEDICINE Young Investigator Award – 3rd Prize Dr Chetna Dhand

NATIONAL MEDICAL RESEARCH COUNCIL Clinician Scientist Award A/Prof. Jodhbir Mehta Transition Award Dr Monisha Nongpiur

Founding Fellows Prof. Aung Tin Prof. Donald Tan Prof. Wong Tien Yin

NATIONAL UNIVERSITY HEALTH SYSTEM AWARDS CEREMONY

AMERICAN ACADEMY OF OPHTHALMOLOGY (AAO) 2016

NATIONAL HEALTH IT EXCELLENCE AWARD 2015

Appreciation Award Prof. Donald Tan

IT Excellence in Providing Quality of Care Singapore Integrated Diabetic Retinopathy Programme (SiDRP)

Senior Achievement Award Prof. Wong Tien Yin

PS21 ExCEL AWARDS 2016

AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 2016

SINGAPORE CHIEF RESIDENCY PROGRAMME

AAO/OPHTHALMIC PHOTOGRAPHERS’ SOCIETY MEETING 2016, CHICAGO, USA

The SNEC Ophthalmic Imaging Service Team 1st Place Corneal Endothelial Photography, Acanthamoeba Keratitis Fundus Photography, Swollen Disc ICG Angiography, Polypoidal Choroidal Vasculopathy Monochromatic Photography, Optic Disc Mass Slit Lamp Photography, Keratoconus The Eye as Art, Radial Iris 2nd Place Corneal Endothelial Photography, Keratic Precipitate External Photography, External Prosthesis ICG Angiography, Choroidal Melanoma ICG Angiography, Subretinal Fluid Monochromatic Photography, Choroidal Melanoma 3rd Place Cross Categories, Filtration Tube Fluorescein Angiography, Polypoidal Choroidal Vasculopathy Fundus Photography, Coloboma With Retinal Detachment Fundus Photography, Morning Glory Syndrome Honorable Mention Fundus Photography, Bilateral Macular Coloboma Ultra-Widefield, Dislocated IOL

Outstanding Researcher Award Prof. Aung Tin

Best Paper Presentation Presbyopic Inlay Section A/Prof. Jodhbir Mehta

Silver Award, Most Innovative Project/Policy The SiDRP Team

SCRP Mentor Excellence Award Prof. Wong Tien Yin

SINGHEALTH DUKE-NUS SCIENTIFIC CONGRESS 2016

Best Poster Award - Health Services & Services Research Ms Amudha Aravindhan

ASIA-PACIFIC ACADEMY OF OPHTHALMOLOGY 2016 Achievement Award Dr Seah Lay Leng Adj. A/Prof. Shamira Perera Dr Yasuo Yanagi

SINGHEALTH EXCELLENCE AWARDS 2016

MENTOR EXCELLENCE AWARD 2016

Prof. Wong Tien Yin (right) was presented with the prestigious SCRP Mentor Excellence Award at the SCRP 2016 graduation dinner

Distinguished Researcher Award A/Prof. Jodhbir Mehta

Distinguished Service Award Dr Seah Lay Leng Dr Sonal Farzavandi

Distinguished Visionary Leader Award Prof. Aung Tin

Outstanding Service in Prevention of Blindness Award Prof. Saw Seang Mei

SingHealth Publish! Award (Medical Research) Mr Andri Kartasasmita Riau

SINGHEALTH RESEARCH GRAND ROUND

ON CALL WITH DR DANIEL TING Outstanding Chief Resident and SingHealth Residency Valedictorian in 2016

I attribute my success in the SNEC Ophthalmology Residency Program to motivation, persistence and eagerness to learn. This programme is well-structured, with an internationally renowned teaching faculty who are involved in research, and who closely supervise and mentor Residents. The partnership with Duke-NUS allows clinicians to translate innovation into patient-centred care.

Medical students contemplating enrolling in this programme should ideally have some research experience in ophthalmology, be keen to pursue academic medicine, and have excellent manual dexterity and binocular 3-D vision. Against the backdrop of innovation, ophthalmology continues to be an exciting specialty.

Contact Us Sharmila Kannan Director, EYE ACP sharmila.kannan@seri.com.sg Monica Lim Siew Chin Senior Manager, EYE ACP monica.lim.s.c@seri.com.sg Sarah Germaine Grant Senior Manager, EYE ACP sarah.germaine.grant@seri.com.sg Cheng Jie Senior Analyst, EYE ACP cheng.jie@seri.com.sg For more information, please contact us at: eye.acp@seri.com.sg

Disclaimer: Singapore EYE is a publication of the Ophthalmology Academic Clinical Program (EYE ACP), Singapore National Eye Centre. No material may be reproduced in part or in whole without prior written consent from the Publisher. Views and opinions expressed in Singapore EYE are not necessarily those of the Publisher or the Editors. Although reasonable care has been taken to ensure the accuracy and objectivity of the information provided in this publication, neither the Publisher, Editors nor 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. Printed in Singapore by Colourscan Print Co Pte Ltd. MCI (P) 133/01/2017.