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Glaucoma Research
The Glaucoma Service is committed to be a forerunner in glaucoma research under the guidance of its Head and foremost glaucomatologist, A/Prof Paul Chew who is one of the key movers in glaucoma research worldwide. The Service recognizes the importance of understanding the disease process and the need for continued development of novel diagnostic and treatment approaches through research in order to improve and provide quality eye care. It is the only unit in Singapore and in Asia where extensive trials on a new diagnostic imaging modality, Anterior Segment Optical Coherence Tomography were conducted in 2004- 2005. Presently, the unit is involved in two multicenter trials, working together with other researchers from USA and England.
The Glaucoma Service is also actively participating in research on laser and surgical glaucoma management. These are randomized controlled trials on the efficacy of treatment with laser or surgery on patients with open angle and angle closure glaucoma.
Retina Research
The Retinal Service collaborates with leading eye centres across the world to participate in international multicentre clinical trials that will benefit patients in Singapore and beyond. The Service is investigating the treatment of two leading causes of lindness and low vision worldwide - age-related macular degeneration (AMD) and diabetic retinopathy. These research projects aim to investigate novel pharmocologic treatments which are revolutionising the care and visual outcomes for all patients with AMD and diabetes. On the local front, doctors at the Retinal Service are investigating the ocular effects of dengue fever in order to better understand the condition of dengue patients who suffer visual loss. The unit is also aims to develop knowledge in the fields of genetic diseases of the eye and visual electrophysiology.
Cataract Research
The NUH Eye Surgery Centre invests in state of the art equipment for cataract surgery. These new equipments reduce surgery time and increase efficiency of the surgeries, leading to better and safer outcomes for patients. Machines used in cataract surgery allow cataracts to be removed through smaller and smaller incisions (wound opening) with smaller probes which have more efficient delivery of energy to emulsify (soften) the cataract before it is removed. Biotechnology companies which design these machines are working in tandem with our surgeons to improve their systems for cataract surgery.
Intraocular lenses (IOLs) which are used during surgery have seen vast improvement in material and lens design over the last 10 to 15 years. Foldable lenses which can go through small incisions and new designs of multifocal (allow vision for both far and near) lenses are in use at our Centre.
Cornea Research
The Cornea Service is actively involved in the research of cornea and external eye diseases. The current areas of research include dry eyes (medical treatment and acupuncture treatment), allergic eye disease in children (newer medications that help break the attack and control and disease), new methods of cornea transplant and pterygium surgery.
Neuro-Ophthalmology Research
The Neuro-ophthalmology Service is a participant in the nationwide Survey of Neuro-ophthalmic Disorders in Asians. This study is now in the data analysis phase. We are also collaborating with the Paediatric Ophthalmologists in work related to amblyopia.
NUS and SERI conducts broad-based research that will improve the understanding of how eye diseases develop, test new diagnostic and treatment modalities, and facilitate these technologies for commercialization. NUS is particularly focused on sight-threatening disorders that are relevant to our society. The Department has already established a high international profile for its work and is widely recognized for its research at the cutting edge of vision sciences.
Current and significant research breakthroughs and developments:
Prof Wong Tien Yin's research discoveries includes:-
- Gene
discovery for Congenital Hereditary Endothelial Dystrophy
In
July 2006, Prof Donald Tan initiated a genetics project on Congenital Hereditary
Endothelial Dystrophy (CHED) with Assoc Prof Aung Tin, as a result
of genetic material obtained from a CHED family who had corneal
transplantation performed by the staff in Myanmar. This led to the
identification of a new gene (SLC4A11) for CHED, and
culminated in a publication in Nature Genetics, and 2 Singhealth
research awards for A/Prof Aung Tin and Dr Eranga Vithana. This new borate
transporter gene, not previously linked to human disease, has opened
up new avenues of genetic research into other more common forms of
endothelial dystrophy, including the common condition of Fuchs’
dystrophy, which shares many of the phenotypical characteristics of
CHED.
Osteo-Odonto
Keratoprosthesis (OOKP)
OOKP surgery is a revolutionary ocular procedure which aims to
restore vision to the most severely blinded end-stage ocular surface
and corneal patients. The 2 stage surgical procedure involves
a multi-disciplinary team of ophthalmic surgeons, oral surgeons,
radiologists and anesthetists to restore vision to severe cases of
Stevens Johnson syndrome, ocular cicatricial pemphigoid, and severe
burns victims for which all other forms of surgery, including
corneal transplantation and stem cell transplants, have failed.
A canine tooth is harvested, drilled to receive an optical cylinder
and implanted in the cheek for 3 months. Second stage surgery
involves retrieving the tooth-cylinder complex and implanting it
into the eye in a complex 6 hour procedure. Prof Donald
Tan, PI of the project led the team in performing the first OOKP
surgery in East Asia in Feb 2004, and over 10 patients, mostly from
the region, have had OOKP surgery this year. Success to date
has been high, with vision restored to all these patients to date.
The program continues for 2 years.
The
Singapore Retinal Imaging and Archival Network:
Computer-assisted
Imaging Programme
The SiRIAN
programme is focused on the development and evaluation of
computer-based, automatic retinal vascular imaging system for risk
prediction. Prof Wong Tien Yin
in
collaboration with Assoc Prof Wynne Hsu and Assoc Prof Lee Mong Li
from the School of Computing in NUS, and Dr Lim Joo Hwee and Dr Liu
Jiang from Institute of Infocomm and Research
have developed
techniques for (1) measurement of retinal vascular caliber, (2)
localization and detection of optic disc and cup, (3) detection of
abnormal retinal lesions (e.g., retinal hemorrhages, microaneurysms,
hard exudates and other lesions), (4) tracking of the vascular
structure to compute vessel caliber, branch angles and tortuosity,
(5) automatic classification of vessels into arteries and veins, (6)
registration of retinal images over multiple time points to detect
changes in the images; and linkage of retinal image features with
demographic and clinical data. The Singapore
Prospective Study Program
(SP2)
SP2 is a large population-based studies of 5,000+ people to
determine vascular risk factors, diabetes and cardiovascular
diseases in Singapore. This is led by Prof Wong Tien Yin with Dr Tai
E Shyong. The Multi-Center
Retinal Stroke Study
This study is a
prospective investigation of patients with acute stroke seen at the
Singapore General Hospital, Royal Melbourne Hospital, Melbourne and
Westmead Hospital, Sydney, Australia. This study has already
recruited 1,600+ patients with acute stroke.
SiMES - Singapore
Malay Eye Study
SiMES is a
large-scale population based study to assess the causes and risk
factors of blindness and visual impairment in our Malay community,
over a 3 year period. Funded by the National Medical Research
Council, SiMES examined 3,280 Malay adults aged between 40 to
80 years. Principal Investigator is Prof Wong Tien Yin, Co-PIs are
Assoc Prof Saw Seang Mei, Assoc Prof Aung Tin and Prof Donald Tan. SiMES
is the first large-scale survey of its kind to be conducted for a
Malay community in the world. SiMES will provide important and
previously unavailable public health information on the frequency of
the most important eye diseases affecting Malay Singaporeans, which
will aid in strategic planning of cost-effective public health
policies in ophthalmology which may ultimately reduce blindness and
visual disability in our ageing population. Since 2008, there have
been 10 papers published or in press in the topophthalmology
journals, including Ophthalmology, IOVS, and Archives of
Ophthalmology. Discovery of relationship between near work
and myopia prevalence
This research, a SERI
collaborative effort between department of Ophthalmology and the
department of COFM, with Assoc Prof Saw Seang Mei heading the
project, and Prof Donald Tan as Co-PI, is a longitudinal
cohort study on 2000 primary schoolchildren to determine true
prevalence rates of myopia and evaluate possible environmental risk
factors responsible. Initial success culminated in a Lancet
publication demonstrating, for the first time, the association
between near work and parental history of myopia with a higher
prevalence of myopia in Primary 1, 2 and 3 schoolchildren. This is a
significant breakthrough in our knowledge of the cause myopia, as
the possibility for environmental or behavioral modification as a
preventive measure for myopia progression is now a reality.
Glaucoma Research
Important
glaucoma research continues to be a major thrust of the department,
under the expertise of Assoc Prof Paul Chew. Novel research in the
field of 3D spatial perception and visuo-motor defects in glaucoma
are being evaluated in the Visual Performance Unit of SERI, under
the direction of Assoc Prof Chew and SERI vision scientist Dr Valerie Cornilleau Peres. Assoc Prof Chew has also been highly active in leading
several clinical trials. The Singapore Indian Chinese Eye Study
(SICC)
This study has started recruitment in 2007, and
aims to examine 3,200 Indians and 3,200 Chinese subjects aged 40-80
years. The study will use the same protocol as SiMES, and will have detailed retinal imaging and DNA storage.
Using the retina to investigate cardiovascular
diseases
Cardiovascular diseases are the most
common causes of death around the world. Traditional risk factors,
such as hypertension, allow physicians to identify persons at risk
of cardiovascular diseases. However, these risk factors have
well-recognized limitations (e.g. many people do not have
hypertension or hyperlipidemia), and there is interest in finding
other cardiovascular risk indicators. Since the retina of the eye
can be viewed non-invasively, the retinal blood vessels offer a
unique perspective of the state of the microcirculation in the heart
and the brain. Narrowing and other changes of the retinal arterioles
reflect cumulative damage due to hypertension, diabetes, and other
vascular processes. Studies led by Prof Wong Tien Yin and his
collaborators (Prof Ronald Klein, Prof Barbara EK Klein, Prof Paul
Mitchell, A/Prof Jie Jing Wang, Dr Ning Cheung, Dr Gerald Liew, Dr E
Shyong Tai, A/Prof Seang Mei Saw, A/Prof Wynne Hsu, A/Prof Mong Li
Lee) has established that an objective assessment of retinal microvascular changes may provide important prognostic information
regarding risk of stroke, coronary heart disease, diabetes and other
conditions. These research have been published in the New England
Journal of Medicine, Lancet and the JAMA. Mouse Model of Myopia
Adjunct
Prof Roger Beuerman led in the development of a mouse model of
myopia, a world first. Previous animal models of myopia included
visual deprivation studies in chicks and tree shrews. This important
achievement paves the way to using our knowledge of the mouse genome
to facilitate research into understanding biological mechanisms of
myopia, which will give us the opportunity to develop new treatments
and drugs for human myopia. Formation of Ocular Stem Cell Research Program
and Collaborative Stem Cell Research Group
In 2001,
Prof Donald Tan and Adjunct Prof Roger Beuerman initiated an
Ocular Stem Cell Research Program, with grants from NMRC, BMRC and
SingHealth Research Funds, and the program formed an important
research pillar for the formation of a larger multidisciplinary,
NMRC-funded Stem Cell Research Group (SCRG) based at the Outram
Campus.
Headed by Assoc Prof Lee Seng Teik and Prof
Donald Tan, the SCRG will undertake laboratory and clinical stem
cell research collaborations in the field of embryonic and adult
stem cells. Five major stem cell programs include the NUS Eye
Department's own ocular surface stem cell project, and other
projects ranging from human oocyte maturation and cloning for tissue
engineering, vascular endothelial progenitor cell culture,
cultivation of hair follicle stem cells, to CNS neural stem cells,
with collaborating clinicians and scientists from the SGH
Departments of Plastic Surgery, Neurology, Obstetrics and
Gynecology, Department of Clinical Research and the National Cancer
Centre. SCRG laboratories are currently based at the SERI
Laboratories, and this ambitious multidisciplinary program will not
only enhance the university focus on stem cell research, but also
create vibrant and productive cross-disciplinary collaborations and
interactions between NUS and other clinician scientists and
researchers in the Outram Campus.
Updated July 2009
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