Singapore's World-Class Research (Seri: Singapore Eye Research Institute)

“Let us battle for truth and enjoy success with humility. Let us not annex success achieved by others.”

Arthur Lim



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SERI SINGAPORE EYE RESEARCH INSTITUTE

SINGAPORE ’ S WORLD-CLASS RESEARCH

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SERI: Singapore’s World-Class Research First published in 2008 by World Scientific World Scientific 5 Toh Tuck Link Singapore 596224 Copyright© Arthur Lim All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. ISBN-13 978-981-283-317-4 (pbk) ISBN-10 981-283-317-x (pbk) Printed in Singapore Designed by SinKho Advertising & Design

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Dedicated to Chew Sek Jin and Donald Tan



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Foreword Introduction



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History of the Singapore Eye Research Institute (SERI)





Chapter 1

20 1987 • Letter to Mr Khaw Boon Wan (Executive Director, NUH) • Joint Venture Proposal: National Medical Enterprise & Professor Arthur Lim

contents



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1989 • Letter from Dr S B Kwa, Permanent Secretary (Health)/Director of Medical Services & Chairman of HCS Pte Ltd 1990 • Letter to Dr SB Kwa, Chairman SNEC 1991 • Letter to Dr S B Kwa, PS (Health)/DMS • Letter to Mr Yeo Cheow Tong, Minister for Health • SNEC Board Paper - 20 September 1991 • Letter from Dr SB Kwa, PS (Health)/DMS • Report on Donations Received for the National Eye Research Institute • SNEC Board Paper – 8 November 1991

Chapter 2

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Chapter 3

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Eye Research in Singapore: From Laboratory to Modern Institute by Assoc Prof Chew Sek Jin

History of the Singapore Eye Research Institute (1997-2006) by Prof Wallace Foulds











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Singapore’s Research Heroes

Chapter 4

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Chapter 5

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Chapter 6

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Chapter 7

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Associate Professor Chew Sek Jin

Professor Donald Tan

Professor Wallace Foulds

• • • • • •

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Dr Kwa Soon Bee Assoc Prof Vivian Balakrishnan Dr Khoo Chong Yew Prof Roger Beuerman Assoc Prof Saw Seang Mei Prof Wong Tien Yin





Progress of the Singapore Eye Research Institute

Chapter 8

102 1999 First National Eye Research Meeting

Chapter 9

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Chapter 10

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Chapter 11

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2000 • Chairman’s Message • Second National Eye Research Meeting • Agenda for Eye Research in the New Millennium: The Role of Ophthalmic Research in Singapore by Dr Wong Tien Yin and Cl Prof Donald Tan

2001 • Chairman’s Message • Director’s Report • Board Members • Report on the First SERI International Meeting

2002/2003 • Chairman’s Message • First SERI-ARVO Meeting on Research in Vision and Ophthalmology



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Chapter 12

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Chapter 13

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Chapter 14

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2004/2005 • Chairman’s Message • Director’s Report • Board Members • Second SERI-ARVO Meeting on Research in Vision and Ophthalmology

2006/2007 • Chairman’s Message

• Milestones



The Singapore National Eye Centre

Chapter 15

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• Singapore National Eye Centre By Ms Charity Wai • At the Changeover of Leadership (1999) By Assoc Prof Vivian Balakrishnan

Chapter 16

• Conclusion – The Best is Yet to Come By Prof Arthur Lim

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Foreword For the first time in the history of medical research in Singapore, an area of research has attracted numerous indications that it has reached a high international standard. Ophthalmic research in Singapore is now world-class, competing effectively with the research at the top ophthalmic research centres of the world. The Association of Research in Vision and Ophthalmology (ARVO), the most important and largest American ophthalmic research group, held its first meeting outside the USA in Singapore in 2003, together with the Singapore Eye Research Institute (SERI). The meeting made such a strong impression that a decision was made to hold the second ARVO-SERI meeting in Singapore again. Following this, ARVO decided to hold annual meetings in Asia as many important research papers come from the region. The meeting was renamed Asia-ARVO; the first meeting was held in Singapore in 2007. Looking at the reports from both 2001 and 2005, not only were there more scientific papers submitted, but there were also more papers on basic research and epidemiology. The impact factor of the papers from Singaporean researchers has gone up two levels from one to three plus. If you look at some of the Western journals and publications, their impact levels are usually below or around three. This is a reflection of the quality of research by our Singapore doctors. Numerous researchers and ophthalmologists from both the developed and developing nations have requested to visit SERI, and many doctors have asked to work on a short- or long-term basis at SERI. I am very delighted with the success of SERI. I would like to, in this publication, recognise the people who supported our goal to achieve world-class standards in research. Fifteen years ago, I expressed the view that Singapore may do well in the service, teaching, and training industries, and reach a very high standard in these fields. However, I did not think it was possible for Singapore to produce world-class ophthalmic research.

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Foreword

Besides Donald Tan and the late Chew Sek Jin, my congratulations go to Wallace Foulds, Roger Beuerman, Aung Tin, Wong Tien Yin, and Saw Seang Mei, not forgetting Cheng Hong Ming, Bill Lam, Deborah Chee, Valerie Cornilleau-Peres, Maurice Yap, Lim Kuang Hui, and Vivian Balakrishnan. In the beginning, there were three key people who supported SERI. In my paper “In Praise of Bureaucrats,” I emphasised that Dr SB Kwa, former Vice-Chancellor of NUS Lim Pin, and Khaw Boon Wan were three important persons who strongly supported SERI. I would also like to thank the following individuals for their support: John Wong and Tan Chorh Chuan. And special thanks to Dr Khoo Chong Yew for promoting medical ethics; as well as Dr Ang Beng Chong, Dr Adrian Koh, Charity Wai, Chiam Soo Lee, and Julie Yeong — although they did not play an active role in SERI, they gave very good strong support to me in many ways. SERI has to attract and retain the best researchers. SERI has to provide researchers with adequate facilities and support staff to continue with quality research. I am delighted that Professor Donald Tan has put together an excellent team. I am confident that he will generate more fascinating research in the coming years. We are proud of you, Donald. I will strongly support your wonderful work as we move into the future.

Professor Arthur Lim Founding Chairman, SERI

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Introduction

The opening of the Singapore National Eye Centre (SNEC) in 1990 marked the beginning of a new era in ophthalmology in Singapore. This prestigious international development was designed to raise the practice of ophthalmology in Singapore to a world-class standard and to provide a centre of ophthalmic excellence for Asia. From an early stage, Prof Lim realised that a centre of excellence such as the SNEC has to offer the best service and training programme. In addition, it has to be innovative and active in research, embracing the view that research would be a stimulus towards the best clinical practice. And through research, improvements in ophthalmic care would benefit patients seeking help at the centre. The development of ophthalmic research was well documented by the late Assoc Prof Chew Sek Jin, PhD, FRCS, the pioneer of ophthalmic research in Singapore, with a supporting article by Prof Wallace Foulds, a world leader in ocular research who has spent 20 years advising me and our researchers in Singapore.

Early Concepts of a National Research Centre In the 1970s, the thrust of ophthalmic development was in clinical services, with a focus on microsurgery and lens implantation. In addition, various subspecialties developed around this period. In 1973, to further his aims of pushing ophthalmic research in Singapore forward, Prof Arthur Lim sought the advice of Prof Wallace Foulds, Emeritus Professor of Ophthalmology at the University of Glasgow, who had successfully headed the Tennent Institute of Ophthalmology in Glasgow for many years.

The opening of the Singapore National Eye Centre (SNEC) in 1990 marked the beginning of a new era in ophthalmology in Singapore.

In 1973, to further his aims of pushing ophthalmic research in Singapore forward, Prof Arthur Lim sought the advice of Prof Wallace Foulds.

To get things moving, it was clear in 1981 that a national eye centre should be established. In 1983, the Singapore Eye Foundation was formed and, with it, the beginning of ophthalmic research emerged. In 1986, Dr SB Kwa became Permanent Secretary and Director of Medical Services (Health), and together with Professor Lim Pin — Vice-Chancellor of the National University of Singapore — established the Eye Department at the National University Hospital (NUH).

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Introduction

1986: Professor Arthur Lim as Founding Head of the NUH Eye Department It was clear that the Eye Department at the NUH was limited in its capacity to bring ophthalmology to a world standard. With the support of Dr SB Kwa, negotiations began between Professor Arthur Lim and Mr Khaw Boon Wan, Executive Director of NUH, to establish a national eye centre. Rapid development was possible because of the enthusiasm and strong support of Mr Khaw. On 1 June 1987, a letter was written to Mr Khaw Boon Wan by Prof Arthur Lim. This was the beginning of an official move to establish ophthalmic research in Singapore. While SNEC and SERI are two different entities, they overlap in some aspects. The original plan was to establish a research institute. However, SNEC was started first and SERI came later. Therefore, eye research in Singapore has its roots in SNEC, which played the important role of bringing together a research team under its research unit.

Brief History At this point, it is useful to trace the brief history of ophthalmic research in Singapore. 1999–2000 Associate Professor Chew Sek Jin was the active force pushing research forward, but his untimely death in December 1998 brought about considerable uncertainty regarding the future of eye research. 2000 A crucial decision was made to appoint Associate Professor Donald Tan, an excellent clinician, as director of the new eye research institute. He worked very hard to coordinate ophthalmic research and was confirmed as the director of SERI in 2000. 2001 This was an important year for SERI. It was clear by then that the obstacles to ophthalmic research had been overcome and that SERI could now move forward rapidly. 14





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From the Director’s Report: In July 2001, the then Director of Medical Services, Ministry of Health, Professor Tan Chorh Chuan, indicated that SERI should function as the coordinating centre for all ophthalmic research, and should include doctors interested in research from both the Singapore Health Services and the National Healthcare Group. SERI now occupied two floors in the new SNEC block.



The new SERI facilities were opened on the fifth and sixth floors of the eight- storey SNEC building by Minister Lim Hng Kiang, Minister for Health and second Minster for Finance. For the first time, SERI was able to bring all of its clinical and basic research activities under one roof, in two custom-built research floors, one for clinical research and the other for laboratory-based research.

Introduction

First SERI International Research Meeting The first SERI International Research Meeting was held at the new SERI facility from 27–30 September 2001. This eye research meeting coincided with the opening of the new SERI facilities by the Minister for Health, Mr Lim Hng Kiang, the guest of honour at the meeting. More than 300 delegates attended the meeting. The response was overwhelming. The full three-day scientific programme was devoted to keynote lectures, with more than 100 scientific abstracts presented either as posters or oral presentations. The success of the meeting marked the great potential of Professor Donald Tan.



Scientific Publications in 2001 Overall, Singapore’s scientific publictions improved significantly from 1991 to 2001. In 1997–1998, there was a slide in the figures for our scientific publications, due to the illness of Associate Professor Chew Sek Jin. However, the year 2000 saw the beginning of a climb as the figures rose again. Most evidently, the significance of each of the scientific publications can be judged by their impact factor, which has increased from 1.53 (1998) to 2.4 (2001), indicating the scientific value of the publications in addition to the significant increase in the number of basic and epidemiological research.



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Introduction

Stem Cells In 2001, SERI embarked on stem cell research. Stem cell researchers at the Outram Campus formed a multidisciplinary Stem Cell Research Group (SCRG) to discuss stem cell research collaboration within the SingHealth institutions and departments in the field of embryonic and adult stem cells. Singapore Myopia Registry (SMR) The Singapore Myopia Registry (SMR) is a national disease registry initiated by the Ministry of Health, set up to collect and provide information on myopia in Singapore for the purpose of health planning, clinical quality assurance, benchmarking, clinical research, and tracking of patients under the National Disease Management Plans. Implemented in 2002, the SMR serves as a national resource to track and research the problem of myopia among the Singaporean population. SMR will serve as our population database for epidemiological research into myopia and related ocular disorders in Asian eyes. Source: Extracted from SERI Research Report 2001

2002/2003 The first joint meeting between SERI and ARVO was the major international ophthalmic research event of the year. This meeting was the first such meeting to be held outside the USA. It took place at the Suntec City Convention Centre from 6–9 February 2003. Over 800 delegates from 36 countries were treated to a wealth of research reports and invited lectures on cutting-edge advances in eye research, complemented by a series of workshops on the design and conduct of eye research. The meeting confirmed Prof Donald Tan’s global leadership in ocular research. 2004/2005 SERI was clearly recognised, in the relatively short time since its inception, as a world-class development. Thus, it attracted the second ARVO meeting held in February 2005 in Singapore. There were numerous other indications that SERI’s research was now world-class.

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2006/2007 The ARVO decided to hold annual meetings in Asia as many important research papers came from Asia. The first Asia–ARVO meeting was held in March 2007. SERI celebrated its 10th anniversary in 2007.

Introduction

“If ophthalmic research in Singapore is to continue to produce outstanding results and be featured in leading international publications, we cannot afford to rest on our laurels. We must seize every opportunity. This is the fascinating and challenging task for Donald Tan and his team in 2007 and beyond.” Arthur Lim Conclusion Having achieved world-class standard in ocular research, there is a tendency to rest on our laurels and be contented with what we have achieved. But if ophthalmic research in Singapore is to continue to produce outstanding results and be featured in leading international publications, we cannot afford to rest on our laurels. We must seize every opportunity. This is the fascinating and challenging task for Donald Tan and his team in 2007 and beyond. The best is yet to come. Let us never forget our pioneers who committed themselves to research at a time when there was little interest and almost no available infrastructure in Singapore.

Professor Arthur Lim Founding Chairman, SERI



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History of the Singapore Eye Research Institute



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Chapter 1

1987

Letter to Mr Khaw Boon Wan, Executive Director, National University Hospital 1 June 1987 Mr Khaw Boon Wan Executive Director, NUH

The idea of the National Eye Institute was mooted as far back as 1981

Re: National Eye Institute I am attaching 3 documents: (i) the financial report (Appendix A) (ii) the background information (Appendix B) (iii) a pamphlet prepared 2 years ago (Appendix C) I would like to set out the outline of my thoughts regarding the Institute in relation to the Department of Ophthalmology at National University Hospital. Dr Arthur Lim

Appendix B Proposal For The National Eye Institute: Background Information The idea of the National Eye Institute (NEI) was mooted as far back as 1981, when the Singapore Eye Foundation was in the process of being set up. From 1983, discussions on the concept of the NEI were actively taking place between the Ministry of Health and Dr Arthur Lim, the outcome being the MOH Report put out in early 1986. Since then, there have been further meetings and negotiations, but to date, an in-principle approval is still wanting.

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The Economic Committee emphasised Singapore’s need to realise its full potential of developing into a centre of medical excellence through the setting up of specialty institutes to concentrate resources and expertise. However, lack of decisive action is causing Singapore’s competitiveness as a major centre of excellence to be eroded, especially in view of the rapid pace of developments taking place in our neighbouring countries. The concept for the Tun Hussein Onn Eye Hospital in

History of the Singapore Eye Research Institute

Kuala Lumpur originated in 1981, the same year we conceptualised our proposed National Eye Institute. By March 1986, the Malaysian hospital was built and ready to admit its first patients. Similar developments are also taking place in Hong Kong, Indonesia, and China. This report aims at reviving interest and generating commitment in the National Eye Institute proposal. Despite the rapid developments in our neighbouring countries, we may still have a chance of success. But immediate action must be taken. I. Introduction The demand for high-quality ophthalmic care in Singapore and Southeast Asia is increasing with the ageing of the population and rising affluence. Although some of our neighbouring countries have already succeeded in setting up eye hospitals, Singapore’s standard of ophthalmic practice is still relatively higher. In order for Singapore to keep pace with her Asian neighbours, an institute with an emphasis on both education and research must be built. It will act as a nucleus to concentrate all manpower resources from both the public and private sectors for the advancement of ophthalmology in Singapore. II. Objectives The primary objective of the institute is to offer the highest possible standard of expertise in ophthalmology to the people of Singapore. A world-class standard will also establish the institute as a regional referral centre. The institute will promote continuing and advanced education as well as R & D in ophthalmology, and will spearhead industry-related joint ventures.

In order for Singapore to keep pace with her Asian neighbours, an institute with an emphasis on both education and research must be built.

III. Concept Bascially, the Institute can be divided into three parts: i. the institute proper ii. the clinical wing iii. the commercial wing

i.

The Institute Proper The institute proper, consisting of laboratories, lecture theatres, etc. is geared for research, teaching, and continuing education. Funds to subsidise R&D projects will come from the commercial wing and from the Singapore Eye Foundation.

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Chapter 1 ii. The Clinical Wing The clinical wing will consist of general, emergency, and specialist clinics. Charges should be structured in such a way that the clinical wing is selfsufficient (similar to that of the NUH). Clinical research may need to be subsidised. iii. The Commercial Wing The commercial wing will be the main revenue centre with space to be leased out for shops (pharmacies, opticial shops, etc.). Space can also be leased out for clinical use, e.g. ophthalmologists and related disciplines. Since the primary objective of the Institute is to fully utilise our medical manpower, the concept of the commercial wing in the Institute is important, as it helps to break down the artificial barrier between private and institutional practices. IV. Business Structure The proposal is to set up the National Eye Institute as a nonprofit-making company. The Institute will be independently run by a board of directors, and will be self-sufficient financially. The major consideration for proposing such a structure is the need for prompt action, and this is only possible without bureaucratic constraints. Unless the Director of the Institute is given a free hand to plan and develop for the first five years, his effectiveness to propel the Institute to international excellence will be limited. The Institute can be returned to the NUH after 10 years. V. Target Time-Frame Our target completion date of the National Eye Institute is 1990, when the International Congress of Ophthalmology will be held in Singapore. The plan calls for immediate action, which we can approach in three phases:

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Phase I:

Incorporate the Eye Institute as a nonprofit-making private institute by 1 July 1987.



Phase II:

Target the Institute’s interim premises to be operational by 1 January 1988.

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Phase III: Finalise plans for the permanent location of the Institute by 1 July 1988. Incorporation of Institute A draft Memorandum & Articles of Association has been drawn up (by Donaldson & Burkinshaw) for the Institute. Initially, with the Institute incorporated as a private concern, it can be amended, dissolved, or absorbed if the NUH finally decides to take over the Institute at a later date.

Interim Facility It is critical to set up an interim facility to bring together staff and resources, to set up the organisation, and to build up momentum so that, when the new building is completed, the work of the Institute is ready to take off.



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1987

Chapter 1

Joint Venture Proposal — National Medical Enterprise and Professor Arthur Lim Numerous meetings were held to establish a private international eye centre as a joint venture with the American healthcare company, the National Medical Enterprise, which owns Mount Elizabeth Hospital (MEH). There were also numerous meetings with other private medical institutions including the Balestier Hospital, the Youngberg Hospital which had an eye department, and the eye clinic of Dr Oh Thiam Hock at Hill Street. There were many discussions to transform one of these into a major eye centre. There were many meetings with Mr Michael Ford, Vice President of the Ameri- can healthcare company, National Medical Enterprise, which owned MEH, and Dr Dallas Riddle, its Chief Executive Officer.

Excerpts from the minutes of the meeting on the proposed purchase of the 17th floor, Mount Elizabeth Hospital, on Thursday, 12th February 1987 at 4pm at Block B, 6th Floor, Mount Elizabeth Hospital Present: Mr Michael Ford, VP, NME Mr Dallas Riddle, CEO, MEH Mr Dennis Brown, ADMIN, MEH Ms Chiam Soo Lee Ms Joni Low 1.

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The meeting commenced with a discussion on the plan to have two operating theatres (Willis and Kibble), according to Dr Lim’s concept of combining surgery with teaching/live demonstrations. There should preferably be two operating theatres with a glass screen all round on one side and four TV monitors for the audience.

2. If built, it would be the first in this region. Currently, there are less than five such theatres in the world, the simple reason being that few surgeons feel comfortable demonstrating their skills to a live audience. Dr Lim is no newcomer — he has been holding regular surgical demonstrations.

Letter from Dr SB Kwa, Permanent Secretary (Health)/Director of Medical Services & Chairman, Health Corporation of Singapore Pte Ltd In February 1989, Dr S B Kwa, Permanent Secretary (Health), Director of Medical Services (Health), and Chairman of HCS Pte Ltd, appointed Prof Arthur Lim as the Medical Director-designate of the Singapore National Eye Centre.

1989

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23 February 1989 Dr Arthur Lim Chief, Dept of Ophthalmology NUH Dear Arthur SINGAPORE NATIONAL EYE CENTRE I am pleased to inform you that the HCS Board has accepted the recommendations of the Protem Eye Centre Planning Committee for immediate implementation. A new subsidiary called the Singapore National Eye Centre (SNEC) Pte Ltd will be incorporated shortly with an authorized capital of $30 million and a paid-up capital of $10 million to see through the creation of the Centre. Accordingly, I am setting up the SNEC Planning Committee and charging it with the responsibility to see through the speedy and successful implementation of the project. I would like to invite you to serve on the SNEC Planning Committee as its Chairman. I would also like to confirm your appointment as the Medical Director-designate of the SNEC. Our vision is for the SNEC to attain international eminence within a decade. I look forward to your acceptance.

I would like to confirm your appointment as the Medical Directordesignate of the SNEC. Our vision is for the SNEC to attain international eminence within a decade.

Yours sincerely Dr Kwa Soon Bee Chairman HCS Pte Ltd \



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1990

Chapter 1 Soon after that, Mr Yeo Cheow Tong, then the Health Minister, had a one-hour private meeting with me at his office and it was with the support of the Minister, together with the determination of Dr Kwa, that the SNEC was formed. It can be said that Dr Kwa played the most important role in the establishment of the SNEC and later the Singapore Eye Research Institute (SERI), supported by Minister Yeo Cheow Tong. Mr Khaw Boon Wan and I met almost every week to establish the numerous details essential for the success of the development. Initially, it was decided to establish SNEC as a service and teaching centre with a relatively small section on research. It was clear that research had to be developed; and on 14 April 1990, I made a strong recommendation to Dr Kwa to establish the Institute of Ophthalmology (or the Singapore Eye Research Institute).

Letter to Dr SB Kwa, Chairman, SNEC 14 April 1990 Dr S B Kwa Chairman, SNEC RE: INSTITUTE OF OPHTHALMOLOGY The proposed research institute of ophthalmology is exciting, as it will complement the SNEC — together, they will form an effective ophthalmic infrastructure to help push Singapore forward as a leading nation for ophthalmic care, research, and development in the 1990s. Ophthalmology, which has remained dormant for centuries in Asia (including Singapore), has awakened. This is because of the recent economic growth in the Pacific Rim nations and in Southeast Asia. During this watershed period, a period of transition, there will be many controversies and uncertainties. The issue before us is just one of the many problems which we will have to face in the coming decade. I am therefore presenting some facts with the hope that we may make the right decision for the future of ophthalmic development in Singapore. There are now before us two closely related, yet different, tertiary developments — a service (SNEC) and a research centre. These two developments should complement, and not rival, each other. 26





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The crucial question is whether research, in particular basic research, can be more effective in the SNEC or whether it can be developed better at the University. In general, the ideal is to have the two centres within one complex. However, there are compelling reasons to do otherwise. The main problem will be the recurrent expenditure. Who will be funding research? I do not think the Shaw Foundation will be prepared to make a substantial capital involvement and then agree to pay for recurrent costs. Research is a very expensive investment, and without the assurance of finance we cannot expect to secure good staff. Nothing of real intrinsic quality will be forthcoming, and the Institute will just be a financial burden to SNEC and will become a proverbial white elephant: a mere show piece without good staff or achievements. It is destined to fail miserably. Both you and I can raise funds. Maybe we can help sustain it for a few years, but we must plan beyond this. Will my successor be able to raise funds? Will our ability to raise funds for the next few years merely delay the onset of the problem?

1990

History of the Singapore Eye Research Institute

The crucial question is whether research, in particular basic research, can be more effective in the SNEC or whether it can be developed better at the University.

Let us now look at my other proposal. By having the Institute at the University, it will be assured of funds for its recurrent expenditure. It will also enjoy certain conveniences: - easy access to the basic research laboratory and animal holding unit - collaborative effort and exchange of knowledge with the University’s many departments, including the Institute of Molecular and Cell Biology - the University would be attractive for those ophthalmologists and professionals who are more dedicated to academic pursuits and research than financial returns It is a setting that can make the institute a great success — a success which you and I will be proud of. Dr Arthur Lim

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1991

Chapter 1

Letter to Dr SB Kwa, Permanent Secretary (Health)/ Director of Medical Services, Ministry of Health 15 July 1991 Dr S B Kwa PS (Health)/DMS, Ministry of Health EYE RESEARCH INSTITUTE I am happy to say that, with the strong support of the government, the handsome and well-equipped Singapore National Eye Centre building has been completed. Every visitor is happy with the facility. It can be said that we have completed phase I of the development of ophthalmology.

However, to become world class — the best eye centre in Asia – and to compete with the top centres of Europe and North America, we need to have a research base.

Phase II will consist of getting an effective team of ophthalmologists together to propel ophthalmology into the 21st century. I believe we have the ophthalmologists who can provide a top-class clinic and research centre. However, to become world class — the best eye centre in Asia — and to compete with the top centres of Europe and North America, we need to have a research base. I am writing to seek your support to have the Eye Research Institute established adjacent to SNEC, as having the two facilities within the same area of one or two acres would give a strong national image, among other advantages. My plan, attached, has been submitted to you as the Chairman of SNEC. It can be modified as there are several ways we can develop a research institute. We have also obtained support from various foundations and my patients. I am also writing to seek your support to help make this development something that Singapore can be proud of. I have recently received a most encouraging report by an independent expert evaluator from Cleveland Clinic, USA, one of the world’s renowned medical centres. Dr Richard G Farmer was invited by your Ministry (Health) to evaluate your hospital and medical centres. He has written to me. His comments are important as it reflects an independent expert evaluation of the SNEC.

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I hope to have your support to ensure that phase II moves forward successfully. I have also written to the University/Ministry of Education to seek their support. With best wishes

1991

History of the Singapore Eye Research Institute

Prof Arthur Lim Medical Director, SNEC



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1991

Chapter 1

Letter to Mr Yeo Cheow Tong, Minister for Health 13 August 1991 Mr Yeo Cheow Tong Minister for Health, Ministry of Health Dear Sir I am writing as a private citizen concerned with the development of medical excellence in our Republic. It is with this in mind that I appeal for your support to help establish in Singapore an eye centre which will be the top eye centre in Asia and hopefully one of the top 10 eye centres in the world.

I appeal for your support to help establish in Singapore an eye centre which will be the top eye centre in Asia and hopefully one of the top 10 eye centres in the world. ... to achieve international excellence, quality service alone is inadequate. We need strong clinical and basic research.

In the past decade, eye development in Singapore has been rapid, due mainly to the strong support from Dr SB Kwa, Permanent Secretary (Health), and more recently from you as Minister for Health and the Vice Chancellor Prof Lim Pin. As a result, the Singapore Eye Foundation (SEF) was formed in 1983, the National University Hospital Eye Department in 1986, the Singapore National Eye Centre (SNEC) in 1990, and the National University of Singapore Eye Department in 1991. In addition, Singapore has in recent years made considerable international impact in numerous directions, one of these being the March 1990 International Ophthalmology Congress (ICO), regarded as one of the most successful international ophthalmic congresses ever held. The SNEC is making good progress, and has already gained considerable local and international recognition. Recently, we had visitors from two leading US medical centres, the Mayo Clinic and the Cleveland Clinic, at the invitation of the Ministry of Health, who visited the SNEC and expressed their confidence in our potential. However, it is well known that to achieve international excellence, quality service alone is inadequate. We need strong clinical and basic research. I have, therefore, proposed the establishment of the National Eye Research Institute, to be developed adjacent to the SNEC if approved. If we can achieve the high level of international reputation and excellence in eye development, this will also help spur the development internationally of the other medical disciplines and professions. In developing a leading centre for eye care, it is important that the poorer

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Singaporeans must also benefit. I therefore propose that another block adjacent to the SNEC for subsidised patients be also established. With this, the poorer citizens of our Republic will enjoy high-quality eye care, although without the added comfort which those who can afford to pay can enjoy.

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I have had discussions with MOH and NUS recently on the proposed developments. Although I have received strong positive support from both, it is apparent that there are obstacles to expeditious development from several ministries, the land office, financial ministerial approval, subvention for subsidised patients, and numerous internal and ‘invisible’ problems. All of these obstacles are man-made, and I believe they can and should be removed or bypassed. It appears that the development will be delayed for several years unless I appeal to the Ministers-in-Charge for their support to overcome the obstacles. This is of considerable urgency, as I hope to be able to retire as the Medical Director of SNEC in 3 years. I really hope to get the development going by 1992. In fact, I have already indicated my intention to retire to the Chairman of SNEC, and have suggested two excellent ophthalmologists who can succeed me as Medical Director. In addition, I have built up a team of young ophthalmologists in their 30s who will be able to carry the whole development into the 21st century. I will be making a full report, including an executive summary of my entire proposal which I hope to complete in a month. The report will be sent to you as soon as it is ready. I sincerely hope that in the meanwhile you can spare a few minutes to consider this issue and give my proposal your support.

All of these obstacles are manmade and I believe they can and should be removed or bypassed.

Yours respectfully Prof Arthur Lim cc: Dr SB Kwa Prof Lim Pin Similar letters sent to: Dr Tony Tan (Minister for Education) Dr Richard Hu (Minister for Finance) Prof S Jayakumar (Minister for Law and Home Affairs) Mr S Dhanabalan (Minister for National Development)



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National Eye Research Institute be set up with 50/50 participation of SNEC/MOH and NUS/MOE.

SNEC Board Paper OPERATION PLANS BY ARTHUR LIM AND CHARITY WAI Board Paper : 20 September 1991 Subject : NATIONAL EYE RESEARCH INSTITUTE 1.

Following the proposal on the establishment of the National Eye Research Institute (NERI) submitted at the last board meeting, further discussions were held on the constitution of the proposed NERI and the details on lease of land and funding of development and recurrent expenditure.

2.

One major concern is the long-term viability of NERI in terms of the recurring expenditure for running costs and grants for the research projects. Another important consideration is the need to foster close links with the University for basic research.

3.

With the proximity of NERI to the SNEC, there are advantages of sharing common facilities and corporate services between SNEC and NERI.

4.

Taking into account the above factors, the following structure is proposed: 4.1 NERI be set up with 50/50 participation of SNEC/MOH and NUS/ MOE; 4.2 NERI be instituted as an extension of the SNEC. The above structure will ensure continued government support and funding for research, joint development, and high-level cooperation between SNEC and NUS, as well as achieving a symbiotic relationship by integrating NERI within the SNEC.

5.

Funds requested for NERI are as follows: 5.1 A capital grant of $9 million from the MOF for building and equipment to match the $3 million private donations collected; 5.2 Grant for recurrent expenditure from the MOF of $500,000 per year for 6 years.

6.

For the Board’s discussion and approval

The

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Letter from Dr SB Kwa, PS (Health)/DMS 1 October 1991 Administrator, SNEC Donations Received for the National Eye Research Centre Thank you for your memo of 24 September 1991. I am currently discussing with my officials and the Department of Inland Revenue on donations for the proposed National Eye Research Centre. I will revert to you and Prof Arthur Lim in due course. Dr SB Kwa PS/DMS

Report on Donations Received for the National Eye Research Institute Name of Donor

Amount of Donation & Date Received / Confirmed

1. Shaw Foundation

$1 million received on 27.12.90 and credited to the MOH Endowment Fund

2. Lee Foundation

$200,000 received on 14.2.91 and credited to the MOH Endowment Fund

3. Hong Leong Foundation

$1 million confirmed on 23.7.91 Donation in two instalments: 50% by end 1991 and 50% by end 1992

4. Drs A Lim, Ang BC & Khoo CY

$200,000 between 3 – 5 years Confirmed on 26.6.91



Total: $ 2.4 million







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SNEC Board Paper OPERATION PLANS BY ARTHUR LIM AND CHARITY WAI Board Paper : 8 November 1991 Subject : PROGRESS REPORT ON PROPOSED NATIONAL EYE RESEARCH INSTITUTE (NERI) 1. Following the last Board discussion, the appropriate corporate structure of the proposed NERI has been further discussed with MOH(Dev) Officers.

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2.

Proposed Constitution The two options being explored are as follows: (A) incorporate as a separate tax-exempt private company limited by guarantee; (B) set up as a subsidiary of SNEC. 2.1 Proposed Model of Constitution Option A to institute the NERI as a separate entity is preferred, as there are fundamental differences between running a clinical service and conducting research: the latter does not attract earnings and is often pursued for altruistic reasons. Therefore, organizationally, it is better to separate the two activities. A separate entity as an approved Institute of Public Character (IPC) will also allow NERI to raise funds for research directly rather than having to channel donations through the MOH Endowment Fund in order for the donations to enjoy tax exemption. In general, donors are more prepared to give towards a specific purpose and a specific entity than to a general fund.

The constitution of the Academy of Medicine, which has been incorporated as a company limited by guarantee, is being studied as a model for NERI. A copy of the Constitution is attached in Appendix A for information. The implications of the constitution and tax-exempt status will be discussed with both our legal and tax advisors.



2.2

Links with the NUS It is vital for the research institute to have strong links with the university for facilitating access to its infrastructure and facilities, especially for basic research which is expensive to duplicate. It is therefore proposed that the research institute be 50/50 owned by the SNEC/MOH and the NUS/MOE. This requires the support of both the MOH and the MOE for NERI. A joint DPC paper will be put up for government support and funding for NERI. The SNEC will undertake the drafting of the DPC paper once details on the structure, physical requirements, and funding are finalised.

Eye Research in Singapore: From Laboratory to Modern Institute

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By Assoc Prof Chew Sek Jin, PhD, FRCSE The rapid pace at which eye research has developed in Singapore is unprecedented and nothing short of a miracle, viewed against a backdrop of ophthalmic vision and research. A Modest Headstart The story of eye research in Singapore begins with a quiet start in a small and unpretentious laboratory with the work of the unassuming Dr Lim Kuang Hui,a also the editor of this timely book. Huddled over a bench in the Microbiology Department of the then University of Singapore, Dr Lim isolated a new strain of picornavirus responsible for an outbreak of epidemic keratoconjunctivitis in 1970. This may seem to be a moderately notable breakthrough at first glance, but it is indeed a landmark in the history of Singapore eye research on several counts. First, Dr Lim was already an established ophthalmologist, but he was working on basic science whereas his colleagues could not be separated from the operating theatre. Second, he was then, and remains today, the sole Singaporean ophthalmologist to be awarded the degree of Doctor of Medicine. Third, and not least of all, he discovered a new cause of a major eye disease. In fact, all literature search on picornaviral eye infection begins with a first reference to Dr Lim’s discovery — the more remarkable because this took place in an era when surgeons rapped the gloved hands of their disciples for the slightest deviance from dogma and established practice.

Two articles by Dr Lim Kuang Hui (the first and only Singaporean ophthalmologist to have his MD in 1978) are attached at the end of this chapter, presenting an interesting approach to eye research and knowledge. a



The story of eye research in Singapore begins with a quiet start in a small and unpretentious laboratory with the work of the unassuming Dr Lim Kuang Hui.

Dr Lim isolated a new strain of picornavirus responsible for an outbreak of epidemic keratoconjunctivitis in 1970. S E R I

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The late Associate Professor Chew Sek Jin with his wife, Esther Chu (former Manager of SERI).

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Since then, the valued letters “MD” have yet to be attached to any Singaporean ophthalmologist, neither were there any boasts of the highest rankings for research publications of any department in any governmental hospital. Under the stewardship of its Deputy Medical Director, Dr Donald Tan, the Singapore National Eye Centre’s (SNEC) Clinical Research Unit not only nurtured expertise in clinical studies, but also attracted commercial research with both foreign and home-grown technology. Not surprisingly, this hum of research activity has bubbled over to make way for another “baby” — the Singapore Eye Research Institute. The Birth of the Singapore Eye Research Institute: 1997 In every age, we find the residue of the past and the seeds of the future. On 1 January 1997, the emergence of the Singapore Eye Research Institute (SERI) marked the germination of seeds planted years ago by Prof Arthur Lim. Under his chairmanship, SERI has grown from its initial role as SNEC’s basic science division to an independent national institute, with a five-year budget of $25 million, all in the space of 18 months. SERI is now affiliated with the SNEC, the National University of Singapore (NUS), and the National Medical Research Council (NMRC). Modelled after the National Eye Institute of the USA, SERI conducts intramural research. Thus, SERI has evolved into the executive arm of the NMRC for eye research. It is the only such national resource and organisation, amongst all medical disciplines, with a responsibility to coordinate ophthalmic and vision research under the auspices of the NMRC.

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On 1 January 1997, the emergence of the Singapore Eye Research Institute (SERI) marked the germination of seeds planted years ago by Prof Arthur Lim.

In addition, SERI coordinates ophthalmic research and integrates resources for the Defence Medical Research Institute (DMRI), the National Science and Technology Board, and the Singapore Polytechnic. Internationally, SERI is the headquarters of the Myopia International Research Foundation and operates Bausch & Lomb Singapore’s research laboratories here. It also undertook a Memorandum of Understanding (MOU) with Harvard Medical International, the Institute of Systems Science (currently the Kent Ridge Digital Laboratories), Xiamen Eye Centre, and AVIMO Optico Electronics.

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Arthur Lim’s unique gift as a “fisher of men” won him the reward of being appointed to head the new Department of Ophthalmology at the National University Hospital.

A formal after-hours tutorials at Prof Arthur Lim’s private clinic at Mt Elizabeth Hospital.

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The Goals and Missions of SERI SERI conducts applied and basic research in myopia, glaucoma, diabetic retinopathy, and other diseases unique to Asia. Its prime focus is on the greatest national and regional problem — myopia. SERI provides an infrastructure to complement and facilitate clinical research undertaken at SNEC and other institutions involved in the study of visual disorders. Moreover, SERI oversees and maintains scientific and ethical standards for clinical and basic research in ophthalmology in Singapore. Working with governmental and private groups, SERI promotes health education on myopia as well as develops primary care and prevention techniques to combat the disorder. The SERI Logo The SERI logo is red, the colour of blood, the essence of human existence. It highlights our aim of benefiting humanity. The eye is recognisable by the ray diagram with parallel light rays from distant objects being focused through the cornea and lens in the eye. Myopic eye disease is reflected by the optics of an elongated myopic eye, representing Singapore’s most common eye problem. Thus, this signifies SERI’s focus on eye diseases, the treatment of which is of critical benefit in Singapore. Prelude: 1970s–1986 Between the late 1980s and 1986, clinical training at the Singapore General Hospital (SGH) was supplemented by formal after-hours tutorials at Prof Arthur Lim’s private clinic at Mt Elizabeth Hospital. His personal patients were persuaded to contribute to the education of the trainees. Thus, they were fed not only intellectually, but also gastronomically, out of Prof Lim’s pockets. The case presentations enforced on the young minds a crisp logic and discipline. These became the cornerstones for enquiring minds who questioned why the local pattern of eye diseases differed so greatly from that found in Duke-Elder’s System of Ophthalmology. Gathering a Team: 1986–1990 Arthur Lim’s unique gift as a “fisher of men” won him the reward of being appointed to head the new Department of Ophthalmology at the National University Hospital (NUH). This provided a vehicle for the gathering of a new team and the birth of formal eye research in Singapore. It was an unostentatious start. The department comprised four full-time residents, backed by committed visiting consultants who shared Prof Lim’s vision.

History of the Singapore Eye Research Institute

Quality assurance was integrated into clinical practice to raise the prevailing clinical standards. This clinical audit has since served as the model for ensuring quality surgical care in Singapore. These were the roots on which the SNEC built its clinical audit system, which has in turn become the envy of other disciplines. With this system in place at NUH, patient data and surgical outcomes were effectively captured and fed a mechanism for generating case reports. At this time, Prof Lim achieved a milestone in glaucoma research with his observation that the prevalence of angle closure glaucoma was fourfold that of open angle glaucoma. This was a complete reversal of established dogma. The high priests of the ophthalmic community were incensed with this upstart defying conventional wisdom. As has become a recurring theme, Arthur Lim was proven right. Enthralled by this early success, budding ophthalmologists found new confidence in the ability of Singapore-bred doctors to exceed the standards of British training and dogma. Thus, a niche was created in which Singapore began to establish its unique role in international eye research. Professor Wallace Foulds, the first visiting Professor of Ophthalmology, sub- sequently joined the department, and was — and remains today — a mentor and guide for clinical training and research. In 1987, senior resident Chew Sek Jin was awarded the Gold Medal for the FRCS examinations. At the close of 1990, he left Singapore to pursue research training in the USA. At his first stop with Professors Herbert Kaufman and Roger Beuerman of the Louisiana Eye Center, he contributed to the development of the ophthalmic confocal microscope. Armed with a MSc in ophthalmic anatomy, he went seeking the “truth”, stopping at the Rockefeller University in New York, where he found himself facing a committee, chaired by Prof Torsten Wiesel, who was responsible for his PhD thesis. At the same time, he engaged in glaucoma research at the New York Eye and Ear Infirmary with Prof Robert Ritch and in the basic science of myopia with Prof Josh Wallman. He was appointed visiting professor at both institutions, and both mentors thought he was working full-time with each of them. Such valuable ties have given Singapore a sound scientific reputation in the USA and an established beach-head in the New World.

Quality assurance was integrated into clinical practice to raise the prevailing clinical standards. This clinical audit has since served as the model for ensuring quality surgical care in Singapore.

Prof Lim achieved a milestone in glaucoma research with his observation that the prevalence of angle closure glaucoma was fourfold that of open angle glaucoma... Arthur Lim was proven right....

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These formative years also saw the birth and maturity of the SNEC, propelled by a new generation of leaders in ophthalmology who were handpicked and nurtured by Arthur Lim.

The SERI Board of Directors began with the original duo of Prof Arthur Lim and his deputy, Assoc Prof Chew Sek Jin. But towards the close of the first frenetic year, it had grown to its full strength of nine.

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These formative years also saw the birth and maturity of the SNEC, propelled by a new generation of leaders in ophthalmology who were hand-picked and nurtured by Arthur Lim.

The Essential Faces and Places of SERI The Faces of Leadership The SERI Board of Directors began with the original duo of Prof Arthur Lim and his deputy, Assoc Prof Chew Sek Jin. But towards the close of the first frenetic year, it had grown to its full strength of nine. The academic input and NUS representation came from the youthful and dynamic new Dean of the Faculty of Medicine, Assoc Prof Tan Chorh Chuan. Additional academic expertise was provided by Professor Chua Nam Hai, Chairman, Institute of Molecular Agrobiology, which along with Prof Chua provided SERI with a model for success in innovative industrial and commercial research. Professor Chua, who holds the prestigious Andrew Mellon Professorship at Rockefeller University, is also a board member of the Institute of Molecular and Cell Biology (IMCB), NUS. SERI’s secretary, Dr Tan Chor Hiang, sits on the board of the National Medical Research Council, which is the IMCB’s founding and supportive parent. Dr Tan also directs the Planning Department of the Ministry of Health. The inclusion of Colonel (Dr) Lionel Lee, the Director of the Defence Medical Research Institute (DMRI) and Chief of the Army Medical Corps, was by virtue of the close collaborations and joint projects on myopia with the Ministry of Defence. Then, there were the three members of the SNEC who made critical contributions towards fully integrating clinical practice with research: Mr Wong Yew Meng, SNEC Chairman, who chairs the SERI Finance Committee; and the two Deputy Directors of SNEC, Dr Donald Tan and Dr Vivian Balakrishnan. The Researchers and Administrators As SERI’s Chairman and Director, Professor Arthur Lim applied his characteristic resourcefulness and persistence to pursuing and realising his goal of providing an infrastructure for eye research to solve the problems caused by myopia and other common eye diseases in Asia, thus breathing life into ophthalmic research.

History of the Singapore Eye Research Institute

As SERI’s first full-time staff member, Assoc Prof Chew Sek Jin saw to the growth of SERI, fuelling its rapid growth into a national organisation within less than a year. This was the result of his dedication to myopia research and close collaborations, locally and internationally. His areas of interest included the development of optical instruments, myopia prevention and non-surgical treatment, and ocular physiology. SERI’s adviser Prof Wallace S Foulds, CBE, complemented Prof Lim’s macroscopic view of the world with careful scrutiny and microscopic review. Foulds helped guide the team forward towards international research. In another capacity, Ms Charity Wai, SNEC’s unflagging administrator and member of the management board of SERI, undertook the formidable task of putting SERI on its feet. For months, she shuttled between accountants, doctors, scientists, architects, lawyers, and health ministry officials. SERI’s administrative arm is headed by its manager Esther Chu, whose varied experience and skills were harnessed to meet the myriad challenges faced in building the laboratories and clinical facilities from scratch. Her previous experience as an architect, administrator (MBA), and laboratory manager and assistant has proved invaluable. She is also the Manager of Singapore R&D for Bausch & Lomb, whose laboratories are closely linked with SERI. There was a critical need for Singapore to shake herself out of a state of nearoblivion in the area of eye research. The big move forward came in 1996, when Assoc Prof Chew scoured the world for talented ophthalmologists who were committed to solving common eye problems in Asia. The hunt resulted in the arrival in 1998 of Prof Cheng Hong Ming from Harvard Medical School, as SERI’s head of research. His pioneering work in MRI and MR spectroscopy as well as contact lens development led to quick advances in myopia research. Professor Cheng contributed to the organisation of commercial links and joint projects with the Harvard Medical School, and to the development of new SERI clinics and laboratories. He and Assoc Prof Chew helped to build SERI and hold the fort from the start. SERI’s prime focus on myopia was given a further boost by the arrival of Dr Deborah Chee in 1997. A senior lecturer in epidemiology from the Imperial

As SERI’s Chairman and Director, Arthur Lim applied his characteristic resourcefulness and persistence to pursuing and realising his goal of providing an infrastructure for eye research to solve the problems caused by myopia and other common eye diseases in Asia

As SERI’s first full-time staff member, Assoc Prof Chew Sek Jin saw to the growth of SERI, fuelling its rapid growth into a national organisation within less than a year. S E R I

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SERI’s adviser Prof Wallace S Foulds complemented Prof Lim’s macroscopic view of the world with careful scrutiny and microscopic review.

College School of Medicine at St Mary’s campus, UK, she brought a string of credentials. She helped design clinical trials for the treatment of myopia and conducted epidemiological surveys, while working simultaneously on a doctorate in the epidemiology of myopia.

Prof Foulds helped guide the team forward towards international research.

He was followed closely by Dr Valarie Cornilleau Peres from the CNRS College de France. Her work in visual psychophysics, 3D vision, optical design, and computer vision provides new expertise on the optical management of myopia.

Professor Bill Lam joined SERI in July 1998 as Chief Scientist. The former Scientific Laboratory Director of the Department of Ophthalmology and Visual Science, University of Hong Kong, came with previous experience at the University of Texas Health Science Center, Albany Medical College, and the Retina Foundation in Boston. Professor Lam provided expertise in analytical biochemistry and drug development, and also contributed to a new postgraduate scientific training programme.

Dr Maurice Yap brings with him his main interest — the role of the lens in myopia. This multi-tasking senior scientist of SERI, who has directed the Centre for Vision Research at the University of Auckland, has been heading the Optometry Centre at the Singapore Polytechnic since 1997. Dr Yap is also the principal investigator of the joint study on myopia between Xiamen Eye Centre and SERI, and is credited with leading the way to a better understanding of the role of near work and stress steroids. By the end of 1998, SERI had more than 30 full-time staff and five research fellows from Myanmar, China, Hong Kong, and Japan. The six administrative officers coordinate five clinics in separate locations, two laboratories, and the general administrative office. The experienced Nursing Manager Peck Chye Fong manages the four teams of optometrists, nurses, and technicians, all serving a multitude of projects.

Professor Bill Lam joined SERI in July 1998 as Chief Scientist.

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Many of the staff are preparing for higher degrees via research. In addition, SERI also provides one to three months of practical research experience for NUS medical students as well as for polytechnic students majoring in biotechnology and optometry.

History of the Singapore Eye Research Institute

Graduate students at SERI who are pursing MSc and PhD degrees are from both Singapore and abroad, i.e. as far as Johns Hopkins University and Imperial College in London and as near as The Chinese University of Hong Kong. The Adjunct Faculty: The Part-timers Dr Lim Kuang Hui would be justly proud that his legacy of microbiology research has been handed down to Dr Chan Tat Keong. This new-generation ophthalmologist trained for two years at the famed Wilmer Ophthalmologic Institute at John Hopkins University. After a full year of clinical corneal experience, he spent an unprecedented second year researching the use of PCR for diagnosing fungal keratitis. He is now the acknowledged ocular microbiologist in Singapore. Complementing and supporting his work is his wife, Dr Saw Seang Mei, who holds a MPH from the School of Hygiene and Public Health, Johns Hopkins University. Her recent PhD, based on a standardised questionnaire for risk factors in myopia, is a major contribution to the field. The young Dr Wong Tien Yin is Singapore’s first resident to return with a MPH from Johns Hopkins University, achieving this distinction before starting his residency, which he is now completing. At the same time, he is undertaking research in the pathology associated with high myopia and is preparing for a PhD. International Links In 1997, SERI established collaborations with colleagues from Johns Hopkins University and Harvard University, Schepens Eye Research Institute, the New York Eye and Ear Infirmary, the Institute of Ophthalmology and Moorfields Eye Hospital in London, City University of New York, Louisiana State University Eye Center, Xiamen Eye Centre, National Taiwan University Hospital, Chinese University of Hong Kong, Kanazawa Medical University, and the New England College of Optometry, where Assoc Prof Chew Sek Jin sits on the scientific advisory board of the Myopia Center. SERI has MOUs with most of these institutions as well as ongoing research projects. That SERI was able to produce scientific results before finding a permanent location is due to premises offered to SERI subunits by research collaborators between 1996 and 1999. Thus, 8,300 sq ft of space is now being used to serve its clinics and laboratories at the School Health Service (SHS) in Outram Road, NUS, the Institute of Health, SGH, Singapore Polytechnic, and of course SNEC. In fact, SERI’s administration office is being housed in a container cabin until the buildings are ready for occupation.

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Chapter 2 SERI’s laboratory in NUS has facilities for microbiology, tissue and cell culture, protein chemistry, microscopy, molecular biology, HPLC, and experimental surgery, and an animal holding unit. It also offers scanning, transmission, and environmental electron microscopy. SERI’s comprehensive clinical facilities include multiple refraction lens, automated perimetry, Scheimpflug photography, slit lamp and fundus photography, corneal photography, ultrasound biometry, contact lens fitting, as well as evaluation and electrophysiology. The clinics housed in the Ministry of Health, NUS, and Singapore Polytechnic provide a continuous stream of enthusiastic volunteers for clinical trials, which offer the benefit of innovative treatment. The Joint Vision Laboratory of SERI, DMRI, and the Singapore Polytechnic Optometry Centre was a bold new relationship of converging interests serving to investigate and treat ophthalmic diseases related to myopia. Myopia: SERI’s Prime Reason for Existence Myopia is a public health problem in many Asian countries and the top ophthalmic disease after cataract. This means that significant manpower and resources are expended on optical services. The ocular complications of myopia can become an even greater financial burden to both individuals and society. In Singapore, optimal employment for National Service is also affected because myopia unnecessarily excludes otherwise healthy and capable young men from combat duties. Recent data show that 50% of Primary Six students are myopic, with 8% exceeding 6 D. In response to requests by the health and defence ministries, SERI has formed a national committee to manage this epidemic. The national plan is the first in the world to implement a bold holistic strategy to reduce myopia. Measures include behaviour modification, optical devices (progressive add power spectacle lenses and rigid gas-permeable contact lenses), and drugs such as topical atropine and pirenzepine. As part of this multi-pronged approach, clinical trials are underway involving national and international institutions like the DMRI, SHS, SNEC, Ministry of Education, Johns Hopkins University, and National Taiwan University Hospital. 44





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Myopia: a Far-sighted Scope SERI’s research programme is comprehensive in addressing prevalent eye diseases in Asia. Its broad range covers epidemiology, visual psychophysics, drug development, multinational studies, genetics, mechanical engineering software design, optical engineering, and clinical evaluations. This research has already resulted in 46 abstracts, 5 book chapters, and 10 journal papers in the 18 months of SERI’s existence. SERI has expanded to target a future role as the FDA in Asia. This would ensure that the products of research in Singapore attain the standards and benchmarks set by the FDA, as the endpoint for development, and the key to successful production and marketing. Working with the Economic Development Board and the National Science and Technology Board, the nation’s two powerhouses for growth, SERI is developing the expertise and facilities to service in-house projects and to attract international research. The ophthalmic industrial giant Bausch & Lomb has its first and only outsourced R&D laboratory at SERI. In addition, SERI organises professional conferences and provides eye screening as a public service.

SERI in the Next Millennium As the year 2000 looms ahead, the major challenges facing the world are the greying population, the Millennium Bug, and monopolistic software giants. There is even talk about the Second Coming, which threatens to make all else irrelevant. Paradoxically, these concerns have propelled SERI from strength to strength and will continue to do so. The economic downturn has heightened Asian pragmatism, a strength and virtue that Singapore is fortunate to possess. Furthermore, adversity has reinforced expertise and support for applied clinical research, both in therapy for diseases with maximal socio-economic impact (such as myopia) and in commercial R&D. Rather than waning in international interest and commitment, the development of eye research in Singapore has increased apace. It is SERI’s destiny to contribute to the understanding and cure of myopia, the greatest eye problem that the world has ever known. SERI has eagerly accepted the challenge.

It is SERI’s destiny to contribute to the understanding and cure of myopia the greatest eye problem that the world has ever known.

Author: This article was written by Assoc Prof Chew Sek Jin after he discovered that he had brain tumor. Despite his illness, he continued to devote his energy to the development of SERI until he passed away in December 1998. Source: Singapore National Eye Centre: The First Ten Years 1990–2000 S E R I

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How a New Virus was Discovered in Singapore in 1970 By Dr Lim Kuang Hui

Summary Prior to 1969, adenoviruses were the major known causes of epidemic kerato-conjunctivitis. Thus, when acute haemorrhagic conjunctivitis first appeared in Ghana, in 1969, the cause was immediately attributed to a virulent strain of adenovirus. But, for two years, whilst the epidemics swept across Africa, the Middle East and Southeast Asia, the cause remained unknown. Two distinct new viruses were isolated in Singapore in 1970 and 1971 when the epidemics reached Singapore. Through a collaborative study with the Virus Reference and Research Center in Baylor College, Houston, these viruses were classified and identified as two new viruses: viz. the coxsackievirus A24 variant and enterovirus serotype 70. Both viruses continued to cause periodic epidemics and pandemics of acute haemorrhagic conjunctivitis throughout the world from 1969–1988. Introduction What I want to say can be said in one sentence — CA 24 and EV 70 — but I would like to tell you a story. Our story begins with a myth associated with man’s first historic landing on the moon and a chance observation by doctors in Africa that an epidemic infection of the eye was probably caused by a variant of adenovirus. A fanciful beginning, but as with all new discoveries, the beginning is always exciting. Prior to 1969, adenoviruses were the major known causes of epidemic kerato-conjunctivitis. Thus when acute haemorrhagic conjunctivitis (AHC) first appeared in Ghana, Africa in June 1969, the cause was immediately attributed to a virulent strain of adenovirus. More than 13,000 cases were reported from that first outbreak, nicknamed “Apollo 11 Disease”. The pandemic swept through coastal Africa, the Middle East and Southeast Asia, but the cause remained unknown. The difficulty then, as it is now, lies in isolating the virus. No virus was recovered from Ghana and the culprit was incriminated, in retrospect, by clinical observations and a blood antibody survey in the population. Epidemic in Singapore AHC reached Singapore in August 1970 and assumed epidemic proportions when more than 60,000 cases were reported within two months. The local press was ablaze with publicity. The local professional body, the Singapore Medical Association, issued a press release to allay public alarm but was mistaken in its assumption of a bacterial or adenoviral aetiology. Our local eye surgeons had studied adenoviral keratoconjunctivitis previously, but a like-syndrome had never been encountered in Singapore before. The epidemic proportions of the outbreak and the new set of clinical features, viz. sudden onset and rapid recovery, the presence of subconjunctival haemorrhages and the rare occurrence of keratitis, suggested that we were dealing with a new disease entity which prompted urgent search for its cause. 46





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Discovery From our first 36 samples of conjunctival swabs and throat garglings, an amazingly high yield of 33 (91 percent) showed cytopathogenic effect on HeLa cell cultures, obtained from the late Dr M F Warbuton of the Commonwealth Serum Laboratory in Victoria, Australia. HeLa cell lines vary in sensitivity and we observed, in retrospect, that the line obtained from Dr Warbuton on which we were working at the time was particularly sensitive to our virus. Dr Marguerite Yin-Murphy, the University of Singapore’s virologist, with whom I collaborated, immediately reported to her chief, the professor of bacteriology, but the professor was skeptical and attributed our findings to “laboratory contaminants”. Nonetheless, he was generous enough to offer us a “corner of a bench” in his department to continue our research. A New Virus Our viral isolates, hitherto unidentified, could not be related to adenoviruses (which are DNA viruses). Repeated isolation of the virus, collated with patient’s neutralising antisera, confirmed that we were onto something positive, i.e. a new virus or a known virus as yet unidentified and not previously associated with such disease. As we recognised the virus to be a small RNA virus, with characteristic properties of enteroviruses belonging to the picornavirus family, we called the new disease syndrome “piconaviral conjunctivitis.” A Second Virus Less than a year later, in June 1971, another epidemic of acute haemorrhagic conjunctivitis hit Singapore and we isolated a second, totally different picornavirus. This second virus was also discovered by the late Dr Reisaku Kono at the National Institute of Health, Tokyo, when epidemic conjunctivitis reached Japan in December 1971. We had, by now, sent our isolates to Dr Joseph Melnick of the Virus Reference and Research Center at Baylor College, Houston. He confirmed our discovery. Thus, for two years, whilst the pandemic swept through the Eastern hemisphere, Melnick, Kono, Yin-Murphy and myself were the only people who had any knowledge as to its cause. Historical Discovery All that is history now. Today, no paper on the aetiology of AHC is complete without a first reference to our discovery. An editorial in the Singapore Medical Journal of January 1973 commented: “The distinctive findings of Yin-Murphy combined with KH Lim in demonstrating the new picornavirus responsible for the epidemic outbreak of haemorrhagic conjunctivitis must be accorded its rightful place in the work on viruses done in Singapore.” The two viruses differ serologically and genetically in the oligonucleotide fractions. Only one genotype of the virus is in circulation worldwide at any time.



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Chapter 2 The First and The Last Word Dr Joseph Melnick, head of the WHO Collaborating Center for Virus Reference and Research, and chairman of the International Committee for the Classification of Viruses, on whose authority the word stands, stated the following in the book Acute Haemorrhagic Conjunctivitis, edited by Dr Keizo Ishii in 1989: “The first epidemic occurred in West Africa in 1969 and the second in Southeast Asia in 1970. Credit goes to YipMurphy for isolating, during the Singapore epidemic, the first enterovirus incriminated as the causative agent, an agent that was subsequently identified by a cooperative study of the WHO Virus Reference Centers as a variant of Coxsackievirus type 24 (CA24v). Subsequent outbreaks caused by CA24v have since been identified in Singapore, Hong Kong, and India, but had not spread to other parts of the world before 1985. “Another novel virus was isolated by Yin-Murphy et al. in Singapore and by Chang et al. in Morocco. Again, through a cooperative programme of the WHO Virus Centers in which Dr Kono’s laboratory played a key role, the agent was identified and classified as a new enterovirus type70 (EV70). EV70 continues to be the agent most often associated with AHC.” Research I earned an MD for my thesis. Marguerite Yin-Murphy established our local university as a WHO collaborating centre and we continue to receive samples and requests from all over the world. “Lab stuff ”, you might say, but this is the stuff that science and perhaps our dreams are made of. Right now, in our laboratories, frontline molecular virologists from the Pasteur Institute and National Institute of Health, Tokyo are collaborating on a study of the evolution of these agents. As for us at the SNEC, setting our sights on excellence at the international level shall be no easy task, as AHC presentations can be mistaken for adenoviral conjunctivitis. References 1. Chatterjee S, Quaracoopome CO, Apenteng A, An epidemic of acute conjunctivitis in Ghana. Ghana Med J, 1970;9;9- 11. 2. Kono R, Sasagawa A, Ishii K, Sugiura S, Ochi M, Matsumuya H, Uchida Y, Kamoyama K, Kaneko M, Sakura N, Pandemic of a new type

of conjunctivitis. Lancet, 1972;1:1191- 1194.

3. Lim KH, Yin-Murphy M, An epidemic of conjunctivitis in Singapore in 1970. Singapore Med J, 1971; 12:5,247. 4. Yin-Murphy M, Lim KH, An epidemic of conjunctivitis in Singapore. Lancet, 1972;2:857- 858. 5. Ishii K, Uchida Y, Miyamura K, Yamazaki S, Acute Haemorrhagic Conjunctivitis. University of Tokyo Press IX, 1989.

Source: Leading Lights in the Asia-Pacific, 2006

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The End of Knowledge By Dr Lim Kuang Hui

What is knowledge? Knowledge may be considered the expression of the human spirit, or the quest for inquiry. Man is the only creature in the whole of creation that has the mental faculty to do this. Man is also the only sentient being that can experience enlightenment. This begs the question: What is the human spirit? What is brain, mind, consciousness, and soul? Simplistically defined, the brain is the physical organ within the cranium. Mind is the personalisation of the brain. Consciousness is the awareness of the light within that grows throughout life — the awareness of the “now” that is the knowing. Soul is more difficult to conceive: is it the immortalisation of the self that does not perish, or is it the non-self that is the unity with “All That Is”? The Concise Oxford Dictionary (fifth edition, 1964) defines knowledge as “the theoretical or practical understanding (of subject, language, etc.); the sum of what is known, as distinct from opinion.” Going by that dictionary definition, knowledge, in particular scientific knowledge, must be measurable and testable. But if we consider science in the wider context as the study of the natural world, then there may be certain elements in our study that cannot be measured, or the tools for such measurement are lacking. From a scientific viewpoint, knowledge may thus be considered the answer to a question. The answer must be adequate to address all the queries raised, bearing in mind that if the answer is going to be too long (thesis dissertation apart), it is not going to be an easy or simple or even satisfactory answer. An example: Why did chicken cross the road? If there is an answer, that is knowledge; if not, it is only speculation and mere opinion. However, Socrates and Confucius both took the view that knowing that one does not know is also knowledge. Perhaps our chicken example has the answer. Just cross, no need to ask — just this, the complete manifestation. Asked to explain zen My puppy with the same name looks, And thumps his tail. Jay Hackett



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Chapter 2 What is the end of knowledge? When have we arrived at the end of knowledge? The end of our search in scientific enquiry is arrived at when there are no further answers to the questions. At the end, all answers to those questions have been exhausted. If you need to ask another question, that will be another investigation. Simplistic as this may be, the search for knowledge or the undertaking of research arises when a question is asked. The question may sound commonplace and is begging to be asked, but no one has the answer yet. And if the answer or discovery is genuine, that is knowledge. At the end, and this must be the bottom line, knowledge or discovery is for humanity. The Doctor of Science is of no use if he lives only in an ivory tower. Prof Wallace Foulds, adviser on research to the Singapore Eye Research Institute, in a lighter moment, cited the science philosopher Karl Popper as stating: “It is impossible to prove the positive by observation of only the negative”. Foulds further stated that we need not have to refer to the ‘Journal of Negative Results’ (if ever there is such a publication) to affirm that when there is nothing, we cannot say something. The black hole phenomenon apart, can there be something in nothing? Taking this negative viewpoint, can we say that when there is nothing, and nothing more, we can adduce at something? We have arrived at not-knowing. The end of knowing is now in knowing the not-knowing. Knowledge leads to experience (although sometimes the process can be reversed). We have to “know” knowing until knowing becomes the experience. Experience will take us on to a different dimension. To experience an experience we have not experienced before requires experience. Knowledge or cognition can only provide a guide. Is knowledge also the truth? The simple answer is no. Knowledge is science, and scientific knowledge is measurable and repeatable, even with abstract physics. But the truth encompasses all and is beyond knowledge. This is when we begin to stray from scientific conception into experiential enquiry. What is the truth? If we are seeking for the truth of eternity, we have to look beyond knowledge. But at the core of being, or non-being, is the mystery. As soon as we “know”, our intellect comes in and that “knowing” becomes a concept. Even so, there are ways of looking at the truth. Most of us consider that the truth is out there waiting to be discovered. But the historian Felipe Fenandez-Armesto maintains in his book, Truth: A History and a Guide for the Perplexed (1997), how wrong this approach can be.

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He says that there are ways of looking, but “each is a method of arriving at one aspect of the truth; the search for the whole truth is unending and an inevitable part of the human condition.” He gives examples from the earliest of communities: “the recognition of danger or opportunity seems to be instinctive and unconscious. As soon as it becomes conscious, it reflects a concept of truth.” What is the ultimate truth? The Zen masters tell us that real truth expounds non-being and secular truth expounds non-void. These two truths are not two but intrinsically one. This fact, which is called the holy truth, is the most esoteric and abstruse teaching of the doctrinal schools. It will be understandable if we realise that the truth of non-being refers to truth in the essential world and the truth of non-void refers to truth in the phenomenal world. But it would be wrong to think there are two kinds of truth. The only and ultimate truth is that which transcends these two truths while containing them within. Why do birds sing? Birds sing because they have a song, not a message. Leave it at that. It illustrates the truth of knowing, that is, at the core of reality, there is no answer. “ Ask me not why, when spring is come, Sweet birds should sing, Or flower fling, Or abeles lie against the sky. I have no reason, cannot tellThough some might answer, dare not I ...”

(From Ch’ing Ming by Geoffrey Smith, Malaya Publishing House, Ltd, Singapore 1949)

When do we know? The master calls and the student answers. The response is appropriate and spontaneous. The truth is not so far away... just this, just this. This is the knowing, this is the comfort of knowledge. Knowledge has led to experience. The fact, which is the ultimate reality. Why research? I shall conclude with a comment on the benefits, rewards and joy of research and my experience of the research “high”. For me, the discovery, if it is genuine, is the fact — the sudden realisation that I alone in the whole universe have this knowledge. Going or coming, awakening or sleeping, I alone (and my collaborators, of course) have this knowledge. This is the research “high”. Like the Buddha said, upon his enlightenment, “Under the heavens and on earth, I alone am sacred.” Not pride of knowledge, but wisdom in knowing. Like that famous researcher must have realised: “Gosh! I can split the atom and I alone know how.”

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Chapter 2 The End The end of research is arrived at when there are no more answers to a particular question. No more chatter ... and all is now quiet in the research lab. We have arrived at the end of knowing. Equipoise Finally, Dr Francis Crawley (Secretary-General of the European Forum for Good Clinical Practice) asked: “What is equipoise?” and offered the following: it is the equilibrium or counterbalancing of what we “know” or “do not know.” He cited examples for the medical community. Scientific equipoise is when the medical community is uncertain as to which treatment modality is best. Personal equipoise is when the patient is himself in a situation of uncertainty as to which treatment is best. “Informed consent” is making the patient as ignorant as the scientific community. And “controlled trial” is comparing “not knowing” to “knowing” against a “gold standard” which can change. Source: Leading Lights in the Asia-Pacific, 2006

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History of the Singapore Eye Research Institute (1997–2006) By Prof Wallace S Foulds,

DSC, FFCS

The Singapore Eye Research Institute (SERI) has only a short history, but during the almost ten years of its existence has already achieved an international reputation for its research output and for the quality of its research. SERI’s output of peer-reviewed publications, mainly in journals with a high impact factor, has grown steadily over the years. A measure of the status that SERI has achieved is its recognition by the Association for Research in Vision and Ophthalmology (ARVO) as an organisation fit to host the first innovative combined SERI/ARVO meeting outside of the USA. The first SERI/ARVO meeting that was organised in Singapore in 2003 by SERI attracted participants from 33 countries, and this prompted ARVO to repeat the exercise again in 2005. This second SERI/ARVO attracted some 750 participants from 36 countries. Another joint meeting is planned for 2007.

Professor Wallace S Foulds

1990 marked the beginning of a new era in ophthalmology in Singapore with the opening of the Singapore National Eye Centre (SNEC).

ARVO was so impressed by the enthusiasm shown by so many researchers from all over Asia who took part in the 2003 and 2005 meetings that it was decided that, although the 2007 meeting would be organised in Singapore by SERI, the name of the meeting would be changed to ASIA-ARVO and subsequent meetings would be held in various locations throughout Asia. In this way, SERI’s trailblazing effort has been greatly to the advantage of ophthalmic research in Asia. 1990 marked the beginning of a new era in ophthalmology in Singapore with the opening of the Singapore National Eye Centre (SNEC). This prestigious development, the brainchild of Professor Arthur SM Lim, was designed to raise the practice of ophthalmology in Singapore to a world-class level and to provide a centre of ophthalmic excellence for Southeast Asia.

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This prestigious development, the brainchild of Professor Arthur SM Lim, was designed to raise the practice of ophthalmology in Singapore to a world-class level and to provide a centre of ophthalmic excellence for Southeast Asia. Advances in human affairs are often the result of one man’s vision. The establishment of the SNEC, and more recently SERI, undoubtedly sprang from the vision of Professor Arthur Lim.

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Originally, it was Professor Lim’s intention that the SNEC be established on the National University Hospital (NUH) campus in close proximity to the extensive campus of the National University of Singapore (NUS). But as it turned out, the Ministry of Health which was responsible for the Singapore General Hospital (SGH) was the first to offer the required funding for the new development; and as a result, SNEC was located on the SGH campus. As Head of the Clinical Department of Ophthalmology at NUH, Professor Lim had initiated a programme of quality assurance in the ophthalmic practice of NUH, an important and at that time innovative feature continued in the SNEC. This pattern of quality assurance entailed the accurate documentation of all cases, especially the assessment of outcome measures in relation to management strategies employed. The information so gathered formed the basis of an increasing number of published case reports and clinical studies. It was the incorporation of quality assurance into the practice of ophthalmology in the SNEC that provided the first impetus to the development of clinical ophthalmic research in Singapore. From the outset, clinical research in the SNEC was encouraged. The volume of clinical research papers and case reports published attested to the enthusiasm with which the challenge of clinical research was met by SNEC’s junior and senior staff. Indeed, the SNEC held the distinction of generating the greatest number of research publications in any government hospital department in Singapore. Eventually, clinical research in SNEC was organised within a Clinical Research Unit under the leadership of Dr Donald Tan, at that time a consultant in the SNEC and subsequently its Deputy Director. As is well known, Donald Tan is now a full Professor in NUS and the successful Director of SERI. Advances in human affairs are often the result of one man’s vision. The establishment of the SNEC, and more recently SERI, undoubtedly sprang from the vision of Professor Arthur Lim. Prior to the inception of the SNEC, there was little ophthalmic research in Singapore with the exception of occasional significant contributions from a few individuals. One such discovery was the one in 1970 by Dr Lim Kuang Hui of a new strain of picornavirus, the cause of an outbreak of epidemic keratoconjunctivitis. Until recently, he was the only ophthalmologist in Singapore to have been awarded

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an MD by the NUS. More recently, Professor Arthur Lim was the recipient of an Honorary MD degree from NUS. From an early stage, Professor Lim realised that a centre of excellence such as the SNEC not only had to offer the best in current ophthalmic medical and surgical practice, but also had to be innovative and active in clinical and basic ophthalmic research. Quite rightly, he held the view that research would be a stimulus towards the establishment of the best ophthalmic practice and the development of new and effective therapeutic strategies. In about 1993, the Singapore Government had become aware that medical research and research in a number of key areas such as biotechnology and information technology were likely to be important in relation to Singapore’s future economic wellbeing. The government had also become aware of the high and increasing prevalence of myopia among the Singaporean population that was having an adverse effect on recruitment to the Singapore Armed Forces (SAF) and more particularly on the training of Air Force pilots.

From an early stage, Professor Lim realised that a centre of excellence such as the SNEC not only had to offer the best in current ophthalmic medical and surgical practice, but also had to be innovative and active in clinical and basic ophthalmic research.

As part of its plans to promote medical research in Singapore, the Government took a decision to set up a National Medical Research Counci (NMRC), to be modelled to some extent on the Medical Research Council of the United Kingdom. The NMRC was to be government-funded and would be responsible for the conduct and funding of all aspects of medical research in Singapore. To assess the potential for medical research in Singapore and the likely costs, the government, through the Ministry of Finance, asked each of several identified specialties(including ophthalmology) to prepare an account of what research might be conducted within individual specialty areas with an indication of what costs would be involved. Professor Lim, admitting that he had no direct experience in the organisation or conduct of research, sought the advice of Professor Wallace Foulds, who was charged with the preparation of a document outlining the areas of research in ophthalmology that might be pursued and giving an estimate of likely costs. This document, which had to be submitted at very short notice as is the way in Singapore within involved faxing some 70 pages of typescript from Glasgow to Singapore within two days notice!

Professor Lim, admitting that he had no direct experience in the organisation or conduct of research, sought the advice of Professor Wallace Foulds. S E R I

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Chapter 3 On the basis of the information supplied by the various specialties, the government set up the NMRC with funding based on the submitted estimates of research costs. In late 1995, the NMRC asked that grant applications be submitted to determine what funding might be made available for the creation of individual research institutes.

About this time, Professor Lim recognized the potential of Dr Chew Sek Jin as a contributor to research in Singapore.

About this time, Professor Lim recognised the potential of Dr Chew Sek Jin as a contributor to research in Singapore. Dr Chew had gained a gold medal for his performance in the Fellowship examination of the Royal College of Surgeons of Edinburgh. In 1990, he had gone to the United States to pursue his research interests there. At the Louisiana State University, working in the laboratory of Professor Roger Beuerman, he had gained an MSc in ophthalmic anatomy using the newly developed confocal microscope to study the cornea in the living eye. Dr Chew subsequently moved to the Rockefeller University in New York to start work on his PhD. In recognition of his research activities and potential, Dr Chew was identified as an appropriate person to lead research in the proposed institute and was offered a proleptic appointment as Deputy Director, a substantive appointment to commence when the institute was established. Dr Chew at this time had authored an extensive document outlining in detail his ideas for myopia research. It was Professor Foulds’ view, however, that the aims of the institute should be widened to include conditions other than myopia that were of importance in Singapore. He accordingly prepared an alternative plan identifying areas of research important to Singapore and South East Asia, including myopia, glaucoma, diabetic retinopathy, and ocular surface disorders. In early 1996, Professor Foulds flew to New York to agree with Dr Chew on a revised plan for a Singapore Eye Research Institute, incorporating material from the two plans that had been prepared. Later, Dr Chew flew to Glasgow to finalise the budget request for the proposed institute. The main outline of a Core Grant Application prepared by Professor Foulds and Dr Chew for submission to the NMRC was in place by mid-1996. This rather lengthy application was submitted to the NMRC in August 1996.

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At this time, it had been agreed in principle by the Singapore authorities that SERI might be established as a company under the Singapore Companies Act. By then, it was known that an ambitious plan of Professor Lim’s to build an eight-storey extension to the SNEC had received government approval and funding. It was also agreed that if SERI, already incorporated as a company, were established as a government-recognised and government-funded research institute, it should occupy two floors in the new extension. Following their receipt of the application in August 1996, the NMRC requested a further finalised submission. In November 1996, Professor Foulds came to Singapore to finalise the application with Dr Chew, prior to its submission to the NMRC, only to hear the sad news that Dr Chew had had a seizure in New York and had been diagnosed with an inoperable brain tumour. Much of the previous application needed revision and re-writing at that time. In the unhappy circumstances of Dr Chew’s absence, this was accomplished by Professor Foulds with the aid of the administrative staff of SNEC. The finalised application was submitted to the NMRC in late November 1996 in the names of Professor Arthur Lim, Dr Chew Sek Jin, Professor Wallace Foulds, and Ms Charity Wai. The NMRC approved the application the next month, with an initial grant of S$19 million. Initially, this sum included S$6.5 million for building costs and S$12.5 million to cover the costs of research activities over a five-year period. The amount of the initially approved grant was subsequently increased by the NMRC to S$24 million with an increased grant of S$4.5 million to cover revised building costs. Additionally, the Ministry of Finance provided an additional direct allocation of S$7.3 million to cover the cost of fitting out SERI’s two research floors. In mid-1997, the incorporation as a company owned by SNEC and incorporated under the Singapore Companies Act was completed. The Articles of Association of the Company set out the aims of SERI as a company as well as boundaries within which the company could act. Among the 30 or so objects and activities of SERI listed in the Articles of Association, the first object was identified as the “promotion of the study of

By then, it was known that an ambitious plan of Professor Lim’s to build an eight-storey extension to the SNEC had received government approval and funding. It was also agreed that if SERI, already incorporated as a company, were established as a government-recognised and funded research institute, it should occupy two floors in the new extension. In November 1996, Professor Foulds came to Singapore to finalise the application with Dr Chew, prior to its submission to the NMRC, only to hear the sad news that Dr Chew had had a seizure in New York and had been diagnosed with an inoperable brain tumour. The finalised application was submitted to the NMRC in late November 1996 in the names of Professor Arthur Lim, Dr Chew Sek Jin, Professor Wallace Foulds, and Ms Charity Wai. The NMRC approved the application the next month, with an initial grant of S$19 million. S E R I

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Chapter 3 debilitating diseases of the eye and allied subjects and generally to improve the standard of knowledge of the means of prevention, diagnosis and methods of treatment and cure of such diseases and to preserve sight for the benefit of mankind without discrimination as to nationality, race or religion”. To this end SERI was charged to “provide research facilities and a conducive treatment environment for research and development in these areas”. Other requirements detailed SERI’s remit in education and training, and included the establishment of close links with “other bodies in Singapore or elsewhere in the world whose objects were, in general, similar to those of SERI’s”. There was also an identified requirement to undertake the publication of books, pamphlets, and journals. SERI, now funded by the NMRC and incorporated as a company, needed building from the ground up, both literally and figuratively, for SERI at that time had no clinical or laboratory accommodation and no research staff. New research laboratories were established on the NUS campus in accommodation provided by the Department of Physiology of NUS. Clinical research facilities were housed initially in the School Health Service at the Institute of Health, at that time situated in Outram Road close to SGH. Later, when the Institute of Health moved to new accommodation, facilities for clinical research were provided by the Singapore Polytechnic in Dover Road, which was a long way from SGH and some distance from the SERI laboratories provided by the Department of Physiology in NUS. SERI’s scattered accommodation was worsened by the necessary siting of SERI’s administrative activities in temporary hutted accommodation on the SGH campus. Initially, this was next to the SNEC; but later as building work on the SNEC extension commenced, a move to temporary accommodation in a neighbouring carpark proved necessary. Dr Chew, who had been promoted to Associate Professor, rapidly established clinical trials in myopia and epidemiological studies in childhood myopia, recruiting appropriately trained clinical staff. With the aid of Professor Roger Beuerman from the USA and Bill Lam from Hong Kong and previously the USA, he recruited scientific laboratory staff and instituted basic research into myopia. 58





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The appointment of Assoc Prof Chew’s wife, Esther Chu, as Manager of SERI was of great help to him during a period of increasingly ill health that, however, did not diminish his great enthusiasm for SERI, nor his capacity for undertaking new projects or recruiting new collaborators. Sadly, towards the end of 1998 Prof Chew’s illness eventually overtook him, and he died quite suddenly on 19 December of that year. His memory and his contribution to the establishment of SERI is commemorated in an eponymous lectureship funded by contributions from those who knew and admired him. The first of these lectures was given in September 2001 as a keynote address during the First Singapore Eye Research Institute International Meeting that was held at that time. The lecture was given by Professor Richard Stone from the University of Pennsylvania and was entitled “The dimensions of myopia”. With his passing, SERI immediately lost its driving force and, to a degree, its sense of direction. Some staff, overtaken by uncertainty, resigned. For a short time, SERI — which had been established only recently with so much promise — looked in danger of foundering for want of leadership. Professor Foulds was charged by the SERI Board with a remit to assess SERI’s research direction and organisation. An in-depth assessment of all SERI’s activities, staffing, budget, and so on was carried out; and the results and recommendations were incorporated in a Strategic Plan that was completed, forwarded to the Board, and adopted by the Board of Directors in February 2000. As recommended in the plan, Professor Tan’s appointment as SERI’s Director was confirmed by the Board together with the appointment of Professor Foulds as Co-Director for a temporary period of two years. Professor Beuerman was appointed as Head of Laboratories and subsequently as Deputy Director of SERI and Scientific Director, positions that he currently holds. The adoption of the Strategic Plan coincided with the planning and building of the eight-storey extension to the SNEC that would allow all of SERI’s far-flung activities to be brought together under one roof. In August 2001, SERI moved to its new facilities and, for the first time, was able to bring together under one roof all of its clinical and basic research activities in

Assoc Prof Chew Sek Jin

Sadly, towards the end of 1998 Prof Chew’s illness eventually overtook him, and he died quite suddenly on 19 December of that year. With his passing, SERI immediately lost its driving force and, to a degree, its sense of direction. Professor Foulds was charged by the SERI Board with a remit to assess SERI’s research direction and organisation.

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Chapter 3 two custom-built research floors, one for clinical research on the 5th floor and the other for laboratory-based research on the 6th floor. SERI’s administrative offices were also housed on the 5th floor. The new facilities were officially opened on 28 September 2001 by Mr Lim Hng Kiang, Minister of Health and second Minister of Finance, the opening coinciding with SERI’s First International Research Meeting at which he was the guest of honour. This meeting, the first such to be held, was not only successful in its own right, but acted as a template for future combined SERI/ARVO meetings.

Prof Roger Beuerman Scientific Director/Deputy Director, SERI

It was also agreed, as suggested in the Strategic Plan, that all clinical research previously conducted in the SNEC within the Clinical Research Unit should become the remit of SERI and that SERI’s budgeting, accounting, and purchasing practice should be relatively independent of the SNEC. While research in myopia would remain an important aspect of SERI’s work, laboratory aspects of myopia research would be concentrated on cell and molecular biology and on molecular genetics, while epidemiological studies and interventional clinical trials would continue. The importance of including other areas of research of relevance to Singapore and Southeast Asia was also highlighted in the Strategic Plan.

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The aims of SERI were identified in the plan as follows: 1. To improve vision, alleviate the effects of sight-threatening disorders, and reduce the prevalence of blindness in Singapore.

From 2000 onwards, SERI’s progress has been rapid.

2. To undertake basic and clinical research to achieve these aims. 3. To establish ophthalmic research in Singapore as having a recognised international status among the scientific and ophthalmological community worldwide. 4. To develop or contribute to the development of new products, devices, or processes which will help to achieve the aims of SERI and additionally be commercially exploitable. From 2000 onwards, SERI’s progress has been rapid. Professor Tan has proved, as was anticipated, to be an effective and innovative leader; and under his leadership and direction, SERI’s research and reputation have thrived. In 2002, SERI was recognised by the Singapore authorities as a charity under the Singapore Charities Act. An important development that took place in February 2003 was the formal recognition of SERI by NUS as an Affiliated Research Institute, thus conferring university status on SERI. As a consequence of the affiliation with NUS, eight members of SERI’s staff were given university appointments in various grades (Adjunct, Visiting, Associate, or Assistant Professor).

In 2002, SERI was recognised by the Singapore authorities as a charity under the Singapore Charities Act. In February 2003 was the formal recognition of SERI by NUS as an Affiliated Research Institute, thus conferring university status on SERI.

With the return to Singapore of a number of researchers who had gone abroad to undertake research training, a number of whom had gained PhD degrees from overseas universities, SERI’s research activities expanded rapidly. SERI’s grant funding increased and new grant-aided staff were appointed. The growing contributions made by researchers trained abroad was recognised by the appointment of Associate Professor Wong Tien Yin (PhD in epidemiology) and Associate Professor Aung Tin (PhD in ophthalmic genetics) as Associate Directors of SERI (International Activities and Education, respectively).

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The growing contributions made by researchers trained abroad was recognised by the appointment of Associate Professor Wong Tien Yin (PhD in epidemiology) and Associate Professor Aung Tin (PhD in ophthalmic genetics) as Associate Directors of SERI (International Activities and Education, respectively).

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In the short years since its inception, and thanks initially to the remarkable energy of the late Prof Chew Sek Jin in spite of the increasing demands of his illness and his own appreciation of the eventual outcome, and subsequently and importantly the dedication and hard work of its present Director Professor Donald Tan, SERI has made some notable advances. Professor Tan’s achievements within SERI and as Head of the NUS Department of Ophthalmology were recognised in June 2005 by his promotion to Professor of Ophthalmology in NUS. Well-equipped laboratories have been established that are capable of cell and molecular biology relevant to SERI’s diverse research interests. A proteomics and microanalysis laboratory has been created, as has been a genetics laboratory and laboratories for cell culture and stem cell work (including work on both conjunctival and retinal stem cells). State-of-the-art equipment allows the exploitation of real-time PCR, gene array technology, and microanalysis, using sophisticated equipment for HPLC and MS equipped with the latest MALDI device that has greatly aided proteomics research. Much of this equipment has been funded by research grants obtained as a result of successful grant applications prepared by Professor Beuerman. Dr Zhou Lei, who has been with SERI almost since its inception, runs the microanalytical laboratory that was established by Professor Bill Lam, who has returned to his home in Boston, USA. Dr Zhou Lei also acts as Deputy Head of Laboratories. Professor Beuerman and his team have a particular interest in the molecular biology of the tear film and other aspects of the ocular surface in health and disease. Among other notable advances, they have identified a new defensin molecule in the tear film that appears to have significant protective functions. Currently, they are investigating the effects of the function of this molecule that result from alterations to its molecular structure. Laboratories within SERI also house the SGH Stem Cell Group. Laboratory work on conjunctival stem cells is a personal interest of Professor Donald Tan’s, while retinal stem cell work will be undertaken by Dr Henry Klassen who has recently been recruited from the USA. SERI, and more particularly Professor Donald Tan, has been among the first to use stem cell technology clinically in the repair of damaged or diseased conjunctiva and in the management of pterygium. As a result of an active collaboration with the Department of Biomolecular Engineering

History of the Singapore Eye Research Institute

at NUS, artificial substrates for the culture of conjunctival stem cells have been developed and are being assessed in clinical practice. An ophthalmic genetics laboratory has been established, headed by Professor Aung Tin and aided by a post-doctoral fellow Dr Eranga Vithana who, like Professor Aung Tin, gained her PhD from London University. Already, a novel gene associated with closed angle glaucoma has been identified and many other genes are under investigation. In basic retina research, a new animal model of retinal capillary ischaemia has been developed, and the effects of the resulting hypoxia on the pattern of angiogenic and angio-inhibitory factors are being investigated in conjunction with Assoc Prof Charanjit Kaur of the Anatomy Department of NUS. This work is relevant to the blinding complications of diabetic eye disease. A number of projects address basic aspects of myopia, and have been greatly aided by a mouse model of myopia and by a mouse lacking a gene for particular muscarinic receptors. As regards facilities for clinical research, the 5th floor houses a number of fully equipped ophthalmic consulting rooms mainly used for clinical trials, epidemiological projects, and the like. There are also optometric consulting rooms; facilities for contact lens work; generous equipment for auto-refraction and for the testing of visual function including visual field analysis and assessment of contrast sensitivity; and equipment for ocular aberrometry, ocular photography, and detailed imaging of anterior segment morphology. A fully equipped electrophysiology laboratory has been established under the direction of Dr Chi Luu, with equipment for advanced electro-retinography including multifocal ERG and both flash- and pattern-evoked cortical responses. Duplicate electrophysiological equipment is available for human clinical studies and for experimental studies in animals, the latter using novel programming developed in collaboration with the Tennent Institute in Glasgow. There is a dedicated pharmacy for randomised drug trials and a YAG/Argon laser system for a glaucoma study that is underway.

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The clinical research facilities are under the direction of Sister Chye Fong Peck, Clinic Manager, who maintains a cheerful disposition in spite of the onus of administering some 35 clinical research projects.

SERI staff

SERI currently has some 30 laboratory-based research staff and 39 researchers engaged in clinical research projects, some of whom are SERI staff and others who have adjunct status in SERI. The total staff complement of SERI now numbers some 80 persons. The organisational demands of SERI’s active research programme are great, as are the demands on the Director’s time and that of SERI’s senior staff. This has necessitated an increase in administrative staff that now numbers some 10 persons.

Peck Chye Fong

The administration of SERI on behalf of the Director is in the capable hands of Ms Karen Chee, Senior Manager of SERI.

Nursing Manager

In addition to its own research within the SNEC building, SERI has established a number of fruitful collaborations within Singapore and abroad. Within Singapore, collaborative research has been established with many university departments and non-university organisations. These have included a number of departments at NUS (Anatomy; Biochemistry; Electrical, Optical and Biomedical Engineering; Community, Occupational, and Family Health (COFM); Mechanical Engineering; Microbiology) and several departments at the Nanyang Technological University.

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Collaborative research with the Department of Community, Occupational and Family Health (COFM) in NUS has been particularly fruitful in the conduct of

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interventional trials in childhood myopia and in epidemiological studies of myopia and other disorders affecting the eye or vision. Associate Professor Saw Seang Mei, who holds appointments both within the COFM Department and SERI, has been particularly active in ophthalmic epidemiology. In conjunction with Professor Saw, researchers within SERI have conducted crosssectional and prospective longitudinal studies of childhood myopia in Singapore (Singapore Study of the Risk Factors of Myopia or SCORM) and in China. Interventional trials of atropine or pirenzepine eyedrops in the control of childhood myopia have shown that the former (Atropine in the Treatment of Myopia or ATOM) significantly reduces the rate of progression of myopia in children. New studies using reduced strength of atropine eyedrops are underway. A detailed epidemiological study of ophthalmic disorders among the Malay population of Singapore is underway (Singapore Malay Eye Study or SiMES). The epidemiology of glaucoma has been studied with the acquisition of useful data on the prevalence and types of glaucoma in Singapore. Associate Professor Wong has also been active in epidemiological research, and has made significant advances in the quantification of retinal vascular morphology in relation to systemic cardiovascular disease and diabetes.

Ms Karen Chee Senior Manager of SERI.

Within Singapore, collaborative research has been established with many university departments and non-university organisations.

The range of SERI’s clinical and basic research activities and the many publications that have resulted are too wide to be addressed in any detail in such a short history as this. SERI is still developing and is increasingly active in many areas of research. Over the coming years, it is hoped and anticipated that SERI’s history will be further embellished as a result. SERI’s presence on the SGH campus is a late development in a long history of eye care at that location. An Eye Unit was first initiated at SGH as early as 1926, evolving into an Ophthalmology Department in 1934. The Ophthalmology Department continued to function in SGH after the foundation of the SNEC in 1990, subsequently being absorbed into the SNEC in 1992. SERI is, of course, a further and much more recent development of the latter.

Source: Leading lights in the Asia-Pacific, 2006.



Author: We are grafeful to Professor Wallace Foulds for his contributions to ophthalmic research in Singapore over the past 20 years.

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Chapter 4

The Late Associate Professor Chew Sek Jin The Pioneer of Research in Singapore “There are a lot of capable people, but few are both capable and respectable like Sek Jin.” Citation by Professor Dennis Lam Chairman, Department of Ophthalmology and Visual Sciences of The Chinese University of Hong Kong Secretary-General of Asia-Pacific Academy of Ophthalmology

There are a lot of capable people, but few are both capable and respectable. Sek Jin was extremely capable and well respected by his patients and all those who had the chance of working with him. He was visionary, selfless, and both a good team leader as well as team player. One of his favorite quotes was, “Let’s work together.”

Professor Dennis Lam (right) with the late Assoc Prof Chew Sek Jin.

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I learnt a lot from him, and he was the one to inspire me to pursue an academic career. He helped me with my first laboratory research project, using confocal microscopy to study corneal wound healing after photorefractive keratectomy in rabbit. The data were presented, as my first oral presentation, at the ARVO meeting. He inspired me to work on the epidemiology of myopia and molecular eye genetics. He assisted me in writing manuscripts and publishing internationally. We went through some difficult times together in the initial period of both his and my academic careers. We supported each other and shared many fond memories. I still remember the two weeks that I spent with him in New York when he was studying for his PhD at the Rockefeller University. We worked from dawn until midnight on the UBM study in the New York Eye and Ear Infirmary, and on the myopia study in chicks in Joshua Wallman’s laboratory. He and his beloved wife,

Singapore’s Research Heroes

Esther, were so kind that they invited me to stay with them in their dormitory where I could sleep on a sofa. Sek Jin and Esther were a lovely couple whom I had a lot of respect for. We had so much fun together, and the memories are still so fresh that it seems that they just happened yesterday. Sek Jin was a very dear friend and I miss him so much!

SNEC Gold Medallist 1997 Associate Professor Chew Sek Jin was the first Singaporean ophthalmologist to successfully attain a PhD degree overseas. After obtaining a MS (Anatomy) from the Louisiana State University Eye Center in USA, he went on to acquire a PhD degree in neuroscience at the Rockefeller University, USA, in 1996. Throughout his career, Assoc Prof Chew achieved academic distinctions. He was the first Singaporean to top the Royal College of Surgeon (Edinburgh) Examination in Ophthalmology, and was awarded the College’s Gold Medal in 1987. In recognition of his work in myopia research, Assoc Prof Chew was appointed to a number of international organisations. He was Vice President of the Myopia International Research Foundation and Director of its Asia-Pacific headquarters based in Singapore. He was also Visiting Professor at the City University of New York and the New York Eye and Ear Infirmary, and Visiting Scientist at the Rockefeller University. Associate Professor Chew published over 50 papers, including the first paper by a local ophthalmologist in the prestigious journal Science. He made over 150 presentations, mainly in the field of myopia research, at regional and international conferences. He headed the Myopia Clinic at SNEC and was Deputy Director of the Singapore Eye Research Institute (SERI). He was also responsible for attracting major grants from top industries such as Bausch and Lomb to support research in SERI. Associate Professor Chew also played a major role in establishing links between SNEC and top universities in the USA, such as Harvard with its strong emphasis on myopia research, and Johns Hopkins University in a collaborative myopia study on RGP lens. In 1997, through his efforts, a number of top specialists from the USA visited SNEC and brought about new areas of collaboration into the 21st century.

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SNEC International Gold Medallist in 1999 Chew Sek Jin (Posthumous Award) Citation by Professor Donald Tan Director, SERI The late Prof Chew Sek Jin was the first of us to acquire MS and PhD degrees. In 1993, he left Singapore to pursue a PhD in the USA in the midst of a promising clinical career. As the first full-time medical staff of the Department of Ophthalmology in the National University Hospital (NUH), he had blazed the trail by devoting his career to full-time research, leading by example in showing how research should and must be integral to the future of ophthalmology in Singapore. After getting his Master’s (in anatomy) from the Louisiana State University Eye Center in the USA, he went on and achieved his PhD degree (in neuroscience) at the Rockefeller University in 1996. Upon his return, he immediately set to work in getting the Singapore Eye Research Institute (SERI) underway. In those early days, he worked day and night writing grant proposals to the National Medical Research Council (NMRC), recruiting scientists locally and overseas, and cajoling medical students to participate in projects. At the same time, he was networking with industry and overseas research collaborators to build a name for Singapore as the potential hub for eye research in Asia. It was at one of those overseas meetings that Sek Jin fell ill, collapsed, and was discovered to have an inoperable brain tumour. Most people would have resigned themselves to fate and would have given up, but not Sek Jin. He worked even harder and faster, knowing that he was living on borrowed time. Within a very short time, he was able to assemble funds to the tune of S$20 million as a five-year grant from the NMRC. At the same time, he set up the SERI laboratories in NUS and built up a team of researchers and support staff from scratch, opening myopia research clinics. On top of that, he was seeing an increasing number of patients, recruiting school children for his myopia trials, as well as establishing successful links and clinical trials with top industry firms such as Bausch and Lomb, Ciba Vision, and others, which continue to this day. 70





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However, I believe that it was not his brilliant academic achievements or his lightning speed in getting things done that has touched our lives the most. I believe all of us will best remember Sek Jin for his fearless courage, his boundless optimism in coping with his brain tumour, his total devotion to his work in spite of his terminal condition, his genuine friendship, and the interest and concern shown to even the most junior medical student. Not once did I hear Sek Jin complain about his condition or about how unfair fate had been. In fact, he was often the one who cheered us on, always telling us to look at the positive side, always painting us his vision of research and getting groups of people working together. Sek Jin was awarded the SNEC Gold Medal Award in 1997. Tonight, we would like to honour him posthumously with the SNEC International Gold Medal to recognise Sek Jin’s achievements internationally. In recognition of his work in myopia research, Sek Jin was appointed to a number of international organisations. He was Vice President of the Myopia International Research Foundation and the Director of its Asia-Pacific headquarters, based in Singapore. He was also appointed Visiting Professor at the City University of New York and the New York Eye and Ear Infirmary, as well as Visiting Scientist at the Rockefeller University. Sek Jin also played a major role in establishing links between SNEC and top universities in the USA, such as Harvard with its strong emphasis in myopia research, and Johns Hopkins University in a collaborative myopia study on RGP lens. He was constantly bringing in top scientists from the USA, UK, Australia, Japan, Taiwan, and China, just to name a few, to create opportunities to start new areas of collaboration into the 21st century. In his short lifespan, Sek Jin published over 50 papers. He also made more than 150 presentations, mainly in the field of myopia research, in regional and international conferences, and in particular at the world’s foremost research meeting — the Association for Research in Vision and Ophthalmology (ARVO) meeting attended by over 10,000 researchers and scientists around the world annually.



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I believe all of us will best remember Sek Jin for his fearless courage, his boundless optimism in coping with his brain tumour, his total devotion to his work in spite of his terminal condition.

It therefore gives me great pleasure to announce that, in recognition of Prof Chew Sek Jin’s significant contributions internationally, a group of international myopia researchers has initiated the Chew Sek Jin ARVO Traveling Fellowship. The funding of this fellowship will be raised jointly by SNEC in Singapore and by the researchers overseas. It is most befitting to come together with the international myopia research community to endow a fellowship in Sek Jin’s name to carry on his life-long ambition and to encourage young ophthalmologists pursuing research to present their work at the ARVO meeting. Last but not least, may I also take this opportunity to pay tribute to Esther, who remained steadfast in her support for Sek Jin throughout those pioneering days and during the trying times of his illness. Esther, who took on the position as the Institute’s Manager, not only looked after the administrative details and the implementation of Sek Jin’s numerous plans, but was also by his side tending to him whenever an attack or a fit came on. We must salute Esther for her exemplary dedication and devotion to Sek Jin. I would like to call upon Esther Chu to come on stage to receive the posthumous award of the SNEC International Gold Medal to the late Prof Chew Sek Jin.

Source: Singapore National Eye centre: The First 10 years (1990 - 2000)

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“Despite the onset of a fatal illness, he continued to direct the institute, organise its programmes, and produce a flood of ideas to encourage his team.” Citation by Dr JF Cullen Visiting Consultant, Singapore National Eye Centre

Chew Sek Jin, ophthalmologist and researcher, died in Singapore, aged 39, on 19 December 1998 of a malignant brain tumour. Having graduated from the National University of Singapore in 1983, he soon found himself as Medical Officer in charge of the Armed Forces Medical Classification Centre, where his abiding interest in myopia originated. In 1986, he joined the newly established Department of Ophthalmology at the National University Hospital under Prof Arthur Lim and, in the following year, came to Edinburgh to take the FRCSE and won the Muthusamy Gold Medal before returning to Singapore as Senior Registrar in 1988. He was soon to realise his deficiencies in scientific training and so, in 1990, he went to New Orleans to earn an MS in basic sciences, and then on to the Rockefeller University where he completed his PhD in 1996. During those years, he continued his research on myopia and on corneal physiology and glaucoma, and was then appointed Vice President of the Myopia International Research Foundation. Returning to Singapore in late 1996, he was appointed Deputy Director of the Eye Research Unit (later to be called the Singapore Eye Research Institute) and proceeded to set up laboratories and organise major basic eye research, in particular to study the epidemiology, prevention, and treatment of myopia. Despite the onset of a fatal illness, he continued to direct the institute, organise its programmes, and produce a flood of ideas to encourage his team. In late November, he chaired the session on myopia at the SNEC Third International Meeting and conducted a lengthy press conference.

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Chapter 4 His wife Esther joined him as administrator of SERI and cared for him with great devotion during the two years of his illness. His ebullience and enthusiasm were evident to the end, and he was comforted by his conversion to Christianity in the last months of his life. He is also survived by his father James Chew, also an ophthalmologist, his mother, and sister Lee Jin.

Source: Royal College of Surgeons of Edinburgh Newsletter. No. 55, Spring 1999.

“He established a ‘beach-head’ for Singapore’s entry into the US and the big league.” Citation by Dr Lim Kuang Hui Visiting Consultant, Singapore National Eye Centre An unassuming young intellectual, Chew Sek Jin (SJ) was the first of our secondgeneration ophthalmologists in Singapore and, arguably, Malaysia. When talking to him, he was always praiseworthy to others, never himself. He concealed his fatal illness even from me, and I was the last to know. SJ attended school in Singapore at the Anglo-Chinese School and National Junior College, bagging numerous merit prizes along the way. He scored the best performance (adjudged by Cambridge’s Trinity College) for the Oxford-Cambridge Entrance Scholarship Award for the study of medicine, but chose to enter our own National University of Singapore on a merit scholarship. Upon graduation, he served full-time with the National Service in the Singapore Armed Forces and was assigned as Medical Officer i/c Ophthalmology Section, Medical Classification Centre. His early talents were already recognised by his peers and, when he became fully qualified in due course, he was appointed Adjunct Senior Research Associate at the Defense Medical Research Institute. SJ started his ophthalmology career as a medical officer in the Department of Ophthalmology, Singapore General Hospital, as did everyone else in those days. He was the first Asian to win a gold medal at the FRCS Ophthalmology finals when he sat for the examination in Edinburgh in 1987/88. 74





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He returned to Singapore and helped to organise the first conjoint FRCSE/M Med (Ophthalmology) examination held in Singapore in 1989. He not only coached the first batch of our ophthalmic residents, but took on their night calls as well, to allow them time to study. His easy entry into the portals of academia in the most prestigious research institutes and his appointments to professorial positions there established a ‘beach-head’ for Singapore’s entry into the US and the big league. Amongst his many appointments were: • Vice President, Myopia International Research Foundation, and Director of its Asia-Pacific HQ • Visiting Professor, City University of New York and New York Eye & Ear Infirmary • Visiting Scientist, Rockefeller University • Clinical Professor of Ophthalmology, LSU Eye Centre • Anatomy Adjucator, Association for Research in Vision and Ophthalmology Although SJ was offered professional positions in Taiwan and Hong Kong, he chose to return to Singapore, the country of his birth. He had chosen to come home even as he confided his trepidation to me; but with the full backing of his mentor, Prof Arthur Lim, he proved himself again and again. As Deputy Director of the nascent Singapore Eye Research Institute (SERI), he attracted major grants from top industries and had research investigators coming from around the world. He established links between Singapore National Eye Centre (SNEC)/Singapore Eye Research Institute (SERI)/Ministry of Health and top institutes in the USA and Europe. He was also a consultant for Myopia Service at SNEC and received the SNEC Gold Medal in 1997. Apart from SJ’s likable personal attributes, the most promising research brain that Singapore has produced in our two generations was nipped in the bud. Notwithstanding whatever successes achieved so far, his full potential was not allowed to bloom to maturity. History has repeated itself with another cruel example.

Source: SMA News. Vol. 40, No. 1, 1999



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Chapter 5

Professor Donald Tan The leader in ophthalmic research He pushed eye research in Singapore from almost nothing to the world stage SNEC Distinguished Service Award As Consultant in charge of clinical research development, Dr Tan has contributed significantly in building up the clinical research arm of the SNEC. He was responsible for setting up the clinical research departmental offices and the first laboratory in the SNEC, which became operational in 1995. He has attracted a substantial grant of S$517,000 from the Singapore National Medical Research Council for the clinical and basic science projects in pterygium. Dr Tan, with a team of ophthalmologists active in research, has presented a creditable list of papers/posters at the prestigious Association for Research in Vision and Ophthalmology (ARVO) meeting for two consecutive years. Dr Tan is the principal investigator of over ten ongoing clinical and basic science research projects in the SNEC. He chairs the Executive Research Committee and sits on the SNEC Medical Board, Management Committee, and Ethics Committee. Dr Tan is also coordinator of the Singapore Eye Bank. Source: APJO Vol 8 (1), 1996

Prof Donald Tan is Director of the Singapore Eye Research Institute (SERI) and Head of the Department of Ophthalmology, National University of Singapore. He also holds a dual appointment as Deputy Director of the Singapore National Eye Centre (SNEC) and Senior Consultant and Head of the Corneal Service at SNEC. 76





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In 2006, Professor Tan was awarded the first Minister for Health Award For Outstanding Performance In Public Health in Singapore for leading the Singapore team which first identified the cause of the global outbreak of Fusarium keratitis.

Professor Donald Tan MBBS, FAMS, FRCSE, FRCSG, FRCOphth Professor and Head, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore Director, Singapore Eye Research Institute Deputy Director, Singapore National Eye Centre



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Chapter 5 He is a Senior Consultant at the National University Hospital in Singapore and is Director of the Singapore Eye Bank. Donald Tan exhibits the rare combination of a talented, dedicated, and caring clinician; a surgeon of the highest calibre; and an active researcher interested and skilled in clinical and basic research. His particular interests have been in ocular surface disorders, especially the aetiology of pterygium at the cell and molecular level; and in corneal transplantation, particularly the problems associated with corneal graft rejection. He spearheaded the development of corneal services at the SNEC, reorganising the corneal transplantation service and establishing the Singapore Eye Bank. Currently, he is actively involved with national initiatives in tissue banking. His refinements of techniques for ocular surface transplantation and the use of amniotic membrane have achieved strikingly good results in a difficult therapeutic area. He is actively pursuing the use of stem cell technology in the treatment of ocular surface disorders and exploring the use of new treatment modalities to prevent graft rejection. Donald Tan enthusiastically promotes clinical research. Before taking on the Directorship of SERI, he was responsible for the establishment of a Clinical Research Unit in SNEC that successfully fostered a culture of research and research publication among involved clinicians. He has organised and promoted the use of randomised controlled clinical trials in areas as diverse as the use of new intraocular drug delivery devices as well as the assessment of instrastromal corneal rings, phakic intraocular lenses, and artificial corneae. Under his Directorship, SERI has conducted seminal epidemiological studies related to the aetiology and progression of myopia in children that have clearly demonstrated and quantified the dual roles of genetic inheritance and close work in the genesis of this condition. An important attribute that contributes to Donald Tan’s success as a researcher, clinician, and administrator, apart from his enormous energy for hard work, is his ability to deliver what he promises. To an extent, this results from foresight and the ability to work with others, but it also stems from his excellent ability to prioritise all of the various demands on his time. 78





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Donald Tan has actively promoted the dissemination of research ideas and results locally and abroad, having instituted a programme of SNEC Research Days and later Annual Research Meetings in Ophthalmology and the Visual Sciences that actively encourage a vibrant research culture in Singapore. In honour of his contribution to ophthalmic and vision research in Asia, he was invited to give the prestigious de Ocampo Lecture and receive the de Ocampo Award at the 18th Congress of the Asia-Pacific Academy of Ophthalmology in 2001. This is the highest award of the Asia-Pacific Academy of Ophthalmology for excellent academic achievements. Donald Tan is a much sought-after lecturer at home and overseas, having been invited to lecture and teach extensively in the region and beyond. He has conducted highly rated teaching courses at the American Academy of Ophthalmology, the International Congress of Ophthalmology, the Asia-Pacific Academy of Ophthalmology, the European Society of Ophthalmology, and the American Society of Cataract and Refractive Surgery. He has been a guest lecturer in universities and centres of excellence in America, Europe, Australia, and Asia. He has published more than 80 scientific papers, mainly in internationally recognised peer-reviewed journals, numerous abstracts, and five book chapters, and serves as reviewer for a number of leading ophthalmic journals. In spite of an extremely busy work schedule, Donald Tan takes a keen interest in the welfare of his staff and colleagues within SERI, SNEC, and NUS. He has played a key role in the establishment in Singapore of a world-class centre of excellence in ophthalmic research, teaching, and clinical care. Source: APJO Vol 14(1), 2002

Appointments Donald Tan is Director of the Singapore Eye Research Institute (SERI) and Deputy Director of the Singapore National Eye Centre (SNEC). He is also a tenured full professor and Head of the Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore. As a Senior Consultant at both the Singapore National Eye Centre and National University Hospital, he heads the SNEC Cornea and External Disease Service and is also in charge of all research activities at SNEC. He is also Medical Director of the Singapore Eye Bank.

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Chapter 5 Internationally, he chairs the International Members Committee of the Association for Research in Vision and Ophthalmology (ARVO), is a founding member of the Asia Pacific Society of Eye Genetics, and most recently was elected as the first President of the newly formed Asia Cornea Society. Professor Tan received his corneal and external disease fellowship training in Moorfields Eye Hospital, London. As head of the SNEC Corneal and External Disease Service, his clinical interests lie in corneal transplantation, ocular surface disease, limbal stem cell transplantation, pterygium surgery, corneal refractive surgery, femtosecond laser-assisted corneal surgery, and keratoprosthesis surgery. His other research interests include ocular drug delivery systems, epidemiology of myopia and pterygium, visual psychophysics, and interventional myopia drug treatments. Professor Tan has published over 180 scientific peer-reviewed articles to date and has written 13 book chapters on cornea, ocular surface stem cells, and pterygium surgery. In addition, he has presented over 300 papers at international meetings, and delivered over 70 guest lectures at international and regional meetings. He is also active in teaching and has conducted more than 60 teaching courses on corneal surgery, refractive surgery, and myopia, both locally and internationally. He is on the editorial board of the The Ocular Surface Journal and the Philippines Journal of Ophthalmology, and is a reviewer of nine ophthalmic and visual science journals. Professor Tan has also trained, to date, 14 corneal fellows, including international fellows from the UK, Netherlands, Philippines, Mexico, Thailand, India, and China. Professor Tan was awarded the Asia-Pacific Academy of Ophthalmology Distinguished Service Award in 1997. For his contribution to ophthalmic and vision research in Asia, he was awarded the 2001 De Ocampo Lecture by the Asia-Pacific Academy of Ophthalmology, and is the youngest recipient of this award for excellence in Asian research. In both 2004 and 2005, he was an award winner at the American Society of Cataract and Refractive Surgery (ASCRS) Film Festival, and also received awards at the 2005 and 2006 ASCRS meetings for Best Paper at the corneal and keratoplasty symposia. In 2006, his contribution to the field of international ophthalmology was recognised in a prestigous Achievement Award from the Board of Trustees of the American Academy of Ophthalmology; Professor Tan is Singapore’s first recipient of this international award. In 2006, 80





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Professor Tan was awarded the first Minister for Health Award For Outstanding Performance In Public Health in Singapore for leading the Singapore team which first identified the cause of the global outbreak of Fusarium keratitis. Professor Tan was pivotal in bringing the Association for Research in Vision and Ophthalmology (ARVO) meeting to Asia. ARVO is the foremost international meeting for vision and ophthalmology research, and for the last 75 years has been held in the USA. Through SERI, Professor Tan was successful in the bid for SERI to hold the first series of international ARVO affiliated meetings to Singapore, the SERI-ARVO Meetings, which were held in 2003 and 2005. In 2007, this meeting was upgraded to become the Asia-ARVO Meeting, again held in Singapore and jointly organized by SERI. SERI will continue to host Asia-ARVO Meetings on a four-yearly basis. Professor Tan’s current interests focus on developing new forms of anterior and posterior lamellar corneal transplantation in Asian eyes, including the use of femtosecond laser technologies, introducing keratoprosthesis surgery to the region. His newest project is the formation of the Asia Cornea Society (ACS), which brings together leading corneal specialists from Asian nations including China, India, Japan, Taiwan, Korea, Philippines, and Singapore; and Professor Tan was elected as the inaugural President of ACS. Registered in Singapore, the goal of ACS is to spearhead the development of educational and research programmes for cornea and related subspecialties in Asia, with the objective of assisting to alleviate corneal blindness in Asia and beyond.



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Chapter 6

Professor Wallace Foulds A world-famous ophthalmic researcher Professor Wallace Foulds, CBE, MD, ChM, Hon DSc, FRCS (Eng & Glasg), Hon FRCOphth, Hon FRACO, Hon FCSSA, Hon FRSM Emeritus Professor of Ophthalmology, University of Glasgow Senior Consultant, Singapore Eye Research Institute Visiting Professor, National University of Singapore

His advice has been invaluable. His leadership in ocular research will always be remembered. SNEC International Gold medallist 1997 Prof Wallace Foulds is well known to ophthalmologists in the Asia Pacific. He is internationally regarded as a world-famous ophthalmic researcher. After training in Moorfields Eye Hospital, London, Prof Foulds was appointed Consultant Ophthalmologist to Addenbrookes Hospital, Cambridge, and Honorary Lecturer in the University of Cambridge. Later, he was appointed to the Tennent Chair of Ophthalmology at the University of Glasgow. His earlier research at the Institute of Ophthalmology, London, under the guidance of Sir Stewart Duke Elder, led to higher-degree theses on the mechanisms of closed angle glaucoma and on the pathogenesis of retinal detachment. As Tennent Professor, he promoted ophthalmic pathology and the application of basic science to clinical problems. His main interests were — and remain — retina, optic nerve, and ocular malignancy. He has written 20 book chapters and about 200 scientific papers, and has given more than 20 named lectures. For his significant contributions to the Tennent Institute during his tenure of the Tennent Chair over a span of some 25 years, he was made Emeritus Professor of Ophthalmology at the University of Glasgow upon his retirement in 1989.

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Over the years, Prof Foulds has held many key positions in major professional bodies. He was Founder President of the Royal College of Ophthalmologists, and was previously President of the Faculty of Ophthalmologists and the Ophthalmological Societies of the United Kingdom. He has been Vice-President

Singapore’s Research Heroes

of the Gonin Society and Chairman of the Association for Eye Research. In 1988, he was conferred the CBE by Her Majesty, Queen Elizabeth II. Prof Foulds has been professionally active in the Asia-Pacific area for many years, having been a frequent guest lecturer in Asia, including India, Pakistan, Malaysia, Japan, Hong Kong, and Singapore. He has been involved in the reorganisation of eye services in Hong Kong and the Prevention of Blindness Programme in India. He is Research Adviser to the Singapore National Eye Centre (SNEC) and sits on the Advisory Board of the recently established Singapore Eye Research Institute. He is also Visiting Professor of the Department of Ophthalmology, National University of Singapore. The Singapore National Eye Centre is indeed honoured to present to Prof Foulds the SNEC International Gold Medal, for his lifelong dedication to ophthalmology and his outstanding contributions to the promotion of education and research in Asia.

Source: Singapore National Eye Centre: The First Ten Years (1990 - 2000)

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Dr Kwa Soon Bee He played a pivotal role in the creation of SNEC and SERI Dr Kwa Soon Bee Former Permanent Secretary (Health)/ Director of Medical Services, Ministry of Health

Dr Kwa supported Prof Arthur Lim’s proposal strongly. It can be said that he was essential in the creation of the Singapore National Eye Centre as a public service success. He was also supportive of Prof Arthur Lim’s initiative to set up SERI. 84





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Dr Kwa supported Prof Arthur Lim’s proposal strongly. It can be said that he was essential in the creation of the Singapore National Eye Centre as a public service success. He was also supportive of Prof Arthur Lim’s initiative to set up SERI. Dr Kwa Soon Bee graduated as a doctor from the University of Malaya in Singapore in 1955 with distinctions in social medicine and public health. He was awarded the Brunei Hawes Gold Medal for Clinical Medicine and the Lim Boon Keng Medal for Medicine. He was admitted as a member of the Royal College of Physicians and Surgeons of Glasgow and of the Royal College of Physicians of Edinburgh, specialising in haematology, in 1962. In 1971, he was elected Fellow of the Royal College of Physicians, Edinburgh, and of the Royal College of Physicians & Surgeons of Glasgow in 1974. As Medical Superintendent of Singapore General Hospital, Dr Kwa pushed for the development of ophthalmology in the hospital, emphasising the importance of further sub-specialisation and research. His vision later led to the establishment of the Singapore National Eye Centre in 1990, making it the first specialty institution to be established in Singapore. Dr Kwa later witnessed the development of SERI into a research institution, which has grown to the prestigious position it enjoys today.

Singapore’s Research Heroes

Dr Kwa is a Fellow of the International Society of Haematology. He was appointed consultant haematologist and medical officer in charge of the Blood Transfusion Service in 1963, and its senior consultant in 1971. In 1969, in recognition of his services to the Blood Transfusion Service, he was awarded the Public Administration Gold Medal by the Singapore Government. Dr Kwa was appointed Medical Superintendent of the Kandang Kerbau Maternity Hospital in 1968 and of the Singapore General Hospital in 1972. He was appointed Permanent Secretary of the Ministry of Health and Director of Medical Services in 1984. Dr Kwa was commissioned as a captain in the Singapore Armed Forces in 1972 and rose to the rank of colonel, holding appointments as Commanding Officer of the Field Hospitals and helping to establish the General Medical Support Group. He was Honorary Consultant Physician to the Singapore Armed Forces in 1972, and Honorary Aide-de-Camp to the President from 1972 to 1988. In recognition of his services to the Singapore Armed Forces, he was awarded the Singapore Armed Forces Good Service Medal in 1976, the Long Service Medal in 1981, and the Public Administration Medal (Military)(Silver) in 1986. Dr Kwa was the founding Chairman of the Health Corporation of Singapore, a Ministry of Health holding company, from 1987 until his retirement in 1996. He was also Chairman of the Singapore General Hospital; the National Skin Centre; the Singapore National Eye Centre; and the Toa Payoh, Kandang Kerbau, and Tan Tock Seng hospitals. He was Chairman of the National University Hospital from 1985 to 1990. Dr Kwa was awarded the Meritorious Service Medal by the Government of Singapore in 1992, in recognition of his distinguished service as a clinician and administrator in the Ministry of Health and for his contributions to the development of the health service in Singapore.



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Assoc Prof Vivian Balakrishnan We want to be the first, the best, and the biggest SNEC Gold Medallist Assoc Prof Vivian Balakrishnan M Med (Ophth), FRCS (Ed)

Representing the second echelon of leadership in the SNEC, Associate Professor Vivian Balakrishnan was appointed Deputy Director of the SNEC in late 1997. He took over the baton from Professor Arthur Lim and became the Centre’s second Director in January 1999 at the age of 38. Associate Professor Balakrishnan has achieved many academic distinctions including the prestigious President’s Scholar honour. After achieving his MMed (Ophthalmology)/FRCS (Ed) qualifications, he became one of a select few overseas ophthalmologists appointed to the highly competitive specialist senior registrar’s post at Moorfields Eye Hospital in London for two years. He has been active in regional and international activities, and was guest lecturer and course instructor for many teaching programmes in Sri Lanka, India, Vietnam, Nepal, and Australia. He was accorded the Asia-Pacific Academy of Ophthalmology Distinguished Service Award in 1999. In addition, A/Prof Balakrishnan also plays an active role in many national activities. He was recently promoted to the rank of Major in the Singapore Armed Forces (SAF), and is Commanding Officer of the 2nd Combat Support Hospital of the SAF. He is an elected Council Member of the Singapore Medical Association, member of the National Library Board, member of the subject committee of the National Singapore 21 Committee, and recently Co-chairman of the Concept Plan Review 2001 Focus Group appointed by the Minister for National Development. These national advisory committees advise the Government on strategic directions for Singapore for the next decade. He is also a well-known debater and TV personality, having hosted the Health Matters series in 1996 and the Heartware series in 1998.

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Upon his appointment as Director of SNEC, he immediately set about shaping the future direction of SNEC. He initiated a strategic review and mapped out major initiatives for the SNEC in its next phase of development. A critical review was also conducted of SNEC’s role as the national centre and its relationship with the newly restructured public healthcare sector under the Singapore Health Services (SingHealth) and National Health Group (NHG) clusters. He also spearheaded the faculty practice plan aimed at retaining our pool of top medical talents by ensuring security and a smooth career transition for senior ophthalmologists to an institutional private practice scheme. He envisioned a strategic global alliance of eye centres, with SNEC being the ophthalmic hub in Asia. To this end, he led a SNEC delegation of senior staff and visited Jules Stein, Johns Hopkins, and Harvard in the USA; Moorfields Eye Hospital in the UK; and the Lions Eye Institute in Australia. The mission has led to the execution of memoranda of understanding with major centres that will form the foundation of a global alliance. He brought a different style of leadership to the SNEC. He is highly intelligent, shrewd in judgment, quick in action, sharp in negotiations, unique and innovative in his perspective of the world, and above all charismatic in his interaction with people at all levels. Yet, he is also easily approachable, unassuming with a strong sense of fair play, and full of genuine concern and compassion for the welfare of every staff. This unique combination of strength and humanity has earned him the trust and respect of all his colleagues, many of whom are his seniors. He was also effective in his advocacy of the SNEC with senior officials of the Ministry of Health and the new SingHealth group. It is therefore no surprise that the major transition of leadership of the SNEC has been so smooth that many have taken it for granted. With his model of beneficient leadership, SNEC is poised to achieve greater heights in its second phase of expansion and development. When he first took over the helm of SNEC, keeping the SNEC team intact was Assoc Prof Balakrishnan’s first priority; and it is a proud fact that over the past years, the best ophthalmologists in the country have been attracted and retained under one roof, and for the last three years there has been no loss of any member of the team. His vision for SNEC was simply, “ We want to be the first, the best, and the biggest.” SNEC aims to be the first in pioneering new techniques, technologies, and

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Chapter 7 treatments in Singapore and preferably the region, if not the world. He challenged all staff members to measure their achievements in terms of priority. He set the goal for SNEC to be the best in outcome and quality of care, which was not to be measured solely by our own standards, but also by what patients felt and by the standards set by our peers. His commitment to quality was manifested in the way he ensured that every procedure was thoroughly supervised before treatment was applied to the patients. Associate Professor Balakrishnan also cemented the sub-specialisation structure in the SNEC by replacing the three existing clinical service departments with the nine sub-speciality services and with the appointment of the respective subspeciality heads. He spurred the heads to focus on further development and elevation of service, teaching, and research in their respective subspecialities. The objective was for them to be experts in each area of subspeciality, and to harness their experience and expertise for the development of ophthalmology as a whole. Finally, he wanted SNEC to continue to be, as we are today, the largest provider of eye care to Singaporeans. Size is not advocated for its own sake, but for the advantage of achieving economies of scale and containing health costs. It facilitates sub-specialisation because with the high volume of cases, each specialist can see enough of a particular condition to maintain top-level skills and currency so that we can nurture the best cornea surgeons, the best refractive surgeons, the best paediatric ophthalmologists, etc. To achieve breadth and depth, such subspecialisation can only occur in a high-volume, busy practice as in the SNEC setting. In a surprise development in June 2000, Assoc Prof Vivian Balakrishnan was asked to relinquish his directorship of the SNEC and to assume the position of Chief Executive Officer of Singapore’s largest acute care hospital, the Singapore General Hospital. Given his outstanding talents, accelerated career moves and public office were not unexpected, although his departure from the SNEC after just over one and a half years in office was too soon.

Source: APJO Vol 12 (2), 2000 88





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On the special occasion of the SNEC 10th Anniversary International Congress, we wish to honour Assoc Prof Vivian Balakrishnan with the SNEC Gold Medal Award as our exemplary leader who has charted new directions for ophthalmology and the SNEC. We offer him our best wishes for an exceptionally bright future ahead.

Singapore’s Research Heroes

Dr Khoo Chong Yew He enforced ethics in research effectively Dr Khoo Chong Yew is well known nationally and internationally for his achievements in the contact lens subspecialty. He has been a council member of the International Contact Lens Council of Ophthalmology since 1986, and was recently appointed as its Chairman. He was awarded the Javal Silver Medal by the Dr Khoo Chong Yew MbBCh, FAMS, FRCS (Ed), Council in 1990 and the Gold Medal in 1994. Besides being invited to deliver many lectures on contact lenses, Dr Khoo has also conducted many teaching courses locally and abroad. He has co-authored the book, Contact Lenses: Medical Aspects, with Dr Montague Rubern, another worldrenowned expert in the field. Dr Khoo was amongst the first visiting consultants appointed to the Department of Ophthalmology of the National University Hospital (NUH) in 1986. With the establishment of the Singapore National Eye Centre (SNEC) in 1991, he made further contributions in a number of areas important to the development of the Centre.

FRACS, FRCOphth (UK) Founder member, Singapore National Eye Research Medical Board Chairman, Ethics Committee, SNEC and Singapore Eye Research Institute (SERI) Clinical Teacher, NUS; and Visiting Consultant, SNEC and National University Hospital

He is adviser to the Cornea Division (Medical Contact Lens and Eye Bank), Chairman of the Ethics Committee, Chairman of the Singapore Eye Bank, as well as a member of the SNEC Medical Board and its Selection Board. Ever active, Dr Khoo’s name appears in many other medical organisations outside the SNEC. He is a past president of the Singapore Medical Association for two terms (1985–1987), and was an elected member of the Singapore Medical Council from 1990 to 1993. He has been invited by the Ministry of Health to serve on many subcommittees including the Health Advisory Council, Committee for Specialists’ Register, the Committee on Medisave for Private Hospital, and more.



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Chapter 7 Until last year, he was Chairman of the Ethics Committee of the Gleneagles Hospital. He has been on the Panel of Advisers and an Executive Committee Member of the Singapore Eye Foundation for 13 years. He was also invited in 1982 to be a member of the Advisory Subcommittee on Specialist Certification of the Academy of Medicine. These multiple appointments on government and professional bodies clearly reflect the high esteem Dr Khoo commands. Equally, Dr Khoo has particularly distinguished himself in his contributions to community ophthalmology. In 1984, he chaired the National Eye Campaign, which mounted eye screening in 75 community centres. Besides the numerous eye-screening projects which he has carried out over the years, he has also been assisting the Home Nursing Foundation since 1986 to provide ophthalmic care to needy patients. In addition, Dr Khoo sits on the Council of the Asia-Pacific Academy of Ophthalmology (APAO) and chairs the APAO Ethics Committee. From 1995 to 1999, he led a Rotary Medical Mission to Cambodia to introduce implant surgery to ophthalmologists in the country. He was accorded the APAO Distinguished Service Honour. In 1996, Dr Khoo was awarded the National Day Public Service Medal (PBM) for his work with the Disciplinary Committee of the Law Society. He holds numerous distinguished appointments at various institutions, but is more involved with the ethical aspects of medicine. He has been the Chairman of the SNEC and SERI ethics committees (IRB) since 1994 and 1998, respectively; Chairman of the National Medical Ethics Committee, Ministry of Health; Chairman of the Independent Ethics Committee, Parkway Group of Hospitals; and was the Chairman of the Singapore Advisory Panel, Medical Protection Society, from 2001 to 2003. He wrote the Ethical Codes of SNEC and APAO. He was also an elected Council Member of the Singapore Medical Council from 1990 to 1993. At the last SERI/ARVO Conference in February 2005, he gave a talk on “How I review a clinical trial”; and at the last Gleneagles Hospital Scientific Seminar in July 2005, he gave a lecture on “Ethics of research”. Papers published on ethics include “Promoting Ethics” (Singapore Medical Journal, 90





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1996, Vol. 37, pp. 457–463) and “Ethical Issues in Ophthalmology and Vision Research” (Annals of Academy of Medicine, July 2006, Vol. 35 No. 7, pp. 512–516.) Internationally, Dr Khoo has been a Council Member of APAO since 1985. Between 1986 and 1990, he was Secretary-General of the XXVI International Congress to Ophthalmology — the most prestigious world ophthalmic event ever to be held in Singapore. In 1992, he was Member of the Board of Expert Advisers, Asian Foundation for the Prevention of Blindness. Between 1998 and 2002, he was Chairman of the IX International Medical Contact Lens Symposium and XXVIII International Congress of Ophthalmology. Dr Khoo’s research areas are the aetiology of myopia, eye changes due to myopia, suppression of myopia progression in school children, contact lens complications, and cornea diseases. He has published several papers on these subjects, namely, “3 Year Study on the Effect of RGP Contact Lenses on Myopic Children” (Singapore Medical Journal, Vol. 40 (4), p. 230), “The Effect of RGP Contact Lenses on Myopic Children” (Asia-Pacific Academy of Ophthalmology, Vol. 11 (4), pp. 6–14), and “Methodologies for Interventional Myopia Studies” (Annals Academy of Medicine, April 2006, Vol. 35 (4), pp. 282–286). He has given guest lectures in France, Canada, Australia, Indonesia, and Brazil. He was invited to give a guest lecture at the Japan Contact Lens Society’s 50th Anniversary Meeting, which was held in 8 July 2007, in Tokyo. In 2006, Dr Khoo was awarded the National Day Public Service Star (BBM) for his work in medical ethics at the Ministry of Health.

Dr Khoo has written an important article on the need for control and ethics in medical research that can be found on the next page.

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Ethical Review at the Singapore Eye Research Institute By Dr CY Khoo

Importance of Ethical Review As more research studies are being carried out in Singapore, there is an increasing need to safeguard research subjects. Tragedies in research in other fields are wake-up calls for us. The recent death of a volunteer subject (in an Asthma Spray Study) in Johns Hopkins showed how important it is to have adequate review and monitoring of a research study. It resulted in the suspension of research work in Johns Hopkins. Also, the complaints from trial subjects in a large neurological study (on Epilepsy and Parkinson’s Disease) in Singapore showed the importance of ethical review and monitoring to protect not only patients’ safety, but also medical confidentiality. The recent debacle in South Korea of its pioneering work in cloning is another wake-up call. The Institutional Review Board (IRB) As more research work is done on eye disorders, more safety rules and regulations are required to ensure the safety of the trial subjects. This is the main function of the Research Ethics Committee, which is sometimes called the Institutional Review Board (IRB) or Domain-Specific Review Board (DSRB). Other functions of the IRB include safeguarding patients’ medical confidentiality, ensuring the scientific validity of the study, preventing any conflict of interest, and monitoring adverse events. History On 18 June 1995, the National Medical Ethics Committee (NMEC) was founded. Two years later, on 4 September 1997, NMEC published its “Ethical Guidelines on Research involving Human Subjects”.1 This was patterned after guidelines set up by the World Health Organization (WHO), the Royal College of Physicians (RCP, London),2 and the Medical Research Council Canada. On 25 June 1998, the Ministry of Health circulated a paper (MOH Paper MH [cf ]24:63/2)3 to its health care institutions recommending that the hospital ethics committees vet all research protocols. At the same time, on 1 July 1998, the Singapore Guideline for Good Clinical Practice (SGGCP) together with the Amalgamated Version of the Medicines (Clinical Trials) Regulations Act 1978 and 1998 (MRA) were officially launched. Since 1996, the SGGCP4 has been incorporated by reference in Regulation 21 of the MRA. Sponsors and researchers in pharmaceutical trials are therefore required by law to comply with SGGCP unless specifically exempted under the Medicines (Clinical Trials) Regulations. The SGGCP and MRA are based on the guidelines set by the International Conference on Harmonization (ICH), governing only drug trials. By law, “clinical trials” are defined as drug trials only. On 28 August 1998, the Ministry of Health circulated another paper (MOH paper No [98]4/7) which stated that “Non-drug Clinical Trials for Medical Devices and Medical Procedures do not fall under the purview of the Medicines Act. However, MOH is of the view that the SGGCP is a desirable standard for all Clinical Trials”. The current Medicines (Clinical Trials) Regulations Act is the 2000 revised edition. Other guidelines, which are nonstatutory, have been formulated by the National Medical Ethics Committee (NMEC) and the Bioethics Advisory Committee (BAC). 92





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Review of Clinical Trials Those who are not familiar with the IRB/DSRB are not aware of the voluminous amount of work that is related to the review of a clinical trial. Faced with numerous voluminous files, how does an IRB member begin to review them? A good place to start is the Subject Information Notes, which explain, in layman’s language, what the study is all about. If I do not understand any word or sentence, I ask that it be further explained in layman’s language. The thickest file is usually the Investigator’s Brochure which lists all the past animal and human studies and their results. Its review can be assigned to a scientific panel, or a Primary Reviewer and Secondary Reviewer in the IRB. If a study is scientifically or methodologically flawed, it is unethical to carry it out. Genetic Studies An increasing number of studies for review involve genes. Because DNA information can affect the subject’s employability, insurability, and reputation, special attention to medical confidentiality is required. All samples and information should be double-coded, one code for the patient database and another code for the genetic database. Protections should be in place to restrict access to the site where the codes linking patient-identifiable information to the genetic database are maintained. Controversies Many issues are still being debated, such as what statutory changes are required to control trials, whether all trials should be reviewed by IRB, whether phase IV trials should be exempted, whether compensation should be paid for all trial-related injuries, and whether investigators and IRB members should be allowed to hold a certain amount of shares in drug or device firms? Common Adverse Events in Eye Research Often, mydriatics/cycloplegics are used in eye research studies. It is well known that these eye drops cause blurring of vision, and this side effect should be emphasised in the subject information notes. Subjects should be reminded of the consequences of blurring of vision, such as slipping, falling down, and clumsiness. Children and the elderly should be accompanied as they are more prone to such accidents. They should be supplied with sunglasses if glare is a problem, or multifocal or progressive glasses for near work. It is also well-known that such drops can precipitate angle-closure glaucoma. This is not uncommon and very real. This side effect should be emphasised in the subject information notes. Special care should be taken whenever steroids are used in the eye as they can cause cataract, glaucoma, infection, and dendritic corneal ulcers. Who should Compensate for Trial-Related Injuries? This is dealt with in the NMEC Guidelines1 3.3.2, the SGGCP4 4.3.2, and the Medicines (Clinical Trials) Regulations5 5.3.

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Chapter 7 The sponsor is liable for compensation, as spelt out in SGGCP4 5.8.1 and NMEC Guidelines1 3.3.2. However, in the event that the investigator is proven negligent, his medical protection insurance is liable. In industry-initiated trials, the sponsor is the company. Most companies adopt the Guidelines of the Association of the British Pharmaceutical Industries (ABPI), a copy of which should be made available and given to the subject. In investigator–initiated trials, the institution is the sponsor, and should compensate the subject for any trial-related injury. As with ABPI guidelines, only unexpected (not listed in the subject information notes) adverse events are covered. No compensation is paid in respect of adverse events that have been set out in the subject information notes and are expected. In all cases, emergency medical treatment should be available. Recent Developments Recent measures taken to prevent ethical problems include funding organisations not approving a study unless it has been cleared by the IRB. Other measures are: Mandatory Ethics Training for Investigators All investigators need to show that they have undergone basic ethics training. One such course is on-line and can be taken at: http://www.citiprogram.org. It involves about 6 hours of reading, with a self-assessment test at the end of each chapter. Mandatory Ethics Training for IRB Members All IRB members are also encouraged to undergo ethics training, so that the quality of the review process will be enhanced. Audit and Accreditation of Research Centres Audit of research centres is carried out to ensure compliance with the Guidelines for Good Clinical Practice. Research centres will need to develop Standard Operating Procedures and demonstrate that they are being followed. An example of an auditing accrediting body is the AAHRP® (The Association for the Accreditation of Human Research Protection Programs, Inc®.) Its website is http//www.aahrpp.org. Conclusion The importance of ethics in research is now acknowledged. The Ministry of Health has recommended that all research studies be reviewed and approved by the IRB. Funding organisations will not approve a study unless it has been cleared by the IRB. All investigators and IRB members are now expected to pass a self-assessment course on ethics. All these measures are taken to ensure the safety of the trial subjects involved in research studies. References 1. 2. 3. 4. 5. 6. 7.

National Medical Ethics Committee: “Ethical Guidelines on Research Involving Human Subject”, Singapore, 4 Sept. 1997. Royal College of Physician: “Research Involving Patients”, London, 1990 . Ministry of Health: Paper MH(cf)24:63/2, Singapore, 25 Jun 1998. SGGCP: Singapore Guidelines for Good Clinical Practice, 1 Jul 1998. Medicines Regulations: The Amalgamated Version of the Medicines (Clinical Trial) Regulations, 1978 and 1998, Singapore, 1 Jul 1998. Ministry of Health: Paper No (98)4/7, Singapore 28 Aug 1998. National Medical Ethics Committee: “Ethical Guidelines for Gene Technology”, Singapore, Feb 2001.

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Prof Roger Beuerman A great help in Singapore’s ocular research Professor Roger Beuerman currently holds the position of Deputy Director (2002) and Scientific Director (2001) of the Singapore Eye Research Institute, and was also appointed as head of Laboratories. He is concomitantly Professor of the Department of Ophthalmology, Department of Anatomy, and Department of Clinical Psychiatry at the School of Medicine, Louisiana State University Health Sciences, USA.

Prof Roger Beuerman Professor of Ophthalmology, Cell Biology and Anatomy, Clinical Psychiatry, and Neuroscience Louisiana State University Health Sciences Centre School of Medicine New Orleans, Louisiana

Roger Beuerman completed his medical studies at the Florida State University, graduating with a PhD in sensory physiology (1973). He also had a post-doctoral research fellowship at the University of Washington School of Medicine, Seattle, Washington (1973–1975). Professor Beuerman has published 29 articles in international peer-reviewed journals. He has authored 9 book chapters in books ranging from engineering to ophthalmology text books. Professor Beuerman has also edited two books in ophthalmology, the most recent on dry eye and ocular surface inflammation, published in July 2004. During this period, he had a direct role in the acquisition of S$2,598,000.00 in grant funds, and has been a collaborator on other studies outside of the Singapore Eye Research Institute. Professor Beuerman has no formal teaching commitments at this time. However, he is active in teaching the laboratory staff basic science in vision and ophthalmology. In the past, he lectured in the Stanford ophthalmology resident review course. Professor Beuerman has been coordinating the development of a programme with the National Institutes of Health and the National Eye Institute for students to carry out their doctoral studies at NIH while enrolled as a graduate

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Chapter 7 student at NUS. Professor Beuerman is the key researcher in myopia at the Singapore Eye Research Institute. His research interests are also in the areas of proteomics and bioinformatics. He has, with the assistance of several NMRC grants, built up a proteomics microanalytical laboratory that is rapidly attracting international attention and collaborators. Several interests are active in the laboratory: drug development, drug kinetics, tear proteomics in dry eye, ocular surface wound healing, and anti-microbial peptides associated with innate immunity. In addition to publishing papers in the highest-quality proteomics journals, Prof Beuerman and his team of researchers have also contributed chapters to a number of books on tears and proteomics. Professor Beuerman formed the Singapore Consortium for Anti-Microbial Peptides, which is developing new analogues of the defensins, anti-microbial peptides with special properties against fungus, and B. pseudomallei, local, very lethal soil bacteria. This project will have the chance to develop significant new intellectual property for SERI. Professor Beuerman has also been involved in every phase of development of the SERI laboratory and in the strategy of organisation. This strategy has been to develop centres of expertise, around which are both high-quality staff and instrumentation as well as grant support to maintain the level of activity. This allows other shortterm projects to be taken in from another eye facility in Singapore, making SERI a good collaborator. In addition, he has played a central role in the development thinking behind the SERI-ARVO meeting as the co-organiser for both meetings thus far.

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Assoc Prof Saw Seang Mei She developed statistics in ocular research important for our success Assoc Prof Saw Seang Mei

Associate Professor Saw Seang Mei received her MBBS degree from the National University of Singapore, and both her MPH and PhD from the Johns Hopkins Bloomberg School of Public Health. She is currently an Associate Professor at the Department of Community, Occupational and Family Medicine as well as Assistant Dean (Graduate Studies), Yong Loo Lin School of Medicine, National University of Singapore. As Assistant Dean (Graduate Studies), she has developed new modules for graduate students (both PhD and Master’s). Her main teaching area is in epidemiology and public health. Professor Saw is the Principal Investigator of the Singapore Cohort study Of the Research factors for Myopia (SCORM), and the STrabismus, Amblyopia and Refractive error study in Singapore preschool children (STARS). The SCORM study is a cohort study of 1979 children aged 7 to 9 years who have been followed up yearly since 1999; while the STARS study is an ongoing study of Chinese children aged 6 to 72 months that aims to determine the prevalence of myopia, amblyopia, and strabismus. Her primary research interests are related to the epidemiology, genetics, and gene–environment interactions for myopia and other eye diseases. She is actively involved in elucidating the patterns of myopia and biometry parameters in Singapore children and adults, as well as evaluating the environmental and genetic risk factors for myopia. She has published papers in more than 120 peer-reviewed international journals including the Lancet and Journal of the American Medical Association (JAMA), and



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Chapter 7 two book chapters. Professor Saw is an Editorial Board member of Ophthalmic and Physiologic Optics and the Annals Academy of Medicine (Singapore), and commenced her appointment as Editorial Board Member of Investigative Ophthalmology and Visual Science in January 2008. She has been awarded several grants from the Biomedical Research Council and National Medical Research Council, Singapore. Professor Saw was the recipient of the Jeans Coombs Award from Johns Hopkins School of Hygiene and Public Health (1998), the Geshin Mohn ARVO Travel Grant (2002), the Edward Clarence Dyason Universitis 21 Award (2005), the Garland W. Clay Award (2006), and the Great Women of our Times Awards from the Science and Technology Category, Singapore (2006). Professor Saw was the past Chair of the 11th International Myopia Conference held from 16th to 18th August, 2006, in Singapore. She has organised several refractive error epidemiology symposiums at the International Congress of Eye Research, World Congress of Ophthalmology, and European Vision and Eye Research meetings. She is currently a Program Committee member of the Clinical/Epidemiologic section, Association for Research in Vision and Ophthalmology (ARVO). Presentations have been made at many international, regional, and national meetings. Professor Saw is a member of the Delta Omega-Alpha Chapter, the Honorary Public Health Society, and the ARVO publications committee. She is also actively involved in the School Graduate Program Committee, School Clinician-Scientist Unit, School Graduate Program Committee Specialists Accreditation Board (SAB) Research Committee, and the National Myopia Prevention Programme committee, and serves as an advisor to the NUH-NUS Medical Publications Support Unit.

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Professor Wong Tien Yin A young dynamic research leader Dr Wong Tien Yin is currently Associate Professor of the National University of Singapore and Associate Director of the Singapore Eye Research Institute. He is concurrently Professor and Deputy Head of the Centre for Eye Research Australia, University of Melbourne. Professor Wong was a President’s scholar and completed his medical school in the National University of Singapore (MBBS, 1992). He did his clinical ophthal- mology training at the Singapore National Eye Centre (SNEC), where he obtained his FRCSE and MMED (Ophth) in 1999. He has a MPH (1997) and a PhD (2002) from the Johns Hopkins University, Baltimore, USA. He has completed fellowships in uveitis from SNEC and medical retinal disease from the University of Sydney. He also has post-doctoral research fellowships at the Johns Hopkins University and the University of Wisconsin, Madison, USA.

Professor Wong Tien Yin MBBS, MMED, FRCSE, FRANZCO, FAFPHM, MPH, PhD Professor & Deputy Head, Centre for Eye Research Australia, University of Melbourne Associate Professor, National University of Singapore Associate Director, Singapore Eye Research Institute

Professor Wong’s clinical and research interest is in the area of medical retinal disease, specifically retinal vascular diseases, focusing on the use of retinal vascular imaging to predict the risk of cardiovascular diseases such as stroke and ischaemic heart disease. He has published 180 peer-reviewed Medline papers, including papers in the highest-impact medical journals such as the New England Journal of Medicine, Lancet, Journal of the American Medical Association ( JAMA), Annals of Internal Medicine, and British Medical Journal. He has given more than 50 invited and named lectures around the world. Professor Wong is the Principal Investigator of multi-centre projects in the USA, Australia, and Singapore, including grants from the National Institutes of Health (NIH), USA. In 2005, he received a grant from the State government in Victoria, Australia, under its highly competitive Science, Technology and Innovation Scheme to develop a $6 million Retinal Vascular Imaging Centre (RetVIC). He is on

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Chapter 7 the Editorial Board of three major journals: the American Journal of Ophthalmology, Investigative Ophthalmology and Visual Sciences, and British Journal of Ophthalmology. Professor Wong has been recognised internationally with numerous awards, including the Jeans Coombs Award from the Johns Hopkins University (1997), the Scholz Award from the Wilmer Ophthalmological Institute (1999), one of the the Ten Outstanding Young Persons of the World for “academic leadership in people younger than 40 years of age” (1999), the Asia Pacific Academy of Ophthalmology Prevention of Blindness Award (2003), and the Sandra Doherty Award from the American Heart Association (2004). For his work on retinal vascular diseases, he has been awarded the highest research award at two universities: first, the 2004 Outstanding Researcher Award from the National University of Singapore, and then the 2005 Woodward Medal in Science and Technology from the University of Melbourne. In 2006, he received three prestigious awards: the Novartis Prize in Diabetes, Young Investigator; the Alcon Award in 2006; and the Commonwealth Health Minister’s Award for Excellence in Health and Medical Research, Australia. Professor Wong was promoted to full Professor at the University of Melbourne in 2006.

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Progress of SERI An effective way to record research is to highlight major development on a yearly basis. In this publication, we selected and highlighted the essential people and events.



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First National Eye Research Meeting This inaugural event on 24 April 1999 marked the inception of a collaborative effort to bring together ophthalmologists, optometrists, and vision scientists in Singapore to discuss and deliberate on ophthalmic and vision research performed in 1998. The First National Eye Research Meeting brought together all organisations in Singapore with an interest in basic and applied eye research. It was the combination and development of the SNEC Research Day and the Tan Tock Seng Hospital’s Annual Research Meeting in Ophthalmology and Visual Sciences. This meeting included new members, namely the Singapore Eye Research Institute, Changi General Hospital, Defence Medical Research Institute, and Optometry Centre of the Singapore Polytechnic. The meeting highlighted the latest work of mature scientists and provided a forum for young investigators with fresh insights in eye research. There were scientific presentations as well as didactic sessions on general topics focusing on new practices and current controversies in conducting research in Singapore. Topics included good clinical practice guidelines, patents, royalties, research methodology, and application of grants.

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The meeting also saw the first delivery of the Chew Sek Jin Lecture, which was established as a tribute in memory of the late Assoc Prof Chew Sek Jin who passed away in December 1998.

(From left) Prof Cheng Hong Ming, Prof Donald Tan, Prof Wallace Foulds, and Prof Arthur Lim at the First National Eye Research Meeting.

Keynote Address : A Perspective on Clinical Research By Prof Paul Lieutman, Johns Hopkins Singapore Clinical research is essential if we are to continue to improve our ability as physicians to cure, treat, or prevent disease. It has also garnered considerable attention in the eyes of the biomedical research community with the recent creation of research grants from the US National Institutes of Health specifically for the training of investigators who will carry out clinical research. Several attributes of clinical research make it particularly important for us as physicians to consider. First, it is necessary if we wish to become better able to cure, treat, or prevent diseases in the future. Without clinical research, we will be reduced to the maintenance and propagation of the present state of knowledge (or ignorance) about human disease. Without clinical research, we will be able to do no better as physicians tomorrow than we can do today. Without clinical research, we will be wholly dependent on testimonials and other non-scientific methods of assessing the value (or lack thereof) of all new therapeutic possibilities. Second, it is the kind of research that we, as physicians, should be best able to do. It is the type of research that takes the greatest advantage of our knowledge of and our direct contact with patients. In the USA, the more common model in the past has been for a physician who wishes to do medical research to train as a physician and as a scientist in the laboratory, and then to try on his or her own to integrate the two and to carry out



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Chapter 8 research on patients, even though none of the laboratory training taught how to do patient-oriented research. As laboratory research becomes more and more sophisticated and complex, and as it demands so much more of one’s time to master and maintain, it becomes increasingly difficult to contemplate active participation in both the practice of medicine and laboratory research. On the other hand, it is far easier to see the wisdom of integrating one’s medical practice with patient-focused research. Third, the results of clinical research are the most relevant to our patients’ welfare. While it is true that the results of laboratory research are more fundamental and more likely to have an enormous impact sometime in the future, the results of clinical research are more easily translatable into immediate benefits for our patients. Clinical research should be particularly attractive to physicians in Singapore and its developing neighbour nations, since the region clearly has the most important resource for clinical research, namely, patients. With respect to that resource, you are at least as well off as we in the USA; and with respect to some diseases, you are uniquely situated. You also have several other important advantages for clinical research. You have a culture that prides itself on its transparency, at least in government, and on integrity. Surely this is the very essence of clinical research, since it searches for truth. You have a cadre of physicians who are very well educated, coupled with an apparent love of hard work and a belief in advancement through merit. On the other hand, there are some inherent problems with respect to clinical research in Singapore. A strong tradition of clinical research is lacking in Singapore, and consequently there are relatively few role models for those who might aspire to become clinical investigators. Also, the exciting structure provides very little incentive for clinicians to engage in clinical research. And it is difficult for the person who is persuaded of the value of clinical research to see a career path that emphasises clinical research.

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Assuming that one accepts the need for clinical research and the potential advantages that Singapore has to offer and is even willing to take the risk of

an unmarked career path, how could one train to become an excellent clinical investigator? Having wrestled with this question for a number of years, we at the Johns Hopkins University have created the first Graduate Training Program in Clinical Investigation in the USA and probably in the world.

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This programme offers a PhD in clinical investigation. It is modelled after the traditional basic science PhD degree course in that it requires a foundation of didactic courses in Methods of Clinical Research, Data Storage and Retrieval for Clinical Studies, Bio Statistics, Principles of Epistemology, Biomedical Writing, Principles of Drug Development, and Ethics of Human Experimentation. We require that one be a physician to enter the programme and that one’s clinical training has been completed prior to entering the programme. We then require that a credible piece of research be produced after the didactic year. It is our belief that the future leaders of academic clinical departments will come from this or another similar programme in the future. Thus, this perspective on clinical research is presented to serve as an invitation to those who wish to participate in Singapore’s knowledge-based economy of the future, to consider doing so through the exciting area of clinical research. The Singapore Eye Research Meeting is pleased to establish the Chew Sek Jin Lecture as a tribute and in memory of the late Assoc Prof Chew Sek Jin, who died in December 1998. He is remembered for his outstanding contribution to myopia research and for his enthusiastic vision to spearhead ophthalmic research in Singapore, which resulted in the birth of the Singapore Eye Research Institute.

Chew Sek Jin Lecture Molecular Genetics of Eye Diseases: Simplifying the Complex By Dr Eric Yap, Defence Medical Research Institute Major advances have been made in the past decade in molecular ophthalmology. There has been greater understanding of the mechanisms of eye development at the cellular and molecular levels. Genes for several hereditary eye diseases have been identified, including those for retinitis pigmentosa, Stargardt’s disease, Leber’s hereditary optic neuropathy, retinoblastoma, and familial open- angle glaucoma.

Dr Eric Yap

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Chapter 8 Progress has also been made to elucidate the genetic factors involved in more common polygenic diseases, such as glaucoma, macular degeneration, and myopia. This has been brought about by the availability of new approaches in genetic epidemiology and molecular biology, and through advances in the Human Genome Project and gene mapping. We have been developing in our laboratory the tools to screen the human genome for disease susceptibility genes: in silico detection of polymorphisms by biocomputing, high-throughput genotyping of STR markers, and genetic statistical software. Analysis of ‘simple’ Mendelian diseases (e.g. retinitis pigmentosa) and ‘complex’ polygenic diseases (e.g. myopia) is currently underway, with a variety of approaches, including allelic association studies in individuals and genetic linkage studies in sibling-pairs and families. Significant associations and mutations in several candidate genes have been found, including a neurotransmitter receptor (DRD2), a photoreceptor (RHO), and components of the extracellular matrix (TIGR, COL2A1). The discovery of disease-causing mutations and susceptibility genes presents major opportunities in understanding the aetiology and pathogenesis of eye diseases, as well as for diagnosis and genetic counseling. However, major scientific and clinical challenges to correlate sequence mutations to disease severity, to understand biological functions of disease genes, and to develop effective therapeutic strategies for complex eye diseases still remain.

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Chairman’s Message I am delighted to see the excellent progress of the Singapore Eye Research Institute under the leadership of Associate Professor Donald Tan. It was not an easy task as he is at the same time a busy and excellent clinician, dealing with hundreds of complicated corneal problems.

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Ophthalmic research in Ophthalmic research in Singapore can be divided into three phases. The first phase was during the early years when scientific papers were essentially clinical, Singapore can be divided into three as there was no infrastructure, no funds, and no support. phases. In the first In the second phase, Associate Professor Donald Tan was appointed Director of phase...there was no Singapore Eye Research Institute, and its potential began to emerge. He has put support. together an impressive infrastructure with laboratories, financial support, and linkage with other research centres; most importantly, he has attracted an effective team. The team includes Professor Roger Beuerman, PhD, a key researcher in myopia; Professor Wallace Foulds, DSc, advisor; Colonel Dr Eric Yap, PhD, genetics; and Dr Saw Seang Mei, PhD, epidemiology.

In the second phase, Associate Professor Donald Tan was appointed Director of In the third phase, we are entering into the most important period where everything is changing rapidly. Will academic research shift away from large institutions Singapore Eye to small groups of individuals with knowledge? Will today’s knowledge economy Research Institute, allow small research centres with international networking and information and its potential betechnology to push ahead more rapidly, out-smarting the old established research gan to emerge. institutions of Europe and America?

It is clear that the future of research is loaded with uncertainties. I see research centres battling for leaders of knowledge, of intellect, of drive, based not on biological age but on the mental capacity to succeed. I see the larger establishments becoming very confused and terrified as everyone is being caught up in the international onslaught of rapid changes. I am proud of what the Singapore Eye Research Institute has achieved. I thank the many leading research brains from other countries who have come together to discuss new and exciting ideas with us. I do hope that all will continue to work together closely, embracing the fascinating rapid changes and heading towards a glorious future. Professor Arthur Lim Chairman





In the third phase, we are entering into the most important period where everything is changing rapidly. It is clear that the future of research is loaded with uncertainties.

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Second National Eye Research Meeting Singapore Eye Research Meeting 2000 / 2nd Combined Meeting in Ophthalmology and Visual Science The Singapore Eye Research Meeting 2000 brought together all organisations in Singapore with an interest in basic and applied ophthalmic and visual science research, in a meeting that aims to be one of the foremost eye research meetings in Asia. Originally the combination and development of the SNEC Research Day and the Tan Tock Seng Hospital’s Annual Research Meeting in Ophthalmology and Visual Sciences, the first National Eye Research Meeting in 1999 brought together all of the ophthalmic and visual science researchers from local institutions. The 2000 meeting again encompassed and showcased all local ophthalmic and visual science research performed within the participating institutions, or in collaboration with international ophthalmic research institutions. In addition, the meeting highlighted the latest advances in ophthalmic surgery, technologies, and laboratory research; and also provided an important forum for young investigators, doctors, and vision scientists to develop fresh insights into eye research. There were be scientific symposia and scientific poster sessions as well as didactic presentations from renowned international ophthalmic researchers.

Invited Speaker: Molecular Biology in this Post-genome Era By Prof Venkatesan Sundaresan The completion of the sequences of several organisms and the recently announced working draft of the sequence of the human genome have ushered in an exciting new era in biology — the post-genome era. In concept, it means that we have in our hands the complete sets of instructions in quaternary genetic code for making a bacterium, a yeast, a worm, and a fly, and very soon, for a plant and a human as well. In practical terms, however, understanding and interpreting this information and putting it to good use will be a formidable task. 10 8





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Currently, in higher eukaryotic organisms, the biological functions for only a very small fraction of the genes are known. The current situation is akin to having obtained a book written in a known alphabet, but telling a story in a language that we cannot understand. Molecular biologists in the post-genome era will need to use a variety of approaches, ranging from genetics to structural biology to computing, to gain this understanding.

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The emergence of the new field of functional genomics — the study of gene functions on a large scale — has been driven by new technologies that utilise the vast information resources from the genome projects for their successful deployment. For example, it is now possible to profile the expression pattern of every gene in the budding yeast under an unlimited number of different conditions and stimuli, using microarrays. Microarrays have also been used in human patients to classify subtypes of tumours in chemotherapy. Another technology, called gene trapping, uses large-scale inactivation of genes within the genome to decipher the biological functions of genes for which only sequence information is available. This process is called “reverse genetics”. High-throughput reverse genetics is now routine in mode organisms(i.e. yeast, worm, etc.). The rapid progress in the functional genomics of these model organisms has also helped stimulate the emergence of comparative genomics. This approach permits genes that are involved in human disease to be characterised more rapidly by first identifying their counterparts in a suitable model organism. At the Institute of Molecular Agrobiology, work on the model organism zebrafish has resulted in the molecular characterisation of genes for genetic diseases related to eye development. Similarly, research on the model plant Arabidopsis has resulted in the isolation of genes that can be used to improve the yields of crop plants such as rice. Therefore, the post-genome era will yield a rich harvest of information on the structure and functions of genes, which was beyond imagination just two decades ago. The challenge is for this information to be harnessed for the benefit of humanity through its impact on agriculture and human health.

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Agenda for Eye Research in the New Millennium The Role of Ophthalmic Research in Singapore

By Dr Wong Tien Yin Department of Ophthalmology, National University of Singapore

Cl Assoc Prof Donald Tan Deputy Director, SNEC Deputy Director, SERI

As we enter this new century and turn our faces to the winds of change, it is timely to look forward to the future of ophthalmology in Singapore. Our future lies in medical innovation and the embracing of new technology, in the discovery of new therapeutic modalities to treat and prevent ocular disease in our community. Our future lies in ophthalmic research. At this stage in the evolution of ophthalmic development in Singapore, we stand at the crossroads of a new research ethic. During the past decade, a major paradigm shift has occurred in our perception of what is important to ophthalmology and ophthalmic institutions in Singapore. No longer are we satisfied with only developing high-quality ophthalmic clinical services, which we will continue to strive for. But we have also been imbued with the need to seek answers to scientific and medical questions which have direct relevance to how we care for our patients, and to seek for them ourselves, within the scientific framework of clinical, epidemiological, and laboratory-based research. With the development of the Singapore Eye Research Institute (SERI), representing the research arm of the Singapore National Eye Centre (SNEC), we are now poised to embark on a path of ophthalmic research which may allow us to be present at the cutting edge of medical innovation.

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For the past 1,000 years, significant developments in clinical medicine were largely driven by developments in medical research. This is not likely to change.

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In ophthalmology and the vision sciences, the many research achievements of the past century included: • the evolution of cataract and refractive surgery; • the identification of genes for inherited corneal and retinal diseases; • the impact of clinical trials in the management of diabetic retinopathy and age- related macular degeneration; and • the elucidation of biology and pathogenesis of glaucoma.1 In this new century, new treatment modalities will be introduced directly from the fruits of such research. Carl Kupfer, director of the National Eye Institute in the USA, identified three areas of vision research that would be significant over the next 20 years.2 The first is in the area of inherited retinal degeneration, including retinitis pigmentosa and various forms of macular degeneration. He believes that we will learn enough about the underlying causes of degeneration of the photoreceptors in these diseases to develop medical treatments that will interrupt or slow down the neurodegenerative process. The second area of progress will come from glaucoma-related research where it is likely that new, highly effective neuro-protective agents will be developed to safeguard the axons in the optic nerve head from damage, thereby preventing vision loss. The third area that has potential for significant progress is the treatment of corneal diseases, particularly in corneal dystrophies where the results from genetic studies will allow development of gene therapy. Beyond the obvious revolution in genetics, other technologies in automation, ocular imaging, medical informatics, and biomedical engineering will also alter the direction, conduct, and results of ophthalmic research in the coming century.3,4 According to Declan Butler, editor of the journal Nature, the way scientists and clinicians obtain information will radically change as more journals move to a fully electronic format.5 This will affect the nature and organisation of libraries and scientific archives, such that future researchers will gather information from their home computers

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Chapter 9 and not set foot in the library at all. This is already happening as more and more readers obtain their reference sources by downloading abstracts and whole articles from literature databanks such as Medline and full-text journals.6

Is There a Role for Ophthalmic Research in Singapore? In Singapore, research is one of three key missions of our healthcare institutions (the other two being service and teaching), but has arguably received less attention than the other two. The first issue we must address is whether ophthalmic research has any major role in Singapore. The question can also be rephrased thus: Given our limited ophthalmic resources, can Singapore produce meaningful vision-related research? If so, the next question is, are there areas of ophthalmic research we should be concentrating on, and those we should avoid and leave to the USA and other countries that have significantly greater resources? Some have argued that research is a luxury in many of our institutions, and should continue to play a minor role next to clinical service and teaching. Others have suggested that we should concentrate only on clinical research, and avoid research on molecular and basic science, which usually require long-term commitments and provide no immediate tangible gains. However, there are at least three important reasons why ophthalmic research in Singapore has an important role. First, research has become an international yardstick. It provides an objective way of comparing and measuring the quality of institutions around the world.7 Research data can be used quantitatively to assess and rank individual departments and institutions. This is already done in the USA, where an important component of the ranking of hospitals and medical schools in the annual US News and World Report series is the amount of National Institutes of Health (NIH) funding a particular institution receives (accounting for 30 percent of the total score, after reputation, which accounts for 40 percent). Wilmer Eye Institute at Johns Hopkins and Massachusetts Eye and Ear Infirmary at Harvard are the top ophthalmic institutions, partly based on the fact that they receive the largest proportion of NIH grants. 112





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Publications in peer-reviewed journals are another objective documentation of the quality of an individual and his/her institution’s work by peers around the world. More than 50 percent of articles published in the British Journal of Ophthalmology comes from work outside the UK.8 The Archives of Ophthalmology publishes a Worldwide Ophthalmology issue each year, summarizing the achievements of ophthalmology and vision research in other countries with active participation from countries such as China and India.

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Second, research is a natural progression in the development of our clinical ophthalmic service, as we move towards being a regional and world-class ophthalmic hub. It may have been a luxury in the past when we were providing basic ophthalmic care to our population, but it will be increasingly seen as an integral component of our status. Our achievements in research therefore enhance the entire reputation of the Singapore ophthalmology community, and provide a foundation from which we market ourselves in the region and in the world. Ultimately, the quality of our research will be seen by our colleagues to directly parallel the quality of the ophthalmic care we can provide. Finally, on an individual level, a clinician who performs research is always thinking and challenging established clinical doctrines, in an attempt to seek the right answer to the relevant question. He does this by virtue of his training in research, utilising scientific principles and evidence-based medicine. In short, such discipline raises the quality of his clinical acumen and makes him a better clinician.

Future Challenges for Ophthalmic Research in This New Century 1.

Identifying Niche Areas for Singapore The first challenge is to identify areas of research in which we should be focusing our resources and energy in the coming century. Before doing so, we need to identify our areas of strengths and weaknesses, and to determine what is useful for our needs and what will fit into the overall plan of ophthalmology development in Singapore.



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Chapter 9 With obvious limitations on the number of clinicians and vision scientists available to participate in ophthalmic research locally, we must be circumspect and prudent to prioritise areas of research. These are, firstly, those that are of direct relevance to our community and our part of the world; and secondly, those that present research challenges with achievable targets to maximise success. From a practical viewpoint, it is essential that we focus on the main causes of ocular morbidity and blindness in our local population. In addition, we must also continue to focus on areas of research which have been our strengths and successes, in order to produce research of international and global standards. A review of the current major areas of research interest within SERI and SNEC reveals that the fields of myopia, glaucoma, cornea, and ocular surface diseases are well represented locally, as these diseases are prevalent in our population. Myopia Research Myopia prevalence is likely to continue to rise, ultimately affecting up to 80 percent of our population. Our ability to conduct epidemiological surveys of myopia developing in our schoolchildren and to perform interventional paediatric clinical trials in an attempt to retard myopia progression continues to improve. Likewise, we must also seek answers to myopia in the laboratory, to determine the molecular and genetic basis for myopia. In addition, the rapid increase in the number of Singaporeans who seek refractive surgery to correct myopia and other forms of refractive error also means that we must evaluate new refractive technologies and seek out those which work best in local Asian eyes. Glaucoma Research With the higher prevalence of angle closure glaucoma here, our forms of Asian glaucoma are clearly different from those in the West. Furthermore, glaucoma represents a significant cause of blindness in Singapore, which will continue to rise in accordance with our rapidly ageing population. 114





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As new pharmacological research brings us new drugs to treat glaucoma, it is imperative that we evaluate the efficacy and safety of these new drugs in our Asian eyes. Our population mix of Chinese, Indians, and Malays is thus obviously ideal for ethno-pharmacological studies.

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Cornea and Ocular Surface Research Ocular surface diseases, such as dry eye and pterygium, are common causes of ocular morbidity in our tropical environment. Pterygium surgery is the third most common ophthalmic surgical procedure in SNEC, after cataract surgery and LASIK. In fact, the prevalence of pterygium in a population survey of Chinese Singaporeans over the age of 40 years approached 10 percent in a recent finding. Pterygium research in Singapore is an example of a niche area of research in which we can excel, by virtue of the fact that it is a relatively rare condition in temperate Western countries. We are now one of the leaders in the field of pterygium research and publications. With the aetiology of pterygium still to be elucidated, we must continue to pursue research in this important niche. Aside from continuing to focus on currently successful research programmes, we also need to prioritise research in other common eye diseases in our population for which we have yet to develop research programmes. One such area is diabetic eye disease. We have a high prevalence of maturity-onset type II diabetes, with seemingly marked differences between Indians, Chinese, and Malays in terms of prevalence, disease severity, and progression. This is an indication of the need to evaluate the prevalence and risk factors for developing blinding diabetic retinopathy in our patients, and to develop cost-effective screening programmes for early diagnosis and treatment. 2.

Clinical, Epidemiological, or Basic Science Research? An important question concerns basic science research. What are the roles of ophthalmic genetic and molecular research in Singapore? In no uncertain terms, with the Human Genome Project completed, genetic research and gene therapy will herald a new era of medicine, and will surely be at the forefront of almost all major ophthalmic breakthroughs in the coming century.

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How can we benefit and even contribute to this revolution? There are no easy or ready answers. First, we must recognise that long-term commitment is crucial and that the rewards will be few and far in between. Second, we should concentrate our resources on a few important diseases relevant to Singapore, such as myopia and glaucoma. In this respect, it has been more cost-efficient to concentrate on clinical and epidemiological research. Both are seen to require less commitment of time than basic science research, and are likely to continue to be an integral part of our overall research strategy in the foreseeable future. For clinical research, we have the advantages of a large pool of Asian patients, a group of highly skilled and experienced clinicians, and the latest in diagnostic and surgical options. For epidemiological research, the advantages are a captive homogeneous population, a unique individual identifier (our identity card number), a well-managed population database (such as the Medisave Scheme), and the unique ability to study the three main racial groups in Asia (Chinese, Malays, and Indians). 3.

The Clinician-Scientist Model A related issue concerns the evolution of the clinician-scientist model. The concept of the clinician-scientist first originated after the Second World War in North American medical schools.9 They were defined as broadbased investigators who discovered fundamental biologic mechanisms and applied them directly to the clinical care and cure of disease. Clinician-scientists were the group of ophthalmologists who were expected to translate discoveries in anatomy, physiology, and pathology to the patient’s bedside; and included giants like Sir Stewart Duke-Elder, Jonas Friendenwald, David Cogan, and many others. While basic scientists are credited with the most important discoveries in medicine, clinician -scientists can help bridge the gap between the science and the actual clinical application.10 Only the clinician can identify the questions that require patient-oriented studies, and then apply those studies to the clinical management of disease.

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In Singapore, the clinician-scientist concept is appealing and perhaps a model we should aim for, given that it is difficult to convince young ophthalmologists to forgo clinical practice to be full-time basic scientists. How would we develop our core of clinician-scientist ophthalmologists? There must be adequate incentive, training, and remuneration. There should be some form of a career track. Specialist trainees who are keen to be research fellows for a year or two should be given similar benefits as doctors going for clinical hospital manpower development programmes. Once a group of doctors is trained, protected research time should be in-built to allow for continued involvement in research. In the future, clinician-scientists may also come from medical students enrolled in the MBBS-PhD programmes. In theory, while the clinician-scientist concept is promising, there are practical problems and limitations. Clinician-scientists will always be severely constrained by service obligations, lack of adequate rewards, and lack of financial and manpower support. There are limitations in the current research-related fellowships, as some incur loss of both seniority and pay. The MBBS-PhD programmes are not attracting enough candidates. Even in the USA, MD-PhD programmes have not been altogether successful. Bright young graduates of these programmes often find themselves unable to meet the competing demands of clinical service, teaching, and research, and are forced to make a choice early on in their careers between either clinical practice or bench work. 4.

Collaboration, Centralisation, and Coordination A further challenge is how best to utilise the limited resources available to us. Our first strategy is to optimise our collaboration with scientists outside ophthalmology, including geneticists, molecular biologists, epidemiologists, and optometrists. This will mean further integration of our present collaboration with the National University of Singapore (NUS), the Defence Medical Research Institute, Johns Hopkins, Moorfields Eye Hospital, and other organisations,

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Chapter 9 as well as developing new collaborative research projects with the Nanyang Technological University and even private organisations and industries. Second, there are distinct advantages of having a centralised research coordinating centre, similar to the National Eye Institute in the USA, but on a smaller scale. The natural choice is SERI, which can take the lead in initiating, coordinating, and maintaining projects, help distribute and channel resources, and prevent duplication of research. To do that, SERI needs to provide sufficient incentives for researchers in different institutions so that they would want to identify with SERI and work with it. This may take the form of small start-up research grants, access to a comprehensive ophthalmic library or laboratory, provision of statistical advice, and perhaps even research coordinators to help manage projects. Third, just as in clinical service and teaching, there is room for private ophthalmologists to be actively involved in ophthalmic research. They too can provide invaluable advice and experience, especially in areas of clinical research. For example, reports on an informative case or a case series should not be confined to the domains of public sector institutions. While research has moved in the direction of large, multi-centre clinical trials,11 the humble case reports can still provide a tremendous amount of useful information.12 For example, the observation that some diabetic patients with large chorioretinal scars never develop proliferative retinopathy has led to considering panretinal photo-coagulation as a therapy. Similarly, the recognition that macular holes might close following spontaneous separation of the posterior vitreous from the retina has led to the development of vitrectomy to treat macular holes. Private ophthalmologists can therefore be an integral part of ophthalmic research in Singapore. Ophthalmic research in Singapore will continue to evolve in this century and we will continue to discover new challenges. In the words of Joseph Goldstein, the Nobel laureate13: 118





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We must reinvigorate the intellectual core of academic medicine. This can be accomplished by training and supporting scholarly physicians who are broadly versed, intensely curious and infectious in their ability to stimulate others to think deeply about human disease. We must modify the academic reward system so that it recognises collaboration.

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We should provide diverse options for bridge builders, no matter what discipline they come from. Innovation should be encouraged. The most precious qualities are originality and creativity. Most argue that these are inborn. If this is indeed true, we must create the environment that permits those with inborn talents to learn and practice their art.

References 1. Sommer A. Past precedents, present pressures, future problems: ophthalmology in 2001. Ophthalmology 1995;102:861–2. 2. Goldsmith MF. 2020 Vision: NIH heads foresee the future. JAMA 1999; 282(24):2287–90. 3. Lee P. The year 2000: placing new technology in context. Arch Ophthalmol 1999;117:1545–6. 4. Forrester JV. Impact of new technologies in ophthalmology. Br J Ophthalmol 1999;83:1211. 5. Butler D. The writing is on the web for science journals in print. Nature 1999;397:195–200. 6. Forrester JV. The BJO goes full text on the web. Br J Ophthalmol 1999;83:383–384. 7. Minckler D. Appreciating ophthalmology’s international connection. Ophthalmology 1995;102:175–6. 8. Forrester JV. More change at the BJO. Br J Ophthalmol 1998;82:721. 9. Drance SM. The future of the clinical scientist. Can J Ophthalmol 1999;34:373–7. 10. Gillies B. The need for clinical research. Aust N Z J Ophthalmol 1999;27:165. 11. Straatsma BR. Clinical trials in the past 25 years and clinical research in the next 25 years. Am J Ophthalmol 1999;127:72–4. 12. Levin LA, Bressler N. The case report: when small is beautiful. Arch Ophthalmol 1996;114:1413. 13. Goldstein JL, Brown MS. The clinical investigator: bewitched, bothered and bewildered — but still loved. J Clin Invest 1997;99:2803–12. Source: Singapore National Eye centre: the First ten Years (1990 - 2000)



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Chairman’s Message Research has become exciting recently. Fascinating advances will emerge as our researchers unfold the mystery of blinding diseases affecting the cornea, the macula, the retina, and the optic nerve. In addition, genetic therapy, microrobotics, microtechnology, the excitement of stem cell development, and the controversy of cloning will spread throughout the scientific world. We are fortunate to have a small but excellent team of dedicated researchers eager to move ahead. We live in a world where changes will come about rapidly; this makes it essential that we review our research programme regularly to ensure that we are moving in the right direction, and that the work we immerse ourselves in will lead to discoveries which will be practical and will benefit our patients. I congratulate Associate Professor Donald Tan for his commitment and leadership in gelling together his excellent team. In a short period of less than half a decade, they have produced many scientific papers published in leading international journals with a mean impact factor of 2.4. In addition, the Singapore Eye Research Institute (SERI) is fortunate in teaming up with the Association for Research in Vision and Ophthalmology (ARVO) to jointly organise a SERI-ARVO scientific meeting in Singapore in February 2003. Recently, several talented young researchers have joined SERI. We must create opportunities for them to propell ophthalmic research to a higher stratosphere. In the coming decade, the ophthalmic world will resound with the triumph of a new generation of dedicated ophthalmic researchers in Singapore. Professor Arthur Lim Chairman

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Director’s Report In 2001, the Singapore Eye Research Institute (SERI) continued to be highly productive and active in terms of research output. In 2001, SERI scientists and affiliated clinicians published 56 scientific articles, presented 139 scientific abstracts, and initiated 36 new research projects. Major other achievements by the institute this year included the relocation of the SERI research facilities to two floors within the new Singapore National Eye Centre (SNEC) Phase II Extension within the Outram Campus, and the successful organising of the First SERI International Meeting in September 2001.

2001

Progress of Singapore Eye Research Institute

National role of SERI In July 2001, SERI was requested by the Director of Medical Services, Ministry of Health, Prof Tan Chorh Chuan, to function as the coordinating centre for all ophthalmic and vision-related biomedical research across both SingHealth and National Healthcare Group ophthalmic institutions and departments. SERI now has participating units from SNEC, The Eye Institute (consisting of National University Hospital (NUH), Tan Tock Seng Hospital (TTSH), and Alexandra Hospital (AH) eye departments from the National Healthcare Group), Changi General Hospital (CGH) Eye Department, and National University of Singapore (NUS) Eye Department, as well as other institutions involved in vision research such as Defence Medical Research Institute (DMRI) and Singapore Polytechnic (SP). SERI is therefore a truly national body for ophthalmic and vision research.

Specific activities in 2001

Relocation to new SERI Facility in SNEC Phase II Expansion In August 2001, SERI moved to its new facility on the fifth and sixth floors of the eight-storey SNEC Phase II Expansion. SERI, for the first time, able to bring together under one roof all of its clinical and basic research activities in two custom-built research floors, one for clinical research and the other for laboratory-based research. The facilities were officially opened by Mr Lim Hng Kiang, Minister of Health and second Minister of Finance, and coincided with SERI’s First International Research Meeting at which the Minister was the guest of honour.



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Chapter 10

Unveiling the plaque From left: Prof Arthur Lim, Chairman, SERI; Dr Ang Chong Lye, Director, SNEC; Guest of Honour, Mr Lim Hng Kiang, Minister of Health and Second Minister of Finance; Assoc Prof Donald Tan, Director, SERI).

SERI 5th Floor — Clinical and Paraclinical Research The 5th floor houses the Myopia Clinic, Clinical Trials Pharmacy, Visual Performance, Electrophysiology, and Spatial Perception Laboratories, and the Administration Office. SERI clinical trials conducted at the Myopia Clinic include approximately 1000 schoolchildren enrolled in four randomised clinical trials on myopia retardation, as well as studies on cataract surgery and refractive surgery.

SERI 6th Floor — SERI Laboratories

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The 6th floor houses two Molecular Biology Laboratories, the Micro-analytical Laboratory, two Tissue Culture Laboratories, and the Human Ocular Surface Stem Cell Laboratory. Under the direction of Professor Roger Beuerman, Scientific Director of SERI, these laboratories conduct research into the aetiological basis of myopia, ocular surface and tear film disorders, and glaucoma, as well as ocular drug delivery studies and ocular stem cell research. Plans are underway for the Stem Cell Research Group, a multidisciplinary NMRC-funded stem cell research group on the Outram Campus, to occupy collaborative labs on this floor in 2002. The floor also houses the SERI Conference Room and research staff offices and workstations.

With the opening of its new accommodation, SERI has come of age and the closer interaction between SNEC clinicians and SERI scientists — as well as our immediate proximity to the animal holding facilities of the SGH Department of Experimental Surgery — fosters a new level of productive and interactive basic, translational, and clinical research.

2001

Progress of Singapore Eye Research Institute

First SERI Meeting in Conjunction with the Third National Eye Research Meeting Research Meeting We hosted the First SERI International Research Meeting at our new SERI Facility on 27–30 September 2001. This eye research meeting, the first of its kind in South Asia, coincided with the opening of the new SERI facilities by Mr Lim Hng Kiang, Minister of Health and second Minister of Finance, who was the guest of honour of the meeting. More than 300 delegates from Asia and beyond attended the meeting, which was conjoined with the third Singapore National Eye Research meeting. The response from the 23 invited speakers from Asia, Europe, and the USA was overwhelming; and the full three-day scientific programme was devoted to keynote lectures, symposia, and special interest group meetings, covering the entire gamut of corneal disease, refractive corneal surgery, myopia, glaucoma, retina, and stem cell research. More than 100 scientific abstracts were presented either as posters or oral presentations. For the first time, an industry symposium was held and opened by a keynote address from the President and Vice-Chancellor of NUS, Professor Shih Choon Fong. At this symposium, representatives of the ophthalmic industry were invited to present new pharmacotherapies, ophthalmic technologies, and research and development strategies. New Research Projects Registered and New Pilot Grants Approved in 2001 A total of 36 new research projects were registered in 2001. These projects ranged widely in the various subspecialties, from myopia, refractive surgery, and cornea to retina, glaucoma, strabismus, and cataract surgery. A total of 11 pilot seed grants were approved in 2001.

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Chapter 10 New Patients in 2001 No SERI patent applications were submitted in 2001. However, three SERI patent applications are currently in preparation. Two patents, one on cultivation of ocular surface stem cells and one on differential gene expression in pterygium, are planned for submission in the first quarter of 2002. Studies on a third potential patent on a novel technique of fundal fluorescein angiography are also currently underway and targeted for 2002 submission. Scientific Publications in 2001 This year, SERI scientists and affiliated clinicians published a total of 56 scientific publications, the largest number of publications in a single year to date. This was a significant increase over publications in 2000, which numbered 44, an increase of 27%. Of these, 52 out of 56 (93%) were published in international scientific journals, while only 4 were published in local indexed journals. In contrast, only 86% of manuscripts were published in international journals last year. Rising Trend in Quality and Impact Factor In spite of the increase in the number of journals published in 2001, a significantly greater proportion of articles were published in high-impact journals: eight papers were published this year in Ophthalmology, the highest-rated clinical ophthalmology journal (impact factor = 3.04); and seven papers were published in the British Journal of Ophthalmology, the highest-rated European ophthalmology journal (impact factor = 1.94). Of greater import is the fact that we published three papers in Investigative Ophthalmology and Visual Science, the top-ranked vision research journal (impact factor = 4.373), and two papers in Lancet (impact factor = 12.41). The total summation of impact factors in 2001 was 103.718, and the average impact factor per article published in 2001 was 2.59.

Additional Publications from the NHG Eye Institute Doctors As SERI assumed the role of the national coordinating body for all vision and ophthalmic research in Singapore in the latter half of 2001, new publications in 2001 from The NHG Eye Institute, National Healthcare Group, were added to the total list of SERI-affiliated publications. The total number of SERI-affiliated publications in 2001 rose to 73 publications. 12 4





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2001

Progress of Singapore Eye Research Institute

Figure 1: Scientific Publications in 1991 - 2001



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Chapter 10 Table 1: No of Scientific Publications 1991-2001

Increase in SNEC/SERI Epidemiological and Basic Laboratory:

SERI Scientific Publications Mean Impact Factor

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Future Directions for 2002 Initiation of Stem Cell Research Group (SCRG) Labs within SERI In 2001, stem cell researchers on the Outram Campus formed a multidisciplinary Stem Cell Research Group (SCRG) to discuss stem cell research collaborations within SingHealth institutions and departments in the field of embryonic and adult stem cells. Headed by A/Prof Lee Seng Teik and A/Prof Donald Tan, five major projects and stem cell research teams were identified, including our own ocular surface stem cell project; other projects ranged from human oocyte maturation and cloning for tissue engineering (A/Prof Tay Sun Kuie, O&G Department, Singapore General Hospital), vascular endothelial progenitor cell culture (A/Prof Wong Meng Cheong, National Cancer Centre), and cultivation of hair follicle stem cells (A/Prof ST Lee, Department of Plastic Surgery, Singapore General Hospital) to CNS neural stem cells (Dr Xiao Zhi Cheng, Department of Clinical Research, Singapore General Hospital).

2001

Progress of Singapore Eye Research Institute

A programme grant of S$2.5 million was submitted to NMRC in the last quarter of 2001, and provisional approval of S$800,000 for core facility, equipment, and manpower has been preliminarily approved. SERI has generously offered space within its 6th floor laboratories to house the core equipment and offer SCRG scientists access to its research facilities for the first 3 years of the programme grant. The SCRG facility within SERI is coordinated by the Director of SERI, our Scientific Director, and A/Prof ST Lee. This will not only enhance our laboratory’s facilities and research capabilities, but also create vibrant and productive cross-disciplinary collaborations and interactions between SERI scientists and other stem cell researchers within the Outram Campus in our labs. Planning for Singapore Myopia Registry Myopia is the most prevalent eye disorder in Singapore. The Singapore Myopia Registry (SMR) is a national disease registry initiated by the Ministry of Health (MOH), set up to collect and provide information on myopia in Singapore for the purpose of health planning, clinical quality assurance, benchmarking, clinical research, and tracking of patients under the National Disease Management Plans. The Director of SERI was appointed by the Director of Medical Services, MOH, to chair the SMR Committee, consisting of representatives from Singapore National Eye Centre, National University Hospital, Changi General Hospital, and Tan Tock Seng Hospital eye departments; private sector ophthal

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Chapter 10 mologists; and the Community of Family Medicine Department and the School Health Service, National University of Singapore. The SMR will be run by the Clinical Trials & Epidemiology Research Unit, with the assistance of SERI. SMR planning has been in progress in 2001, and will be implemented in 2002. The importance of SMR as a national resource to track and research on the problem of myopia in our population cannot be underestimated, and SMR will serve as our population database for epidemiological research into myopia and related ocular disorders in Asian eyes. Planning for SERI Primate Facility Within the last 2 years, it is becoming clear that primate research will have a pivotal role in SERI’s research endeavours as we begin to perform clinical trials on new drug delivery systems, test new surgical techniques, and perform myopia and ocular growth studies, using primates as the optimal animal model for these forms of research. SERI researchers this year travelled to Fujian Province, China, to perform a pilot series of experiments at the Fuzhou Centre for Primate Research on myopia and corneal wound healing after LASIK surgery; based on the successful implementation of these pilot primate projects, further primate studies are planned. To cope with the future demand for primate research, SERI has initiated plans with the Department of Experimental Surgery (DES) to assist in the expansion of their animal holding facility on the 3rd floor of the department, and to plan for a SERI-sponsored Primate Research Facility. The aim is to establish a comprehensive, high-quality primate facility — complete with a dedicated operating theatre, treatment rooms, and eye examination suites — which will be fully accredited by international agencies in order to enable primate research to meet USFDA standards. Plans to collaborate with the Washington University Primate Facility, which runs a large primate colony on the island of Bogor, Indonesia, are underway, and SERI will be consulting the director, Prof Bill Morton, who will visit SERI and DES in March 2002.

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Strategic Collaboration with Lions Eye Institute SERI has initiated discussions with Prof Ian Constable, director of the Lions Eye Institute (LEI), Perth, Australia, to develop a strategic collaboration between SERI and LEI for the purposes of mutually advantageous collaborative research and education in ophthalmic and vision research. LEI, as a clinical centre, has had

close ties and a pre-existing MOU with SNEC; but it is now recognised that LEI is the leading vision research institute in the Southern hemisphere, and there will be a major advantage for SERI to collaborate and work closely with LEI scientists and researchers.

2001

Progress of Singapore Eye Research Institute

Ongoing collaborative research projects between our institutes include clinical trials on the first artificial cornea device (known as AlphaCor), invented by LEI scientists; planned studies on the world’s first solid-state refractive laser, the QVis Quantum laser, again invented at LEI; and a collaborative primate research project evaluating a new retinal antiangiogenesis gene therapy procedure for the treatment of subretinal neovascular membranes in blinding eye disorders such as diabetes and age-related macular degeneration. In 2002, we hope to initiate formal trials with the Quantum laser to treat moderate-to-high myopia, to initiate antiangiogenesis primate studies, and to explore further research opportunities for collaboration between the two institutes. Donald Tan Director



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2001: BOARD MEMBERS Prof Lim Siew Ming, Arthur Chairman

Dr Ang Chong Lye Director, Singapore National Eye Centre

BG (Retired), Assoc Prof Lee Kim Hock, Lionel Director, Defence Medical Research Institute

Prof Lim Mong King Deputy President, Nanyang Technological University

Prof Lim Yean Leng Chairman, National Medical Research Council

Prof Tan Chorh Chuan Director of Medical Services, Ministry of Health

Assoc Prof Donald Tan Tiang Hwee Director, Singapore Eye Research Institute Deputy Director, Singapore National Eye Centre Head, Ophthalmology Department, National University of Singapore

Mr Wong Yew Meng Partner, PricewaterhouseCoopers

Assoc Prof Vivian Balakrishnan CEO, Singapore General Hospital As at 31 December 2001

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Report on the First SERI International Meeting 2001

2001

Progress of Singapore Eye Research Institute

The First Singapore Eye Research Institute International Meeting was held from September 27–30, 2001, in conjunction with the 3rd Singapore National Eye Research Meeting. The meeting was held at the new premises of the Singapore National Eye Centre (SNEC) extension, which houses the two research floors of SERI. The meeting celebrated the official opening of the Singapore Eye Research Institute by Mr Lim Hng Kiang, Minister of Health and second Minister for Finance, who was the guest of honour at the meeting. The conference commemorated SERI’s coming of age and brought together old friends and research partners who have helped build up ophthalmic and vision science research in Singapore over the last four years. With key clinicians and scientists from collaborating institutions all over the world, the promotion of international and global exchange in vision research that exists in SERI has helped us to develop strategic initiatives in major research programmes in eye diseases relevant to our part of the world; these include research programmes in myopia, glaucoma, diabetes, and ocular stem cell research. The response from the 23 invited speakers from Asia, Europe, and the USA was overwhelming. The full three-day scientific programme was packed with keynote lectures, symposia, and special interest groups covering the entire gamut of corneal diseases, refractive corneal surgery, myopia, glaucoma, retina, and stem cell research. More than 100 scientific abstracts were presented either as posters or oral presentations. The meeting was well participated with over 300 delegates from the US, UK, India, Italy, Indonesia, China, Malaysia, and Singapore. For the first time, an Industry Symposium — where the industry was invited to present new pharmacotherapeutics, ophthalmic technologies, and R&D strategies — was incorporated. We were privileged to have a keynote lecture delivered by Vice-Chancellor of NUS, Prof Shih Choon Fong, at this Symposium. The meeting also hosted the 2nd Asia Pacific Society of Eye Genetics meeting. The highlight of the meeting was the Young Investigator Awards, which awards outstanding clinical and basic ophthalmic research, presented at the meeting.



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Vice-Chancellor of NUS, Prof Shih Choon Fong, Keynote Speaker of the Industry Symposium

Sitting down, left to right: Prof Neville Mcbrien, Australia; Dr Cesar Gomemezparalta, Mexico; Prof Arthur Lim, Singapore; Assoc Prof Geoffrey Crawford, Australia. Standing, left to right: Dr Ang Chong Lye, Singapore; Prof Elizabeth Rackozy, Australia; Prof Shomi Bhatthachrya, UK; Prof Graziella Pelligrini, Italy.

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Chapter 11

Chairman’s Message I am delighted that that SERI’s excellent research work continues to progress and has clearly attracted researchers from all over the world. I congratulate Associate Professor Donald Tan, our Director, for it is not easy to attract established researchers from the developed nations. Professor Tan organised a successful first SERI-ARVO meeting outside the USA. I am delighted that he has convinced the ARVO officials to hold the second meeting outside USA in Singapore in February 2005. We are proud of A/P Donald Tan’s achievements.

2002–2003

Progress of Singapore Eye Research Institute

Yet we need to think of the rapid and dramatic reforms which are affecting the world. With the dramatic changes in the world, almost everything in every nation will change. What we learn today in medicine may be obsolete in 10 years. In the same way in research, we need to think whether the hundreds of hours in research will be of benefit. The relevance to public needs is essential. We must review what we are doing and whether our innovations will benefit patients with serious eye conditions, in particular, blindness. We must question ourselves whether we are too concerned with intellectual stimulus and the excitement of finding something new, and consequently fail to focus on whether we have found a way to benefit our patients and reduce blindness.

Professor Arthur Lim MD (Hon), FRCS

These are vital issues we must address in the coming years. Professor Arthur Lim Chairman





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Chapter 11

First SERI-ARVO Meeting on Research in Vision and Ophthalmology

The meeting was launched with a spectacular multiple laser show by Guest of Honour, Dr Tony Tan, Deputy Prime Minister and Minister for Defence, Singapore (4th from left)

New ground was broken when the Singapore Eye Research Institute (SERI) hosted the first combined meeting of the Association for Research in Vision and Ophthalmology (ARVO). ARVO meetings, based in the USA, constitute the leading forum for ophthalmic research in the world. The SERI-ARVO meeting was the first such meeting to be held outside the USA.

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“Congratulations to you and your team for putting together such a first-class meeting. The SERI-ARVO conference was a credit to you all and I felt very honoured to have been an integral part of it…” Ivan Goldberg, Australia

2002–2003

Progress of Singapore Eye Research Institute

The meeting was held at the Suntec Singapore International Convention and Exhibition Centre from 6–9 February 2003. Over 800 delegates from 36 countries were treated to a wealth of research reports and invited lectures on cutting-edge advances in eye research, complemented by a series of workshops on the design and conduct of eye research. The Guest of Honour who gave the Opening Address was Dr Tony Tan, Deputy Prime Minister and Minister for Defence, Singapore. Professor Robert Weinreb, President of ARVO and a Singapore Alumni Association Distinguished Visitor, also gave a welcome address. Professor Sheila West of the USA was the NUS Hong Leong Professorial Visitor.

The topics covered in the meeting ranged over the whole gamut of ophthalmic research, with an emphasis on translational research bridging the disciplines of basic science and clinical ophthalmology. A galaxy of invited speakers from around the world addressed the meeting on topics as diverse as recent advances in ocular inflammation, glaucoma, myopia, cornea and refractive surgery, retinal disorders, epidemiology, stem cell research, and genetics. In all of the symposia on these topics the growing importance of cell and molecular biology, molecular genetics (including genomics and proteomics) and stem cell technology was abundantly clear. The sensational recent advances in our knowledge of the human genome, some 50 years after the identification of the structure of the DNA molecule, have led to a wave of new technologies that are being actively exploited in eye research. The exciting possibilities of replacing irreversibly damaged ocular tissues by the use of stem cells or the application of gene therapy for presently untreatable retinal disorders were among the many highlights of the meeting. In all, there were 140 presentations in keynote addresses, symposia, invited lectures, and workshops. A total of 290 posters complemented 63 free paper presentations. Two sponsored lunch-time symposias addressed the controversy of nutritional supplements in ophthalmology and newer medical therapies for glaucoma. Poster presenters had an opportunity to have their posters discussed in rapid-fire sessions, where brief illustrated presentations of posters led to lively discussion and sometimes critical comment.

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Chapter 11 A welcome reception was organised in the Singapore National Eye Centre that gave delegates an opportunity to visit SERI’s research laboratories and clinical facilities. The highlight of the social programme was the Lunar New Year Dinner at Chijmes. “It was really a very nice experience. I would say an experience of a lifetime, such good organisational skills, on-the-dot punctuality, etc., only to name a few. I have attended many conferences in Europe and Australia, but did not enjoy and learn so much. You have not forgotten the ethnic roots of the East. That was marvelous…” Sanjay Chowdhury, India “… I thought it was an excellent meeting and I hope it acts as a model for future meetings in the Asian area…” Creig Hoyt, USA “Congratulations on organising an excellent meeting…beautifully organised as usual and I have to say I learnt a lot myself, especially from the stem cell discussion! That is the sort of thing people should be exposed to…” Peng T Khaw, United Kingdom An important goal of the meeting was to encourage young investigators to attend and present their work. To this end, SERI offered a number of Travel Fellowship Grants that supported the travel costs of 28 young researchers from nine different countries. These awards were sponsored by Alcon, Bausch & Lomb, SERI-Santen Japan, and the Tear Film and Ocular Surface Society.

“I want to congratulate you and all your staff on the splendid success of the SERIARVO Meeting. One could see how much hard work you had put into it to make sure it was a success, and I am sure that you must be very pleased with the outcome. You really did a very good job and I think everybody had a great time…” Hugh Taylor, Australia 13 6





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Awards to young investigators for excellence in research, as demonstrated in presentations or posters, were given to six young researchers in the categories of basic research in visual science and in clinical ophthalmology. The major award in the visual science category for an outstanding presentation went to Ken Fukuda of Japan for his work on the effects of IL-4 on the metabolism of extracellular matrix proteins by human conjunctival fibroblasts. In the clinical category, the top award was shared by Adrienne Csutak of Hungary for her study of plasminogen activator inhibitors in tears after excimer laser photorefractive keratectomy and Chua Wei Han of Singapore for his study of refractive errors and their correction in Singapore school children.

2002–2003

Progress of Singapore Eye Research Institute

An exhibition of the latest in ophthalmic instrumentation and technology with participation by 21 companies attracted a lot of interest. The Organising Committee has received a large number of congratulatory letters and e-mails from many of those attending. The meeting has been judged a great success, and we are very pleased that the 2nd SERI-ARVO meeting will be held in Singapore in February 2005. Guests and delegates were invited to partake in the unique practice of “loh hei” for a healthy and wealthy Goat Year at the SERI-ARVO meeting! (from left) Ang Chong Lye, Director, SNEC; Robert Weinreb, President, ARVO; Karen Chee, Manager, SERI; Roger Beuerman, Deputy Director, SERI; Wong Tien Yin, Assoc Director, SERI; Charity Wai, COO, SNEC; Donald Tan, Director, SNEC

Source: SERI Research Report 2002/2003

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Chapter 12

Chairman’s Message It has been my privilege and honour to be closely linked with the development of the Singapore Eye Research Institute (SERI) since its foundation. It gives me great pleasure to note that our Director, Professor Donald Tan, has pushed research in ophthalmology to great heights with some of his key researchers — Wallace Foulds, Roger Beuerman, Aung Tin, and many others. One outstanding young researcher in ophthalmology in Singapore is Associate Professor Wong Tien Yin. We hope that in the coming years, he too will continue to make major contributions to the discipline. Let us look at research from a broader perspective: its development in Singapore, in the National University of Singapore (NUS) and in the context of NUS, collaboration with Duke University School of Medicine to set up the NUS Graduate Medical School, which will propel medical research in the coming years. According to the Times Higher Education Supplement’s World University Rankings, the National University of Singapore ranks 22nd in the world, and the standing of the Faculty of Biomedicine (which is really based on medical research) has improved from the 25th position to the 15th position and continues to improve. Congratulations to our researchers, especially Philip Yeo, who has been instrumental in pushing medical research in Singapore. While we acknowledge and congratulate SERI for its achievements, we have to review openly what we can do in the next 10 years. How can we work more closely with the Biopolis? How can we help our university improve its standing to become one of the top 10 universities of the world? How do we attract talent and, having talents of our own, how do we develop them to be the best? The director and other heads of departments have to recognise and nurture young talents, especially outstanding ones, and do everything possible to develop and attract them so that Singapore, the university, SNEC, and SERI can benefit. This is a challenge, and this is what the Board of Directors should address together with our outstanding researchers in SERI. Professor Arthur Lim Chairman

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Director’s Report

SERI is the leading centre in Southeast Asia for ophthalmic and visual science research. In the relatively short time since its inception, SERI has established an international reputation as an eye research centre of excellence with an internationally recognised high profile.

CORE RESEARCH DIVISION

The SERI Clinical Research Unit conducts ocular therapeutics, surgical and laserrelated human clinical trials, and clinical studies in visual psychophysics. Clinical trials conducted include cataract, glaucoma, corneal transplantation, pterygium and retinal surgery trials, pharmaceutical and ocular drug delivery trials, visual psychophysics studies, and refractive surgery and myopia clinical trials.

2004–2005

Progress of Singapore Eye Research Institute

During the year, the clinic supported a total of 25 prospective clinical trials in the fields of cataract surgery, refractive surgery, glaucoma, uveitis, corneal disease, age-related macular degeneration, diabetes, myopia, and ocular surface stem cell surgery. The SERI Epidemiological Unit conducts and coordinates large-scale epidemiological and population-based projects studying eye diseases in our community. Six major SERI epidemiological studies are currently ongoing to evaluate the risk factors and prevalence of recognised complex traits such as refractive error, glaucoma, cataract, age-related macular degeneration, and diabetic retinopathy in different ethnic groups. The SERI Visual Psychophysics Unit focuses on visual function and the improvement of visual performance. In 2004/2005, the unit conducted several visual neuroscience-oriented clinical trials on perceptual learning and vision enhancement in myopia and post-refractive surgery ametropia, in collaboration with DMERI and NeuroVision. The SERI Laboratory Sciences Unit comprises Cell and Molecular Biology Laboratories, the Analytical Chemistry Laboratory, Tissue Culture Laboratories, the Ocular Surface Stem Cell Laboratory, part of the Outram Campus Stem Cell Research Group (SCRG) (also housed in SERI), the Ocular Genetics Laboratory, and a new multidisciplinary Proteomics Facility within the Micro-Analytical Chemistry Laboratory. Our scientists have continued to consolidate various

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Chapter 12 translational studies on myopia and eye growth, wound healing, tear film studies, ocular surface stem cells, and artificial substrates for tissue engineering.

Major New Research Initiatives in 2004/2005 with clinical impact 1.

Osteo-Odonto Keratoprosthesis (OOKP) in the Surgical Rehabilitation of Severe End-stage Corneal and Ocular Surface Disorders This is a form of artificial cornea surgery which offers the only hope of visual rehabilitation to patients with end-stage, high-risk corneal and ocular surface diseases, for which conventional corneal and stem cell transplants will not work. The Director of SERI introduced this new and experimental procedure in 2004, which is performed by a team of eye and dental surgeons. The procedure involves embedding a PMMA optical cylinder into an autologous tooth root, which is transplanted into the host cornea. Unavailable in the USA and most of Asia, the Singapore National Eye Centre is the only centre in the region offering this difficult procedure at the moment. To date, a total of 12 patients from Singapore, Indonesia, Malaysia, Thailand, and Sri Lanka have benefited from this programme. Clinical impact of the research:

OOKP represents the absolute cutting edge in the surgical treatment of the most severe eye diseases of the anterior segment. As OOKP surgery is now available in Asia, this will have major benefit to those blind from severe end-stage eye diseases for which there is no other alternative. The fact that OOKP studies are also extremely limited in terms of the number of cases performed in the world (plus the fact that OOKP surgery is not yet available in the USA) has made Singapore and Singapore National Eye Centre (SNEC) a leading centre for cutting-edge eye surgery and artificial corneal research in the world. Future research directions in this area include possibilities of bioengineering tooth alternatives for edentulous patients and to avoid tooth removal. 2.

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Stem cell and tissue-engineering research SERI’s research team has developed a world’s first by pioneering a procedure that uses cultured adult conjunctival stem cells to treat patients suffering from pterygium, a common disorder among Asians, and other severe ocular surface diseases. The team devised a serum-free stem cell culture system to expand conjunctival stem cells in the laboratory to form a tissue-engineered conjunctival equivalent and, with this, performed the first series of human cultured conjunctival stem cell transplants. The elimination

of animal serum and cells from the culture process represents a significant advantage over current culture methods, and the process is undergoing the final stages of patent application. Clinical impact of the research:

To date, more than 30 patients have benefited from this new breakthrough at SERI, and this breakthrough technique has been used to treat common diseases such as pterygium, glaucoma and stem cell corneal conditions (e.g. chemical injuries, ocular surface cancer, and corneal blindness due to generalised stem cell deficiency).

RESEARCH OUTCOMES IN 2004/2005

2004–2005

Progress of Singapore Eye Research Institute

PUBLICATIONS In 2004, SERI scientists and clinician investigators from both clusters, Singapore Health Services and National Healthcare Group, published an unprecedented total of 120 scientific articles in peer-reviewed ophthalmology and visual science journals, as compared to 103 articles published in 2003/04. Despite the significant increase in the number of publications, our mean journal impact factor also rose slightly to 2.87, as compared to 2.45 in 2003/04. Academic staff also presented 159 scientific abstracts at local and international clinical and research meetings. New research initiatives conti- nued to enter our pipeline, and SERI clinicians and scientists initiated a total of 40 new research projects in 2004. GRANTS AWARDED SERI scientists and affiliated clinicians were awarded a total of S$2,847,818 in individual research grants and commercially funded grants. This represented additional extramural research funding equivalent to 83% of SERI’s Institutional Block Grant of S$3,449,730 from the National Medical Research Council.

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2004–2005

Chapter 12 AWARDS During the year, SERI scientists and clinicians received five awards for research excellence. MAJOR EVENT SERI was privileged to once again host the SERI-ARVO international vision research meeting in Singapore in 2005. This meeting was jointly sponsored by the world’s largest organisation for eye research, Association for Research in Vision and Ophthalmology (ARVO). ARVO has a membership of more than 10,500 members representing more than 60 countries. The 2nd meeting was again hailed as a highly successful milestone in Asian vision research, with an attendance exceeding 700 delegates from 36 countries. For the first time, selected abstracts from the meeting were compiled and published as a supplement to the prestigious journal, American Journal of Ophthalmology, with an impact factor of 2.258.

NEW RESEARCH GRANTS AND RESEARCH PROJECTS

This year, a total of 40 new research projects were submitted and approved by the SERI Institutional Review Board. During the same period, a total of 18 research projects were completed. SERI scientists and affiliate clinicians continued to be highly successful in competitive research grants during this period. From April 2004 to March 2005, a total of S$3,000,184 (S$2,854,539 in 2003/04) in individual and programme research grants was attained. This represented additional extramural research funding equivalent to 76% of SERI’s Institutional Block Grant of S$3,773,898.

IN APPRECIATION

Finally, it leaves me to thank our Board of Directors and all the staff at SERI — the various committees, our clinical partners, industry sponsors, study patients, and their families for their support, contributions, commitment, and encouragement. I would also like to thank the National Medical Research Council for the continued funding support. Donald Tan Director 14 2





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Progress of Singapore Eye Research Institute

2004–2005

2004/2005: Board Members

SERI Board of Directors: left-right: CI Assoc Prof Ang Chong Lye, Prof Donald Tan, Prof Lim Mong Kin, Assoc Prof Lionel Lee, Mr Wong Yew Meng, Prof Arthur Lim (Chairman)

Board Members

Prof Lim Siew Ming, Arthur Chairman

The SERI Board comprises representatives from the Singapore Health Services, National Healthcare Group, and institutions involved in vision research such as the Defence Medical Research Institute and the National University of Singapore.

Cl Assoc Prof Ang Chong Lye Medical Director, Singapore National Eye Centre

BG, Assoc Prof Lee Kim Hock, Lionel Director, Defence Medical Research Institute

Prof Lim Mong King Deputy President, Nanyang Technological University

Prof Tan Chorh Chuan Director of Medical Services, Ministry of Health

Prof Donald Tan Tiang Hwee - Director, Singapore Eye Research Institute - Deputy Director, Singapore National Eye Centre - Head, Department of Ophthalmology, National University of Singapore

Prof John Wong Eu Li Dean, Faculty of Medicine, National University of Singapore

Wong Yew Meng Partner, PricewaterhouseCoopers

Ms Dawn Tay Company Secretary, Singapore Health Services

Source: SERI Research Report 2004/2005



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2004–2005

Chapter 12

Second SERI-ARVO Meeting on Research in Vision and Ophthalmology The meeting was held at the Suntec Singapore International Convention and Exhibition Centre from 16–19 February 2005. Once again, the meeting received an overwhelming response, with 526 abstracts submitted by young researchers, clinicians, and invited speakers from 36 different countries (at our First SERI-ARVO Meeting, a total of 353 abstracts were presented). A total of 148 symposium presentations, which included no less than 60 invited international speakers, addressed the important clinical and translational aspects of vision and ophthalmic research, which included topics on angiogenesis, angiography, stem cell biology, genetics, immunology, inflammation and infection, epidemiology, visual psychophysics and physiological optics, as well as subspecialty symposia on ocular surface, cornea, dry eye, cataract/lens, uveitis, glaucoma, retina, myopia, and refractive surgery. ARVO is the largest vision and research organisation in the world. This year, a special ARVO Symposium entitled “Hot Topics in Eye and Vision Research” was presented by a scientific delegation from ARVO, led by Gary W. Abrams, President of ARVO. In addition, a total of six plenary lectures highlighting important research advances in the major subspecialty fields were delivered by leading international vision researchers from around the globe. The pre-meeting workshops focusing on the design and conduct of eye research were also well received. The topics were expanded and included a basic research workshop introducing emerging technologies such as genomics, proteomics, and metabolomics; a clinical workshop on the conduct of randomised controlled trials; and a highly popular workshop on pearls in grant writing, in writing scientific manuscripts, and on how to avoid pitfalls in oral or poster presentations. For the first time, selected abstracts from the meeting were compiled and printed

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as a supplement to the prestigious journal, American Journal of Ophthalmology, with an impact factor of 2.258. In the spirit of encouraging young doctors and scientists in research, the SERIARVO Meeting again awarded a total of 40 SERI-ARVO Travel Awards, with funds generously donated by industry sponsors such as Allergan, Bausch & Lomb, and Tear Film and Ocular Surface Society. The meeting also awarded young researchers for outstanding clinical or basic ophthalmic research presented at the meeting. The Outstanding Awards for the basic and clinical categories went to Ms Clare S McCarthy of Australia and Dr Pravin Krishna Vaddavalli of India, respectively. Drs Leonard Ang and Marcus Lim of the Singapore National Eye Centre received the Merit Awards for the basic and clinical categories, respectively.

2004–2005

Progress of Singapore Eye Research Institute

Overall, the meeting was again judged a significant success by many attendees, and several compliments were received from the delegates and speakers. More than 700 people from 36 countries attended the meeting. Participants completed a meeting evaluation form; out of the 193 forms received, 188 of them would like to see the meeting held again, and 192 of them found the meeting to be useful.

Source: SERI Research Report 2004/2005

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2006–2007

Chapter 13

Chairman’s Message A once-in-a-lifetime ophthalmic development has emerged in Asia that is ready to compete with and challenge the world’s leading eye centres in research. This exciting development is none other than the Singapore Eye Research Centre. The world-class research that SERI conducts will help spread the international influence of Singapore as we move towards our goal of being a global city and a leading nation influencing developments in Asia and the world. It is wonderful that ophthalmic research in Singapore has reached such a high level in just ten years. We must acknowledge the remarkable contributions of two Singaporean pioneers — the late Professor Chew Sek Jin and, currently, Professor Donald Tan. Having achieved world-class standards in ocular research, there is a tendency to rest on our laurels and be contented with what we have achieved. But if ophthalmic research in Singapore is to continue to produce outstanding results and be featured in leading international publications, we cannot afford cosy indifference. We must seize every opportunity. This is the fascinating and challenging task for Donald Tan and his team in 2007 and beyond. I am confident we will succeed.

Professor Arthur Lim Chairman

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Chapter 14

Formation of Singapore Eye Foundation (SEF).

1986

1990

Establishment of Department of Ophthalmology, National University Hospital.



Shaw Foundation donated $1 million.

Meeting with Mr Michael Ford (Vice President, National Medical Enterprise, USA) at Mount Elizabeth Hospital, to build a major eye centre in the private sector. Letter to Khaw Boon Wan, Executive Director, NUH National Eye Institute.





World Congress (26th International Congress of Ophthalmology) held in Singapore.

1991

1983



Weekly tutorials at Arthur Lim’s private clinic at Mt Elizabeth Hospital — more clinical teaching relating to research work in Singapore. The main thing was to form SNEC.

Decision made to establish SNEC.

1987

1970s



1988

Milestones

Singapore National Eye Centre (SNEC) was established.

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1996 Prof Foulds flew to New York to agree with Dr Chew on a revised plan for SERI, incorporating material from the two plans that had been prepared. Later that year, a finalised submission for SERI was produced. The Singapore Eye Research Institute (SERI) was incorporated as a company and as a wholly –owned subsidiary of SNEC. 14 8 148



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Birth of Singapore Eye Research Institute (SERI). The incorporation as a company owned by SNEC under the Singapore Companies Act was completed. Aims of SERI as a company were set up. Prof Arthur Lim assumed the role of Chairman and Director of SERI. Dr Chew Sek Jin, who was later promoted to Assoc Prof in NUS, became its Deputy Director.

Assoc Prof Chew Sek Jin passed away.

1999

1997

Met top ophthalmic researchers and bio- statisticians to discuss research directions for SNEC and potential collaborative studies.

1998

1993

Chapter 14

1st National Eye Research meeting was held. Dr Donald Tan was appointed as Acting Deputy Director of SERI. Prof Foulds was persuaded to accept a temporary position as Co-Director of SERI.

Prof Foulds appointed as Co-Director. Prof Beuerman appointed as Head of Laboratories.

The SERI new facilities, occupying two floors of the SNEC building, was officially opened by the Minister of Health, Mr Kim Hng Kiang. SERI entered into stem cell research under the directions of A/Prof Lee Seng Teik and A/Prof Donald Tan.

SERI was recognised by the Singapore authorities as a charity under the Singapore Charities Act.

2003

2001 In commemoration of Prof Chew Sek Jin, the first of his lectures was given as a keynote address during the meeting.

The formal recognition of SERI by NUS as an Affiliated Research Institute, thus conferring university status on SERI.

2005

Prof Tan’s appointment as SERI’s Director was confirmed.

First SERI-ARVO Meeting on Research in Vision and Ophthalmology.

Second SERI-ARVO Meeting on Research in Vision and Ophthalmology. Prof Donald Tan promotion to Professor of Ophthalmology in NUS.

2007

2nd National Eye Research Meeting was held.

First Singapore Eye Research Institute International Meeting in conjunction with the 3rd National Eye Research Meeting.

2002

2000

Chapter 14

Asia-ARVO Meeting on Research in Vision and Ophthalmology.

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Chapter 15

Singapore National Eye Centre By Charity Wai

Ms Charity Wai Chief Operating Officer, SNEC

“A journey of a thousand miles begins with the first step.”



Lao Tze

Singapore, a country of four million people and a short history of 40 years of independence, has made laudable achievements in diverse fields such as commerce, industry, telecommunications, and information technology. In ophthalmology, a world-class eye development was conceived out of an aspiration more than a decade ago to create a centre of international excellence not only in Singapore, but also in the region and beyond.

How It All Began The tremendous potential for ophthalmology to be a world-class development was first recognised by Prof Arthur Lim, an eminent, internationally renowned eye surgeon in private practice. He mooted the concept of a national eye institute as early as the 1980s. Many rounds of proposals, discussions, and correspondence with senior officials ensued, and these eventually led to the government’s decision to commit S$17 million (US$10 million) to support the establishment of a national eye centre in 1989.

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Despite the protracted meetings and negotiations over more than five years, the final agreement was said to be sealed with a simple handshake between Prof Arthur Lim and Dr Kwa Soon Bee, the then Permanent Secretary, Ministry of Health. Professor Lim was also asked to meet the then Minister of Health, Mr Yeo Cheow Tong, to give his personal assurance of commitment to the success of the proposed national eye centre. His appointment as the founding Medical Director came shortly thereafter. These events took place in early 1989. At that time, the planning of the XXVI In-

Singapore National Eye Centre

ternational Congress of Ophthalmology, the largest medical congress being organised in Singapore at that time, was well underway. The congress eventually attracted 7,600 participants from 94 countries worldwide. A number of key staff in the organising team, such as Charity Wai and Kathy Chen, went on to work with Prof Lim on the national eye centre project. A flurry of activities followed, the first of which was the incorporation of the Singapore National Eye Centre (SNEC) on 3 March 1989. The double-barrel name (Singapore National) did not come about by accident. It was discussed and agreed to by a panel of five permanent secretaries. It was felt that naming it as National Eye Centre was not quite adequate should its name be published or used in international circles. Hence, the name “Singapore National Eye Centre” (SNEC) came into being. The special logo commissioned for the SNEC also depicted its global mission.

The congress organising team all ready for action

The dilapidated Surgical A and B blocks on the campus of the Singapore General Hospital was the site earmarked for the SNEC. As the structure of the building was still sound, the decision was made not to demolish and rebuild, but to retrofit the building for the new eye centre to save time and cost.

The Pioneering Team Within 10 months, the two blocks were transformed into an ultra-modern ambulatory eye facility, and the pioneer team of staff attended to their first patients in October 1990. Nine pioneering staff made up the commissioning team. Dr Peter Tseng and Dr Heng Lee Kwang, who were both Senior Registrars at that time, worked closely with the Administrator, Charity Wai, who was assisted by Kathy Chen and Katherine Leong, then Finance and Administration Manager. The nursing team was led by the late Matron Esther Lim, supported by nursing sisters Lim Mein Chee, Margaret Tan, and Tan Joon Fong, who were joined by Sister Lor Siew Ngim several months later. The team toiled and laboured to get SNEC operational in the start-up phase, and this entailed numerous planning and coordination meetings. Singleness of purpose and close camaraderie bound the team members together in an effective team under the leadership of our first Medical Director. The Centre received its first patients on 15 October 1990. After three months of soft launch, the official opening of the SNEC took place on 18 January 1991, with the then Minister for Health, Mr Yeo Cheow Tong, as our guest of honour. The

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Chapter 15 inaugural Board of Directors consisted of Dr Kwa Soon Bee, then Permanent Secretary of the Ministry of Health and Chairman of Health Corporation of Singapore and Mr Khaw Boon Wan.

The Years of Spectacular Growth There has been no looking back since then. The growth of SNEC has been phenomenal. From the original team of 9 staff, the Centre now has a staff strength of 446, comprising 45 senior consultants and consultants; 4 associate consultants; 15 registrars; 8 trainees; 133 nursing staff; 56 paramedical staff; 65 administrative staff; and 120 clerical, secretarial, and ancillary staff. Our patient load at the end of our first year of operation was 38,000. Today, we attend to over 250,000 outpatient visits a year and perform 14,000 major eye surgeries and 16,000 laser procedures annually. The level of clinical activities places the SNEC amongst the highest-volume ambulatory eye centres in the world. In January 1996, SNEC and the National University Hospital (NUH) came together to form a strategic partnership for the joint provision of services at the NUH Eye Department under the directive of the then Minister of Health, Mr George Yeo. For close to 5 years, the ophthalmologists of the NUH Eye Department also became full-time staff of the SNEC until the formation of the two clusters, Singapore Health Services Pte Ltd and National Healthcare Group Pte Ltd, in 2000. Over the years, the Centre has also developed from a single venue to a network of services spreading across several locations: the Mt Alvernia Hospital Branch (March 1998–present); KK Women’s and Children’s Hospital (February 1999– present), Changi General Hospital (December 1999–present), and Alexandra Hospital (November 1998–September 2000). In the last 16 years, ophthalmology has developed into a vibrant, world-class discipline in Singapore. SNEC strives in its mission to provide Singaporeans with high-quality and cost-effective eye care. The Centre serves as a focal point for the convergence of ophthalmologists from the various hospitals, the university, and the private sector to work together as a cohesive unit developing the three core areas of service, research, and education.

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The greatest achievement in clinical service development was the establishment of the nine major subspecialties with capabilities of diagnosis, specialised

Singapore National Eye Centre

treatment, and management of a whole range of eye conditions: cataract and comprehensive ophthalmology, cornea and external eye disease, glaucoma, neuro-ophthalmology, ocular inflammation and immunology, oculoplastic/ aesthetic eyeplastic, paediatric ophthalmology, refractive surgery, and vitro- retina. The range of subspecialties offered by the SNEC is surpassed by few centres in the world. Along with subspecialisation was the inculcation of a quality culture, an enduring legacy from our founding Medical Director. Professor Arthur Lim introduced the quality assurance system into the SNEC and would not compromise on its implementation. In the early days, as expected, there were intense reactions and resistance from some of the staff; but in the end, his good judgement and counsel prevailed. Today, there is no dispute about the enormous benefits SNEC has reaped from these two singularly most important developments in our clinical service.

Education, Research, and International Activities The Centre plays an active role in education, supporting the undergraduate and postgraduate teaching programmes of the University as well as organising many subspecialty courses and international conferences regularly. For more than a decade, thousands of participants have joined our various educational programmes and conferences from countries in the region and beyond: Malaysia, Indonesia, the Philippines, Thailand, Vietnam, Myanmar, India, Bangladesh, Nepal, Sri Lanka, Hong Kong, People’s Republic of China, Japan, Korea, Taiwan, United Kingdom, Germany, the Netherlands, Spain, the United States of America, etc.

The Singapore Eye Research Institute (SERI) SERI was established in 1997 as a wholly owned subsidiary of the Singapore National Eye Centre, with the objective of conducting basic and applied research in myopia, glaucoma, diabetic retinopathy, and other ophthalmic diseases unique to Asia. SERI also aims to provide an infrastructure to complement and facilitate the clinical research at SNEC and other institutions involved in the study of visual disorders. In addition, the Institute sets and maintains scientific and ethical standards for clinical and basic research in ophthalmology in Singapore. The Institute’s first Director was the late Prof Chew Sek Jin, who spearheaded major myopia research projects while he was pursuing his PhD in the Rockefeller University in the USA. His unexpected demise in December 1998 was a major

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Chapter 15 setback for SERI until Prof Donald Tan assumed the leadership of the Institute in February 1999. Under him, the core of local and foreign researchers has been making further forays into vision research, with an emphasis on new areas such as molecular genetics, molecular and cell biology of eye diseases, tissue engineering, proteomics, visual psychophysics, ocular epidemiology, and biostatistics.

Further Expansion — Phase 2 With the tremendous growth achieved since its inception, the proposal for a Phase 2 new wing was put to the SNEC Board as early as 1992. Numerous rounds of board deliberations then followed. The proposals submitted ranged from a mere extension of space with a project cost of less than S$6 million to a full-fledged multi-storey new wing that would substantially boost the existing facilities. After six years of discussions, numerous designs proposed by two architectural firms, 22 board meetings, 3 DPC papers/revisions, and many rounds of high-level lobbying, the SNEC Phase 2 was finally approved in 1997 as a new, purpose-built, 8-storey facility, adding another 15,000 sq m to SNEC’s existing area of 6,500 sq m at a total project cost of S$50 million (US$30 million), funded by the Ministry of Health. The Centre’s Phase 2 expansion was successfully completed in October 2001. Phase 2 provided 28 new outpatient consultation rooms, 5 operating theatres, an expanded day ward, a 150-seat auditorium, two dedicated floors to house the Singapore Eye Research Institute’s research clinics, laboratories and administrative offices, as well as comprehensive ancillary and support facilities.

People: Our Human Capital SNEC places great importance in managing its most valuable asset: our human capital. The success of the SNEC is characterised by the presence of many groups of highly educated, highly qualified professionals — the doctors, nurses, and paramedical and administrative staff. We are very proud of the fact that, in the last 16 years, we have retained almost all of our senior consultants and other senior members of staff. As SNEC advances into the new knowledge era, it will confront a borderless world where top talent is extremely mobile. The competitive advantage belongs to organisations that are able to attract, develop, and retain talent. The key lies in the ability to harness the full potential of the talent in the organisation. 15 6





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Emergence of the Second-Echelon Leadership After a decade at the helm, Prof Arthur Lim decided to step down in December 1998 to make way for the second generation of leadership who had been handpicked and nurtured by him, despite repeated appeals for him to remain. Associate Professor Vivian Balakrishnan, who was appointed Deputy Medical Director a year earlier, took over the baton from Prof Lim in January 1999 in an emotionally charged changing-of-the-guard ceremony witnessed by all SNEC staff and many of our challengers in the medical field. Associate Professor Vivian Balakrishnan immediately set about shaping the future direction of the SNEC. He envisioned a strategic alliance of eye centres, with SNEC being the ophthalmic hub in Asia. He led a SNEC delegation of senior staff to Jules Stein, Johns Hopkins, and Harvard in the USA; Moorfields Eye Hospital in UK; and the Lions Eye Institute in Australia. The visits culminated in the signing of various memoranda of understanding that would form the foundation of a strategic alliance. He also initiated a strategic review of the Centre and mapped out major initiatives for the SNEC in its next phase of development, including a critical review of SNEC’s role as the national eye centre in the newly restructured public healthcare sector distributed between the Singapore Health Services (SingHealth) and the National Healthcare Group (NHG) networks. The Strategic Review 2000 helped to identify critical core competencies and develop the necessary roadmaps for the further development of our staff and enhancement of our talent pool. The team-building session with senior medical, administrative, nursing, and paramedical staff made a tremendous impact organisation-wide. In June 2000, SNEC was completely taken by surprise when Assoc Prof Vivian Balakrishnan was asked to assume the position of Chief Executive Officer of Singapore’s largest acute care hospital, the Singapore General Hospital. Given his outstanding talents, accelerated career moves were not unexpected, but his departure from the SNEC after just over one and a half years was too soon. In fact, Assoc Prof Vivian Balakrishnan went on to join politics in 2001, and was made an office holder as Minister of State for National Development and also later for Trade and Industry. In 2005, he was made full Minister in charge of Community Development, Youth and Sports and 2nd Minister for Trade and Industry.



Source: Extracted from leading lights in the Asia-Pacific, 2006.

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At the Changeover of Leadership (1999) By Assoc Prof Vivian Balakrishnan Incoming Medical Director Singapore National Eye Centre

I never fully appreciated the enormity of this task until I saw or heard Prof Lim’s speech just a while ago, as Julie Goh (Prof Lim’s secretary) leaned over to me and said, “This is his baby.” This building, everyone down here, the system, the patients, everything here represents — in a concrete or human form — his ideas, his ideals, and his achievements.

Prof Arthur Lim (centre), Founding Medical Director, and Assoc Prof Vivian Balakrishnan (left), Director of SNEC (1999 – 2000), being honoured by Dr Ang Chong Lye, incoming Director of SNEC, who took office in September 2000.

Charity (our administrator) and I have prepared a whole citation to read, but I think it’s really, really unnecessary. It would not do him justice, anyway. The only thing which I think I want to say is that none of us, certainly not I, will be big enough to fill his shoes, and I have got no illusions about that. For those of you who know me, know that I call a spade a spade. I categorically assure you that I am pretty sure that I cannot fill his shoes. Nevertheless, we have an inherited team down here, working hand in hand. It is something that is obviously too precious to drop, mindful of Prof Lim and our duty to our country. I think we need to make this Centre world-class, not just because we want glory, not even for Prof Lim’s glory. We need to because, first of all, our patients demand it. Secondly, those of us who intend to spend, hopefully, the rest of our professional lives down here demand that. Thirdly, even if you did not want to, the fact is that competition is coming, anyway.

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How are we going to do that? Because we can’t clone him and we agreed that none of us are in his category. I think the only way we can make SNEC world-class is by working as a tem and as a group. And to realise that, we’ve got to build on what I call institutional excellence.

Singapore National Eye Centre

It’s not going to be in pockets of individual excellence or individual fame, as I think the time has passed for that, but rather for all of us, as a group, to be much stronger than we could be in our individual capacities. I hope that I will have the support of all the team members down here and that we do it not for selfish reasons, but firstly for our patients, secondly for each other, and thirdly for the country. As for Prof Lim himself, you would have noticed that we have made a quick amendment. On Saturday, he finally agreed to be appointed Emeritus Senior Visiting Consultant. Some of us, including Donald and Charity, will know that we spent hours over the weekend trying to coerce, persuade — cannot bribe him, threaten even — to force him to take up some role here. And I told him that it is not for his sake, but it is really for our sake because we need his support, influence, and advice, his connections, and his presence, which only he can provide us with. I am glad that he has accepted that. We’ve got a few more things in mind, but we think we will take it one step at a time.

Source: Singapore National Eye Centre, The first Ten Years 1990 - 2000



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Chapter 16

Conclusion The Best is Yet to Come Let us never forget our pioneers who committed themselves to research at a time when there was little interest and almost nothing available in Singapore.

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By Prof Arthur Lim

Having achieved world-class standards in ocular research, there is a tendency to rest on our laurels and be contented with what we have achieved. But if ophthalmic research in Singapore is to continue to produce outstanding results and be featured in leading international publications we cannot afford cosy indifference. We must seize every opportunity. This is the fascinating and challenging task for Donald Tan and his team in 2007 and beyond. The best is yet to come. Let us never forget our pioneers who committed themselves to research at a time when there was little interest and almost nothing available in Singapore.

SERI Board Members with Managment of SERI Standing: Left – Right

Mr Sia Kheng Hong (Company Secretary), Cl Prof Ang Chong Lye (Director, SNEC), Mr Wong Yew Meng Prof Donald Tan, Director, SERI Prof Roger Beuerman, Scientific Director, SERI Prof Lim Mong Kin Ms Karen Chee, Senior Manager, sERI Seated: Left – Right

Professor Wong Tien Yin

Prof Wallace S Foulds Prof Lionel Lee Prof Arthur Lim, Chairman, sERI Prof Tan Chorh Chuan

MBBS, MMED, FRCSE, FRANZCO, FAFPHM, MPH, PhD Professor & Deputy Head, Centre for Eye Research Australia, University of Melbourne Associate Professor, National University of Singapore Associate Director, Singapore Eye Research Institute

1

2

3

1. Arthur with Professor Tan Chorh Chuan, President of National University of Singapore.

4

1

2. Sek Jin (4th from right) with fellow ophthalmologists. 3. Sek Jin (2nd from right) and staff of NUH/NUS at Arthur’s birthday celebration.

5

5. Arthur with Sek Jin.

4. Arthur with Professor John Wong, Dean, Faculty of Medicine, National University of Singapore.

6

6. Sek Jin with Vivian Balakrishnan and Wong Poh Kim at a research meeting at Arthur’s residence.