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

SERI

SINGAPORE’SWORLD-CLASSRESEARCH

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“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’S WORLD-CLASSRESEARCH

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SERISINGAPORE’SWORLD-CLASSRESEARCH

arthur lim

SINGAPORE EYE RESEARCH INSTITUTE

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SERI:Singapore’sWorld-ClassResearchFirstpublishedin2008byWorld Scientific

WorldScientific5TohTuckLinkSingapore596224

Copyright©ArthurLim

Allrightsreserved.Thisbook,orpartsthereof,maynotbereproducedinanyformorbyanymeans,electronicormechanical,includingphotocopying,recordingoranyinformationstorageandretrievalsystemnowknownortobeinvented,withoutwrittenpermissionfromthePublisher.

ISBN-13978-981-283-317-4(pbk)ISBN-10981-283-317-x(pbk)

PrintedinSingapore

DesignedbySinKhoAdvertising&Design

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DedicatedtoChewSekJinandDonaldTan

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con

ten

ts

Foreword 11 Introduction 13

History of the Singapore Eye Research Institute (SERI)

Chapter 1 201987• LettertoMrKhawBoonWan(ExecutiveDirector,NUH)• JointVentureProposal:NationalMedicalEnterprise&ProfessorArthurLim

1989• LetterfromDrSBKwa,PermanentSecretary(Health)/Director ofMedicalServices&ChairmanofHCSPteLtd

1990• LettertoDrSBKwa,ChairmanSNEC

1991• LettertoDrSBKwa,PS(Health)/DMS• LettertoMrYeoCheowTong,MinisterforHealth• SNECBoardPaper-20September1991• LetterfromDrSBKwa,PS(Health)/DMS• ReportonDonationsReceivedfortheNationalEyeResearchInstitute• SNECBoardPaper–8November1991

Chapter 2 35EyeResearchinSingapore:FromLaboratorytoModernInstituteby Assoc Prof Chew Sek Jin

Chapter 3 53HistoryoftheSingaporeEyeResearchInstitute(1997-2006)by Prof Wallace Foulds

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Singapore’s Research Heroes

Chapter 4 68AssociateProfessorChewSekJin

Chapter 5 76ProfessorDonaldTan

Chapter 6 82ProfessorWallaceFoulds

Chapter 7 84• DrKwaSoonBee• AssocProfVivianBalakrishnan• DrKhooChongYew• ProfRogerBeuerman• AssocProfSawSeangMei• ProfWongTienYin

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Progress of the Singapore Eye Research Institute

Chapter 8 1021999 FirstNationalEyeResearchMeeting

Chapter 9 1072000 •Chairman’sMessage• SecondNationalEyeResearchMeeting• AgendaforEyeResearchintheNewMillennium: TheRoleofOphthalmicResearchinSingapore by Dr Wong Tien Yin and Cl Prof Donald Tan

Chapter 10 1202001 • Chairman’sMessage• Director’sReport• BoardMembers• ReportontheFirstSERIInternationalMeeting

Chapter 11 1332002/2003 • Chairman’sMessage• FirstSERI-ARVOMeetingonResearchinVisionandOphthalmology

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Chapter 12 1382004/2005 • Chairman’sMessage• Director’sReport• BoardMembers• SecondSERI-ARVOMeetingonResearchinVisionandOphthalmology

Chapter 13 1462006/2007 • Chairman’sMessage

Chapter 14 147• Milestones

The Singapore National Eye Centre

Chapter 15 152• SingaporeNationalEyeCentre By Ms Charity Wai

• AttheChangeoverofLeadership(1999) By Assoc Prof Vivian Balakrishnan

Chapter 16 160• Conclusion–TheBestisYettoCome By Prof Arthur Lim

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ForthefirsttimeinthehistoryofmedicalresearchinSingapore,anareaofresearchhas attracted numerous indications that it has reached a high internationalstandard. Ophthalmic research in Singapore is now world-class, competingeffectivelywiththeresearchatthetopophthalmicresearchcentresoftheworld.

The Association of Research in Vision andOphthalmology (ARVO), themostimportantandlargestAmericanophthalmicresearchgroup,helditsfirstmeetingoutsidetheUSAinSingaporein2003,togetherwiththeSingaporeEyeResearchInstitute (SERI). Themeetingmade such a strong impression that a decisionwasmadetoholdthesecondARVO-SERImeetinginSingaporeagain.Followingthis,ARVOdecidedtoholdannualmeetingsinAsiaasmanyimportantresearchpapers come from the region. Themeetingwas renamedAsia-ARVO; the firstmeetingwasheldinSingaporein2007.

Lookingatthereportsfromboth2001and2005,notonlyweretheremorescien-tificpaperssubmitted,but therewerealsomorepapersonbasic researchandepidemiology.TheimpactfactorofthepapersfromSingaporeanresearchershasgoneuptwo levels fromoneto threeplus. Ifyou lookatsomeof theWesternjournalsandpublications,theirimpactlevelsareusuallybeloworaroundthree.ThisisareflectionofthequalityofresearchbyourSingaporedoctors.

Numerous researchers and ophthalmologists from both the developed anddevelopingnationshaverequestedtovisitSERI,andmanydoctorshaveaskedtoworkonashort-orlong-termbasisatSERI.

IamverydelightedwiththesuccessofSERI.Iwouldliketo,inthispublication,recognisethepeoplewhosupportedourgoaltoachieveworld-classstandardsinresearch.

Fifteenyearsago,IexpressedtheviewthatSingaporemaydowellintheservice,teaching,andtrainingindustries,andreachaveryhighstandardinthesefields.However, I did not think itwas possible for Singapore to produceworld-classophthalmicresearch.

Foreword

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Foreword BesidesDonaldTanandthelateChewSekJin,mycongratulationsgotoWallaceFoulds, Roger Beuerman, Aung Tin,Wong Tien Yin, and Saw SeangMei, notforgettingChengHongMing,BillLam,DeborahChee,ValerieCornilleau-Peres,MauriceYap,LimKuangHui,andVivianBalakrishnan.

Inthebeginning,therewerethreekeypeoplewhosupportedSERI.Inmypaper“InPraiseofBureaucrats,”IemphasisedthatDrSBKwa,formerVice-ChancellorofNUSLimPin,andKhawBoonWanwerethreeimportantpersonswhostronglysupported SERI. I would also like to thank the following individuals for theirsupport:JohnWongandTanChorhChuan.AndspecialthankstoDrKhooChongYewforpromotingmedicalethics;aswellasDrAngBengChong,DrAdrianKoh,CharityWai,ChiamSooLee, and JulieYeong—although theydidnotplayanactiveroleinSERI,theygaveverygoodstrongsupporttomeinmanyways.

SERIhastoattractandretainthebestresearchers.SERIhastoprovideresearcherswithadequatefacilitiesandsupportstafftocontinuewithqualityresearch.

IamdelightedthatProfessorDonaldTanhasputtogetheranexcellentteam.Iamconfidentthathewillgeneratemorefascinatingresearchinthecomingyears.

Weareproudofyou,Donald.Iwillstronglysupportyourwonderfulworkaswemoveintothefuture.

Professor Arthur LimFounding Chairman, SERI

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IntroductionTheopeningoftheSingaporeNationalEyeCentre(SNEC)in1990markedthebe-ginningofanewerainophthalmologyinSingapore.ThisprestigiousinternationaldevelopmentwasdesignedtoraisethepracticeofophthalmologyinSingaporetoaworld-classstandardandtoprovideacentreofophthalmicexcellenceforAsia.

Fromanearlystage,ProfLimrealisedthatacentreofexcellencesuchastheSNEChas tooffer thebestserviceand trainingprogramme. Inaddition, ithas tobeinnovativeandactiveinresearch,embracingtheviewthatresearchwouldbeastimulustowardsthebestclinicalpractice.Andthroughresearch,improvementsinophthalmiccarewouldbenefitpatientsseekinghelpatthecentre.

ThedevelopmentofophthalmicresearchwaswelldocumentedbythelateAssocProfChewSekJin,PhD,FRCS,thepioneerofophthalmicresearchinSingapore,withasupportingarticlebyProfWallaceFoulds,aworldleaderinocularresearchwhohasspent20yearsadvisingmeandourresearchersinSingapore.

Early Concepts of a National Research CentreInthe1970s,thethrustofophthalmicdevelopmentwasinclinicalservices,withafocusonmicrosurgeryandlensimplantation.Inaddition,varioussubspecialtiesdevelopedaroundthisperiod.In1973,tofurtherhisaimsofpushingophthalmicresearchinSingaporeforward,ProfArthurLimsoughttheadviceofProfWallaceFoulds,EmeritusProfessorofOphthalmologyattheUniversityofGlasgow,whohadsuccessfullyheadedtheTennentInstituteofOphthalmologyinGlasgowformanyyears.

Toget thingsmoving, itwasclear in1981 thatanationaleyecentreshouldbeestablished.In1983,theSingaporeEyeFoundationwasformedand,withit,thebeginningofophthalmicresearchemerged.

In 1986, Dr SB Kwa became Permanent Secretary and Director of MedicalServices(Health),andtogetherwithProfessorLimPin—Vice-ChancelloroftheNationalUniversityofSingapore—establishedtheEyeDepartmentattheNationalUniversityHospital(NUH).

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

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

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1986: Professor Arthur Lim as Founding Head of the NUH Eye DepartmentIt was clear that the Eye Department at the NUH was limited in its capac-itytobringophthalmologytoaworldstandard.WiththesupportofDrSBKwa,negotiationsbeganbetweenProfessorArthurLimandMrKhawBoonWan,Ex-ecutiveDirectorofNUH,toestablishanationaleyecentre.RapiddevelopmentwaspossiblebecauseoftheenthusiasmandstrongsupportofMrKhaw.

On1June1987,a letterwaswrittentoMrKhawBoonWanbyProfArthurLim.Thiswas thebeginningofanofficialmove toestablishophthalmic research inSingapore.

WhileSNECandSERIaretwodifferententities,theyoverlapinsomeaspects.Theoriginalplanwastoestablisharesearchinstitute.However,SNECwasstartedfirstandSERIcamelater.Therefore,eyeresearchinSingaporehasitsrootsinSNEC,whichplayedthe importantroleofbringingtogetheraresearchteamunder itsresearchunit.

Brief HistoryAt this point, it is useful to trace the brief history of ophthalmic research inSingapore.

1999–2000AssociateProfessorChewSekJinwastheactiveforcepushingresearchforward,buthisuntimelydeathinDecember1998broughtaboutconsiderableuncertaintyregardingthefutureofeyeresearch.

2000A crucial decision was made to appoint Associate Professor Donald Tan, anexcellentclinician,asdirectoroftheneweyeresearchinstitute.HeworkedveryhardtocoordinateophthalmicresearchandwasconfirmedasthedirectorofSERIin2000.

2001Thiswasan importantyear forSERI. Itwasclearby then that theobstacles toophthalmicresearchhadbeenovercomeandthatSERIcouldnowmoveforwardrapidly.

Introduction

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From the Director’s Report: InJuly2001,thethenDirectorofMedicalServices,MinistryofHealth,Professor TanChorhChuan, indicated thatSERIshould functionas thecoordinating centreforallophthalmicresearch,andshouldincludedoctorsinterestedin researchfromboththeSingaporeHealthServicesandtheNationalHealthcare Group.SERInowoccupiedtwofloorsinthenewSNECblock.

ThenewSERIfacilitieswereopenedonthefifthandsixthfloorsoftheeight- storeySNECbuildingbyMinisterLimHngKiang,MinisterforHealthand secondMinsterforFinance.Forthefirsttime,SERIwasabletobringallofits clinicalandbasicresearchactivitiesunderoneroof,intwocustom-built researchfloors,oneforclinicalresearchandtheotherforlaboratory-based research.

First SERI International Research MeetingThefirstSERIInternationalResearchMeetingwasheldatthenewSERI

facilityfrom27–30September2001.Thiseyeresearchmeetingcoincided with the opening of the newSERI facilities by theMinister forHealth, MrLimHngKiang,theguestofhonouratthemeeting.Morethan300 delegates attended themeeting. The responsewas overwhelming. The full three-day scientific programme was devoted to keynote lectures, withmorethan100scientificabstractspresentedeitheraspostersororal presentations.Thesuccessofthemeetingmarkedthegreatpotentialof ProfessorDonaldTan.

Scientific Publications in 2001Overall, Singapore’s scientific publictions improved significantly from

1991to2001.In1997–1998,therewasaslideinthefiguresforourscientific publications, due to the illness of Associate Professor Chew Sek Jin. However,theyear2000sawthebeginningofaclimbasthefiguresrose again. Most evidently, the significance of each of the scientific publications can be judged by their impact factor, which has increased from1.53 (1998) to2.4 (2001), indicating the scientific value ofthepublicationsinadditiontothesignificantincreaseinthenumber ofbasicandepidemiologicalresearch.

Introduction

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Stem CellsIn 2001, SERI embarked on stem cell research. Stem cell researchers attheOutramCampusformedamultidisciplinaryStemCellResearchGroup(SCRG)todiscussstemcellresearchcollaborationwithintheSingHealthinstitutionsanddepartmentsinthefieldofembryonicandadultstemcells.

Singapore Myopia Registry (SMR)TheSingaporeMyopiaRegistry(SMR)isanationaldiseaseregistryinitiatedby theMinistry ofHealth, set up to collect and provide information onmyopia in Singapore for the purpose of health planning, clinical qualityassurance,benchmarking,clinicalresearch,andtrackingofpatientsundertheNationalDiseaseManagementPlans.

Implementedin2002,theSMRservesasanationalresourcetotrackandre-searchtheproblemofmyopiaamongtheSingaporeanpopulation.SMRwillserveasourpopulationdatabaseforepidemiologicalresearchintomyopiaandrelatedoculardisordersinAsianeyes.

Source: Extracted from SERI Research Report 2001

2002/2003The first joint meeting between SERI and ARVO was the major internationalophthalmicresearcheventoftheyear.Thismeetingwasthefirstsuchmeetingto be held outside theUSA. It took place at the Suntec City Convention Cen-tre from 6–9 February 2003. Over 800 delegates from 36 countries weretreated to a wealth of research reports and invited lectures on cutting-edgeadvancesineyeresearch,complementedbyaseriesofworkshopsonthedesignandconductofeyeresearch. ThemeetingconfirmedProfDonaldTan’sgloballeadershipinocularresearch.

2004/2005SERIwasclearlyrecognised,intherelativelyshorttimesinceitsinception,asaworld-class development. Thus, it attracted the secondARVOmeeting held inFebruary2005inSingapore.TherewerenumerousotherindicationsthatSERI’sresearchwasnowworld-class.

Introduction

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2006/2007TheARVOdecidedtoholdannualmeetingsinAsiaasmanyimportantresearchpaperscamefromAsia.ThefirstAsia–ARVOmeetingwasheldinMarch2007.SERIcelebratedits10thanniversaryin2007.

ConclusionHavingachievedworld-classstandardinocularresearch,thereisatendencytorestonourlaurelsandbecontentedwithwhatwehaveachieved.Butifophthalmicresearch in Singapore is to continue to produce outstanding results and befeatured in leading international publications, we cannot afford to rest onourlaurels.Wemustseizeeveryopportunity.ThisisthefascinatingandchallengingtaskforDonaldTanandhisteamin2007andbeyond.

The best is yet to come. Let us never forget our pioneers who committedthemselves to research at a timewhen therewas little interest and almost noavailableinfrastructureinSingapore.

Professor Arthur LimFounding Chairman, SERI

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

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History of the Singapore Eye Research Institute

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1987

Letter to Mr Khaw Boon Wan, Executive Director, National University Hospital

1 June 1987

Mr Khaw Boon WanExecutive Director, NUH

Re: National Eye InstituteI 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 BProposal For The National Eye Institute: Background Information

TheideaoftheNationalEyeInstitute(NEI)wasmootedasfarbackas1981,whenthe Singapore Eye Foundationwas in the process of being set up. From 1983,discussions on the concept of theNEI were actively taking place between theMinistryofHealthandDrArthurLim,theoutcomebeingtheMOHReportputoutinearly1986.Sincethen,therehavebeenfurthermeetingsandnegotiations,buttodate,anin-principleapprovalisstillwanting.

TheEconomicCommitteeemphasisedSingapore’sneedtorealiseitsfullpotentialofdevelopingintoacentreofmedicalexcellencethroughthesettingupofspecialtyinstitutestoconcentrateresourcesandexpertise.However,lackofdecisiveactionis causing Singapore’s competitiveness as a major centre of excellence to beeroded,especiallyinviewoftherapidpaceofdevelopmentstakingplaceinourneighbouring countries.The concept for theTunHusseinOnnEyeHospital in

Chapter 1

The idea of the National Eye Institute was

mooted as far back as 1981

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KualaLumpuroriginatedin1981,thesameyearweconceptualisedourproposedNationalEyeInstitute.ByMarch1986,theMalaysianhospitalwasbuiltandreadytoadmit itsfirstpatients.Similardevelopmentsarealso takingplace inHongKong,Indonesia,andChina.

ThisreportaimsatrevivinginterestandgeneratingcommitmentintheNationalEyeInstituteproposal.Despitetherapiddevelopmentsinourneighbouringcountries,wemaystillhaveachanceofsuccess.Butimmediateactionmustbetaken.

I. IntroductionThedemandforhigh-qualityophthalmiccareinSingaporeandSoutheastAsiaisincreasingwiththeageingofthepopulationandrisingaffluence.Althoughsomeofourneighbouringcountrieshavealreadysucceededinsettingupeyehospitals,Singapore’sstandardofophthalmicpracticeisstillrelativelyhigher.InorderforSingaporetokeeppacewithherAsianneighbours,aninstitutewithanemphasisonbotheducationandresearchmustbebuilt.Itwillactasanucleustoconcentrateallmanpowerresources fromboththepublicandprivatesectorsfortheadvancementofophthalmologyinSingapore.

II. ObjectivesTheprimaryobjectiveoftheinstituteistoofferthehighestpossiblestandardof expertise in ophthalmology to the people of Singapore. A world-classstandard will also establish the institute as a regional referral centre. TheinstitutewillpromotecontinuingandadvancededucationaswellasR&Dinophthalmology,andwillspearheadindustry-relatedjointventures.

III. ConceptBascially,theInstitutecanbedividedintothreeparts:i. theinstituteproperii. theclinicalwingiii. thecommercialwing

i. The Institute Proper The institute proper, consisting of laboratories, lecture theatres, etc. is gearedforresearch,teaching,andcontinuingeducation.Fundstosubsidise R&DprojectswillcomefromthecommercialwingandfromtheSingapore EyeFoundation.

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


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ii. The Clinical WingThe clinical wing will consist of general, emergency, and specialist clinics.Charges should be structured in such a way that the clinical wing is self-sufficient (similar to that of the NUH). Clinical research may need to besubsidised.

iii. The Commercial WingThecommercialwingwillbethemainrevenuecentrewithspacetobeleasedoutforshops(pharmacies,opticialshops,etc.).Spacecanalsobeleasedoutforclinicaluse,e.g.ophthalmologistsandrelateddisciplines.

Since the primary objective of the Institute is to fully utilise our medicalmanpower,theconceptofthecommercialwingintheInstituteisimportant,asithelpstobreakdowntheartificialbarrierbetweenprivateandinstitutionalpractices.

IV. Business StructureTheproposal is to set up theNational Eye Institute as anonprofit-makingcompany.TheInstitutewillbeindependentlyrunbyaboardofdirectors,andwillbeself-sufficientfinancially.

Themajorconsiderationforproposingsuchastructureistheneedforpromptaction,andthisisonlypossiblewithoutbureaucraticconstraints.UnlesstheDirectoroftheInstituteisgivenafreehandtoplananddevelopforthefirstfiveyears,hiseffectivenesstopropeltheInstitutetointernationalexcellencewillbelimited.TheInstitutecanbereturnedtotheNUHafter10years.

V. Target Time-FrameOur targetcompletiondateof theNationalEye Institute is 1990,when theInternationalCongressofOphthalmologywillbeheldinSingapore.Theplancallsforimmediateaction,whichwecanapproachinthreephases:

PhaseI: Incorporate the Eye Institute as a nonprofit-making privateinstituteby1July1987.

PhaseII: Target the Institute’s interim premises to be operational by 1January1988.

Chapter 1

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PhaseIII: FinaliseplansforthepermanentlocationoftheInstituteby1July1988.

Incorporation of InstituteA draft Memorandum & Articles of Association has been drawn up (byDonaldson & Burkinshaw) for the Institute. Initially, with the Instituteincorporatedasaprivateconcern,itcanbeamended,dissolved,orabsorbediftheNUHfinallydecidestotakeovertheInstituteatalaterdate.

Interim FacilityItiscriticaltosetupaninterimfacilitytobringtogetherstaffandresources,tosetuptheorganisation,andtobuildupmomentumsothat,whenthenewbuildingiscompleted,theworkoftheInstituteisreadytotakeoff.

Chapter 1 -The BeginningHistory of the Singapore Eye Research Institute

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Joint Venture Proposal — National Medical Enterprise and Professor Arthur Lim

Numerous meetings were held to establish a private international eye centreasajointventurewiththeAmericanhealthcarecompany,theNationalMedicalEnterprise, which owns Mount Elizabeth Hospital (MEH). There were alsonumerousmeetingswithotherprivatemedicalinstitutionsincludingtheBalestierHospital,theYoungbergHospitalwhichhadaneyedepartment,andtheeyeclinicofDrOhThiamHockatHillStreet.Thereweremanydiscussionstotransformoneoftheseintoamajoreyecentre.

ThereweremanymeetingswithMrMichaelFord,VicePresidentof theAmeri-canhealthcarecompany,NationalMedicalEnterprise,whichownedMEH,andDrDallasRiddle,itsChiefExecutiveOfficer.

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, NMEMr Dallas Riddle, CEO, MEHMr Dennis Brown, ADMIN, MEHMs Chiam Soo LeeMs Joni Low

1. 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.

1987

Chapter 1

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Letter from Dr SB Kwa, Permanent Secretary (Health)/Director of Medical Services & Chairman, Health Corporation of Singapore Pte Ltd

InFebruary1989,DrSBKwa,PermanentSecretary(Health),DirectorofMedicalServices(Health),andChairmanofHCSPteLtd,appointedProfArthurLimastheMedicalDirector-designateoftheSingaporeNationalEyeCentre.

23 February 1989

Dr Arthur LimChief, Dept of OphthalmologyNUH

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.

Yours sincerelyDr Kwa Soon BeeChairmanHCS Pte Ltd

\

1989

I would 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.


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14 April 1990

Dr S B KwaChairman, SNEC

RE: INSTITUTE OF OPHTHALMOLOGYThe 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.

1990

Letter to Dr SB Kwa, Chairman, SNEC

Soonafter that,MrYeoCheowTong,thentheHealthMinister,hadaone-hourprivatemeetingwithmeathisofficeanditwaswiththesupportoftheMinister,togetherwiththedeterminationofDrKwa,thattheSNECwasformed.ItcanbesaidthatDrKwaplayedthemostimportantroleintheestablishmentoftheSNECandlatertheSingaporeEyeResearchInstitute(SERI),supportedbyMinisterYeoCheowTong.MrKhawBoonWanandImetalmosteveryweektoestablishthenumerousdetailsessentialforthesuccessofthedevelopment.

Initially,itwasdecidedtoestablishSNECasaserviceandteachingcentrewitharelativelysmallsectiononresearch.Itwasclearthatresearchhadtobedeveloped;andon14April1990,ImadeastrongrecommendationtoDrKwatoestablishtheInstituteofOphthalmology(ortheSingaporeEyeResearchInstitute).

Chapter 1

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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?

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

1990

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.


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15 July 1991

Dr S B KwaPS (Health)/DMS, Ministry of Health

EYE RESEARCH INSTITUTEI 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.

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.

1991 Letter to Dr SB Kwa, Permanent Secretary (Health)/

Director of Medical Services, Ministry of Health

Chapter 1

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.

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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

Prof Arthur LimMedical Director, SNEC

1991


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13 August 1991

Mr Yeo Cheow TongMinister 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.

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

Letter to Mr Yeo Cheow Tong, Minister for Health

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.

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1991Singaporeans 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.

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.

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)

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


32


OPERATION PLANS BY ARTHUR LIM AND CHARITY WAIBoardPaper : 20September1991Subject : NATIONALEYERESEARCHINSTITUTE

1. Following the proposal on the establishment of the National EyeResearchInstitute(NERI)submittedatthelastboardmeeting,furtherdiscussionswereheldontheconstitutionoftheproposedNERIandthedetailsonleaseoflandandfundingofdevelopmentandrecurrentexpenditure.

2. Onemajorconcernisthelong-termviabilityofNERIintermsoftherecurringexpenditure for runningcostsandgrants for theresearchprojects.AnotherimportantconsiderationistheneedtofostercloselinkswiththeUniversityforbasicresearch.

3. With the proximity of NERI to the SNEC, there are advantages ofsharingcommonfacilitiesandcorporateservicesbetweenSNECandNERI.

4. Taking into account the above factors, the following structure isproposed:4.1 NERIbesetupwith50/50participationofSNEC/MOHandNUS/

MOE;4.2NERIbeinstitutedasanextensionoftheSNEC. Theabovestructurewillensurecontinuedgovernmentsupport and funding for research, joint development, and high-level cooperation between SNEC and NUS, as well as achieving a symbioticrelationshipbyintegratingNERIwithintheSNEC.

5. FundsrequestedforNERIareasfollows:5.1 A capital grant of $9 million from the MOF for building and

equipmenttomatchthe$3millionprivatedonationscollected;5.2 GrantforrecurrentexpenditurefromtheMOFof$500,000per

yearfor6years.

6. FortheBoard’sdiscussionandapproval

SNEC Board Paper

The National Eye Research Institute

be set up with 50/50 participation of

SNEC/MOH and NUS/MOE.

Chapter 1

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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 KwaPS/DMS

Report on Donations Received for the National Eye Research Institute

Name of Donor Amount of Donation & Date Received / Confirmed

1.ShawFoundation $1million receivedon27.12.90andcreditedtothe MOHEndowmentFund

2.LeeFoundation $200,000 receivedon14.2.91andcreditedtothe MOHEndowmentFund

3.HongLeongFoundation $1millionconfirmedon23.7.91 Donationintwoinstalments: 50%byend1991and 50%byend1992

4.DrsALim,AngBC& $200,000KhooCY between3–5years Confirmedon26.6.91

Total: $ 2.4 million

1991


34


OPERATION PLANS BY ARTHUR LIM AND CHARITY WAIBoardPaper : 8November1991Subject : PROGRESSREPORTONPROPOSEDNATIONAL EYERESEARCHINSTITUTE(NERI)

1. Following the lastBoarddiscussion, the appropriate corporate structure oftheproposedNERIhasbeenfurtherdiscussedwithMOH(Dev)Officers.

2. ProposedConstitution Thetwooptionsbeingexploredareasfollows: (A) incorporate as a separate tax-exempt private company limited by guarantee; (B) setupasasubsidiaryofSNEC. 2.1 ProposedModelofConstitution OptionAtoinstitutetheNERIasaseparateentityispreferred,asthere are fundamentaldifferencesbetween runninga clinical service and conducting research: the latter does not attract earnings and is oftenpursuedforaltruisticreasons.Therefore,organizationally,itis bettertoseparatethetwoactivities.Aseparateentityasanapproved InstituteofPublicCharacter(IPC)willalsoallowNERItoraisefunds forresearchdirectlyratherthanhavingtochanneldonationsthrough theMOHEndowmentFund inorder for thedonations toenjoy tax exemption.Ingeneral,donorsaremorepreparedtogivetowardsa specificpurposeandaspecificentitythantoageneralfund. The constitution of the Academy of Medicine, which has been incorporatedasacompanylimitedbyguarantee,isbeingstudiedas amodelforNERI.AcopyoftheConstitutionisattachedinAppendixA forinformation.Theimplicationsoftheconstitutionandtax-exempt statuswillbediscussedwithbothourlegalandtaxadvisors.

2.2 LinkswiththeNUS 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 researchwhich is expensive to duplicate. It is thereforeproposedthattheresearchinstitutebe50/50ownedbythe SNEC/MOHandtheNUS/MOE.This requires thesupportofboth theMOHandtheMOEforNERI.AjointDPCpaperwillbeputupfor governmentsupportandfundingforNERI.TheSNECwillundertake thedraftingoftheDPCpaperoncedetailsonthestructure,physical requirements,andfundingarefinalised.

SNEC Board Paper

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EyeResearchinSingapore:FromLaboratorytoModernInstitute

TherapidpaceatwhicheyeresearchhasdevelopedinSingaporeisunprecedentedandnothingshortofamiracle,viewedagainstabackdropofophthalmicvisionandresearch.

A Modest HeadstartThestoryofeyeresearch inSingaporebeginswithaquietstart inasmallandunpretentious laboratorywiththeworkof theunassumingDrLimKuangHui,aalso the editor of this timely book.Huddledover a bench in theMicrobiologyDepartmentofthethenUniversityofSingapore,DrLimisolatedanewstrainofpicornavirusresponsibleforanoutbreakofepidemickeratoconjunctivitisin1970.Thismayseemtobeamoderatelynotablebreakthroughatfirstglance,butitisindeedalandmarkinthehistoryofSingaporeeyeresearchonseveralcounts.

First,Dr Limwas already an establishedophthalmologist, buthewasworkingon basic science whereas his colleagues could not be separated from theoperatingtheatre.Second,hewasthen,andremainstoday,thesoleSingaporeanophthalmologist to be awarded the degree of Doctor ofMedicine. Third, andnot least of all, he discovered a new cause of amajor eye disease. In fact, allliteraturesearchonpicornaviraleyeinfectionbeginswithafirstreferencetoDrLim’sdiscovery—themoreremarkablebecausethistookplaceinanerawhensurgeons rapped the glovedhandsof their disciples for the slightest deviancefromdogmaandestablishedpractice.

ByAssocProfChewSekJin, PhD, FRCSE

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. aTwo 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.

Chapter 2

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36


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

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Sincethen,thevaluedletters“MD”haveyettobeattachedtoanySingaporeanophthalmologist,neitherwerethereanyboastsofthehighestrankingsforresearchpublications of any department in any governmental hospital. Under thestewardship of its Deputy Medical Director, Dr Donald Tan, the SingaporeNationalEyeCentre’s(SNEC)ClinicalResearchUnitnotonlynurturedexpertiseinclinicalstudies,butalsoattractedcommercialresearchwithbothforeignandhome-growntechnology.Notsurprisingly,thishumofresearchactivityhasbubbledovertomakewayforanother“baby”—theSingaporeEyeResearchInstitute.

The Birth of the Singapore Eye Research Institute: 1997In every age, we find the residue of the past and the seeds of the future.On1January1997,theemergenceoftheSingaporeEyeResearchInstitute(SERI)markedthegerminationofseedsplantedyearsagobyProfArthurLim.

Under his chairmanship, SERI has grown from its initial role as SNEC’s basicsciencedivisiontoanindependentnational institute,withafive-yearbudgetof$25million,allinthespaceof18months.

SERI is now affiliated with the SNEC, the National University of Singapore(NUS),andtheNationalMedicalResearchCouncil(NMRC).ModelledaftertheNationalEyeInstituteoftheUSA,SERIconductsintramuralresearch.Thus,SERIhasevolvedintotheexecutivearmoftheNMRCforeyeresearch.It istheonlysuchnationalresourceandorganisation,amongstallmedicaldisciplines,witharesponsibilitytocoordinateophthalmicandvisionresearchundertheauspicesoftheNMRC.

Inaddition,SERIcoordinatesophthalmicresearchandintegratesresourcesfortheDefenceMedicalResearchInstitute(DMRI),theNationalScienceandTechnologyBoard,andtheSingaporePolytechnic.

Internationally, SERI is the headquarters of theMyopia International ResearchFoundation and operates Bausch & Lomb Singapore’s research laboratorieshere.

ItalsoundertookaMemorandumofUnderstanding(MOU)withHarvardMedicalInternational, theInstituteofSystemsScience(currentlytheKentRidgeDigitalLaboratories),XiamenEyeCentre,andAVIMOOpticoElectronics.

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.


1991

38


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.

Chapter 2

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

The Goals and Missions of SERISERI conducts applied and basic research in myopia, glaucoma, diabeticretinopathy,andotherdiseasesuniquetoAsia.Itsprimefocusisonthegreatestnational and regional problem—myopia. SERI provides an infrastructure tocomplement and facilitate clinical research undertaken at SNEC and otherinstitutions involved in the study of visual disorders.Moreover, SERI overseesandmaintainsscientificandethicalstandardsforclinicalandbasicresearchinophthalmology in Singapore. Working with governmental and private groups,SERIpromoteshealtheducationonmyopiaaswellasdevelopsprimarycareandpreventiontechniquestocombatthedisorder.

The SERI LogoThe SERI logo is red, the colour of blood, the essence of human existence. Ithighlights our aim of benefiting humanity. The eye is recognisable by the raydiagramwithparallel lightrays fromdistantobjectsbeingfocusedthroughthecorneaand lens in theeye.Myopiceyedisease is reflectedby theopticsofanelongated myopic eye, representing Singapore’s most common eye problem.Thus, this signifies SERI’s focuson eye diseases, the treatment ofwhich is ofcriticalbenefitinSingapore.

Prelude: 1970s–1986Between the late 1980s and 1986, clinical training at the Singapore GeneralHospital (SGH) was supplemented by formal after-hours tutorials at ProfArthurLim’sprivateclinicatMtElizabethHospital.Hispersonalpatientswerepersuadedtocontributetotheeducationofthetrainees.Thus,theywerefednotonlyintellectually,butalsogastronomically,outofProfLim’spockets.Thecasepresentationsenforcedon theyoungmindsacrisp logicanddiscipline.Thesebecame the cornerstones for enquiring minds who questioned why the localpatternofeyediseasesdifferedsogreatlyfromthatfoundinDuke-Elder’sSystem of Ophthalmology.

Gathering a Team: 1986–1990Arthur Lim’s unique gift as a “fisher of men” won him the reward of beingappointed to head the new Department of Ophthalmology at the NationalUniversityHospital (NUH).Thisprovideda vehicle for thegatheringof anewteamandthebirthofformaleyeresearchinSingapore.Itwasanunostentatiousstart.Thedepartmentcomprisedfourfull-timeresidents,backedbycommittedvisitingconsultantswhosharedProfLim’svision.

SERI


39

Quality assurance was integrated into clinical practice to raise the prevailingclinicalstandards.ThisclinicalaudithassinceservedasthemodelforensuringqualitysurgicalcareinSingapore.TheseweretherootsonwhichtheSNECbuiltitsclinicalauditsystem,whichhasinturnbecometheenvyofotherdisciplines.WiththissysteminplaceatNUH,patientdataandsurgicaloutcomeswereeffectivelycapturedandfedamechanismforgeneratingcasereports.

At this time, Prof Lim achieved a milestone in glaucoma research with hisobservationthat theprevalenceofangleclosureglaucomawasfourfoldthatofopenangleglaucoma.Thiswasacompletereversalofestablisheddogma.Thehighpriestsoftheophthalmiccommunitywereincensedwiththisupstartdefyingconventionalwisdom.Ashasbecomearecurringtheme,ArthurLimwasprovenright. Enthralled by this early success, budding ophthalmologists found newconfidence in the ability of Singapore-bred doctors to exceed the standards ofBritishtraininganddogma.Thus,anichewascreatedinwhichSingaporebegantoestablishitsuniqueroleininternationaleyeresearch.

Professor Wallace Foulds, the first visiting Professor of Ophthalmology, sub-sequentlyjoinedthedepartment,andwas—andremainstoday—amentorandguideforclinicaltrainingandresearch.

In1987,seniorresidentChewSekJinwasawardedtheGoldMedalfortheFRCSexaminations.Atthecloseof1990,heleftSingaporetopursueresearchtrainingintheUSA.AthisfirststopwithProfessorsHerbertKaufmanandRogerBeuermanoftheLouisianaEyeCenter,hecontributedtothedevelopmentoftheophthalmicconfocalmicroscope.ArmedwithaMScinophthalmicanatomy,hewentseekingthe“truth”,stoppingattheRockefellerUniversityinNewYork,wherehefoundhimselffacingacommittee,chairedbyProfTorstenWiesel,whowasresponsibleforhisPhDthesis.

At the same time, he engaged in glaucoma research at theNewYorkEye andEarInfirmarywithProfRobertRitchandinthebasicscienceofmyopiawithProfJoshWallman.Hewasappointedvisitingprofessoratbothinstitutions,andbothmentorsthoughthewasworkingfull-timewitheachofthem.SuchvaluabletieshavegivenSingaporeasoundscientificreputationintheUSAandanestablishedbeach-headintheNewWorld.

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....


40


TheseformativeyearsalsosawthebirthandmaturityoftheSNEC,propelledbyanewgenerationofleadersinophthalmologywhowerehand-pickedandnurturedbyArthurLim.

The Essential Faces and Places of SERI

The Faces of LeadershipTheSERIBoardofDirectorsbeganwiththeoriginalduoofProfArthurLimandhisdeputy,AssocProfChewSekJin.Buttowardsthecloseofthefirstfreneticyear,ithadgrowntoitsfullstrengthofnine.

TheacademicinputandNUSrepresentationcamefromtheyouthfulanddynamicnewDeanof theFacultyofMedicine,AssocProfTanChorhChuan.AdditionalacademicexpertisewasprovidedbyProfessorChuaNamHai,Chairman,InstituteofMolecularAgrobiology,whichalongwithProfChuaprovidedSERIwithamodelfor success in innovative industrial and commercial research. Professor Chua,whoholdstheprestigiousAndrewMellonProfessorshipatRockefellerUniversity,isalsoaboardmemberof the InstituteofMolecularandCellBiology (IMCB),NUS.

SERI’ssecretary,DrTanChorHiang,sitsontheboardoftheNationalMedicalResearchCouncil,whichistheIMCB’sfoundingandsupportiveparent.DrTanalsodirectsthePlanningDepartmentoftheMinistryofHealth.

The inclusion of Colonel (Dr) Lionel Lee, theDirector of theDefenceMedicalResearchInstitute(DMRI)andChiefoftheArmyMedicalCorps,wasbyvirtueoftheclosecollaborationsandjointprojectsonmyopiawiththeMinistryofDefence.Then,therewerethethreemembersoftheSNECwhomadecriticalcontributionstowardsfullyintegratingclinicalpracticewithresearch:MrWongYewMeng,SNECChairman,whochairstheSERIFinanceCommittee;andthetwoDeputyDirectorsofSNEC,DrDonaldTanandDrVivianBalakrishnan.

The Researchers and AdministratorsAsSERI’sChairmanandDirector,ProfessorArthurLimappliedhischaracteristicresourcefulnessandpersistencetopursuingandrealisinghisgoalofprovidinganinfrastructureforeyeresearchtosolvetheproblemscausedbymyopiaandothercommoneyediseasesinAsia,thusbreathinglifeintoophthalmicresearch.

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 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.

Chapter 2

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41

AsSERI’sfirstfull-timestaffmember,AssocProfChewSekJinsawtothegrowthofSERI,fuellingitsrapidgrowthintoanationalorganisationwithinlessthanayear.Thiswastheresultofhisdedicationtomyopiaresearchandclosecollaborations,locallyandinternationally.Hisareasofinterestincludedthedevelopmentofopticalinstruments,myopiapreventionandnon-surgicaltreatment,andocularphysiology.

SERI’sadviserProfWallaceSFoulds,CBE,complementedProfLim’smacroscopicview of theworldwith careful scrutiny andmicroscopic review. Foulds helpedguidetheteamforwardtowardsinternationalresearch.

Inanothercapacity,MsCharityWai,SNEC’sunflaggingadministratorandmemberofthemanagementboardofSERI,undertooktheformidabletaskofputtingSERIon its feet.Formonths, sheshuttledbetweenaccountants,doctors, scientists,architects,lawyers,andhealthministryofficials.

SERI’s administrative arm is headedby itsmanager EstherChu,whose variedexperience and skills were harnessed to meet the myriad challenges facedin building the laboratories and clinical facilities from scratch. Her previousexperience as an architect, administrator (MBA), and laboratorymanager andassistanthasprovedinvaluable.SheisalsotheManagerofSingaporeR&DforBausch&Lomb,whoselaboratoriesarecloselylinkedwithSERI.

Therewasacriticalneed forSingapore toshakeherselfoutofastateofnear-oblivionintheareaofeyeresearch.Thebigmoveforwardcamein1996,whenAssoc Prof Chew scoured the world for talented ophthalmologists who werecommittedtosolvingcommoneyeproblemsinAsia.

Thehuntresultedinthearrivalin1998ofProfChengHongMingfromHarvardMedicalSchool,asSERI’sheadofresearch.HispioneeringworkinMRIandMRspectroscopyaswellascontactlensdevelopmentledtoquickadvancesinmyopiaresearch.ProfessorChengcontributed to theorganisationof commercial linksandjointprojectswiththeHarvardMedicalSchool,andtothedevelopmentofnewSERIclinicsandlaboratories.HeandAssocProfChewhelpedtobuildSERIandholdthefortfromthestart.

SERI’s prime focus onmyopia was given a further boost by the arrival of DrDeborah 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.


42


College School ofMedicine at StMary’s campus,UK, she brought a string ofcredentials. She helped design clinical trials for the treatment of myopia andconductedepidemiologicalsurveys,whileworkingsimultaneouslyonadoctorateintheepidemiologyofmyopia.

ProfessorBillLamjoinedSERIinJuly1998asChiefScientist.TheformerScientificLaboratory Director of the Department of Ophthalmology and Visual Science,University of Hong Kong, came with previous experience at the University ofTexasHealthScienceCenter,AlbanyMedicalCollege,andtheRetinaFoundationinBoston.ProfessorLamprovidedexpertiseinanalyticalbiochemistryanddrugdevelopment, and also contributed to a new postgraduate scientific trainingprogramme.

HewasfollowedcloselybyDrValarieCornilleauPeresfromtheCNRSCollegedeFrance.Herworkinvisualpsychophysics,3Dvision,opticaldesign,andcomputervisionprovidesnewexpertiseontheopticalmanagementofmyopia.

DrMauriceYapbringswithhimhismaininterest—theroleofthelensinmyopia.Thismulti-taskingseniorscientistofSERI,whohasdirectedtheCentreforVisionResearchattheUniversityofAuckland,hasbeenheadingtheOptometryCentreattheSingaporePolytechnicsince1997.DrYapisalsotheprincipalinvestigatorofthejointstudyonmyopiabetweenXiamenEyeCentreandSERI,andiscreditedwithleadingthewaytoabetterunderstandingoftheroleofnearworkandstresssteroids.

Bytheendof1998,SERIhadmorethan30full-timestaffandfiveresearchfellowsfromMyanmar, China, Hong Kong, and Japan. The six administrative officerscoordinate five clinics in separate locations, two laboratories, and the generaladministrativeoffice.TheexperiencedNursingManagerPeckChyeFongmanagesthefourteamsofoptometrists,nurses,andtechnicians,allservingamultitudeofprojects.

Manyofthestaffarepreparingforhigherdegreesviaresearch.Inaddition,SERIalso provides one to three months of practical research experience for NUSmedicalstudentsaswellasforpolytechnicstudentsmajoringinbiotechnologyandoptometry.

SERI’s adviser Prof Wallace

S Foulds complemented Prof Lim’s macroscopic

view of the world with careful scrutiny

and microscopic review.

Prof Foulds helped guide the team

forward towards international

research.

Chapter 2

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

SERI


43

GraduatestudentsatSERIwhoarepursingMScandPhDdegreesarefrombothSingaporeandabroad,i.e.asfarasJohnsHopkinsUniversityandImperialCollegeinLondonandasnearasTheChineseUniversityofHongKong.

The Adjunct Faculty: The Part-timersDrLimKuangHuiwouldbejustlyproudthathislegacyofmicrobiologyresearchhasbeenhandeddowntoDrChanTatKeong.Thisnew-generationophthalmologisttrained for two years at the famed Wilmer Ophthalmologic Institute at JohnHopkinsUniversity.After a full yearof clinical corneal experience,he spent anunprecedented second year researching the use of PCR for diagnosing fungalkeratitis.HeisnowtheacknowledgedocularmicrobiologistinSingapore.

Complementingandsupportinghisworkishiswife,DrSawSeangMei,whoholdsaMPHfromtheSchoolofHygieneandPublicHealth,JohnsHopkinsUniversity.HerrecentPhD,basedonastandardisedquestionnaireforriskfactorsinmyopia,isamajorcontributiontothefield.

TheyoungDrWongTienYinisSingapore’sfirstresidenttoreturnwithaMPHfrom Johns Hopkins University, achieving this distinction before starting hisresidency, which he is now completing. At the same time, he is undertakingresearchinthepathologyassociatedwithhighmyopiaandispreparingforaPhD.

International LinksIn 1997, SERI established collaborations with colleagues from Johns HopkinsUniversityandHarvardUniversity,SchepensEyeResearchInstitute,theNewYorkEyeandEarInfirmary,theInstituteofOphthalmologyandMoorfieldsEyeHospitalinLondon,CityUniversityofNewYork,LouisianaStateUniversityEyeCenter,XiamenEyeCentre,NationalTaiwanUniversityHospital,ChineseUniversityofHongKong,KanazawaMedicalUniversity,andtheNewEnglandCollegeofOptometry,whereAssocProfChewSekJinsitsonthescientificadvisoryboardoftheMyopiaCenter.SERIhasMOUswithmostoftheseinstitutionsaswellasongoingresearchprojects.That SERI was able to produce scientific results before finding a permanentlocation isdue topremisesoffered toSERI subunitsby research collaboratorsbetween1996and1999.Thus,8,300sqftofspaceisnowbeingusedtoserveitsclinicsandlaboratoriesattheSchoolHealthService(SHS)inOutramRoad,NUS,theInstituteofHealth,SGH,SingaporePolytechnic,andofcourseSNEC.Infact,SERI’sadministrationofficeisbeinghousedinacontainercabinuntilthebuildingsarereadyforoccupation.


44


SERI’s laboratory inNUShasfacilitiesformicrobiology,tissueandcellculture,protein chemistry, microscopy, molecular biology, HPLC, and experimentalsurgery,andananimalholdingunit. Italsooffersscanning, transmission,andenvironmentalelectronmicroscopy.

SERI’scomprehensiveclinicalfacilitiesincludemultiplerefractionlens,automatedperimetry,Scheimpflugphotography,slitlampandfundusphotography,cornealphotography,ultrasoundbiometry,contactlensfitting,aswellasevaluationandelectrophysiology.

The clinicshoused in theMinistry ofHealth,NUS, andSingaporePolytechnicprovideacontinuousstreamofenthusiasticvolunteersforclinicaltrials,whichofferthebenefitofinnovativetreatment.TheJointVisionLaboratoryofSERI,DMRI,andtheSingaporePolytechnicOptometryCentrewasaboldnewrelationshipofconverginginterestsservingtoinvestigateandtreatophthalmicdiseasesrelatedtomyopia.

Myopia: SERI’s Prime Reason for ExistenceMyopiaisapublichealthprobleminmanyAsiancountriesandthetopophthalmicdiseaseaftercataract.Thismeansthatsignificantmanpowerandresourcesareexpendedonopticalservices.Theocularcomplicationsofmyopiacanbecomeanevengreaterfinancialburdentobothindividualsandsociety.InSingapore,optimalemploymentforNationalServiceisalsoaffectedbecausemyopiaunnecessarilyexcludesotherwisehealthyandcapableyoungmenfromcombatduties.

Recentdatashowthat50%ofPrimarySixstudentsaremyopic,with8%exceeding6D.Inresponsetorequestsbythehealthanddefenceministries,SERIhasformedanationalcommitteetomanagethisepidemic.Thenationalplanisthefirstintheworldtoimplementaboldholisticstrategytoreducemyopia.

Measures include behaviour modification, optical devices (progressive addpowerspectaclelensesandrigidgas-permeablecontactlenses),anddrugssuchas topical atropine and pirenzepine. As part of this multi-pronged approach,clinical trialsareunderway involvingnationaland international institutions likethe DMRI, SHS, SNEC,Ministry of Education, Johns Hopkins University, andNationalTaiwanUniversityHospital.

Chapter 2

SERI


45

Myopia: a Far-sighted ScopeSERI’s research programme is comprehensive in addressing prevalent eyediseasesinAsia.Itsbroadrangecoversepidemiology,visualpsychophysics,drugdevelopment,multinational studies,genetics,mechanical engineeringsoftwaredesign, optical engineering, and clinical evaluations. This researchhas alreadyresultedin46abstracts,5bookchapters,and10journalpapersinthe18monthsofSERI’sexistence.

SERIhasexpandedtotargetafutureroleastheFDAinAsia.ThiswouldensurethattheproductsofresearchinSingaporeattainthestandardsandbenchmarksset by the FDA, as the endpoint for development, and the key to successfulproductionandmarketing.

Workingwith theEconomicDevelopmentBoardand theNationalScienceandTechnologyBoard,thenation’stwopowerhousesforgrowth,SERIisdevelopingtheexpertiseandfacilitiestoservicein-houseprojectsandtoattractinternationalresearch.TheophthalmicindustrialgiantBausch&Lombhasitsfirstandonlyoutsourced R&D laboratory at SERI. In addition, SERI organises professionalconferencesandprovideseyescreeningasapublicservice.

SERI in the Next MillenniumAs the year 2000 looms ahead, themajor challenges facing theworld are thegreying population, the Millennium Bug, and monopolistic software giants.There is even talkabout theSecondComing,which threatens tomakeall elseirrelevant.

Paradoxically,theseconcernshavepropelledSERIfromstrengthtostrengthandwillcontinuetodoso.TheeconomicdownturnhasheightenedAsianpragmatism,astrengthandvirtuethatSingaporeisfortunatetopossess.Furthermore,adversityhasreinforcedexpertiseandsupportforappliedclinicalresearch,bothintherapyfor diseases with maximal socio-economic impact (such as myopia) and incommercialR&D.Ratherthanwaningininternationalinterestandcommitment,thedevelopmentofeyeresearchinSingaporehasincreasedapace.

It isSERI’sdestinytocontributetotheunderstandingandcureofmyopia, thegreatesteyeproblemthattheworldhaseverknown.SERIhaseagerlyacceptedthechallenge.


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.

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

Source: Singapore National Eye Centre: The First Ten Years 1990–2000

46


Chapter 2

How a New Virus was Discovered in Singapore in 1970By 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.

IntroductionWhat 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 SingaporeAHC 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.

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DiscoveryFrom 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 VirusOur 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 VirusLess 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 DiscoveryAll 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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The First and The Last WordDr 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 Yip-Murphy 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.”

ResearchI 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. ChatterjeeS,QuaracoopomeCO,ApentengA,AnepidemicofacuteconjunctivitisinGhana.Ghana Med J,1970;9;9-11.

2. KonoR,SasagawaA,IshiiK,SugiuraS,OchiM,MatsumuyaH,UchidaY,KamoyamaK,KanekoM,SakuraN,Pandemicofanewtype

ofconjunctivitis.Lancet,1972;1:1191-1194.

3. LimKH,Yin-MurphyM,AnepidemicofconjunctivitisinSingaporein1970.Singapore Med J,1971;12:5,247.

4. Yin-MurphyM,LimKH,AnepidemicofconjunctivitisinSingapore.Lancet,1972;2:857-858.

5. IshiiK,UchidaY,MiyamuraK,YamazakiS,Acute Haemorrhagic Conjunctivitis.UniversityofTokyoPressIX,1989.

Chapter 2

Source: Leading Lights in the Asia-Pacific, 2006

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The End of KnowledgeBy 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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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 tell-Though 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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Source: Leading Lights in the Asia-Pacific, 2006

Chapter 2

The EndThe 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.

EquipoiseFinally, 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.

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HistoryoftheSingaporeEyeResearchInstitute(1997–2006)ByProfWallaceSFoulds,DSC, FFCS

TheSingaporeEyeResearchInstitute(SERI)hasonlyashorthistory,butduringthealmosttenyearsofitsexistencehasalreadyachievedaninternationalreputationforitsresearchoutputandforthequalityofitsresearch.

SERI’soutputofpeer-reviewedpublications,mainlyinjournalswithahighimpactfactor,hasgrownsteadilyovertheyears.AmeasureofthestatusthatSERIhasachieved is its recognition by the Association for Research in Vision andOphthalmology(ARVO)asanorganisationfittohostthefirstinnovativecombinedSERI/ARVOmeetingoutsideoftheUSA.

ThefirstSERI/ARVOmeetingthatwasorganisedinSingaporein2003bySERIattractedparticipantsfrom33countries,andthispromptedARVOtorepeattheexerciseagainin2005.ThissecondSERI/ARVOattractedsome750participantsfrom36countries.Anotherjointmeetingisplannedfor2007.

ARVOwassoimpressedbytheenthusiasmshownbysomanyresearchersfromalloverAsiawhotookpart inthe2003and2005meetingsthat itwasdecidedthat,althoughthe2007meetingwouldbeorganisedinSingaporebySERI,thenameofthemeetingwouldbechangedtoASIA-ARVOandsubsequentmeetingswouldbeheldinvariouslocationsthroughoutAsia.Inthisway,SERI’strailblazingefforthasbeengreatlytotheadvantageofophthalmicresearchinAsia.

1990marked the beginning of a new era in ophthalmology in Singapore withthe opening of the Singapore National Eye Centre (SNEC). This prestigiousdevelopment,thebrainchildofProfessorArthurSMLim,wasdesignedtoraisethepracticeofophthalmologyinSingaporetoaworld-classlevelandtoprovideacentreofophthalmicexcellenceforSoutheastAsia.

Chapter 3

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

Professor Wallace S Foulds

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Originally,itwasProfessorLim’sintentionthattheSNECbeestablishedontheNationalUniversityHospital(NUH)campusincloseproximitytotheextensivecampusoftheNationalUniversityofSingapore(NUS).Butasitturnedout,theMinistry of Health which was responsible for the Singapore General Hospital(SGH)wasthefirsttooffertherequiredfundingforthenewdevelopment;andasaresult,SNECwaslocatedontheSGHcampus.

AsHeadoftheClinicalDepartmentofOphthalmologyatNUH,ProfessorLimhadinitiatedaprogrammeofqualityassuranceintheophthalmicpracticeofNUH,animportantandatthattimeinnovativefeaturecontinuedintheSNEC.Thispatternofqualityassuranceentailedtheaccuratedocumentationofallcases,especiallythe assessment of outcome measures in relation to management strategiesemployed.Theinformationsogatheredformedthebasisofanincreasingnumberofpublishedcasereportsandclinicalstudies.ItwastheincorporationofqualityassuranceintothepracticeofophthalmologyintheSNECthatprovidedthefirstimpetustothedevelopmentofclinicalophthalmicresearchinSingapore.

Fromtheoutset,clinicalresearchintheSNECwasencouraged.Thevolumeofclinical researchpapersandcasereportspublishedattestedto theenthusiasmwithwhichthechallengeofclinicalresearchwasmetbySNEC’sjuniorandseniorstaff.Indeed,theSNECheldthedistinctionofgeneratingthegreatestnumberofresearchpublicationsinanygovernmenthospitaldepartmentinSingapore.

Eventually, clinical research in SNECwas organisedwithin a Clinical ResearchUnitundertheleadershipofDrDonaldTan,atthattimeaconsultantintheSNECandsubsequentlyitsDeputyDirector.Asiswellknown,DonaldTanisnowafullProfessorinNUSandthesuccessfulDirectorofSERI.

Advances in human affairs are often the result of one man’s vision. Theestablishmentof theSNEC,andmore recentlySERI,undoubtedlysprang fromthevisionofProfessorArthurLim.

PriortotheinceptionoftheSNEC,therewaslittleophthalmicresearchinSingaporewiththeexceptionofoccasionalsignificantcontributionsfromafewindividuals.Onesuchdiscoverywastheone in1970byDrLimKuangHuiofanewstrainofpicornavirus,thecauseofanoutbreakofepidemickeratoconjunctivitis.Untilrecently, hewas the only ophthalmologist in Singapore to have been awarded

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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anMDbytheNUS.Morerecently,ProfessorArthurLimwastherecipientofanHonoraryMDdegreefromNUS.

Fromanearlystage,ProfessorLimrealisedthatacentreofexcellencesuchastheSNECnotonlyhadtoofferthebestincurrentophthalmicmedicalandsurgicalpractice,butalsohadtobeinnovativeandactiveinclinicalandbasicophthalmicresearch.Quiterightly,heheldtheviewthatresearchwouldbeastimulustowardstheestablishmentofthebestophthalmicpracticeandthedevelopmentofnewandeffectivetherapeuticstrategies.

Inabout1993,theSingaporeGovernmenthadbecomeawarethatmedicalresearchandresearchinanumberofkeyareassuchasbiotechnologyandinformationtech-nologywere likely tobe important in relation toSingapore’s futureeconomicwell-being.

ThegovernmenthadalsobecomeawareofthehighandincreasingprevalenceofmyopiaamongtheSingaporeanpopulationthatwashavinganadverseeffectonrecruitmenttotheSingaporeArmedForces(SAF)andmoreparticularlyonthetrainingofAirForcepilots.

AspartofitsplanstopromotemedicalresearchinSingapore,theGovernmenttook adecision to set up aNationalMedicalResearchCounci (NMRC), tobemodelledtosomeextentontheMedicalResearchCounciloftheUnitedKingdom.The NMRC was to be government-funded and would be responsible for theconductandfundingofallaspectsofmedicalresearchinSingapore.

To assess thepotential formedical research inSingapore and the likely costs,thegovernment,throughtheMinistryofFinance,askedeachofseveralidentifiedspecialties(including ophthalmology) to prepare an account of what researchmightbeconductedwithinindividualspecialtyareaswithanindicationofwhatcostswouldbeinvolved.ProfessorLim,admittingthathehadnodirectexperienceintheorganisationorconductofresearch,soughttheadviceofProfessorWallaceFoulds,whowaschargedwiththepreparationofadocumentoutliningtheareasofresearchinophthalmologythatmightbepursuedandgivinganestimateoflikelycosts.Thisdocument,whichhadtobesubmittedatveryshortnoticeasisthewayinSingaporewithin involvedfaxingsome70pagesof typescript fromGlasgowtoSingaporewithintwodaysnotice!

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

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.


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Onthebasisoftheinformationsuppliedbythevariousspecialties,thegovernmentset up theNMRCwith funding based on the submitted estimates of researchcosts.

Inlate1995,theNMRCaskedthatgrantapplicationsbesubmittedtodeterminewhat fundingmight bemade available for the creation of individual researchinstitutes.

About this time,ProfessorLimrecognised thepotentialofDrChewSek Jinasa contributor to research in Singapore.Dr Chewhad gained a goldmedal forhisperformanceintheFellowshipexaminationoftheRoyalCollegeofSurgeonsofEdinburgh.In1990,hehadgonetotheUnitedStatestopursuehisresearchinterests there. At the Louisiana State University, working in the laboratory ofProfessorRogerBeuerman,hehadgainedanMScinophthalmicanatomyusingthenewlydevelopedconfocalmicroscopetostudythecorneainthelivingeye.DrChewsubsequentlymovedtotheRockefellerUniversityinNewYorktostartworkonhisPhD.

In recognition of his research activities and potential, Dr Chewwas identifiedas an appropriate person to lead research in the proposed institute and wasofferedaprolepticappointmentasDeputyDirector,asubstantiveappointmenttocommencewhentheinstitutewasestablished.

Dr Chew at this time had authored an extensive document outlining in detailhisideasformyopiaresearch.ItwasProfessorFoulds’view,however,thattheaimsoftheinstituteshouldbewidenedtoincludeconditionsotherthanmyopiathatwere of importance in Singapore.He accordingly prepared an alternative planidentifyingareasofresearchimportanttoSingaporeandSouthEastAsia,includingmyopia,glaucoma,diabeticretinopathy,andocularsurfacedisorders.

In early 1996, Professor Foulds flew toNewYork to agreewithDrChewon arevisedplanforaSingaporeEyeResearchInstitute,incorporatingmaterialfromthetwoplansthathadbeenprepared.Later,DrChewflewtoGlasgowtofinalisethebudgetrequestfortheproposedinstitute.ThemainoutlineofaCoreGrantApplication prepared by Professor Foulds andDr Chew for submission to theNMRCwasinplacebymid-1996.ThisratherlengthyapplicationwassubmittedtotheNMRCinAugust1996.

About this time, Professor Lim

recognized the potential of Dr

Chew Sek Jin as a contributor

to research in Singapore.

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Atthistime,ithadbeenagreedinprinciplebytheSingaporeauthoritiesthatSERImightbeestablishedasacompanyundertheSingaporeCompaniesAct.Bythen,itwasknownthatanambitiousplanofProfessorLim’stobuildaneight-storeyextension to theSNEChad receivedgovernment approval and funding. Itwasalso agreed that if SERI, already incorporated as a company, were establishedasagovernment-recognisedandgovernment-fundedresearchinstitute,itshouldoccupytwofloorsinthenewextension.

Followingtheir receiptof theapplication inAugust1996, theNMRCrequesteda further finalised submission. In November 1996, Professor Foulds came toSingaporetofinalisetheapplicationwithDrChew,priortoitssubmissiontotheNMRC,onlytohearthesadnewsthatDrChewhadhadaseizureinNewYorkandhadbeendiagnosedwithaninoperablebraintumour.

Much of the previous application needed revision and re-writing at that time.IntheunhappycircumstancesofDrChew’sabsence,thiswasaccomplishedbyProfessorFouldswiththeaidoftheadministrativestaffofSNEC.

ThefinalisedapplicationwassubmittedtotheNMRCinlateNovember1996inthenamesofProfessorArthurLim,DrChewSekJin,ProfessorWallaceFoulds,andMsCharityWai.TheNMRCapprovedtheapplicationthenextmonth,withaninitialgrantofS$19million.

Initially,thissumincludedS$6.5millionforbuildingcostsandS$12.5milliontocover the costs of research activities over a five-year period. The amount ofthe initially approvedgrantwas subsequently increasedby theNMRC toS$24millionwithanincreasedgrantofS$4.5milliontocoverrevisedbuildingcosts.Additionally, theMinistryofFinanceprovidedanadditionaldirectallocationofS$7.3milliontocoverthecostoffittingoutSERI’stworesearchfloors.

Inmid-1997,theincorporationasacompanyownedbySNECandincorporatedundertheSingaporeCompaniesActwascompleted.TheArticlesofAssociationoftheCompanysetouttheaimsofSERIasacompanyaswellasboundarieswithinwhichthecompanycouldact.

Among the 30 or so objects and activities of SERI listed in the Articles ofAssociation, 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.


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debilitating diseases of the eye and allied subjects and generally to improvethestandardofknowledgeofthemeansofprevention,diagnosisandmethodsof treatmentandcureofsuchdiseasesandtopreservesight for thebenefitofmankindwithoutdiscriminationas tonationality, raceor religion”.To thisendSERI was charged to “provide research facilities and a conducive treatmentenvironmentforresearchanddevelopmentintheseareas”.

OtherrequirementsdetailedSERI’sremitineducationandtraining,andincludedtheestablishmentofcloselinkswith“otherbodiesinSingaporeorelsewhereintheworldwhoseobjectswere,ingeneral,similartothoseofSERI’s”.Therewasalsoanidentifiedrequirementtoundertakethepublicationofbooks,pamphlets,andjournals.

SERI,nowfundedbytheNMRCandincorporatedasacompany,neededbuildingfromthegroundup,both literallyandfiguratively, forSERIatthattimehadnoclinicalorlaboratoryaccommodationandnoresearchstaff.

NewresearchlaboratorieswereestablishedontheNUScampusinaccommodationprovidedbytheDepartmentofPhysiologyofNUS.Clinicalresearchfacilitieswerehoused initially in theSchoolHealthService at the Institute ofHealth, at thattimesituatedinOutramRoadclosetoSGH.Later,whentheInstituteofHealthmoved to new accommodation, facilities for clinical research were providedby theSingaporePolytechnic inDoverRoad,whichwasa longway fromSGHand somedistance from the SERI laboratories providedby theDepartment ofPhysiologyinNUS.

SERI’sscatteredaccommodationwasworsenedbythenecessarysitingofSERI’sadministrative activities in temporary hutted accommodation on the SGHcampus.Initially,thiswasnexttotheSNEC;butlaterasbuildingworkontheSNECextensioncommenced,amovetotemporaryaccommodationinaneighbouringcarparkprovednecessary.

Dr Chew, who had been promoted to Associate Professor, rapidly establishedclinicaltrialsinmyopiaandepidemiologicalstudiesinchildhoodmyopia,recruitingappropriately trained clinical staff. With the aid of Professor Roger BeuermanfromtheUSAandBillLamfromHongKongandpreviouslytheUSA,herecruitedscientificlaboratorystaffandinstitutedbasicresearchintomyopia.

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TheappointmentofAssocProfChew’swife,EstherChu,asManagerofSERIwasofgreathelptohimduringaperiodofincreasinglyillhealththat,however,didnotdiminishhisgreatenthusiasmforSERI,norhiscapacityforundertakingnewprojectsorrecruitingnewcollaborators.

Sadly,towardstheendof1998ProfChew’sillnesseventuallyovertookhim,andhediedquitesuddenlyon19Decemberofthatyear.

HismemoryandhiscontributiontotheestablishmentofSERIiscommemoratedinaneponymouslectureshipfundedbycontributionsfromthosewhoknewandadmiredhim.ThefirstoftheselectureswasgiveninSeptember2001asakeynoteaddressduringtheFirstSingaporeEyeResearchInstituteInternationalMeetingthatwasheldatthattime.ThelecturewasgivenbyProfessorRichardStonefromtheUniversityofPennsylvaniaandwasentitled“Thedimensionsofmyopia”.

Withhispassing,SERIimmediatelylostitsdrivingforceand,toadegree,itssenseofdirection.Somestaff,overtakenbyuncertainty,resigned.Forashorttime,SERI—whichhadbeenestablishedonlyrecentlywithsomuchpromise—lookedindangeroffounderingforwantofleadership.

ProfessorFouldswaschargedby theSERIBoardwitharemit toassessSERI’sresearchdirectionandorganisation.Anin-depthassessmentofallSERI’sactivities,staffing,budget,andsoonwascarriedout;andtheresultsandrecommendationswereincorporatedinaStrategicPlanthatwascompleted,forwardedtotheBoard,andadoptedby theBoardofDirectors inFebruary2000.As recommended intheplan,ProfessorTan’sappointmentasSERI’sDirectorwasconfirmedbytheBoard togetherwith the appointment of Professor Foulds asCo-Director for atemporaryperiodoftwoyears.

ProfessorBeuermanwasappointedasHeadofLaboratoriesandsubsequentlyasDeputyDirectorofSERIandScientificDirector,positionsthathecurrentlyholds.

Theadoptionof theStrategicPlancoincidedwiththeplanningandbuildingofthe eight-storey extension to theSNEC thatwould allow all of SERI’s far-flungactivitiestobebroughttogetherunderoneroof.

InAugust2001,SERImovedtoitsnewfacilitiesand,forthefirsttime,wasabletobringtogetherunderoneroofallofitsclinicalandbasicresearchactivitiesin

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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twocustom-builtresearchfloors,oneforclinicalresearchonthe5thfloorandtheotherforlaboratory-basedresearchonthe6thfloor.SERI’sadministrativeofficeswerealsohousedonthe5thfloor.

Thenewfacilitieswereofficiallyopenedon28September2001byMrLimHngKiang,MinisterofHealthandsecondMinisterofFinance,theopeningcoincidingwithSERI’sFirst InternationalResearchMeetingatwhichhewas theguestofhonour.Thismeeting,thefirstsuchtobeheld,wasnotonlysuccessfulinitsownright,butactedasatemplateforfuturecombinedSERI/ARVOmeetings.

Itwasalsoagreed,assuggested in theStrategicPlan, thatallclinical researchpreviously conducted in the SNEC within the Clinical Research Unit shouldbecometheremitofSERIandthatSERI’sbudgeting,accounting,andpurchasingpracticeshouldberelativelyindependentoftheSNEC.

While research in myopia would remain an important aspect of SERI’s work,laboratory aspects of myopia research would be concentrated on cell andmolecularbiologyandonmoleculargenetics,whileepidemiologicalstudiesandinterventionalclinicaltrialswouldcontinue.

TheimportanceofincludingotherareasofresearchofrelevancetoSingaporeandSoutheastAsiawasalsohighlightedintheStrategicPlan.

Prof Roger BeuermanScientific Director/Deputy Director, SERI

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TheaimsofSERIwereidentifiedintheplanasfollows:

1. To improve vision, alleviate the effects of sight-threatening disorders, and reducetheprevalenceofblindnessinSingapore.

2. Toundertakebasicandclinicalresearchtoachievetheseaims.

3. To establish ophthalmic research in Singapore as having a recognised internationalstatusamongthescientificandophthalmologicalcommunity worldwide.

4. To develop or contribute to the development of new products, devices, or processeswhichwill help to achieve the aims of SERI and additionally be commerciallyexploitable.

From2000onwards,SERI’sprogresshasbeenrapid.ProfessorTanhasproved,aswasanticipated,tobeaneffectiveandinnovativeleader;andunderhisleadershipanddirection,SERI’sresearchandreputationhavethrived.

In2002,SERIwasrecognisedbytheSingaporeauthoritiesasacharityundertheSingaporeCharitiesAct.

An important development that took place in February 2003 was the formalrecognitionofSERIbyNUSasanAffiliatedResearch Institute, thusconferringuniversity status on SERI. As a consequence of the affiliationwithNUS, eightmembersofSERI’s staffweregivenuniversity appointments in variousgrades(Adjunct,Visiting,Associate,orAssistantProfessor).

WiththereturntoSingaporeofanumberofresearcherswhohadgoneabroadtoundertakeresearchtraining,anumberofwhomhadgainedPhDdegreesfromoverseas universities, SERI’s research activities expanded rapidly. SERI’s grantfundingincreasedandnewgrant-aidedstaffwereappointed.

ThegrowingcontributionsmadebyresearcherstrainedabroadwasrecognisedbytheappointmentofAssociateProfessorWongTienYin(PhDinepidemiology)and Associate Professor Aung Tin (PhD in ophthalmic genetics) as AssociateDirectorsofSERI(InternationalActivitiesandEducation,respectively).

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

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.


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In the short years since its inception, and thanks initially to the remarkableenergyof the lateProfChewSek Jin inspiteof the increasingdemandsofhisillness and his own appreciation of the eventual outcome, and subsequentlyand importantly the dedication and hard work of its present DirectorProfessorDonaldTan,SERIhasmadesomenotableadvances.ProfessorTan’sachievementswithinSERIandasHeadoftheNUSDepartmentofOphthalmologywererecognisedinJune2005byhispromotiontoProfessorofOphthalmologyinNUS.

Well-equipped laboratories have been established that are capable of cell andmolecularbiologyrelevanttoSERI’sdiverseresearchinterests.Aproteomicsandmicroanalysislaboratoryhasbeencreated,ashasbeenageneticslaboratoryandlaboratoriesforcellcultureandstemcellwork(includingworkonbothconjunctivaland retinal stem cells). State-of-the-art equipment allows the exploitation ofreal-time PCR, gene array technology, and microanalysis, using sophisticatedequipment forHPLCandMSequippedwith the latestMALDIdevice that hasgreatlyaidedproteomicsresearch.

MuchofthisequipmenthasbeenfundedbyresearchgrantsobtainedasaresultofsuccessfulgrantapplicationspreparedbyProfessorBeuerman.DrZhouLei,who has been with SERI almost since its inception, runs the microanalyticallaboratory thatwasestablishedbyProfessorBillLam,whohas returned tohishomeinBoston,USA.DrZhouLeialsoactsasDeputyHeadofLaboratories.

Professor Beuerman and his team have a particular interest in themolecularbiology of the tear film and other aspects of the ocular surface in health anddisease. Among other notable advances, they have identified a new defensinmolecule in the tear film that appears to have significant protective functions.Currently,theyareinvestigatingtheeffectsofthefunctionofthismoleculethatresultfromalterationstoitsmolecularstructure.

LaboratorieswithinSERIalsohousetheSGHStemCellGroup.LaboratoryworkonconjunctivalstemcellsisapersonalinterestofProfessorDonaldTan’s,whileretinalstemcellworkwillbeundertakenbyDrHenryKlassenwhohasrecentlybeenrecruitedfromtheUSA.SERI,andmoreparticularlyProfessorDonaldTan,hasbeenamong thefirst tousestemcell technologyclinically in the repairofdamaged or diseased conjunctiva and in themanagement of pterygium. As aresultofanactivecollaborationwiththeDepartmentofBiomolecularEngineering

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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atNUS,artificialsubstratesforthecultureofconjunctivalstemcellshavebeendevelopedandarebeingassessedinclinicalpractice.

An ophthalmic genetics laboratory has been established, headed by ProfessorAung Tin and aided by a post-doctoral fellow Dr Eranga Vithana who, likeProfessorAungTin,gainedherPhDfromLondonUniversity.Already,anovelgeneassociatedwithclosedangleglaucomahasbeenidentifiedandmanyothergenesareunderinvestigation.

Inbasicretinaresearch,anewanimalmodelofretinalcapillaryischaemiahasbeendeveloped,andtheeffectsoftheresultinghypoxiaonthepatternofangiogenicandangio-inhibitoryfactorsarebeinginvestigatedinconjunctionwithAssocProfCharanjitKauroftheAnatomyDepartmentofNUS.Thisworkisrelevanttotheblindingcomplicationsofdiabeticeyedisease.

Anumber of projects address basic aspects ofmyopia, andhave been greatlyaidedbyamousemodelofmyopiaandbyamouselackingageneforparticularmuscarinicreceptors.

As regards facilities for clinical research, the 5thfloorhousesanumberof fullyequipped ophthalmic consulting rooms mainly used for clinical trials,epidemiologicalprojects,andthelike.

There are also optometric consulting rooms; facilities for contact lens work;generous equipment for auto-refraction and for the testing of visual functionincluding visual field analysis and assessment of contrast sensitivity; andequipmentforocularaberrometry,ocularphotography,anddetailedimagingofanteriorsegmentmorphology.

A fully equipped electrophysiology laboratory has been established under thedirection of Dr Chi Luu, with equipment for advanced electro-retinographyincludingmultifocalERGandbothflash-andpattern-evokedcorticalresponses.Duplicateelectrophysiologicalequipmentisavailableforhumanclinicalstudiesand for experimental studies in animals, the latter using novel programmingdevelopedincollaborationwiththeTennentInstituteinGlasgow.

ThereisadedicatedpharmacyforrandomiseddrugtrialsandaYAG/Argonlasersystemforaglaucomastudythatisunderway.


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TheclinicalresearchfacilitiesareunderthedirectionofSisterChyeFongPeck,Clinic Manager, whomaintains a cheerful disposition in spite of the onus ofadministeringsome35clinicalresearchprojects.

SERIcurrentlyhassome30 laboratory-based researchstaff and39 researchersengaged inclinical researchprojects,someofwhomareSERIstaffandotherswhohaveadjunctstatusinSERI.ThetotalstaffcomplementofSERInownumberssome80persons.

The organisational demands of SERI’s active research programme are great,asarethedemandsontheDirector’stimeandthatofSERI’sseniorstaff.Thishasnecessitatedanincreaseinadministrativestaffthatnownumberssome10persons.

TheadministrationofSERIonbehalfoftheDirectorisinthecapablehandsofMsKarenChee,SeniorManagerofSERI.

InadditiontoitsownresearchwithintheSNECbuilding,SERIhasestablishedanumberoffruitfulcollaborationswithinSingaporeandabroad.

Within Singapore, collaborative research has been established with manyuniversitydepartmentsandnon-universityorganisations.ThesehaveincludedanumberofdepartmentsatNUS(Anatomy;Biochemistry;Electrical,OpticalandBiomedicalEngineering;Community,Occupational,andFamilyHealth(COFM);MechanicalEngineering;Microbiology)andseveraldepartmentsattheNanyangTechnologicalUniversity.

Collaborative research with the Department of Community, Occupational andFamilyHealth (COFM) inNUShas beenparticularly fruitful in the conduct of

Chapter 3

Peck Chye FongNursing Manager

SERI staff

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interventionaltrialsinchildhoodmyopiaandinepidemiologicalstudiesofmyopiaandotherdisordersaffecting theeyeorvision.AssociateProfessorSawSeangMei,whoholdsappointmentsbothwithintheCOFMDepartmentandSERI,hasbeenparticularlyactiveinophthalmicepidemiology.

InconjunctionwithProfessorSaw,researcherswithinSERIhaveconductedcross-sectionalandprospectivelongitudinalstudiesofchildhoodmyopiainSingapore(SingaporeStudyoftheRiskFactorsofMyopiaorSCORM)andinChina.

Interventionaltrialsofatropineorpirenzepineeyedropsinthecontrolofchildhoodmyopia have shown that the former (Atropine in the Treatment ofMyopia orATOM)significantlyreducestherateofprogressionofmyopiainchildren.Newstudiesusingreducedstrengthofatropineeyedropsareunderway.

A detailed epidemiological study of ophthalmic disorders among the MalaypopulationofSingaporeisunderway(SingaporeMalayEyeStudyorSiMES).TheepidemiologyofglaucomahasbeenstudiedwiththeacquisitionofusefuldataontheprevalenceandtypesofglaucomainSingapore.

AssociateProfessorWonghasalsobeenactiveinepidemiologicalresearch,andhasmadesignificantadvancesinthequantificationofretinalvascularmorphologyinrelationtosystemiccardiovasculardiseaseanddiabetes.

TherangeofSERI’sclinicalandbasicresearchactivitiesandthemanypublicationsthathaveresultedaretoowidetobeaddressedinanydetailinsuchashorthistoryasthis.SERIisstilldevelopingandisincreasinglyactiveinmanyareasofresearch.Over the coming years, it is hoped and anticipated that SERI’s historywill befurtherembellishedasaresult.

SERI’spresenceontheSGHcampusisalatedevelopmentinalonghistoryofeyecareatthatlocation.AnEyeUnitwasfirstinitiatedatSGHasearlyas1926,evolving into an Ophthalmology Department in 1934. The OphthalmologyDepartment continued to function in SGH after the foundation of the SNECin1990,subsequentlybeingabsorbedintotheSNECin1992.SERIis,ofcourse,afurtherandmuchmorerecentdevelopmentofthelatter.

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

Ms Karen CheeSenior Manager of SERI.


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

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

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The Late Associate Professor Chew Sek JinThePioneerofResearchinSingapore

“There are a lot of capable people, but few are both capable and respectable like Sek Jin.”

Citation by Professor Dennis LamChairman, Department of Ophthalmology and Visual Sciences of The Chinese University of Hong Kong

Secretary-General of Asia-Pacific Academy of Ophthalmology

Therearealotofcapablepeople,butfewarebothcapableandrespectable.SekJinwasextremelycapableandwellrespectedbyhispatientsandall thosewhohadthechanceofworkingwithhim.Hewasvisionary,selfless,andbothagoodteamleaderaswellasteamplayer.Oneofhisfavoritequoteswas,“Let’sworktogether.”

Ilearntalotfromhim,andhewastheonetoinspiremetopursueanacademiccareer.Hehelpedmewithmy first laboratory researchproject, using confocalmicroscopy to study corneal wound healing after photorefractive keratectomyin rabbit. Thedatawerepresented, asmyfirst oral presentation, at theARVOmeeting.Heinspiredmetoworkontheepidemiologyofmyopiaandmoleculareyegenetics.Heassistedmeinwritingmanuscriptsandpublishinginternationally.Wewentthroughsomedifficulttimestogetherintheinitialperiodofbothhisandmyacademiccareers.Wesupportedeachotherandsharedmanyfondmemories.IstillrememberthetwoweeksthatIspentwithhiminNewYorkwhenhewasstudying forhisPhDat theRockefellerUniversity.Weworked fromdawnuntilmidnightontheUBMstudyintheNewYorkEyeandEarInfirmary,andonthemyopiastudyinchicksinJoshuaWallman’slaboratory.Heandhisbelovedwife,

Professor Dennis Lam (right)

with the late Assoc Prof Chew

Sek Jin.

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Esther,were so kind that they invitedme to staywith them in their dormitorywhereIcouldsleeponasofa.SekJinandEstherwerealovelycouplewhomIhadalotofrespectfor.Wehadsomuchfuntogether,andthememoriesarestillsofreshthatitseemsthattheyjusthappenedyesterday.

SekJinwasaverydearfriendandImisshimsomuch!

SNEC Gold Medallist 1997AssociateProfessorChewSekJinwasthefirstSingaporeanophthalmologist tosuccessfullyattainaPhDdegreeoverseas.AfterobtainingaMS(Anatomy)fromtheLouisianaStateUniversityEyeCenter inUSA,hewentontoacquireaPhDdegreeinneuroscienceattheRockefellerUniversity,USA,in1996.

Throughouthiscareer,AssocProfChewachievedacademicdistinctions.HewasthefirstSingaporeantotoptheRoyalCollegeofSurgeon(Edinburgh)ExaminationinOphthalmology,andwasawardedtheCollege’sGoldMedalin1987.

Inrecognitionofhiswork inmyopiaresearch,AssocProfChewwasappointedtoanumberofinternationalorganisations.HewasVicePresidentoftheMyopiaInternationalResearchFoundationandDirectorof itsAsia-PacificheadquartersbasedinSingapore.HewasalsoVisitingProfessorattheCityUniversityofNewYorkandtheNewYorkEyeandEarInfirmary,andVisitingScientistattheRockefellerUniversity.

Associate Professor Chew published over 50 papers, including the first paperbyalocalophthalmologistintheprestigiousjournalScience.Hemadeover150presentations,mainlyinthefieldofmyopiaresearch,atregionalandinternationalconferences.HeheadedtheMyopiaClinicatSNECandwasDeputyDirectoroftheSingaporeEyeResearchInstitute(SERI).HewasalsoresponsibleforattractingmajorgrantsfromtopindustriessuchasBauschandLombtosupportresearchinSERI.

AssociateProfessorChewalsoplayedamajorroleinestablishinglinksbetweenSNECandtopuniversitiesintheUSA,suchasHarvardwithitsstrongemphasisonmyopiaresearch,andJohnsHopkinsUniversityinacollaborativemyopiastudyonRGPlens.In1997,throughhisefforts,anumberoftopspecialistsfromtheUSAvisitedSNECandbroughtaboutnewareasofcollaborationintothe21stcentury.


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SNEC International Gold Medallist in 1999Chew Sek Jin (Posthumous Award)

Citation by Professor Donald TanDirector, SERI

ThelateProfChewSekJinwasthefirstofustoacquireMSandPhDdegrees.In1993,heleftSingaporetopursueaPhDintheUSAinthemidstofapromisingclinicalcareer.Asthefirstfull-timemedicalstaffoftheDepartmentofOphthalmologyintheNationalUniversityHospital(NUH),hehadblazedthetrailbydevotinghiscareertofull-timeresearch,leadingbyexampleinshowinghowresearchshouldandmustbeintegraltothefutureofophthalmologyinSingapore.

AftergettinghisMaster’s(inanatomy)fromtheLouisianaStateUniversityEyeCenterintheUSA,hewentonandachievedhisPhDdegree(inneuroscience)attheRockefellerUniversityin1996.Uponhisreturn,heimmediatelysettoworkingettingtheSingaporeEyeResearchInstitute(SERI)underway.

In those early days, he worked day and night writing grant proposals to theNational Medical Research Council (NMRC), recruiting scientists locally andoverseas,andcajolingmedicalstudents toparticipate inprojects.At thesametime, he was networking with industry and overseas research collaborators tobuildanameforSingaporeasthepotentialhubforeyeresearchinAsia.

ItwasatoneofthoseoverseasmeetingsthatSekJinfellill,collapsed,andwasdiscoveredtohaveaninoperablebraintumour.Mostpeoplewouldhaveresignedthemselves to fateandwouldhavegivenup,butnotSek Jin.Heworkedevenharderandfaster,knowingthathewaslivingonborrowedtime.

Within a very short time, hewas able to assemble funds to the tune of S$20millionasafive-yeargrantfromtheNMRC.Atthesametime,hesetuptheSERIlaboratories inNUSandbuiltupa teamofresearchersandsupportstaff fromscratch, opening myopia research clinics. On top of that, he was seeing anincreasingnumberofpatients,recruitingschoolchildrenforhismyopiatrials,aswellasestablishingsuccessfullinksandclinicaltrialswithtopindustryfirmssuchasBauschandLomb,CibaVision,andothers,whichcontinuetothisday.

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However, I believe that it was not his brilliant academic achievements or hislightning speed in getting things done that has touched our lives themost. IbelieveallofuswillbestrememberSekJinforhisfearlesscourage,hisboundlessoptimismincopingwithhisbraintumour,histotaldevotiontohisworkinspiteofhis terminalcondition,hisgenuine friendship,and the interestandconcernshowntoeventhemostjuniormedicalstudent.

Notoncedid IhearSek Jincomplainabouthisconditionorabouthowunfairfatehadbeen.Infact,hewasoftentheonewhocheereduson,alwaystellingustolookatthepositiveside,alwayspaintingushisvisionofresearchandgettinggroupsofpeopleworkingtogether.

Sek Jinwas awarded theSNECGoldMedalAward in 1997.Tonight,wewouldlike to honour him posthumouslywith the SNEC InternationalGoldMedal torecogniseSekJin’sachievementsinternationally.

Inrecognitionofhisworkinmyopiaresearch,SekJinwasappointedtoanumberofinternationalorganisations.HewasVicePresidentoftheMyopiaInternationalResearchFoundationandtheDirectorofitsAsia-Pacificheadquarters,basedinSingapore.HewasalsoappointedVisitingProfessorattheCityUniversityofNewYorkandtheNewYorkEyeandEarInfirmary,aswellasVisitingScientistattheRockefellerUniversity.

Sek Jin also played amajor role in establishing links between SNEC and topuniversities in the USA, such asHarvard with its strong emphasis inmyopiaresearch,andJohnsHopkinsUniversityinacollaborativemyopiastudyonRGPlens.HewasconstantlybringingintopscientistsfromtheUSA,UK,Australia,Japan,Taiwan,andChina,justtonameafew,tocreateopportunitiestostartnewareasofcollaborationintothe21stcentury.

Inhisshortlifespan,SekJinpublishedover50papers.Healsomademorethan150presentations,mainlyinthefieldofmyopiaresearch,inregionalandinternationalconferences,and inparticularat theworld’s foremost researchmeeting—theAssociationforResearchinVisionandOphthalmology(ARVO)meetingattendedbyover10,000researchersandscientistsaroundtheworldannually.


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Itthereforegivesmegreatpleasuretoannouncethat,inrecognitionofProfChewSekJin’ssignificantcontributionsinternationally,agroupofinternationalmyopiaresearchershasinitiatedtheChewSekJinARVOTravelingFellowship.

ThefundingofthisfellowshipwillberaisedjointlybySNECinSingaporeandbytheresearchersoverseas.Itismostbefittingtocometogetherwiththeinternationalmyopia research community to endow a fellowship in Sek Jin’s name to carryon his life-long ambition and to encourage young ophthalmologists pursuingresearchtopresenttheirworkattheARVOmeeting.

Lastbutnotleast,mayIalsotakethisopportunitytopaytributetoEsther,whoremainedsteadfastinhersupportforSekJinthroughoutthosepioneeringdaysandduringthetryingtimesofhisillness.

Esther,whotookonthepositionastheInstitute’sManager,notonlylookedaftertheadministrativedetailsandtheimplementationofSekJin’snumerousplans,butwasalsobyhissidetendingtohimwheneveranattackorafitcameon.WemustsaluteEstherforherexemplarydedicationanddevotiontoSekJin.

IwouldliketocalluponEstherChutocomeonstagetoreceivetheposthumousawardoftheSNECInternationalGoldMedaltothelateProfChewSekJin.

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

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.

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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 CullenVisiting Consultant, Singapore National Eye Centre

ChewSekJin,ophthalmologistandresearcher,diedinSingapore,aged39,on19December1998ofamalignantbraintumour.

HavinggraduatedfromtheNationalUniversityofSingaporein1983,hesoonfoundhimselfasMedicalOfficerinchargeoftheArmedForcesMedicalClassificationCentre,wherehisabidinginterestinmyopiaoriginated.

In 1986,he joined thenewly establishedDepartmentofOphthalmologyat theNationalUniversityHospital under Prof Arthur Lim and, in the following year,cametoEdinburghtotaketheFRCSEandwontheMuthusamyGoldMedalbeforereturningtoSingaporeasSeniorRegistrarin1988.

Hewassoontorealisehisdeficienciesinscientifictrainingandso,in1990,hewenttoNewOrleanstoearnanMSinbasicsciences,andthenontotheRockefellerUniversitywherehecompletedhisPhDin1996.Duringthoseyears,hecontinuedhisresearchonmyopiaandoncornealphysiologyandglaucoma,andwasthenappointedVicePresidentoftheMyopiaInternationalResearchFoundation.

Returning toSingapore in late 1996,hewas appointedDeputyDirectorof theEyeResearchUnit(latertobecalledtheSingaporeEyeResearchInstitute)andproceeded to set up laboratories and organise major basic eye research, inparticulartostudytheepidemiology,prevention,andtreatmentofmyopia.

Despitetheonsetofafatalillness,hecontinuedtodirecttheinstitute,organiseits programmes, and produce a flood of ideas to encourage his team. In lateNovember, he chaired the session onmyopia at the SNECThird InternationalMeetingandconductedalengthypressconference.


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HiswifeEstherjoinedhimasadministratorofSERIandcaredforhimwithgreatdevotionduringthetwoyearsofhisillness.Hisebullienceandenthusiasmwereevident to the end, andhewas comfortedby his conversion toChristianity inthelastmonthsofhislife.HeisalsosurvivedbyhisfatherJamesChew,alsoanophthalmologist,hismother,andsisterLeeJin.

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 HuiVisiting Consultant, Singapore National Eye Centre

Anunassumingyoungintellectual,ChewSekJin(SJ)wasthefirstofoursecond-generationophthalmologistsinSingaporeand,arguably,Malaysia.Whentalkingtohim,hewasalwayspraiseworthy toothers,neverhimself.Heconcealedhisfatalillnessevenfromme,andIwasthelasttoknow.

SJ attended school in Singapore at the Anglo-Chinese School and NationalJuniorCollege,baggingnumerousmeritprizesalongtheway.Hescoredthebestperformance(adjudgedbyCambridge’sTrinityCollege)fortheOxford-CambridgeEntranceScholarshipAwardforthestudyofmedicine,butchosetoenterourownNationalUniversityofSingaporeonameritscholarship.

Upongraduation,heservedfull-timewiththeNationalServiceintheSingaporeArmedForcesandwasassignedasMedicalOfficeri/cOphthalmologySection,Medical Classification Centre.His early talentswere already recognised by hispeersand,whenhebecamefullyqualifiedinduecourse,hewasappointedAdjunctSeniorResearchAssociateattheDefenseMedicalResearchInstitute.

SJ started his ophthalmology career as amedical officer in theDepartment ofOphthalmology,SingaporeGeneralHospital,asdideveryoneelseinthosedays.HewasthefirstAsiantowinagoldmedalattheFRCSOphthalmologyfinalswhenhesatfortheexaminationinEdinburghin1987/88.

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HereturnedtoSingaporeandhelpedtoorganisethefirstconjointFRCSE/MMed(Ophthalmology)examinationheld inSingapore in 1989.Henotonlycoachedthefirstbatchofourophthalmicresidents,buttookontheirnightcallsaswell,toallowthemtimetostudy.

His easy entry into the portals of academia in themost prestigious researchinstitutes and his appointments to professorial positions there established a‘beach-head’forSingapore’sentryintotheUSandthebigleague.

Amongsthismanyappointmentswere:• VicePresident,MyopiaInternationalResearchFoundation,andDirectorof itsAsia-PacificHQ• VisitingProfessor,CityUniversityofNewYorkandNewYorkEye&Ear Infirmary• VisitingScientist,RockefellerUniversity• ClinicalProfessorofOphthalmology,LSUEyeCentre• AnatomyAdjucator,AssociationforResearchinVisionandOphthalmology

Although SJ was offered professional positions in Taiwan andHong Kong, hechosetoreturntoSingapore, thecountryofhisbirth.Hehadchosentocomehomeevenasheconfidedhistrepidationtome;butwiththefullbackingofhismentor,ProfArthurLim,heprovedhimselfagainandagain.

AsDeputyDirectorof thenascentSingaporeEyeResearch Institute (SERI),heattractedmajorgrantsfromtopindustriesandhadresearchinvestigatorscomingfrom around the world. He established links between SingaporeNational EyeCentre(SNEC)/SingaporeEyeResearchInstitute(SERI)/MinistryofHealthandtopinstitutesintheUSAandEurope.HewasalsoaconsultantforMyopiaServiceatSNECandreceivedtheSNECGoldMedalin1997.

Apart fromSJ’s likable personal attributes, themost promising research brainthat Singapore has produced in our two generations was nipped in the bud.Notwithstandingwhateversuccessesachievedso far,his fullpotentialwasnotallowed to bloom to maturity. History has repeated itself with another cruelexample.


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

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Chapter 5

Professor Donald TanTheleaderinophthalmicresearch

He pushed eye research in Singapore from almost nothing to the world stage

SNEC Distinguished Service AwardAsConsultantinchargeofclinicalresearchdevelopment,DrTanhascontributedsignificantly in building up the clinical research arm of the SNEC. He wasresponsibleforsettinguptheclinicalresearchdepartmentalofficesandthefirstlaboratory in theSNEC,whichbecameoperational in 1995.Hehasattractedasubstantial grant of S$517,000 from the SingaporeNationalMedical ResearchCouncilfortheclinicalandbasicscienceprojectsinpterygium.

Dr Tan, with a team of ophthalmologists active in research, has presented acreditable list of papers/posters at theprestigiousAssociation forResearch inVisionandOphthalmology(ARVO)meetingfortwoconsecutiveyears.DrTanistheprincipalinvestigatorofovertenongoingclinicalandbasicscienceresearchprojectsintheSNEC.HechairstheExecutiveResearchCommitteeandsitsontheSNECMedicalBoard,ManagementCommittee,andEthicsCommittee.DrTanisalsocoordinatoroftheSingaporeEyeBank.

Source: APJO Vol 8 (1), 1996

ProfDonaldTanisDirectoroftheSingaporeEyeResearchInstitute(SERI)andHeadoftheDepartmentofOphthalmology,NationalUniversityofSingapore.HealsoholdsadualappointmentasDeputyDirectoroftheSingaporeNationalEyeCentre(SNEC)andSeniorConsultantandHeadoftheCornealServiceatSNEC.

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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 TanMBBS, 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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HeisaSeniorConsultantattheNationalUniversityHospitalinSingaporeandisDirectoroftheSingaporeEyeBank.

Donald Tan exhibits the rare combination of a talented, dedicated, and caringclinician;asurgeonofthehighestcalibre;andanactiveresearcherinterestedandskilledinclinicalandbasicresearch.Hisparticularinterestshavebeeninocularsurfacedisorders,especiallytheaetiologyofpterygiumatthecellandmolecularlevel; and in corneal transplantation, particularly theproblemsassociatedwithcornealgraft rejection.HespearheadedthedevelopmentofcornealservicesattheSNEC,reorganisingthecornealtransplantationserviceandestablishingtheSingaporeEyeBank.Currently,heisactivelyinvolvedwithnationalinitiativesintissuebanking.

Hisrefinementsoftechniquesforocularsurfacetransplantationandtheuseofamnioticmembranehaveachievedstrikinglygoodresultsinadifficulttherapeuticarea.Heisactivelypursuingtheuseofstemcelltechnologyinthetreatmentofocular surfacedisorders andexploring theuseofnew treatmentmodalities topreventgraftrejection.

Donald Tan enthusiastically promotes clinical research. Before taking on theDirectorship of SERI, he was responsible for the establishment of a ClinicalResearch Unit in SNEC that successfully fostered a culture of research andresearchpublicationamonginvolvedclinicians.Hehasorganisedandpromotedtheuseofrandomisedcontrolledclinicaltrialsinareasasdiverseastheuseofnewintraoculardrugdeliverydevicesaswellastheassessmentofinstrastromalcornealrings,phakicintraocularlenses,andartificialcorneae.

Under his Directorship, SERI has conducted seminal epidemiological studiesrelatedtotheaetiologyandprogressionofmyopia inchildrenthathaveclearlydemonstratedandquantifiedthedualrolesofgeneticinheritanceandcloseworkinthegenesisofthiscondition.

AnimportantattributethatcontributestoDonaldTan’ssuccessasaresearcher,clinician, andadministrator, apart fromhis enormousenergy forhardwork, ishisabilitytodeliverwhathepromises.Toanextent,thisresultsfromforesightandtheabilitytoworkwithothers,butitalsostemsfromhisexcellentabilitytoprioritiseallofthevariousdemandsonhistime.

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DonaldTanhasactivelypromotedthedisseminationofresearchideasandresultslocallyandabroad,havinginstitutedaprogrammeofSNECResearchDaysandlaterAnnualResearchMeetingsinOphthalmologyandtheVisualSciencesthatactivelyencourageavibrantresearchcultureinSingapore.

InhonourofhiscontributiontoophthalmicandvisionresearchinAsia,hewasinvitedtogive theprestigiousdeOcampoLectureandreceive thedeOcampoAward at the 18th Congress of the Asia-Pacific Academy of Ophthalmology in2001.ThisisthehighestawardoftheAsia-PacificAcademyofOphthalmologyforexcellentacademicachievements.

DonaldTanisamuchsought-afterlecturerathomeandoverseas,havingbeeninvitedtolectureandteachextensivelyintheregionandbeyond.Hehasconductedhighly rated teaching courses at the American Academy of Ophthalmology,the International Congress of Ophthalmology, the Asia-Pacific Academy ofOphthalmology,theEuropeanSocietyofOphthalmology,andtheAmericanSocietyofCataractandRefractiveSurgery.HehasbeenaguestlecturerinuniversitiesandcentresofexcellenceinAmerica,Europe,Australia,andAsia.

He has published more than 80 scientific papers, mainly in internationallyrecognisedpeer-reviewedjournals,numerousabstracts,andfivebookchapters,andservesasreviewerforanumberofleadingophthalmicjournals.Inspiteofanextremelybusyworkschedule,DonaldTantakesakeeninterestinthewelfareofhisstaffandcolleagueswithinSERI,SNEC,andNUS.HehasplayedakeyroleintheestablishmentinSingaporeofaworld-classcentreofexcellenceinophthalmicresearch,teaching,andclinicalcare.

Source: APJO Vol 14(1), 2002

AppointmentsDonaldTanisDirectoroftheSingaporeEyeResearchInstitute(SERI)andDeputyDirectoroftheSingaporeNationalEyeCentre(SNEC).HeisalsoatenuredfullprofessorandHeadoftheDepartmentofOphthalmology,YongLooLinSchoolofMedicine,NationalUniversityofSingapore.AsaSeniorConsultantatboththeSingaporeNationalEyeCentre andNationalUniversityHospital, heheads theSNECCorneaandExternalDiseaseServiceandisalsoinchargeofallresearchactivities at SNEC. He is also Medical Director of the Singapore Eye Bank.


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Internationally,hechairstheInternationalMembersCommitteeoftheAssociationforResearchinVisionandOphthalmology(ARVO),isafoundingmemberoftheAsiaPacificSocietyofEyeGenetics, andmost recentlywaselectedas thefirstPresidentofthenewlyformedAsiaCorneaSociety.

Professor Tan received his corneal and external disease fellowship training inMoorfields EyeHospital, London. As head of the SNECCorneal and ExternalDiseaseService,hisclinicalinterestslieincornealtransplantation,ocularsurfacedisease, limbal stem cell transplantation, pterygium surgery, corneal refractivesurgery,femtosecondlaser-assistedcornealsurgery,andkeratoprosthesissurgery.Hisotherresearchinterestsincludeoculardrugdeliverysystems,epidemiologyofmyopiaandpterygium,visualpsychophysics,andinterventionalmyopiadrugtreatments.

ProfessorTanhaspublishedover180scientificpeer-reviewedarticlestodateandhaswritten13bookchaptersoncornea,ocularsurfacestemcells,andpterygiumsurgery.Inaddition,hehaspresentedover300papersatinternationalmeetings,anddeliveredover70guestlecturesatinternationalandregionalmeetings.Heisalsoactiveinteachingandhasconductedmorethan60teachingcoursesoncornealsurgery, refractivesurgery,andmyopia,both locallyand internationally.HeisontheeditorialboardoftheThe Ocular Surface JournalandthePhilippines Journal of Ophthalmology,andisareviewerofnineophthalmicandvisualsciencejournals. ProfessorTanhasalso trained, todate, 14corneal fellows, includinginternational fellows from theUK,Netherlands, Philippines,Mexico, Thailand,India,andChina.Professor Tan was awarded the Asia-Pacific Academy of OphthalmologyDistinguished Service Award in 1997. For his contribution to ophthalmic andvision research in Asia, hewas awarded the 2001DeOcampo Lecture by theAsia-Pacific Academy of Ophthalmology, and is the youngest recipient of thisawardforexcellenceinAsianresearch.Inboth2004and2005,hewasanawardwinnerattheAmericanSocietyofCataractandRefractiveSurgery(ASCRS)FilmFestival,andalsoreceivedawardsatthe2005and2006ASCRSmeetingsforBestPaperatthecornealandkeratoplastysymposia.In2006,hiscontributiontothefieldofinternationalophthalmologywasrecognisedinaprestigousAchievementAwardfromtheBoardofTrusteesoftheAmericanAcademyofOphthalmology;ProfessorTanisSingapore’sfirstrecipientofthisinternationalaward.In2006,

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ProfessorTanwasawardedthefirstMinisterforHealthAwardForOutstandingPerformanceInPublicHealthinSingaporeforleadingtheSingaporeteamwhichfirstidentifiedthecauseoftheglobaloutbreakofFusarium keratitis.

ProfessorTanwaspivotalinbringingtheAssociationforResearchinVisionandOphthalmology (ARVO) meeting to Asia. ARVO is the foremost internationalmeetingforvisionandophthalmologyresearch,andforthelast75yearshasbeenheldintheUSA.ThroughSERI,ProfessorTanwassuccessfulinthebidforSERItoholdthefirstseriesofinternationalARVOaffiliatedmeetingstoSingapore,theSERI-ARVOMeetings,whichwereheldin2003and2005.In2007,thismeetingwasupgradedtobecometheAsia-ARVOMeeting,againheldinSingaporeandjointlyorganizedbySERI.SERIwillcontinuetohostAsia-ARVOMeetingsonafour-yearlybasis.

Professor Tan’s current interests focus on developing new forms of anteriorandposterior lamellar corneal transplantation inAsianeyes, including theuseof femtosecond laser technologies, introducingkeratoprosthesissurgery to theregion. Hisnewestproject is the formationof theAsiaCorneaSociety (ACS),whichbrings together leading corneal specialists fromAsiannations includingChina,India,Japan,Taiwan,Korea,Philippines,andSingapore;andProfessorTanwaselectedastheinauguralPresidentofACS.RegisteredinSingapore,thegoalofACSistospearheadthedevelopmentofeducationalandresearchprogrammesfor corneaand relatedsubspecialties inAsia,with theobjectiveofassisting toalleviatecornealblindnessinAsiaandbeyond.


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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 1997ProfWallaceFouldsiswellknowntoophthalmologistsintheAsiaPacific.Heisinternationallyregardedasaworld-famousophthalmicresearcher.

After training inMoorfields EyeHospital, London, Prof Foulds was appointedConsultantOphthalmologisttoAddenbrookesHospital,Cambridge,andHonoraryLecturerintheUniversityofCambridge.Later,hewasappointedtotheTennentChairofOphthalmologyattheUniversityofGlasgow.HisearlierresearchattheInstituteofOphthalmology,London,undertheguidanceofSirStewartDukeElder,ledtohigher-degreethesesonthemechanismsofclosedangleglaucomaandonthepathogenesisofretinaldetachment.

As Tennent Professor, he promoted ophthalmic pathology and the applicationof basic science to clinical problems. Hismain interests were— and remain—retina,opticnerve,andocularmalignancy.Hehaswritten20bookchaptersandabout200scientificpapers, andhasgivenmore than20named lectures.ForhissignificantcontributionstotheTennentInstituteduringhistenureoftheTennentChairoveraspanofsome25years,hewasmadeEmeritusProfessorofOphthalmologyattheUniversityofGlasgowuponhisretirementin1989.

Over theyears,ProfFouldshasheldmanykeypositions inmajorprofessionalbodies. He was Founder President of the Royal College of Ophthalmologists,and was previously President of the Faculty of Ophthalmologists and theOphthalmologicalSocietiesoftheUnitedKingdom.HehasbeenVice-President

Professor Wallace Foulds Aworld-famousophthalmicresearcher

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Professor Wallace Foulds Aworld-famousophthalmicresearcher

oftheGoninSocietyandChairmanoftheAssociationforEyeResearch.In1988,hewasconferredtheCBEbyHerMajesty,QueenElizabethII.

ProfFouldshasbeenprofessionallyactiveintheAsia-Pacificareaformanyyears,havingbeenafrequentguestlecturerinAsia,includingIndia,Pakistan,Malaysia,Japan,HongKong,andSingapore.HehasbeeninvolvedinthereorganisationofeyeservicesinHongKongandthePreventionofBlindnessProgrammeinIndia.

HeisResearchAdvisertotheSingaporeNationalEyeCentre(SNEC)andsitsontheAdvisoryBoardoftherecentlyestablishedSingaporeEyeResearchInstitute.He is also Visiting Professor of the Department of Ophthalmology, NationalUniversityofSingapore.

TheSingaporeNationalEyeCentreisindeedhonouredtopresenttoProfFouldstheSNECInternationalGoldMedal,forhislifelongdedicationtoophthalmologyandhisoutstandingcontributionstothepromotionofeducationandresearchinAsia.

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


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Dr Kwa Soon BeeHeplayedapivotalroleinthecreationofSNECandSERI

DrKwasupportedProfArthurLim’sproposalstrongly.ItcanbesaidthathewasessentialinthecreationoftheSingaporeNationalEyeCentreasapublicservicesuccess.HewasalsosupportiveofProfArthurLim’sinitiativetosetupSERI.

DrKwaSoonBeegraduatedasadoctorfromtheUniversityofMalayainSingaporein1955withdistinctionsinsocialmedicineandpublichealth.HewasawardedtheBruneiHawesGoldMedalforClinicalMedicineandtheLimBoonKengMedalforMedicine.

HewasadmittedasamemberoftheRoyalCollegeofPhysiciansandSurgeonsof Glasgow and of the Royal College of Physicians of Edinburgh, specialisinginhaematology, in1962. In1971,hewaselectedFellowof theRoyalCollegeofPhysicians, Edinburgh, and of the Royal College of Physicians & Surgeons ofGlasgowin1974.

AsMedicalSuperintendentofSingaporeGeneralHospital,DrKwapushedforthedevelopmentofophthalmology in thehospital,emphasising the importanceoffurthersub-specialisationandresearch.HisvisionlaterledtotheestablishmentoftheSingaporeNationalEyeCentrein1990,makingitthefirstspecialtyinstitutiontobeestablishedinSingapore.

DrKwalaterwitnessedthedevelopmentofSERIintoaresearchinstitution,whichhasgrowntotheprestigiouspositionitenjoystoday.

Dr Kwa Soon BeeFormer 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.

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DrKwaisaFellowoftheInternationalSocietyofHaematology.HewasappointedconsultanthaematologistandmedicalofficerinchargeoftheBloodTransfusionService in 1963, and its senior consultant in 1971. In 1969, in recognitionof his services to the Blood Transfusion Service, he was awarded the PublicAdministrationGoldMedalbytheSingaporeGovernment.

DrKwawasappointedMedicalSuperintendentoftheKandangKerbauMaternityHospitalin1968andoftheSingaporeGeneralHospitalin1972.HewasappointedPermanentSecretaryoftheMinistryofHealthandDirectorofMedicalServicesin1984.

DrKwawascommissionedasacaptainintheSingaporeArmedForcesin1972androsetotherankofcolonel,holdingappointmentsasCommandingOfficeroftheFieldHospitalsandhelpingtoestablishtheGeneralMedicalSupportGroup.HewasHonoraryConsultantPhysiciantotheSingaporeArmedForcesin1972,andHonoraryAide-de-CamptothePresidentfrom1972to1988.

InrecognitionofhisservicestotheSingaporeArmedForces,hewasawardedtheSingaporeArmedForcesGoodServiceMedalin1976,theLongServiceMedalin1981,andthePublicAdministrationMedal(Military)(Silver)in1986.

DrKwawas the foundingChairmanof theHealthCorporationofSingapore, aMinistryofHealthholdingcompany,from1987untilhisretirementin1996.HewasalsoChairmanoftheSingaporeGeneralHospital;theNationalSkinCentre;theSingaporeNationalEyeCentre;andtheToaPayoh,KandangKerbau,andTanTockSenghospitals.HewasChairmanoftheNationalUniversityHospitalfrom1985to1990.

Dr Kwa was awarded the Meritorious Service Medal by the Government ofSingaporein1992,inrecognitionofhisdistinguishedserviceasaclinicianandadministratorintheMinistryofHealthandforhiscontributionstothedevelopmentofthehealthserviceinSingapore.


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SNEC Gold Medallist RepresentingthesecondechelonofleadershipintheSNEC,AssociateProfessorVivianBalakrishnanwasappointedDeputyDirectoroftheSNECinlate1997.HetookoverthebatonfromProfessorArthurLimandbecametheCentre’ssecondDirectorinJanuary1999attheageof38.

Associate Professor Balakrishnan has achieved many academic distinctionsincludingtheprestigiousPresident’sScholarhonour.AfterachievinghisMMed(Ophthalmology)/FRCS(Ed)qualifications,hebecameoneofaselectfewoverseasophthalmologistsappointedtothehighlycompetitivespecialistseniorregistrar’spostatMoorfieldsEyeHospitalinLondonfortwoyears.

Hehasbeenactiveinregionalandinternationalactivities,andwasguestlecturerandcourseinstructorformanyteachingprogrammesinSriLanka,India,Vietnam,Nepal,andAustralia.HewasaccordedtheAsia-PacificAcademyofOphthalmologyDistinguishedServiceAwardin1999.

Inaddition,A/ProfBalakrishnanalsoplaysanactiveroleinmanynationalactivities.HewasrecentlypromotedtotherankofMajorintheSingaporeArmedForces(SAF),andisCommandingOfficerofthe2ndCombatSupportHospitaloftheSAF.HeisanelectedCouncilMemberoftheSingaporeMedicalAssociation,memberoftheNationalLibraryBoard,memberofthesubjectcommitteeoftheNationalSingapore21Committee,andrecentlyCo-chairmanoftheConceptPlanReview2001FocusGroupappointedbytheMinister forNationalDevelopment.ThesenationaladvisorycommitteesadvisetheGovernmentonstrategicdirectionsforSingaporeforthenextdecade.Heisalsoawell-knowndebaterandTVpersonality,having hosted theHealthMatters series in 1996 and theHeartware series in1998.

Assoc Prof Vivian BalakrishnanWewanttobethefirst,thebest,andthebiggest

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Assoc Prof Vivian Balakrishnan M Med (Ophth), FRCS (Ed)

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Assoc Prof Vivian BalakrishnanWewanttobethefirst,thebest,andthebiggest

UponhisappointmentasDirectorofSNEC,he immediatelysetaboutshapingthefuturedirectionofSNEC.Heinitiatedastrategicreviewandmappedoutmajorinitiatives for theSNEC in itsnextphaseofdevelopment.Acritical reviewwasalsoconductedofSNEC’sroleasthenationalcentreanditsrelationshipwiththenewlyrestructuredpublichealthcaresectorundertheSingaporeHealthServices(SingHealth)andNationalHealthGroup(NHG)clusters.Healsospearheadedthe faculty practiceplan aimedat retainingourpool of topmedical talentsbyensuringsecurityandasmoothcareertransitionforseniorophthalmologiststoaninstitutionalprivatepracticescheme.

He envisioned a strategic global alliance of eye centres, with SNEC being theophthalmic hub inAsia. To this end, he led a SNECdelegationof senior staffandvisitedJulesStein,JohnsHopkins,andHarvardintheUSA;MoorfieldsEyeHospitalintheUK;andtheLionsEyeInstituteinAustralia.Themissionhasledtotheexecutionofmemorandaofunderstandingwithmajorcentresthatwillformthefoundationofaglobalalliance.

Hebroughtadifferentstyleof leadershiptotheSNEC.Heishighly intelligent,shrewdinjudgment,quickinaction,sharpinnegotiations,uniqueandinnovativeinhisperspectiveoftheworld,andaboveallcharismaticinhisinteractionwithpeopleatalllevels.Yet,heisalsoeasilyapproachable,unassumingwithastrongsenseoffairplay,andfullofgenuineconcernandcompassionforthewelfareofeverystaff.Thisuniquecombinationofstrengthandhumanityhasearnedhimthetrustandrespectofallhiscolleagues,manyofwhomarehisseniors.HewasalsoeffectiveinhisadvocacyoftheSNECwithseniorofficialsoftheMinistryofHealthandthenewSingHealthgroup.ItisthereforenosurprisethatthemajortransitionofleadershipoftheSNEChasbeensosmooththatmanyhavetakenitforgranted.Withhismodelofbeneficientleadership,SNECispoisedtoachievegreaterheightsinitssecondphaseofexpansionanddevelopment.

Whenhefirst tookover thehelmofSNEC,keeping theSNECteamintactwasAssocProfBalakrishnan’sfirstpriority;andit isaproudfactthatoverthepastyears,thebestophthalmologistsinthecountryhavebeenattractedandretainedunderoneroof,andforthelastthreeyearstherehasbeennolossofanymemberoftheteam.

HisvisionforSNECwassimply,“Wewanttobethefirst,thebest,andthebiggest.”SNEC aims to be the first in pioneering new techniques, technologies, and


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treatmentsinSingaporeandpreferablytheregion,ifnottheworld.Hechallengedallstaffmemberstomeasuretheirachievementsintermsofpriority.

HesetthegoalforSNECtobethebestinoutcomeandqualityofcare,whichwasnottobemeasuredsolelybyourownstandards,butalsobywhatpatients feltandbythestandardssetbyourpeers.Hiscommitmenttoqualitywasmanifestedin the way he ensured that every procedure was thoroughly supervised beforetreatmentwasappliedtothepatients.

AssociateProfessorBalakrishnanalsocementedthesub-specialisationstructurein the SNEC by replacing the three existing clinical service departments withthe nine sub-speciality services and with the appointment of the respectivesubspecialityheads.Hespurredtheheadstofocusonfurtherdevelopmentandelevationofservice,teaching,andresearchintheirrespectivesubspecialities.Theobjectivewasforthemtobeexpertsineachareaofsubspeciality,andtoharnesstheirexperienceandexpertiseforthedevelopmentofophthalmologyasawhole.

Finally,hewantedSNECtocontinuetobe,aswearetoday,thelargestproviderofeyecaretoSingaporeans.Size isnotadvocatedfor itsownsake,butfortheadvantageofachievingeconomiesofscaleandcontaininghealthcosts.Itfacilitatessub-specialisation because with the high volume of cases, each specialist canseeenoughofaparticularconditiontomaintaintop-levelskillsandcurrencysothatwecannurturethebestcorneasurgeons,thebestrefractivesurgeons,thebestpaediatricophthalmologists,etc.Toachievebreadthanddepth,suchsub-specialisation can only occur in a high-volume, busy practice as in the SNECsetting.

InasurprisedevelopmentinJune2000,AssocProfVivianBalakrishnanwasaskedtorelinquishhisdirectorshipof theSNECandtoassumethepositionofChiefExecutiveOfficerofSingapore’slargestacutecarehospital,theSingaporeGeneralHospital.Givenhisoutstandingtalents,acceleratedcareermovesandpublicofficewerenotunexpected,althoughhisdeparturefromtheSNECafterjustoveroneandahalfyearsinofficewastoosoon.

OnthespecialoccasionoftheSNEC10thAnniversaryInternationalCongress,wewishtohonourAssocProfVivianBalakrishnanwiththeSNECGoldMedalAwardasourexemplaryleaderwhohaschartednewdirectionsforophthalmologyandtheSNEC.Weofferhimourbestwishesforanexceptionallybrightfutureahead.

Source: APJO Vol 12 (2), 2000

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Dr Khoo Chong Yew is well known nationally and internationally for hisachievements in thecontact lenssubspecialty.HehasbeenacouncilmemberoftheInternationalContactLensCouncilofOphthalmologysince1986,andwasrecentlyappointedasitsChairman.HewasawardedtheJavalSilverMedalbytheCouncilin1990andtheGoldMedalin1994.

Besidesbeinginvitedtodelivermanylecturesoncontactlenses,DrKhoohasalsoconductedmany teaching courses locally and abroad.Hehas co-authored thebook,Contact Lenses: Medical Aspects,withDrMontagueRubern,anotherworld-renownedexpertinthefield.

DrKhoowasamongstthefirstvisitingconsultantsappointedtotheDepartmentofOphthalmologyoftheNationalUniversityHospital(NUH)in1986.Withtheestablishment of the SingaporeNational EyeCentre (SNEC) in 1991, hemadefurthercontributionsinanumberofareasimportanttothedevelopmentoftheCentre.

He is adviser to the Cornea Division (Medical Contact Lens and Eye Bank),ChairmanoftheEthicsCommittee,ChairmanoftheSingaporeEyeBank,aswellasamemberoftheSNECMedicalBoardanditsSelectionBoard.

Everactive,DrKhoo’snameappearsinmanyothermedicalorganisationsoutsidetheSNEC.HeisapastpresidentoftheSingaporeMedicalAssociationfortwoterms(1985–1987),andwasanelectedmemberoftheSingaporeMedicalCouncilfrom1990to1993.

HehasbeeninvitedbytheMinistryofHealthtoserveonmanysubcommitteesincluding theHealthAdvisoryCouncil,Committee forSpecialists’Register, theCommitteeonMedisaveforPrivateHospital,andmore.

Dr Khoo Chong YewMbBCh, FAMS, FRCS (Ed), 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


Dr Khoo Chong YewHeenforcedethicsinresearcheffectively

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Untillastyear,hewasChairmanoftheEthicsCommitteeoftheGleneaglesHospital.He has been on the Panel of Advisers and an Executive CommitteeMemberoftheSingaporeEyeFoundationfor13years.Hewasalsoinvitedin1982tobeamemberoftheAdvisorySubcommitteeonSpecialistCertificationoftheAcademyofMedicine.

These multiple appointments on government and professional bodies clearlyreflectthehighesteemDrKhoocommands.

Equally,Dr Khoo has particularly distinguished himself in his contributions tocommunity ophthalmology. In 1984, he chaired the National Eye Campaign,whichmountedeyescreening in75communitycentres.Besides thenumerouseye-screeningprojectswhichhehascarriedoutovertheyears,hehasalsobeenassistingtheHomeNursingFoundationsince1986toprovideophthalmiccaretoneedypatients.

In addition, Dr Khoo sits on the Council of the Asia-Pacific Academy ofOphthalmology (APAO)andchairs theAPAOEthicsCommittee.From1995 to1999,heledaRotaryMedicalMissiontoCambodiatointroduceimplantsurgerytoophthalmologists in the country.Hewas accorded theAPAODistinguishedServiceHonour.

In1996,DrKhoowasawardedtheNationalDayPublicServiceMedal(PBM)forhisworkwiththeDisciplinaryCommitteeoftheLawSociety.

Heholdsnumerousdistinguished appointments at various institutions, but ismoreinvolvedwiththeethicalaspectsofmedicine.HehasbeentheChairmanoftheSNECandSERIethicscommittees(IRB)since1994and1998,respectively;Chairman of the National Medical Ethics Committee, Ministry of Health;Chairman of the Independent Ethics Committee, ParkwayGroup ofHospitals;and was the Chairman of the Singapore Advisory Panel, Medical ProtectionSociety, from 2001 to 2003. He wrote the Ethical Codes of SNEC and APAO.HewasalsoanelectedCouncilMemberoftheSingaporeMedicalCouncilfrom1990 to 1993. At the last SERI/ARVOConference in February 2005, he gave atalk on “How I review a clinical trial”; and at the last Gleneagles HospitalScientificSeminarinJuly2005,hegavealectureon“Ethicsofresearch”.Paperspublished on ethics include “Promoting Ethics” (Singapore Medical Journal,

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1996, Vol. 37, pp. 457–463) and “Ethical Issues inOphthalmology and VisionResearch”(Annals of Academy of Medicine, July2006,Vol.35No.7,pp.512–516.)

Internationally,DrKhoohasbeenaCouncilMemberofAPAOsince1985.Between1986and1990,hewasSecretary-GeneraloftheXXVIInternationalCongresstoOphthalmology—themostprestigiousworldophthalmiceventevertobeheldin Singapore. In 1992, hewasMember of theBoardof ExpertAdvisers,AsianFoundation for the Prevention of Blindness. Between 1998 and 2002, he wasChairmanof the IX InternationalMedicalContactLensSymposiumandXXVIIIInternationalCongressofOphthalmology.

DrKhoo’sresearchareasaretheaetiologyofmyopia,eyechangesduetomyopia,suppressionofmyopiaprogressioninschoolchildren,contactlenscomplications,andcorneadiseases.Hehaspublishedseveralpapersonthesesubjects,namely,“3YearStudyontheEffectofRGPContactLensesonMyopicChildren”(Singapore Medical Journal, Vol.40(4),p.230),“TheEffectofRGPContactLensesonMyopicChildren” (Asia-Pacific Academy of Ophthalmology, Vol. 11 (4), pp. 6–14), and“MethodologiesforInterventionalMyopiaStudies”(Annals Academy of Medicine, April 2006, Vol. 35 (4), pp. 282–286). He has given guest lectures in France,Canada,Australia,Indonesia,andBrazil.Hewasinvitedtogiveaguest lectureattheJapanContactLensSociety’s50thAnniversaryMeeting,whichwasheldin8July2007,inTokyo.

In2006,DrKhoowasawardedtheNationalDayPublicServiceStar(BBM)forhisworkinmedicalethicsattheMinistryofHealth.

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 InstituteBy Dr CY Khoo

Importance of Ethical ReviewAs 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.

HistoryOn 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 non-statutory, have been formulated by the National Medical Ethics Committee (NMEC) and the Bioethics Advisory Committee (BAC).

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Review of Clinical TrialsThose 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 StudiesAn 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.

ControversiesMany 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 ResearchOften, 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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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 DevelopmentsRecent 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 InvestigatorsAll 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 MembersAll 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 CentresAudit 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.

ConclusionThe 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.

Source:Leading Lights in the Asia-Pacific,2006

References1. NationalMedicalEthicsCommittee:“EthicalGuidelinesonResearchInvolvingHumanSubject”,Singapore,4Sept.1997.2. RoyalCollegeofPhysician:“ResearchInvolvingPatients”,London,1990.3. MinistryofHealth:PaperMH(cf)24:63/2,Singapore,25Jun1998.4. SGGCP:SingaporeGuidelinesforGoodClinicalPractice,1Jul1998.5. MedicinesRegulations:TheAmalgamatedVersionoftheMedicines(ClinicalTrial)Regulations,1978and1998,Singapore,1Jul1998.6. MinistryofHealth:PaperNo(98)4/7,Singapore28Aug1998.7. NationalMedicalEthicsCommittee:“EthicalGuidelinesforGeneTechnology”,Singapore,Feb2001.

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Prof Roger BeuermanAgreathelpinSingapore’socularresearch

ProfessorRogerBeuermancurrentlyholdsthepositionofDeputyDirector(2002)andScientificDirector(2001)oftheSingaporeEyeResearchInstitute,andwasalso appointed as head of Laboratories. He is concomitantly Professor of theDepartment of Ophthalmology, Department of Anatomy, and Department ofClinicalPsychiatryat theSchoolofMedicine,LouisianaStateUniversityHealthSciences,USA.

RogerBeuermancompletedhismedicalstudiesat theFloridaStateUniversity,graduatingwithaPhDinsensoryphysiology(1973).Healsohadapost-doctoralresearchfellowshipattheUniversityofWashingtonSchoolofMedicine,Seattle,Washington(1973–1975).

Professor Beuerman has published 29 articles in international peer-reviewedjournals.Hehasauthored9bookchapters inbooks ranging fromengineeringto ophthalmology text books. Professor Beuerman has also edited two booksinophthalmology,themostrecentondryeyeandocularsurfaceinflammation,publishedinJuly2004.Duringthisperiod,hehadadirectroleintheacquisitionofS$2,598,000.00ingrantfunds,andhasbeenacollaboratoronotherstudiesoutsideoftheSingaporeEyeResearchInstitute.

Professor Beuerman has no formal teaching commitments at this time.However,heisactiveinteachingthelaboratorystaffbasicscienceinvisionandophthalmology.Inthepast,helecturedintheStanfordophthalmologyresidentreviewcourse.ProfessorBeuermanhasbeencoordinatingthedevelopmentofaprogrammewiththeNationalInstitutesofHealthandtheNationalEyeInstituteforstudentstocarryouttheirdoctoralstudiesatNIHwhileenrolledasagraduate

Prof Roger BeuermanProfessor of Ophthalmology, Cell Biology and Anatomy,Clinical Psychiatry, and NeuroscienceLouisiana State University Health Sciences CentreSchool of MedicineNew Orleans, Louisiana


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student at NUS. Professor Beuerman is the key researcher in myopia at theSingaporeEyeResearchInstitute.Hisresearchinterestsarealsointheareasofproteomics and bioinformatics. He has, with the assistance of several NMRCgrants,builtupaproteomicsmicroanalyticallaboratorythatisrapidlyattractinginternational attention and collaborators. Several interests are active in thelaboratory:drugdevelopment,drugkinetics, tearproteomics indryeye,ocularsurface wound healing, and anti-microbial peptides associated with innateimmunity. In addition to publishing papers in the highest-quality proteomicsjournals, Prof Beuerman and his team of researchers have also contributedchapters to anumberof bookson tears andproteomics. ProfessorBeuermanformedtheSingaporeConsortiumforAnti-MicrobialPeptides,whichisdevelopingnewanaloguesofthedefensins,anti-microbialpeptideswithspecialpropertiesagainstfungus,andB. pseudomallei,local,verylethalsoilbacteria.ThisprojectwillhavethechancetodevelopsignificantnewintellectualpropertyforSERI.

ProfessorBeuermanhasalsobeeninvolvedineveryphaseofdevelopmentoftheSERIlaboratoryandinthestrategyoforganisation.Thisstrategyhasbeentodevelopcentresofexpertise,aroundwhicharebothhigh-qualitystaffandinstrumentationaswellasgrantsupporttomaintainthelevelofactivity.Thisallowsothershort-termprojectstobetakeninfromanothereyefacilityinSingapore,makingSERIagoodcollaborator.Inaddition,hehasplayedacentralroleinthedevelopmentthinkingbehindtheSERI-ARVOmeetingas theco-organiser forbothmeetingsthusfar.

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AssociateProfessorSawSeangMeireceivedherMBBSdegreefromtheNationalUniversityofSingapore, andbothherMPHandPhD from the JohnsHopkinsBloombergSchoolofPublicHealth.She is currently anAssociateProfessor atthe Department of Community, Occupational and FamilyMedicine as well asAssistantDean(GraduateStudies),YongLooLinSchoolofMedicine,NationalUniversityofSingapore.AsAssistantDean(GraduateStudies),shehasdevelopednewmodulesforgraduatestudents(bothPhDandMaster’s).

Hermain teachingarea is inepidemiologyandpublichealth.ProfessorSaw isthePrincipalInvestigatoroftheSingaporeCohortstudyOftheResearchfactorsforMyopia(SCORM),andtheSTrabismus,AmblyopiaandRefractiveerrorstudyinSingaporepreschoolchildren(STARS).TheSCORMstudyisacohortstudyof1979childrenaged7to9yearswhohavebeenfollowedupyearlysince1999;whiletheSTARSstudyisanongoingstudyofChinesechildrenaged6to72monthsthataimstodeterminetheprevalenceofmyopia,amblyopia,andstrabismus.

Her primary research interests are related to the epidemiology, genetics, andgene–environment interactions for myopia and other eye diseases. She isactivelyinvolvedinelucidatingthepatternsofmyopiaandbiometryparametersin Singapore children and adults, aswell as evaluating the environmental andgeneticriskfactorsformyopia.

Shehaspublishedpapersinmorethan120peer-reviewedinternationaljournalsincludingtheLancetandJournal of the American Medical Association(JAMA),and

Assoc ProfSaw Seang Mei


Assoc Prof Saw Seang MeiShedevelopedstatisticsinocularresearchimportantforoursuccess

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twobookchapters.ProfessorSawisanEditorialBoardmemberofOphthalmic and Physiologic OpticsandtheAnnals Academy of Medicine (Singapore),andcommencedherappointmentasEditorialBoardMemberofInvestigative Ophthalmology and Visual Science in January 2008. Shehas been awarded several grants from theBiomedicalResearchCouncilandNationalMedicalResearchCouncil,Singapore.

ProfessorSawwastherecipientoftheJeansCoombsAwardfromJohnsHopkinsSchoolofHygieneandPublicHealth(1998),theGeshinMohnARVOTravelGrant(2002),theEdwardClarenceDyasonUniversitis21Award(2005),theGarlandW.ClayAward(2006),andtheGreatWomenofourTimesAwardsfromtheScienceandTechnologyCategory,Singapore(2006).

Professor Sawwas the past Chair of the 11th InternationalMyopia Conferenceheld from 16th to 18th August, 2006, in Singapore. She has organised severalrefractive error epidemiology symposiums at the International Congress ofEye Research, World Congress of Ophthalmology, and European Vision andEyeResearchmeetings.She is currently aProgramCommitteememberof theClinical/Epidemiologic section, Association for Research in Vision andOphthalmology (ARVO).Presentationshavebeenmadeatmany international,regional,andnationalmeetings.

Professor Saw is amember of theDeltaOmega-Alpha Chapter, theHonoraryPublicHealthSociety,andtheARVOpublicationscommittee.SheisalsoactivelyinvolvedintheSchoolGraduateProgramCommittee,SchoolClinician-ScientistUnit,SchoolGraduateProgramCommitteeSpecialistsAccreditationBoard(SAB)ResearchCommittee,andtheNationalMyopiaPreventionProgrammecommittee,andservesasanadvisortotheNUH-NUSMedicalPublicationsSupportUnit.

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Professor Wong Tien YinMBBS, 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 Tien YinAyoungdynamicresearchleader

DrWongTienYiniscurrentlyAssociateProfessoroftheNationalUniversityofSingaporeandAssociateDirectoroftheSingaporeEyeResearchInstitute.HeisconcurrentlyProfessorandDeputyHeadoftheCentreforEyeResearchAustralia,UniversityofMelbourne.

ProfessorWongwasaPresident’sscholarandcompletedhismedicalschoolintheNationalUniversityofSingapore(MBBS,1992).Hedidhisclinicalophthal-mologytrainingattheSingaporeNationalEyeCentre(SNEC),whereheobtainedhisFRCSEandMMED(Ophth)in1999.HehasaMPH(1997)andaPhD(2002)from the JohnsHopkinsUniversity,Baltimore,USA.Hehas completed fellow-ships inuveitis fromSNECandmedical retinal disease from theUniversity ofSydney. He also has post-doctoral research fellowships at the Johns HopkinsUniversityandtheUniversityofWisconsin,Madison,USA.

ProfessorWong’sclinicalandresearch interest is intheareaofmedicalretinaldisease,specificallyretinalvasculardiseases,focusingontheuseofretinalvas-cular imaging topredict theriskofcardiovasculardiseasessuchasstrokeandischaemicheart disease.Hehaspublished 180peer-reviewedMedlinepapers,includingpapersinthehighest-impactmedicaljournalssuchastheNew England Journal of Medicine,Lancet, Journal of the American Medical Association ( JAMA),Annals of Internal Medicine,andBritish Medical Journal.Hehasgivenmorethan50invitedandnamedlecturesaroundtheworld.

ProfessorWongisthePrincipalInvestigatorofmulti-centreprojectsintheUSA,Australia,andSingapore,includinggrantsfromtheNationalInstitutesofHealth(NIH), USA. In 2005, he received a grant from the State government inVictoria,Australia,underitshighlycompetitiveScience,TechnologyandInnovationSchemetodevelopa$6millionRetinalVascularImagingCentre(RetVIC).Heison


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theEditorialBoardofthreemajorjournals:theAmerican Journal of Ophthalmol-ogy,Investigative Ophthalmology and Visual Sciences,andBritish Journal of Ophthal-mology.

ProfessorWonghasbeenrecognisedinternationallywithnumerousawards,in-cludingtheJeansCoombsAwardfromtheJohnsHopkinsUniversity(1997),theScholzAwardfromtheWilmerOphthalmologicalInstitute(1999),oneofthetheTenOutstandingYoungPersonsoftheWorldfor“academicleadershipinpeopleyoungerthan40yearsofage”(1999),theAsiaPacificAcademyofOphthalmologyPreventionofBlindnessAward(2003),andtheSandraDohertyAwardfromtheAmericanHeartAssociation(2004).

For his work on retinal vascular diseases, he has been awarded the highestresearchawardattwouniversities:first,the2004OutstandingResearcherAwardfromtheNationalUniversityofSingapore,andthenthe2005WoodwardMedalinScienceandTechnologyfromtheUniversityofMelbourne.In2006,hereceivedthreeprestigiousawards:theNovartisPrizeinDiabetes,YoungInvestigator;theAlconAwardin2006;andtheCommonwealthHealthMinister’sAwardforExcel-lenceinHealthandMedicalResearch,Australia.

ProfessorWongwaspromotedtofullProfessorattheUniversityofMelbournein2006.

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Progress of SERIAn 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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This inaugural event on 24April 1999marked the inception of a collaborativeefforttobringtogetherophthalmologists,optometrists,andvisionscientistsinSingaporetodiscussanddeliberateonophthalmicandvisionresearchperformedin1998.

TheFirstNational EyeResearchMeetingbrought together all organisations inSingaporewithaninterestinbasicandappliedeyeresearch.Itwasthecombina-tionanddevelopmentoftheSNECResearchDayandtheTanTockSengHospital’sAnnualResearchMeetinginOphthalmologyandVisualSciences.Thismeetingincluded newmembers, namely the Singapore Eye Research Institute, ChangiGeneralHospital,DefenceMedicalResearchInstitute,andOptometryCentreoftheSingaporePolytechnic.

The meeting highlighted the latest work of mature scientists and provided aforum for young investigators with fresh insights in eye research. There werescientificpresentationsaswellasdidacticsessionsongeneraltopicsfocusingonnew practices and current controversies in conducting research in Singapore.Topics included good clinical practice guidelines, patents, royalties, researchmethodology,andapplicationofgrants.

Themeetingalsosawthefirstdeliveryof theChewSek JinLecture,whichwasestablishedasatributeinmemoryofthelateAssocProfChewSekJinwhopassedawayinDecember1998.

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Keynote Address : A Perspective on Clinical ResearchBy Prof Paul Lieutman, Johns Hopkins Singapore

Clinical research is essential if we are to continue to improve our ability asphysicianstocure,treat,orpreventdisease.Ithasalsogarneredconsiderableat-tentionintheeyesofthebiomedicalresearchcommunitywiththerecentcreationofresearchgrantsfromtheUSNationalInstitutesofHealthspecificallyforthetrainingofinvestigatorswhowillcarryoutclinicalresearch.

Several attributes of clinical researchmake it particularly important for us asphysicianstoconsider.

First, it isnecessary ifwewishtobecomebetterable tocure, treat,orpreventdiseasesinthefuture.Withoutclinicalresearch,wewillbereducedtothemain-tenanceandpropagationofthepresentstateofknowledge(orignorance)abouthumandisease.

Withoutclinicalresearch,wewillbeabletodonobetterasphysicianstomorrowthanwecandotoday.Withoutclinicalresearch,wewillbewhollydependentontestimonials and other non-scientificmethods of assessing the value (or lackthereof)ofallnewtherapeuticpossibilities.

Second,itisthekindofresearchthatwe,asphysicians,shouldbebestabletodo.Itisthetypeofresearchthattakesthegreatestadvantageofourknowledgeofandourdirectcontactwithpatients.

IntheUSA,themorecommonmodelinthepasthasbeenforaphysicianwhowishes todomedical research to trainasaphysicianandasascientist in thelaboratory,andthentotryonhisorherowntointegratethetwoandtocarryout

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

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researchonpatients,eventhoughnoneofthelaboratorytrainingtaughthowtodopatient-orientedresearch.

Aslaboratoryresearchbecomesmoreandmoresophisticatedandcomplex,andasitdemandssomuchmoreofone’stimetomasterandmaintain,itbecomesincreasinglydifficult to contemplate activeparticipation inboth thepracticeofmedicineandlaboratoryresearch.Ontheotherhand, it isfareasiertoseethewisdomofintegratingone’smedicalpracticewithpatient-focusedresearch.

Third,theresultsofclinicalresearcharethemostrelevanttoourpatients’wel-fare.Whileitistruethattheresultsoflaboratoryresearcharemorefundamentalandmorelikelytohaveanenormousimpactsometimeinthefuture,theresultsofclinicalresearcharemoreeasily translatable into immediatebenefits forourpatients.

ClinicalresearchshouldbeparticularlyattractivetophysiciansinSingaporeanditsdevelopingneighbournations,sincetheregionclearlyhasthemostimportantresourceforclinicalresearch,namely,patients.Withrespecttothatresource,youareatleastaswelloffasweintheUSA;andwithrespecttosomediseases,youareuniquelysituated.

You also have several other important advantages for clinical research. Youhaveaculturethatpridesitselfonitstransparency,atleastingovernment,andonintegrity.Surelythisistheveryessenceofclinicalresearch,sinceitsearchesfortruth.Youhaveacadreofphysicianswhoareverywelleducated,coupledwithanapparentloveofhardworkandabeliefinadvancementthroughmerit.

On the other hand, there are some inherent problemswith respect to clinicalresearch in Singapore. A strong tradition of clinical research is lacking inSingapore,andconsequentlytherearerelatively fewrolemodelsforthosewhomightaspiretobecomeclinicalinvestigators.

Also,theexcitingstructureprovidesverylittleincentiveforclinicianstoengageinclinicalresearch.Anditisdifficultforthepersonwhoispersuadedofthevalueofclinicalresearchtoseeacareerpaththatemphasisesclinicalresearch.

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

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anunmarked careerpath, howcouldone train tobecomeanexcellent clinicalinvestigator?Havingwrestledwiththisquestionforanumberofyears,weattheJohnsHopkinsUniversity have created the firstGraduate Training Program inClinicalInvestigationintheUSAandprobablyintheworld.

This programmeoffers a PhD in clinical investigation. It ismodelled after thetraditionalbasic sciencePhDdegree course in that it requires a foundationofdidacticcoursesinMethodsofClinicalResearch,DataStorageandRetrievalforClinical Studies, Bio Statistics, Principles of Epistemology, BiomedicalWriting,PrinciplesofDrugDevelopment,andEthicsofHumanExperimentation.

Werequirethatonebeaphysiciantoentertheprogrammeandthatone’sclinicaltraininghasbeencompletedpriortoenteringtheprogramme.Wethenrequirethatacrediblepieceofresearchbeproducedafterthedidacticyear.Itisourbeliefthatthefuture leadersofacademicclinicaldepartmentswillcomefromthisoranothersimilarprogrammeinthefuture.

Thus,thisperspectiveonclinicalresearchispresentedtoserveasaninvitationtothosewhowishtoparticipateinSingapore’sknowledge-basedeconomyofthefuture,toconsiderdoingsothroughtheexcitingareaofclinicalresearch.

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 ComplexByDrEricYap,DefenceMedicalResearchInstitute

Major advanceshavebeenmade in thepastdecade inmolecularophthalmol-ogy. There has been greater understanding of the mechanisms of eye devel-opment at the cellular and molecular levels. Genes for several hereditary eyediseaseshavebeenidentified,includingthoseforretinitispigmentosa,Stargardt’sdisease,Leber’shereditaryopticneuropathy,retinoblastoma,andfamilialopen-angleglaucoma.

Progress of Singapore Eye Research Institute

Dr Eric Yap

1999

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Progresshasalsobeenmadetoelucidatethegenetic factors involved inmorecommon polygenic diseases, such as glaucoma, macular degeneration, andmyopia. This has been brought about by the availability of new approachesin genetic epidemiology and molecular biology, and through advances in theHumanGenomeProjectandgenemapping.

We have been developing in our laboratory the tools to screen the humangenome for disease susceptibility genes: in silico detection of polymorphismsby biocomputing, high-throughput genotyping of STR markers, and geneticstatisticalsoftware.

Analysisof‘simple’Mendeliandiseases(e.g.retinitispigmentosa)and‘complex’polygenic diseases (e.g. myopia) is currently underway, with a variety ofapproaches, including allelic association studies in individuals and geneticlinkage studies in sibling-pairs and families. Significant associations andmutationsinseveralcandidategeneshavebeenfound,includinganeurotrans-mitter receptor (DRD2), a photoreceptor (RHO), and components of theextracellularmatrix(TIGR,COL2A1).The discovery of disease-causingmutations and susceptibility genes presentsmajor opportunities in understanding the aetiology and pathogenesis of eyediseases, as well as for diagnosis and genetic counseling. However, majorscientific and clinical challenges to correlate sequence mutations to diseaseseverity, to understand biological functions of disease genes, and to developeffectivetherapeuticstrategiesforcomplexeyediseasesstillremain.

1999

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

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Chairman’sMessageI am delighted to see the excellent progress of the Singapore Eye ResearchInstituteundertheleadershipofAssociateProfessorDonaldTan.Itwasnotaneasytaskashe isat thesametimeabusyandexcellentclinician,dealingwithhundredsofcomplicatedcornealproblems.

Ophthalmic research in Singapore can be divided into three phases. The firstphasewasduringtheearlyyearswhenscientificpaperswereessentiallyclinical,astherewasnoinfrastructure,nofunds,andnosupport.

Inthesecondphase,AssociateProfessorDonaldTanwasappointedDirectorofSingaporeEyeResearchInstitute,anditspotentialbegantoemerge.Hehasputtogetheranimpressiveinfrastructurewithlaboratories,financialsupport,andlink-agewithotherresearchcentres;mostimportantly,hehasattractedaneffectiveteam.The team includesProfessorRogerBeuerman,PhD, a key researcher inmyopia;ProfessorWallaceFoulds,DSc,advisor;ColonelDrEricYap,PhD,genet-ics;andDrSawSeangMei,PhD,epidemiology.

Inthethirdphase,weareenteringintothemostimportantperiodwhereevery-thingischangingrapidly.Willacademicresearchshiftawayfromlargeinstitutionstosmallgroupsofindividualswithknowledge?Willtoday’sknowledgeeconomyallow small research centres with international networking and informationtechnologytopushaheadmorerapidly,out-smartingtheoldestablishedresearchinstitutionsofEuropeandAmerica?

Itisclearthatthefutureofresearchisloadedwithuncertainties.Iseeresearchcen-tresbattlingforleadersofknowledge,ofintellect,ofdrive,basednotonbiologicalagebutonthementalcapacitytosucceed.Iseethelargerestablishmentsbecom-ingveryconfusedandterrifiedaseveryoneisbeingcaughtupintheinternationalonslaughtofrapidchanges.IamproudofwhattheSingaporeEyeResearchInstitutehasachieved.Ithankthemany leading researchbrains fromother countrieswhohave come together todiscussnewandexciting ideaswithus. Idohopethatallwillcontinuetoworktogetherclosely,embracingthefascinatingrapidchangesandheadingtowardsagloriousfuture.Professor Arthur LimChairman

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Ophthalmic research in Singapore can be divided into three phases. In the first phase...there was no support.

In the second phase, Associate Professor Donald Tan was appointed Director of Singapore Eye Research Institute, and its potential be-gan to emerge.

In the third phase, we are entering into the most important pe-riod where everything is changing rapidly.

It is clear that the future of research is loaded with uncertainties.


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SecondNationalEyeResearchMeetingSingapore Eye Research Meeting 2000 / 2nd Combined Meeting in Ophthalmology and Visual Science

TheSingaporeEyeResearchMeeting2000broughttogetherallorganisationsinSingaporewith an interest inbasic andappliedophthalmic and visual scienceresearch,inameetingthataimstobeoneoftheforemosteyeresearchmeetingsinAsia.

OriginallythecombinationanddevelopmentoftheSNECResearchDayandtheTanTockSengHospital’sAnnualResearchMeetinginOphthalmologyandVisualSciences,thefirstNationalEyeResearchMeetingin1999broughttogetheralloftheophthalmicandvisualscienceresearchersfromlocalinstitutions.

The2000meetingagainencompassedandshowcasedalllocalophthalmicandvisualscienceresearchperformedwithintheparticipatinginstitutions,orincol-laborationwith international ophthalmic research institutions. In addition, themeetinghighlightedthelatestadvancesinophthalmicsurgery,technologies,andlaboratoryresearch;andalsoprovidedanimportantforumforyounginvestiga-tors,doctors, and vision scientists todevelop fresh insights into eye research.Therewerebescientificsymposiaandscientificpostersessionsaswellasdidacticpresentationsfromrenownedinternationalophthalmicresearchers.

Invited Speaker: Molecular Biology in this Post-genome Era By Prof Venkatesan Sundaresan

Thecompletionofthesequencesofseveralorganismsandtherecentlyannouncedworkingdraftofthesequenceofthehumangenomehaveusheredinanexcitingnewerainbiology—thepost-genomeera.Inconcept,itmeansthatwehaveinourhandsthecompletesetsofinstructionsinquaternarygeneticcodeformakingabacterium,ayeast,aworm,andafly,andverysoon,foraplantandahumanaswell.Inpracticalterms,however,understandingandinterpretingthisinformationandputtingittogoodusewillbeaformidabletask.

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Currently, in higher eukaryotic organisms, the biological functions for only avery small fraction of the genes are known. The current situation is akin tohaving obtained a book written in a known alphabet, but telling a story in alanguagethatwecannotunderstand.Molecularbiologistsinthepost-genomeerawillneedtouseavarietyofapproaches,rangingfromgeneticstostructuralbiol-ogytocomputing,togainthisunderstanding.

The emergence of the new field of functional genomics— the study of genefunctionsonalargescale—hasbeendrivenbynewtechnologiesthatutilisethevast information resources from the genome projects for their successfuldeployment.Forexample,itisnowpossibletoprofiletheexpressionpatternofevery gene in the budding yeast under an unlimited number of differentconditions and stimuli, using microarrays. Microarrays have also been usedinhumanpatientstoclassifysubtypesoftumoursinchemotherapy.

Anothertechnology,calledgenetrapping,useslarge-scaleinactivationofgeneswithinthegenometodecipherthebiologicalfunctionsofgenesforwhichonlysequenceinformationisavailable.Thisprocessiscalled“reversegenetics”.High-through-putreversegeneticsisnowroutineinmodeorganisms(i.e.yeast,worm,etc.).Therapid progress in the functional genomics of thesemodel organismshas alsohelpedstimulatetheemergenceofcomparativegenomics.Thisapproachpermitsgenesthatareinvolvedinhumandiseasetobecharacterisedmorerapidlybyfirstidentifyingtheircounterpartsinasuitablemodelorganism.

At the InstituteofMolecularAgrobiology,workon themodelorganismzebraf-ishhasresultedinthemolecularcharacterisationofgenesforgeneticdiseasesrelatedtoeyedevelopment.Similarly, researchonthemodelplantArabidopsishasresultedintheisolationofgenesthatcanbeusedtoimprovetheyieldsofcropplantssuchasrice.Therefore,thepost-genomeerawillyieldarichharvestof information on the structure and functions of genes, which was beyondimagination just two decades ago. The challenge is for this information to beharnessed for the benefit of humanity through its impact on agriculture andhumanhealth.

2000

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

By Dr Wong Tien YinDepartment of Ophthalmology, National University of Singapore

Cl Assoc Prof Donald TanDeputy Director, SNECDeputy Director, SERI

Aswe enter this new century and turn our faces to thewinds of change, it istimelytolookforwardtothefutureofophthalmologyinSingapore.Ourfutureliesinmedicalinnovationandtheembracingofnewtechnology,inthediscoveryofnewtherapeuticmodalitiestotreatandpreventoculardiseaseinourcommunity.Ourfutureliesinophthalmicresearch.

AtthisstageintheevolutionofophthalmicdevelopmentinSingapore,westandatthecrossroadsofanewresearchethic.Duringthepastdecade,amajorparadigmshifthasoccurredinourperceptionofwhatisimportanttoophthalmologyandophthalmicinstitutionsinSingapore.

Nolongerarewesatisfiedwithonlydevelopinghigh-qualityophthalmicclinicalservices,whichwewillcontinuetostrivefor.Butwehavealsobeenimbuedwiththeneedtoseekanswerstoscientificandmedicalquestionswhichhavedirectrelevance to how we care for our patients, and to seek for them ourselves,withinthescientificframeworkofclinical,epidemiological,andlaboratory-basedresearch.

WiththedevelopmentoftheSingaporeEyeResearchInstitute(SERI),represent-ingtheresearcharmoftheSingaporeNationalEyeCentre(SNEC),wearenowpoised toembarkonapathofophthalmic researchwhichmayallowus tobepresentatthecuttingedgeofmedicalinnovation.

The Face of Ophthalmic Research to ComeFor the past 1,000 years, significant developments in clinical medicine werelargelydrivenbydevelopmentsinmedicalresearch.Thisisnotlikelytochange.

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Inophthalmologyandthevisionsciences,themanyresearchachievementsofthepastcenturyincluded:• theevolutionofcataractandrefractivesurgery;• theidentificationofgenesforinheritedcornealandretinaldiseases;• theimpactofclinicaltrialsinthemanagementofdiabeticretinopathyandage- relatedmaculardegeneration;and• theelucidationofbiologyandpathogenesisofglaucoma.1

In this new century, new treatmentmodalitieswill be introduceddirectly fromthefruitsofsuchresearch.CarlKupfer,directoroftheNationalEyeInstituteinthe USA, identified three areas of vision research that would be significantoverthenext20years.2

The first is in the area of inherited retinal degeneration, including retinitispigmentosaandvariousformsofmaculardegeneration.Hebelievesthatwewilllearnenoughabouttheunderlyingcausesofdegenerationofthephotoreceptorsinthesediseasestodevelopmedicaltreatmentsthatwillinterruptorslowdowntheneurodegenerativeprocess.

The second area of progresswill come from glaucoma-related researchwhereitislikelythatnew,highlyeffectiveneuro-protectiveagentswillbedevelopedtosafeguard the axons in the optic nerve head from damage, thereby preventingvisionloss.

The third area that has potential for significant progress is the treatment ofcorneal diseases, particularly in corneal dystrophies where the results fromgeneticstudieswillallowdevelopmentofgenetherapy.

Beyond the obvious revolution in genetics, other technologies in automation,ocular imaging,medical informatics,andbiomedicalengineeringwillalsoalterthedirection,conduct,andresultsofophthalmicresearchinthecomingcentury.3,4

AccordingtoDeclanButler,editorofthejournalNature, thewayscientistsandcliniciansobtaininformationwillradicallychangeasmorejournalsmovetoafullyelectronicformat.5

Thiswill affect the nature and organisation of libraries and scientific archives,suchthatfutureresearcherswillgatherinformationfromtheirhomecomputers

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andnotsetfootinthelibraryatall.Thisisalreadyhappeningasmoreandmorereaders obtain their reference sources by downloading abstracts and wholearticlesfromliteraturedatabankssuchasMedlineandfull-textjournals.6

Is There a Role for Ophthalmic Research in Singapore?InSingapore,researchisoneofthreekeymissionsofourhealthcareinstitutions(theothertwobeingserviceandteaching),buthasarguablyreceivedlessattentionthan the other two. The first issue we must address is whether ophthalmicresearchhasanymajorroleinSingapore.

Thequestioncanalsoberephrasedthus:Givenourlimitedophthalmicresourc-es, can Singapore producemeaningful vision-related research? If so, the nextquestionis,arethereareasofophthalmicresearchweshouldbeconcentratingon,andthoseweshouldavoidandleavetotheUSAandothercountriesthathavesignificantlygreaterresources?

Somehavearguedthatresearchisaluxuryinmanyofourinstitutions,andshouldcontinuetoplayaminorrolenexttoclinicalserviceandteaching.Othershavesuggestedthatweshouldconcentrateonlyonclinicalresearch,andavoidresearchonmolecularandbasicscience,whichusually require long-termcommitmentsandprovidenoimmediatetangiblegains.

However, there are at least three important reasons why ophthalmic researchinSingaporehasanimportantrole.First,researchhasbecomeaninternationalyardstick.Itprovidesanobjectivewayofcomparingandmeasuringthequalityofinstitutionsaroundtheworld.7Researchdatacanbeusedquantitativelytoassessandrankindividualdepartmentsandinstitutions.

This is already done in theUSA,where an important component of the rank-ingofhospitalsandmedicalschoolsintheannualUSNewsandWorldReportseriesistheamountofNationalInstitutesofHealth(NIH)fundingaparticularinstitutionreceives(accountingfor30percentofthetotalscore,afterreputation,whichaccountsfor40percent).WilmerEyeInstituteatJohnsHopkinsandMas-sachusettsEyeandEarInfirmaryatHarvardarethetopophthalmicinstitutions,partlybasedonthefactthattheyreceivethelargestproportionofNIHgrants.

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Publications in peer-reviewed journals are another objective documentation ofthe quality of an individual and his/her institution’s work by peers aroundthe world. More than 50 percent of articles published in the British Journal of OphthalmologycomesfromworkoutsidetheUK.8TheArchives of Ophthalmol-ogy publishes a Worldwide Ophthalmology issue each year, summarizing theachievementsofophthalmologyandvisionresearchinothercountrieswithactiveparticipationfromcountriessuchasChinaandIndia.

Second, research is a natural progression in the development of our clinicalophthalmic service, as we move towards being a regional and world-classophthalmichub.Itmayhavebeenaluxuryinthepastwhenwewereprovidingbasicophthalmic care toourpopulation,but itwill be increasingly seenasanintegralcomponentofourstatus.

Our achievements in research therefore enhance the entire reputation of theSingaporeophthalmologycommunity,andprovideafoundationfromwhichwemarket ourselves in the region and in theworld.Ultimately, the quality of ourresearch will be seen by our colleagues to directly parallel the quality of theophthalmiccarewecanprovide.

Finally, on an individual level, a clinician who performs research is alwaysthinking and challenging established clinical doctrines, in an attempt to seekthe right answer to the relevant question.Hedoes this by virtueof his trainingin research,utilisingscientificprinciplesandevidence-basedmedicine.Inshort,suchdiscipline raises thequalityofhisclinicalacumenandmakeshimabetterclinician.

Future Challenges for Ophthalmic Research in This New Century

1. Identifying Niche Areas for Singapore Thefirst challenge is to identify areasof research inwhichweshouldbe focusingourresourcesandenergyinthecomingcentury.Beforedoingso, weneedtoidentifyourareasofstrengthsandweaknesses,andtodetermine what is useful for our needs and what will fit into the overall plan of ophthalmologydevelopmentinSingapore.

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Withobviouslimitationsonthenumberofcliniciansandvisionscientistsavailabletoparticipateinophthalmicresearchlocally,wemustbecircum-spect andprudent toprioritise areasof research.Theseare, firstly, thosethatareofdirectrelevancetoourcommunityandourpartoftheworld;andsecondly,thosethatpresentresearchchallengeswithachievabletargetstomaximisesuccess.

Fromapracticalviewpoint,itisessentialthatwefocusonthemaincausesofocularmorbidityandblindnessinourlocalpopulation.Inaddition,wemust also continue to focus on areas of research which have been ourstrengthsandsuccesses,inordertoproduceresearchofinternationalandglobalstandards.

A review of the currentmajor areas of research interestwithin SERI andSNECrevealsthatthefieldsofmyopia,glaucoma,cornea,andocularsur-facediseasesarewellrepresentedlocally,asthesediseasesareprevalentinourpopulation.

Myopia ResearchMyopiaprevalenceislikelytocontinuetorise,ultimatelyaffectingupto80percentofourpopulation.Ourabilitytoconductepidemiologicalsurveysofmyopiadevelopinginourschoolchildrenandtoperforminterventionalpae-diatricclinicaltrialsinanattempttoretardmyopiaprogressioncontinuestoimprove.Likewise,wemustalsoseekanswerstomyopiainthelabora-tory,todeterminethemolecularandgeneticbasisformyopia.

In addition, the rapid increase in the number of Singaporeanswho seekrefractivesurgerytocorrectmyopiaandotherformsofrefractiveerroralsomeans that we must evaluate new refractive technologies and seek outthosewhichworkbestinlocalAsianeyes.

Glaucoma ResearchWith thehigherprevalenceofangleclosureglaucomahere,our formsofAsianglaucomaareclearlydifferentfromthoseintheWest.Furthermore,glaucomarepresentsasignificantcauseofblindness inSingapore,whichwillcontinuetoriseinaccordancewithourrapidlyageingpopulation.

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Asnewpharmacologicalresearchbringsusnewdrugstotreatglaucoma,itisimperativethatweevaluatetheefficacyandsafetyofthesenewdrugsinourAsianeyes.OurpopulationmixofChinese,Indians,andMalaysisthusobviouslyidealforethno-pharmacologicalstudies.Cornea and Ocular Surface ResearchOcularsurfacediseases,suchasdryeyeandpterygium,arecommoncausesofocularmorbidity inour tropical environment.Pterygiumsurgery is thethirdmostcommonophthalmicsurgicalprocedureinSNEC,aftercataractsurgeryandLASIK.Infact,theprevalenceofpterygiuminapopulationsur-veyofChineseSingaporeansovertheageof40yearsapproached10percentinarecentfinding.

PterygiumresearchinSingaporeisanexampleofanicheareaofresearchinwhichwecanexcel,byvirtueofthefactthatitisarelativelyrareconditionintemperateWesterncountries.Wearenowoneoftheleadersinthefieldofpterygiumresearchandpublications.Withtheaetiologyofpterygiumstilltobeelucidated,wemustcontinuetopursueresearchinthisimportantniche.

Asidefromcontinuingtofocusoncurrentlysuccessfulresearchprogrammes,wealsoneed toprioritise research inother commoneyediseases inourpopulation forwhichwe have yet to develop research programmes.Onesuchareaisdiabeticeyedisease.

Wehaveahighprevalenceofmaturity-onsettypeIIdiabetes,withseeminglymarked differences between Indians, Chinese, and Malays in terms ofprevalence,diseaseseverity,andprogression.This isan indicationof theneed to evaluate the prevalence and risk factors for developing blindingdiabeticretinopathyinourpatients,andtodevelopcost-effectivescreeningprogrammesforearlydiagnosisandtreatment.

2. Clinical, Epidemiological, or Basic Science Research?Animportantquestionconcernsbasicscienceresearch.WhataretherolesofophthalmicgeneticandmolecularresearchinSingapore?Innouncertainterms,withtheHumanGenomeProjectcompleted,geneticresearchandgenetherapywillheraldaneweraofmedicine,andwillsurelybeatthefore-frontofalmostallmajorophthalmicbreakthroughsinthecomingcentury.

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Howcanwebenefitandevencontribute to this revolution?Therearenoeasyorreadyanswers.First,wemustrecognisethatlong-termcommitmentiscrucialandthattherewardswillbefewandfarinbetween.Second,weshouldconcentrateourresourcesonafewimportantdiseasesrelevanttoSingapore,suchasmyopiaandglaucoma.

Inthisrespect,ithasbeenmorecost-efficienttoconcentrateonclinicalandepidemiologicalresearch.Bothareseentorequirelesscommitmentoftimethanbasicscienceresearch,andarelikelytocontinuetobeanintegralpartofouroverallresearchstrategyintheforeseeablefuture.

Forclinicalresearch,wehavetheadvantagesofalargepoolofAsianpatients,a group of highly skilled and experienced clinicians, and the latest indiagnosticandsurgicaloptions.Forepidemiologicalresearch,theadvantagesareacaptivehomogeneouspopulation,auniqueindividualidentifier(ouridentity cardnumber), awell-managedpopulationdatabase (such as theMedisave Scheme), and the unique ability to study the threemain racialgroupsinAsia(Chinese,Malays,andIndians).

3. The Clinician-Scientist ModelA related issue concerns the evolution of the clinician-scientist model.Theconceptoftheclinician-scientistfirstoriginatedaftertheSecondWorldWar in North American medical schools.9 They were defined as broad-basedinvestigatorswhodiscoveredfundamentalbiologicmechanismsandappliedthemdirectlytotheclinicalcareandcureofdisease.

Clinician-scientistswerethegroupofophthalmologistswhowereexpectedto translate discoveries in anatomy, physiology, and pathology to the pa-tient’sbedside;andincludedgiantslikeSirStewartDuke-Elder,JonasFrien-denwald,DavidCogan,andmanyothers.

While basic scientists are credited with the most important discoveriesinmedicine,clinician-scientistscanhelpbridgethegapbetweenthescienceand the actual clinical application.10 Only the clinician can identify thequestionsthatrequirepatient-orientedstudies,andthenapplythosestudiestotheclinicalmanagementofdisease.

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In Singapore, the clinician-scientist concept is appealing and perhapsa model we should aim for, given that it is difficult to convince youngophthalmologists to forgoclinicalpractice tobe full-timebasicscientists.Howwouldwedevelopourcoreofclinician-scientistophthalmologists?

Theremustbeadequateincentive,training,andremuneration.Thereshouldbe some form of a career track. Specialist trainees who are keen to beresearchfellowsforayearortwoshouldbegivensimilarbenefitsasdoctorsgoingforclinicalhospitalmanpowerdevelopmentprogrammes.

Once a group of doctors is trained, protected research time should bein-built to allow for continued involvement in research. In the future,clinician-scientistsmay also come frommedical students enrolled in theMBBS-PhDprogrammes.

In theory, while the clinician-scientist concept is promising, there arepractical problems and limitations. Clinician-scientists will always beseverelyconstrainedbyserviceobligations, lackofadequaterewards,andlackoffinancialandmanpowersupport.Therearelimitationsinthecurrentresearch-relatedfellowships,assomeincurlossofbothseniorityandpay.

TheMBBS-PhDprogrammes are not attracting enough candidates. Evenin the USA, MD-PhD programmes have not been altogether successful.Brightyounggraduatesoftheseprogrammesoftenfindthemselvesunabletomeetthecompetingdemandsofclinicalservice,teaching,andresearch,andareforcedtomakeachoiceearlyonintheircareersbetweeneitherclinicalpracticeorbenchwork.

4. Collaboration, Centralisation, and CoordinationAfurtherchallengeishowbesttoutilisethelimitedresourcesavailabletous.Ourfirststrategyistooptimiseourcollaborationwithscientistsoutsideophthalmology,includinggeneticists,molecularbiologists,epidemiologists,andoptometrists.This will mean further integration of our present collaboration with theNational University of Singapore (NUS), the Defence Medical ResearchInstitute,JohnsHopkins,MoorfieldsEyeHospital,andotherorganisations,


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aswellasdevelopingnewcollaborativeresearchprojectswiththeNanyangTechnologicalUniversityandevenprivateorganisationsandindustries.

Second, there are distinct advantages of having a centralised researchcoordinating centre, similar to theNationalEye Institute in theUSA,butonasmallerscale.Thenaturalchoice isSERI,whichcantakethe leadininitiating, coordinating, and maintaining projects, help distribute andchannelresources,andpreventduplicationofresearch.

Todo that, SERI needs to provide sufficient incentives for researchers indifferentinstitutionssothattheywouldwanttoidentifywithSERIandworkwith it. Thismay take the formof small start-up research grants, accesstoacomprehensiveophthalmiclibraryorlaboratory,provisionofstatisticaladvice,andperhapsevenresearchcoordinatorstohelpmanageprojects.

Third, just as in clinical service and teaching, there is room for privateophthalmologiststobeactivelyinvolvedinophthalmicresearch.Theytoocanprovideinvaluableadviceandexperience,especiallyinareasofclinicalresearch.Forexample,reportsonaninformativecaseoracaseseriesshouldnotbeconfinedtothedomainsofpublicsectorinstitutions.

While research hasmoved in the direction of large, multi-centre clinicaltrials,11 the humble case reports can still provide a tremendous amountof useful information.12 For example, the observation that some diabeticpatientswithlargechorioretinalscarsneverdevelopproliferativeretinopathyhasledtoconsideringpanretinalphoto-coagulationasatherapy.

Similarly, the recognition that macular holes might close followingspontaneousseparationoftheposteriorvitreousfromtheretinahasledtothedevelopmentofvitrectomytotreatmacularholes.Privateophthalmolo-gistscanthereforebeanintegralpartofophthalmicresearchinSingapore.

OphthalmicresearchinSingaporewillcontinuetoevolveinthiscenturyandwewillcontinuetodiscovernewchallenges.InthewordsofJosephGold-stein,theNobellaureate13:

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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.

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.

References1. Sommer A. Past precedents, present pressures, future problems: ophthalmology in2001.Ophthalmology1995;102:861–2.

2. GoldsmithMF.2020Vision:NIHheadsforeseethefuture. JAMA1999;282(24):2287–90.

3. LeeP.Theyear2000:placingnewtechnologyincontext.Arch Ophthalmol 1999;117:1545–6.

4. ForresterJV.Impactofnewtechnologiesinophthalmology.Br J Ophthalmol 1999;83:1211.

5. ButlerD.Thewritingisonthewebforsciencejournalsinprint.Nature1999;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. ForresterJV.MorechangeattheBJO.Br J Ophthalmol1998;82:721.

9. DranceSM.Thefutureoftheclinicalscientist.Can J Ophthalmol1999;34:373–7.

10.GilliesB.Theneedforclinicalresearch.Aust N Z J Ophthalmol 1999;27:165.

11.StraatsmaBR.Clinicaltrialsinthepast25yearsandclinicalresearchinthenext25years. 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.GoldsteinJL,BrownMS.Theclinicalinvestigator:bewitched,botheredandbewildered —butstillloved.J Clin Invest1997;99:2803–12.

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Researchhasbecomeexcitingrecently.Fascinatingadvanceswillemergeasourresearchers unfold the mystery of blinding diseases affecting the cornea, themacula,theretina,andtheopticnerve.Inaddition,genetictherapy,microrobot-ics,microtechnology,theexcitementofstemcelldevelopment,andthecontro-versyofcloningwillspreadthroughoutthescientificworld.

We are fortunate to have a small but excellent team of dedicated researcherseagertomoveahead.Weliveinaworldwherechangeswillcomeaboutrapidly;thismakesitessentialthatwereviewourresearchprogrammeregularlytoensurethatwearemovingintherightdirection,andthattheworkweimmerseourselvesinwillleadtodiscoverieswhichwillbepracticalandwillbenefitourpatients.

IcongratulateAssociateProfessorDonaldTanforhiscommitmentandleadershipingellingtogetherhisexcellentteam.Inashortperiodoflessthanhalfadecade,they have produced many scientific papers published in leading internationaljournalswithameanimpactfactorof2.4.Inaddition,theSingaporeEyeResearchInstitute(SERI)isfortunateinteamingupwiththeAssociationforResearchinVision and Ophthalmology (ARVO) to jointly organise a SERI-ARVO scientificmeetinginSingaporeinFebruary2003.

Recently, several talented young researchershave joinedSERI.Wemust createopportunitiesforthemtopropellophthalmicresearchtoahigherstratosphere.Inthecomingdecade,theophthalmicworldwillresoundwiththetriumphofanewgenerationofdedicatedophthalmicresearchersinSingapore.

Professor Arthur LimChairman

Chairman’sMessage

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Director’sReportIn 2001, the Singapore Eye Research Institute (SERI) continued to be highlyproductiveandactiveintermsofresearchoutput.In2001,SERIscientistsandaffiliated clinicians published 56 scientific articles, presented 139 scientific ab-stracts,andinitiated36newresearchprojects.Majorotherachievementsbytheinstitute this year included the relocationof theSERI research facilities to twofloorswithinthenewSingaporeNationalEyeCentre(SNEC)PhaseIIExtensionwithintheOutramCampus,andthesuccessfulorganisingoftheFirstSERIInter-nationalMeetinginSeptember2001.

National role of SERIIn July2001,SERIwas requestedby theDirectorofMedicalServices,MinistryofHealth,ProfTanChorhChuan, to functionasthecoordinatingcentre forallophthalmicandvision-relatedbiomedical researchacrossbothSingHealthandNationalHealthcareGroupophthalmicinstitutionsanddepartments.SERInowhas participating units from SNEC, The Eye Institute (consisting of NationalUniversity Hospital (NUH), Tan Tock Seng Hospital (TTSH), and AlexandraHospital (AH) eye departments from theNationalHealthcareGroup), ChangiGeneralHospital(CGH)EyeDepartment,andNationalUniversityofSingapore(NUS)EyeDepartment,aswellasotherinstitutionsinvolvedinvisionresearchsuchasDefenceMedicalResearchInstitute(DMRI)andSingaporePolytechnic(SP).SERIisthereforeatrulynationalbodyforophthalmicandvisionresearch.

Specific activities in 2001Relocation to new SERI Facility in SNEC Phase II ExpansionInAugust 2001, SERImoved to its new facility on the fifth and sixth floors ofthe eight-storey SNEC Phase II Expansion. SERI, for the first time, able tobringtogetherunderoneroofallofitsclinicalandbasicresearchactivitiesintwocustom-built research floors, one for clinical research and the other forlaboratory-basedresearch.ThefacilitieswereofficiallyopenedbyMrLimHngKiang,MinisterofHealthandsecondMinisterofFinance, andcoincidedwithSERI’sFirst International Research Meeting at which the Minister was the guest ofhonour.

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SERI 5th Floor — Clinical and Paraclinical ResearchThe 5th floor houses the Myopia Clinic, Clinical Trials Pharmacy, VisualPerformance, Electrophysiology, and Spatial Perception Laboratories, and theAdministrationOffice.SERIclinicaltrialsconductedattheMyopiaClinicincludeapproximately1000schoolchildrenenrolledinfourrandomisedclinicaltrialsonmyopiaretardation,aswellasstudiesoncataractsurgeryandrefractivesurgery.

SERI 6th Floor — SERI LaboratoriesThe 6th floor houses twoMolecular Biology Laboratories, theMicro-analyticalLaboratory, two Tissue Culture Laboratories, and the Human Ocular SurfaceStemCellLaboratory.UnderthedirectionofProfessorRogerBeuerman,ScientificDirectorofSERI,theselaboratoriesconductresearchintotheaetiologicalbasisofmyopia,ocularsurfaceandtearfilmdisorders,andglaucoma,aswellasoculardrugdeliverystudiesandocularstemcellresearch.PlansareunderwayfortheStemCellResearchGroup,amultidisciplinaryNMRC-fundedstemcellresearchgroupontheOutramCampus,tooccupycollaborativelabsonthisfloorin2002.TheflooralsohousestheSERIConferenceRoomandresearchstaffofficesandworkstations.

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).

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With the opening of its new accommodation, SERI has come of age and thecloserinteractionbetweenSNECcliniciansandSERIscientists—aswellasourimmediateproximitytotheanimalholdingfacilitiesoftheSGHDepartmentofExperimentalSurgery—fostersanewlevelofproductiveandinteractivebasic,translational,andclinicalresearch. 20

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First SERI Meeting in Conjunction with the Third National Eye Research Meeting

Research MeetingWehostedtheFirstSERIInternationalResearchMeetingatournewSERIFacilityon27–30September2001.Thiseyeresearchmeeting,thefirstofitskindinSouthAsia,coincidedwiththeopeningofthenewSERIfacilitiesbyMrLimHngKiang,MinisterofHealthandsecondMinisterofFinance,whowastheguestofhonourofthemeeting.Morethan300delegatesfromAsiaandbeyondattendedthemeeting,whichwasconjoinedwiththethirdSingaporeNationalEyeResearchmeeting.Theresponsefromthe23invitedspeakersfromAsia,Europe,andtheUSAwasoverwhelming;and the full three-day scientific programme was devoted to keynote lectures,symposia, and special interest group meetings, covering the entire gamut ofcornealdisease, refractivecornealsurgery,myopia,glaucoma,retina,andstemcellresearch.

More than 100 scientific abstracts were presented either as posters or oralpresentations.For thefirst time,an industrysymposiumwasheldandopenedbyakeynoteaddressfromthePresidentandVice-ChancellorofNUS,ProfessorShihChoonFong.Atthissymposium,representativesoftheophthalmicindustrywere invited topresentnewpharmacotherapies, ophthalmic technologies, andresearchanddevelopmentstrategies.

New Research Projects Registered and New Pilot Grants Approved in 2001Atotalof36newresearchprojectswereregisteredin2001.Theseprojectsrangedwidelyinthevarioussubspecialties,frommyopia,refractivesurgery,andcorneatoretina,glaucoma,strabismus,andcataractsurgery.Atotalof11pilotseedgrantswereapprovedin2001.


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Additional Publications from the NHG Eye Institute DoctorsAsSERIassumedtheroleofthenationalcoordinatingbodyforallvisionandoph-thalmicresearchinSingaporeinthelatterhalfof2001,newpublicationsin2001fromTheNHGEyeInstitute,NationalHealthcareGroup,wereaddedtothetotallistofSERI-affiliatedpublications.ThetotalnumberofSERI-affiliatedpublicationsin2001roseto73publications.

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New Patients in 2001NoSERIpatentapplicationsweresubmittedin2001.However,threeSERIpat-entapplicationsarecurrentlyinpreparation.Twopatents,oneoncultivationofocularsurfacestemcellsandoneondifferentialgeneexpressioninpterygium,are planned for submission in the first quarter of 2002. Studies on a thirdpotentialpatentonanoveltechniqueoffundalfluoresceinangiographyarealsocurrentlyunderwayandtargetedfor2002submission.

Scientific Publications in 2001Thisyear,SERIscientistsandaffiliatedclinicianspublishedatotalof56scientificpublications, the largest number of publications in a single year to date.Thiswasasignificantincreaseoverpublicationsin2000,whichnumbered44,anincreaseof27%.Ofthese,52outof56(93%)werepublishedininternationalsci-entificjournals,whileonly4werepublishedinlocalindexedjournals.Incontrast,only86%ofmanuscriptswerepublishedininternationaljournalslastyear.

Rising Trend in Quality and Impact FactorInspiteof the increase in thenumberof journalspublished in2001,asignifi-cantly greater proportion of articles were published in high-impact journals:eightpaperswerepublishedthisyearinOphthalmology,thehighest-ratedclinicalophthalmologyjournal(impactfactor=3.04);andsevenpaperswerepublishedintheBritish Journal of Ophthalmology,thehighest-ratedEuropeanophthalmologyjournal(impactfactor=1.94).Ofgreaterimportisthefactthatwepublishedthreepapers in Investigative Ophthalmology and Visual Science, the top-ranked visionresearch journal(impact factor=4.373),andtwopapers inLancet (impact fac-tor=12.41).Thetotalsummationofimpactfactorsin2001was103.718,andtheaverageimpactfactorperarticlepublishedin2001was2.59.

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Figure 1: Scientific Publications in 1991 - 2001

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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 SERIIn2001,stemcellresearchersontheOutramCampusformedamultidisciplinaryStemCellResearchGroup(SCRG)todiscussstemcellresearchcollaborationswithin SingHealth institutions and departments in the field of embryonic andadultstemcells.HeadedbyA/ProfLeeSengTeikandA/ProfDonaldTan,fivemajorprojectsandstemcellresearchteamswereidentified,includingourownocularsurfacestemcellproject;otherprojectsrangedfromhumanoocytematu-ration and cloning for tissue engineering (A/Prof Tay SunKuie,O&GDepart-ment,SingaporeGeneralHospital),vascularendothelialprogenitorcellculture(A/ProfWongMengCheong,NationalCancerCentre),andcultivationofhairfol-liclestemcells(A/ProfSTLee,DepartmentofPlasticSurgery,SingaporeGeneralHospital)toCNSneuralstemcells(DrXiaoZhiCheng,DepartmentofClinicalResearch,SingaporeGeneralHospital).

AprogrammegrantofS$2.5millionwassubmittedtoNMRCinthelastquarterof2001,andprovisionalapprovalofS$800,000forcorefacility,equipment,andmanpowerhasbeenpreliminarilyapproved.SERIhasgenerouslyofferedspacewithinits6thfloorlaboratoriestohousethecoreequipmentandofferSCRGsci-entistsaccesstoitsresearchfacilitiesforthefirst3yearsoftheprogrammegrant.TheSCRGfacilitywithinSERIiscoordinatedbytheDirectorofSERI,ourScientificDirector,andA/ProfSTLee.Thiswillnotonlyenhanceourlaboratory’sfacilitiesandresearchcapabilities,butalsocreatevibrantandproductivecross-disciplin-arycollaborationsandinteractionsbetweenSERIscientistsandotherstemcellresearcherswithintheOutramCampusinourlabs.

Planning for Singapore Myopia RegistryMyopia is the most prevalent eye disorder in Singapore. The SingaporeMyopiaRegistry(SMR)isanationaldiseaseregistryinitiatedbytheMinistryofHealth(MOH),setuptocollectandprovideinformationonmyopiainSingaporefor the purpose of health planning, clinical quality assurance, benchmarking,clinicalresearch,andtrackingofpatientsundertheNationalDiseaseManage-mentPlans.TheDirectorofSERIwasappointedbytheDirectorofMedicalSer-vices,MOH, to chair theSMRCommittee, consistingof representatives fromSingapore National Eye Centre, National University Hospital, Changi GeneralHospital,andTanTockSengHospitaleyedepartments;privatesectorophthal-

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mologists;andtheCommunityofFamilyMedicineDepartmentandtheSchoolHealthService,NationalUniversityofSingapore.TheSMRwillberunbytheClini-calTrials&EpidemiologyResearchUnit,withtheassistanceofSERI.

SMRplanninghasbeeninprogressin2001,andwillbeimplementedin2002.TheimportanceofSMRasanationalresourcetotrackandresearchontheprob-lemofmyopiainourpopulationcannotbeunderestimated,andSMRwillserveasourpopulationdatabaseforepidemiologicalresearchintomyopiaandrelatedoculardisordersinAsianeyes.

Planning for SERI Primate FacilityWithin the last 2 years, it is becoming clear that primate researchwill have apivotalroleinSERI’sresearchendeavoursaswebegintoperformclinicaltrialsonnewdrugdeliverysystems,testnewsurgical techniques,andperformmyo-piaandoculargrowthstudies,usingprimatesastheoptimalanimalmodelfortheseformsofresearch.SERIresearchersthisyeartravelledtoFujianProvince,China,toperformapilotseriesofexperimentsattheFuzhouCentreforPrimateResearchonmyopiaandcornealwoundhealingafterLASIKsurgery;basedonthe successful implementationof thesepilot primateprojects, further primatestudiesareplanned.

Tocopewith the futuredemand forprimate research,SERIhas initiatedplanswiththeDepartmentofExperimentalSurgery(DES)toassistintheexpansionoftheiranimalholdingfacilityonthe3rdfloorofthedepartment,andtoplanforaSERI-sponsoredPrimateResearchFacility.Theaimistoestablishacomprehen-sive,high-qualityprimatefacility—completewithadedicatedoperatingtheatre,treatment rooms, and eye examination suites—whichwill be fully accreditedby international agencies in order to enable primate research tomeetUSFDAstandards.PlanstocollaboratewiththeWashingtonUniversityPrimateFacility,whichrunsalargeprimatecolonyontheislandofBogor,Indonesia,areunder-way,andSERIwillbeconsultingthedirector,ProfBillMorton,whowillvisitSERIandDESinMarch2002.

Strategic Collaboration with Lions Eye InstituteSERIhasinitiateddiscussionswithProfIanConstable,directoroftheLionsEyeInstitute(LEI),Perth,Australia,todevelopastrategiccollaborationbetweenSERIandLEI for thepurposesofmutually advantageouscollaborative researchandeducation inophthalmicandvision research.LEI,asaclinical centre,hashad

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closetiesandapre-existingMOUwithSNEC;butitisnowrecognisedthatLEIistheleadingvisionresearchinstituteintheSouthernhemisphere,andtherewillbeamajoradvantageforSERItocollaborateandworkcloselywithLEIscientistsandresearchers.

Ongoing collaborative researchprojectsbetweenour institutes include clinicaltrialson thefirstartificial corneadevice (knownasAlphaCor), inventedbyLEIscientists;plannedstudiesontheworld’sfirstsolid-staterefractivelaser,theQ-VisQuantumlaser,againinventedatLEI;andacollaborativeprimateresearchprojectevaluatinganewretinalantiangiogenesisgenetherapyprocedureforthetreatmentofsubretinalneovascularmembranesinblindingeyedisorderssuchasdiabetesandage-relatedmaculardegeneration.

In2002,wehopetoinitiateformaltrialswiththeQuantumlasertotreatmoder-ate-to-highmyopia,to initiateantiangiogenesisprimatestudies,andtoexplorefurtherresearchopportunitiesforcollaborationbetweenthetwoinstitutes.

Donald TanDirector


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2001: BOARD MEMBERS

Prof Lim Siew Ming, ArthurChairman

Dr Ang Chong LyeDirector, Singapore National Eye Centre

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

Prof Lim Mong KingDeputy President, Nanyang Technological University

Prof Lim Yean LengChairman, National Medical Research Council

Prof Tan Chorh ChuanDirector of Medical Services, Ministry of Health

Assoc Prof Donald Tan Tiang HweeDirector, Singapore Eye Research Institute

Deputy Director, Singapore National Eye Centre

Head, Ophthalmology Department, National University of Singapore

Mr Wong Yew MengPartner, PricewaterhouseCoopers

Assoc Prof Vivian BalakrishnanCEO, Singapore General Hospital

As at 31 December 2001

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ReportontheFirstSERIInternationalMeeting2001TheFirstSingaporeEyeResearchInstituteInternationalMeetingwasheldfromSeptember 27–30, 2001, in conjunction with the 3rd Singapore National EyeResearchMeeting.

The meeting was held at the new premises of the Singapore National EyeCentre (SNEC) extension, which houses the two research floors of SERI. ThemeetingcelebratedtheofficialopeningoftheSingaporeEyeResearchInstitutebyMrLimHngKiang,MinisterofHealthandsecondMinisterforFinance,whowastheguestofhonouratthemeeting.

The conference commemorated SERI’s coming of age and brought togetherold friends and research partners who have helped build up ophthalmic andvisionscienceresearchinSingaporeoverthelastfouryears.Withkeycliniciansandscientistsfromcollaboratinginstitutionsallovertheworld,thepromotionofinternational and global exchange in vision research that exists in SERI hashelpedus todevelopstrategic initiatives inmajor researchprogrammes ineyediseasesrelevanttoourpartoftheworld;theseincluderesearchprogrammesinmyopia,glaucoma,diabetes,andocularstemcellresearch.

The response from the 23 invited speakers from Asia, Europe, and the USAwas overwhelming. The full three-day scientific programme was packed withkeynotelectures,symposia,andspecialinterestgroupscoveringtheentiregamutofcornealdiseases,refractivecornealsurgery,myopia,glaucoma,retina,andstemcellresearch.Morethan100scientificabstractswerepresentedeitheraspostersororalpresentations.Themeetingwaswellparticipatedwithover300delegatesfromtheUS,UK,India,Italy,Indonesia,China,Malaysia,andSingapore.

Forthefirsttime,anIndustrySymposium—wherethe industrywasinvitedtopresentnewpharmacotherapeutics,ophthalmictechnologies,andR&Dstrategies—was incorporated.Wewereprivileged tohaveakeynote lecturedeliveredbyVice-ChancellorofNUS,ProfShihChoonFong,atthisSymposium.Themeetingalsohostedthe2ndAsiaPacificSocietyofEyeGeneticsmeeting.Thehighlightof themeetingwas the Young Investigator Awards, which awards outstandingclinicalandbasicophthalmicresearch,presentedatthemeeting.

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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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Chairman’sMessageIamdelightedthatthatSERI’sexcellentresearchworkcontinuestoprogressandhasclearlyattractedresearchersfromallovertheworld.IcongratulateAssociateProfessor Donald Tan, our Director, for it is not easy to attract establishedresearchersfromthedevelopednations.

ProfessorTanorganisedasuccessfulfirstSERI-ARVOmeetingoutsidetheUSA.I amdelighted thathehas convinced theARVOofficials tohold the secondmeetingoutsideUSAinSingaporeinFebruary2005.WeareproudofA/PDon-aldTan’sachievements.

Yetweneedtothinkoftherapidanddramaticreformswhichareaffectingtheworld.Withthedramaticchangesintheworld,almosteverythingineverynationwillchange.

Whatwelearntodayinmedicinemaybeobsoletein10years.Inthesamewayinresearch,weneedtothinkwhetherthehundredsofhoursinresearchwillbeofbenefit.Therelevancetopublicneedsisessential.Wemustreviewwhatweare doing and whether our innovations will benefit patients with serious eyeconditions,inparticular,blindness.Wemustquestionourselveswhetherwearetoo concernedwith intellectual stimulus and the excitementof finding some-thingnew,andconsequently fail to focusonwhetherwehave foundaway tobenefitourpatientsandreduceblindness.

Thesearevitalissueswemustaddressinthecomingyears.


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Professor Arthur LimMD (Hon), FRCS

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New ground was broken when the Singapore Eye Research Institute (SERI)hostedthefirstcombinedmeetingoftheAssociationforResearchinVisionandOphthalmology (ARVO). ARVO meetings, based in the USA, constitute theleadingforumforophthalmicresearchintheworld.TheSERI-ARVOmeetingwasthefirstsuchmeetingtobeheldoutsidetheUSA.

“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

FirstSERI-ARVOMeetingonResearchinVisionandOphthalmology

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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)

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The meeting was held at the Suntec Singapore International Convention andExhibitionCentrefrom6–9February2003.Over800delegatesfrom36countriesweretreatedtoawealthofresearchreportsandinvitedlecturesoncutting-edgeadvancesineyeresearch,complementedbyaseriesofworkshopsonthedesignandconductofeyeresearch.

TheGuestofHonourwhogavetheOpeningAddresswasDrTonyTan,DeputyPrimeMinisterandMinister forDefence,Singapore.ProfessorRobertWeinreb,President of ARVO and a Singapore Alumni AssociationDistinguished Visitor,also gave awelcome address. Professor SheilaWest of theUSAwas theNUSHongLeongProfessorialVisitor.

Thetopicscovered in themeetingrangedover thewholegamutofophthalmicresearch, with an emphasis on translational research bridging the disciplinesof basic science and clinical ophthalmology. A galaxy of invited speakers fromaroundtheworldaddressedthemeetingontopicsasdiverseasrecentadvancesin ocular inflammation, glaucoma,myopia, cornea and refractive surgery, reti-naldisorders,epidemiology,stemcellresearch,andgenetics. Inallof thesym-posia on these topics the growing importance of cell and molecular biology,moleculargenetics(includinggenomicsandproteomics)andstemcelltechnolo-gywasabundantlyclear.Thesensationalrecentadvancesinourknowledgeofthehuman genome, some 50 years after the identification of the structure of theDNAmolecule, have led to awaveof new technologies that are being activelyexploited in eye research. The exciting possibilities of replacing irreversiblydamaged ocular tissues by the use of stem cells or the application of genetherapy for presently untreatable retinal disorders were among the manyhighlightsofthemeeting.

In all, there were 140 presentations in keynote addresses, symposia, invitedlectures, and workshops. A total of 290 posters complemented 63 free paperpresentations.

Two sponsored lunch-time symposias addressed the controversy of nutritionalsupplementsinophthalmologyandnewermedicaltherapiesforglaucoma.Posterpresentershadanopportunity tohavetheirpostersdiscussed inrapid-fireses-sions,wherebriefillustratedpresentationsofpostersledtolivelydiscussionandsometimescriticalcomment.

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Awelcome receptionwasorganised in theSingaporeNationalEyeCentre thatgavedelegates anopportunity to visit SERI’s research laboratories and clinicalfacilities.ThehighlightofthesocialprogrammewastheLunarNewYearDinneratChijmes.

“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 KingdomAnimportantgoalofthemeetingwastoencourageyounginvestigatorstoattendandpresenttheirwork.Tothisend,SERIofferedanumberofTravelFellowshipGrantsthatsupportedthetravelcostsof28youngresearchersfromninedifferentcountries.TheseawardsweresponsoredbyAlcon,Bausch&Lomb,SERI-SantenJapan,andtheTearFilmandOcularSurfaceSociety.

“I want to congratulate you and all your staff on the splendid success of the SERI-ARVO 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 out-come. You really did a very good job and I think everybody had a great time…” Hugh Taylor, Australia

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Awards to young investigators for excellence in research, as demonstrated inpresentations or posters, were given to six young researchers in the catego-riesofbasic research invisualscienceand inclinicalophthalmology.Thema-jorawardinthevisualsciencecategoryforanoutstandingpresentationwenttoKenFukudaof Japan forhisworkon theeffectsof IL-4on themetabolismofextracellularmatrixproteinsbyhumanconjunctivalfibroblasts.

In theclinicalcategory, the topawardwassharedbyAdrienneCsutakofHun-gary forherstudyofplasminogenactivator inhibitors in tearsafterexcimer la-serphotorefractivekeratectomyandChuaWeiHanofSingaporeforhisstudyofrefractiveerrorsandtheircorrectioninSingaporeschoolchildren.

Anexhibitionof the latest inophthalmic instrumentationand technologywithparticipationby21companiesattractedalotofinterest.

TheOrganisingCommitteehasreceivedalargenumberofcongratulatorylettersande-mailsfrommanyofthoseattending.Themeetinghasbeenjudgedagreatsuccess,andweareverypleasedthatthe2ndSERI-ARVOmeetingwillbeheldinSingaporeinFebruary2005.

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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

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Chairman’sMessageIthasbeenmyprivilegeandhonourtobecloselylinkedwiththedevelopmentoftheSingaporeEyeResearchInstitute(SERI)sinceitsfoundation.Itgivesmegreatpleasure tonote thatourDirector,ProfessorDonaldTan,haspushed researchinophthalmology togreatheightswithsomeofhiskey researchers—WallaceFoulds,RogerBeuerman,AungTin,andmanyothers.Oneoutstandingyoungre-searcherinophthalmologyinSingaporeisAssociateProfessorWongTienYin.Wehopethatinthecomingyears,hetoowillcontinuetomakemajorcontributionstothediscipline.

Letuslookatresearchfromabroaderperspective:itsdevelopmentinSingapore,in the National University of Singapore (NUS) and in the context of NUS,collaboration with Duke University School of Medicine to set up the NUSGraduateMedicalSchool,whichwillpropelmedicalresearchinthecomingyears.

According to the Times Higher Education Supplement’s World UniversityRankings,theNationalUniversityofSingaporeranks22ndintheworld,andthestanding of the Faculty of Biomedicine (which is really based on medical re-search)hasimprovedfromthe25thpositiontothe15thpositionandcontinuestoimprove.Congratulationstoourresearchers,especiallyPhilipYeo,whohasbeeninstrumentalinpushingmedicalresearchinSingapore.

WhileweacknowledgeandcongratulateSERI for itsachievements,wehave toreviewopenlywhatwecandointhenext10years.HowcanweworkmorecloselywiththeBiopolis?Howcanwehelpouruniversityimproveitsstandingtobecomeoneofthetop10universitiesoftheworld?Howdoweattracttalentand,havingtalentsofourown,howdowedevelopthemtobethebest?

Thedirectorandotherheadsofdepartmentshavetorecogniseandnurtureyoungtalents,especiallyoutstandingones,anddoeverythingpossibletodevelopandattractthemsothatSingapore,theuniversity,SNEC,andSERIcanbenefit.Thisisachallenge,andthisiswhattheBoardofDirectorsshouldaddresstogetherwithouroutstandingresearchersinSERI.


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Director’sReport

SERI is the leadingcentre inSoutheastAsia forophthalmicandvisualscienceresearch. In the relatively short time since its inception, SERI has establishedaninternationalreputationasaneyeresearchcentreofexcellencewithaninter-nationallyrecognisedhighprofile.

CORE RESEARCH DIVISIONTheSERIClinicalResearchUnitconductsoculartherapeutics,surgicalandlaser-relatedhumanclinicaltrials,andclinicalstudiesinvisualpsychophysics.Clinicaltrialsconductedincludecataract,glaucoma,cornealtransplantation,pterygiumand retinalsurgery trials,pharmaceuticalandoculardrugdelivery trials,visualpsychophysicsstudies,andrefractivesurgeryandmyopiaclinicaltrials.

Duringtheyear,theclinicsupportedatotalof25prospectiveclinicaltrialsinthefieldsofcataractsurgery, refractivesurgery,glaucoma,uveitis, cornealdisease,age-relatedmaculardegeneration,diabetes,myopia,andocularsurfacestemcellsurgery.

TheSERIEpidemiologicalUnitconductsandcoordinateslarge-scaleepidemio-logicalandpopulation-basedprojectsstudyingeyediseases inourcommunity.SixmajorSERIepidemiologicalstudiesarecurrentlyongoingtoevaluatetheriskfactorsandprevalenceofrecognisedcomplextraitssuchasrefractiveerror,glau-coma, cataract, age-relatedmacular degeneration, and diabetic retinopathy indifferentethnicgroups.

TheSERIVisualPsychophysicsUnitfocusesonvisualfunctionandtheimprove-ment of visual performance. In 2004/2005, the unit conducted several visualneuroscience-orientedclinicaltrialsonperceptual learningandvisionenhance-ment in myopia and post-refractive surgery ametropia, in collaboration withDMERIandNeuroVision.

The SERI Laboratory Sciences Unit comprises Cell and Molecular BiologyLaboratories, theAnalytical Chemistry Laboratory, TissueCulture Laboratories,theOcularSurfaceStemCellLaboratory,partoftheOutramCampusStemCellResearchGroup(SCRG)(alsohousedinSERI),theOcularGeneticsLaboratory,and a new multidisciplinary Proteomics Facility within the Micro-AnalyticalChemistry Laboratory. Our scientists have continued to consolidate various

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translationalstudiesonmyopiaandeyegrowth,woundhealing,tearfilmstudies,ocularsurfacestemcells,andartificialsubstratesfortissueengineering.

Major New Research Initiatives in 2004/2005 with clinical impact1. 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 ofvisualrehabilitationtopatientswithend-stage,high-riskcornealandocularsurfacediseases,forwhichconventionalcornealandstemcelltransplantswillnotwork.TheDirectorofSERI introducedthisnewandexperimentalprocedure in 2004,which isperformedby a teamof eye anddental sur-geons.TheprocedureinvolvesembeddingaPMMAopticalcylinderintoanautologoustoothroot,whichistransplantedintothehostcornea.Unavail-ableintheUSAandmostofAsia,theSingaporeNationalEyeCentreistheonlycentreintheregionofferingthisdifficultprocedureatthemoment.Todate,atotalof12patientsfromSingapore,Indonesia,Malaysia,Thailand,andSriLankahavebenefitedfromthisprogramme.

Clinical impact of the research:

OOKP represents the absolute cutting edge in the surgical treatment ofthemostsevereeyediseasesoftheanteriorsegment.AsOOKPsurgeryisnowavailableinAsia,thiswillhavemajorbenefittothoseblindfromsevereend-stageeyediseasesforwhichthereisnootheralternative.ThefactthatOOKPstudiesarealsoextremely limitedintermsofthenumberofcasesperformedintheworld(plusthefactthatOOKPsurgeryisnotyetavailableintheUSA)hasmadeSingaporeandSingaporeNationalEyeCentre(SNEC)aleadingcentreforcutting-edgeeyesurgeryandartificialcornealresearchintheworld.Futureresearchdirectionsinthisareaincludepossibilitiesofbioengineeringtoothalternativesforedentulouspatientsandtoavoidtoothremoval.

2. Stem cell and tissue-engineering researchSERI’s research team has developed a world’s first by pioneering aprocedurethatusesculturedadultconjunctivalstemcellstotreatpatientssuffering from pterygium, a common disorder among Asians, and othersevere ocular surface diseases. The team devised a serum-free stem cellculturesystemtoexpandconjunctivalstemcellsinthelaboratorytoformatissue-engineeredconjunctivalequivalentand,withthis,performedthefirstseriesofhumanculturedconjunctivalstemcelltransplants.Theelimination

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ofanimalserumandcellsfromthecultureprocessrepresentsasignificantadvantageovercurrentculturemethods,andtheprocessisundergoingthefinalstagesofpatentapplication.

Clinical impact of the research:

Todate,morethan30patientshavebenefitedfromthisnewbreakthroughatSERI,andthisbreakthroughtechniquehasbeenusedtotreatcommondiseases such as pterygium, glaucoma and stem cell corneal conditions(e.g.chemicalinjuries,ocularsurfacecancer,andcornealblindnessduetogeneralisedstemcelldeficiency).

RESEARCH OUTCOMES IN 2004/2005PUBLICATIONSIn 2004, SERI scientists and clinician investigators from both clusters,SingaporeHealthServices andNationalHealthcareGroup, published anunprecedentedtotalof120scientificarticlesinpeer-reviewedophthalmol-ogyandvisualscience journals,ascomparedto103articlespublished in2003/04.Despite the significant increase in the number of publications,our mean journal impact factor also rose slightly to 2.87, as comparedto2.45in2003/04.

Academic staff also pre-sented 159 scientificabstracts at local andinternationalclinicalandresearch meetings. Newresearchinitiativesconti-nuedtoenterourpipeline,and SERI clinicians andscientistsinitiatedatotalof 40 new researchprojectsin2004.

GRANTS AWARDEDSERIscientistsandaffiliatedclinicianswereawardedatotalofS$2,847,818in individual research grants and commercially funded grants. Thisrepresented additional extramural research funding equivalent to 83% ofSERI’sInstitutionalBlockGrantofS$3,449,730fromtheNationalMedicalResearchCouncil.

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AWARDSDuring the year, SERI scientists and clinicians received five awards forresearchexcellence.

MAJOR EVENT SERIwasprivilegedtoonceagainhosttheSERI-ARVOinternationalvisionresearchmeetinginSingaporein2005.Thismeetingwasjointlysponsoredbytheworld’slargestorganisationforeyeresearch,AssociationforResearchinVisionandOphthalmology(ARVO).ARVOhasamembershipofmorethan10,500membersrepresentingmorethan60countries.The2ndmeet-ingwas again hailed as a highly successfulmilestone inAsian vision re-search,withanattendanceexceeding700delegatesfrom36countries.

Forthefirsttime,selectedabstractsfromthemeetingwerecompiledandpublishedasasupplementtotheprestigious journal,American Journal of Ophthalmology,withanimpactfactorof2.258.

NEW RESEARCH GRANTS AND RESEARCH PROJECTSThisyear,atotalof40newresearchprojectsweresubmittedandapprovedbytheSERIInstitutionalReviewBoard.Duringthesameperiod,atotalof18researchprojectswerecompleted.

SERIscientistsandaffiliateclinicianscontinuedtobehighlysuccessfulincompetitiveresearchgrantsduringthisperiod.FromApril2004toMarch2005, a total of S$3,000,184 (S$2,854,539 in 2003/04) in individual andprogramme research grants was attained. This represented additionalextramuralresearchfundingequivalentto76%ofSERI’sInstitutionalBlockGrantofS$3,773,898.

IN APPRECIATIONFinally,itleavesmetothankourBoardofDirectorsandallthestaffatSERI—the various committees, our clinical partners, industry sponsors, studypatients,and their families for theirsupport,contributions,commitment,andencouragement.IwouldalsoliketothanktheNationalMedicalResearchCouncilforthecontinuedfundingsupport.

Donald TanDirector

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2004–

2005

Board Members

TheSERIBoardcomprisesrepresentativesfromtheSingaporeHealthServices,NationalHealthcareGroup,andinstitutionsinvolvedinvisionresearchsuchastheDefenceMedicalResearchInstituteandtheNationalUniversityofSingapore.

Prof Lim Siew Ming, ArthurChairman

Cl Assoc Prof Ang Chong LyeMedical Director,Singapore National Eye Centre

BG, Assoc Prof Lee Kim Hock, LionelDirector, Defence Medical Research Institute

Prof Lim Mong KingDeputy President,Nanyang Technological University

Prof Tan Chorh ChuanDirector 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 LiDean, Faculty of Medicine,National University of Singapore

Wong Yew MengPartner,PricewaterhouseCoopers

Ms Dawn TayCompany Secretary,Singapore Health Services


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)

Progress of Singapore Eye Research InstituteProgress of Singapore Eye Research Institute

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2004–

2005 SecondSERI-ARVO

MeetingonResearchinVisionandOphthalmologyThemeeting was held at the Suntec Singapore International Convention andExhibitionCentrefrom16–19February2005.

Once again, the meeting received an overwhelming response, with 526abstractssubmittedbyyoungresearchers,clinicians,andinvitedspeakersfrom36differentcountries(atourFirstSERI-ARVOMeeting,atotalof353abstractswerepresented).

A total of 148 symposium presentations, which included no less than 60invitedinternationalspeakers,addressedtheimportantclinicalandtranslationalaspects of vision and ophthalmic research, which included topics onangiogenesis,angiography,stemcellbiology,genetics, immunology, inflamma-tionandinfection,epidemiology,visualpsychophysicsandphysiologicaloptics,aswellassubspecialtysymposiaonocularsurface,cornea,dryeye,cataract/lens,uveitis,glaucoma,retina,myopia,andrefractivesurgery.

ARVOisthelargestvisionandresearchorganisationintheworld.Thisyear,aspe-cialARVOSymposiumentitled“HotTopicsinEyeandVisionResearch”waspre-sentedbyascientificdelegationfromARVO,ledbyGaryW.Abrams,PresidentofARVO.Inaddition,atotalofsixplenarylectureshighlightingimportantresearchadvancesinthemajorsubspecialtyfieldsweredeliveredbyleadinginternationalvisionresearchersfromaroundtheglobe.

Thepre-meetingworkshopsfocusingonthedesignandconductofeyeresearchwerealsowellreceived.Thetopicswereexpandedandincludedabasicresearchworkshop introducing emerging technologies such as genomics, proteomics,andmetabolomics;aclinicalworkshopontheconductofrandomisedcontrolledtrials;andahighlypopularworkshoponpearlsingrantwriting,inwritingscien-tificmanuscripts,andonhowtoavoidpitfallsinoralorposterpresentations.

Forthefirsttime,selectedabstractsfromthemeetingwerecompiledandprinted

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asasupplementtotheprestigiousjournal,American Journal of Ophthalmology, withanimpactfactorof2.258.

Inthespiritofencouragingyoungdoctorsandscientistsinresearch,theSERI-ARVOMeetingagainawardedatotalof40SERI-ARVOTravelAwards,withfundsgenerouslydonatedbyindustrysponsorssuchasAllergan,Bausch&Lomb,andTearFilmandOcularSurfaceSociety.

Themeeting also awarded young researchers foroutstanding clinical or basicophthalmicresearchpresentedatthemeeting.TheOutstandingAwardsforthebasicandclinicalcategorieswent toMsClareSMcCarthyofAustraliaandDrPravinKrishnaVaddavalliofIndia,respectively.DrsLeonardAngandMarcusLimoftheSingaporeNationalEyeCentrereceivedtheMeritAwardsforthebasicandclinicalcategories,respectively.

Overall,themeetingwasagainjudgedasignificantsuccessbymanyattendees,andseveralcomplimentswerereceivedfromthedelegatesandspeakers.Morethan700peoplefrom36countriesattendedthemeeting.Participantscompletedameetingevaluationform;outofthe193formsreceived,188ofthemwouldliketoseethemeetingheldagain,and192ofthemfoundthemeetingtobeuseful.


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2006–

2007 Chairman’sMessage

Aonce-in-a-lifetimeophthalmicdevelopmenthasemergedinAsiathatisreadytocompete with and challenge the world’s leading eye centres in research. ThisexcitingdevelopmentisnoneotherthantheSingaporeEyeResearchCentre.Theworld-classresearchthatSERIconductswillhelpspreadtheinternationalinflu-enceofSingaporeaswemovetowardsourgoalofbeingaglobalcityandalead-ingnationinfluencingdevelopmentsinAsiaandtheworld.

It iswonderful thatophthalmicresearch inSingaporehasreachedsuchahighlevelinjusttenyears.WemustacknowledgetheremarkablecontributionsoftwoSingaporeanpioneers—thelateProfessorChewSekJinand,currently,ProfessorDonaldTan.

Having achievedworld-class standards in ocular research, there is a tendencyto rest on our laurels and be contented with what we have achieved. But ifophthalmic research in Singapore is to continue to produce outstandingresults andbe featured in leading international publications,we cannot affordcosy indifference.Wemustseizeeveryopportunity.This is the fascinatingandchallengingtaskforDonaldTanandhisteamin2007andbeyond.

Iamconfidentwewillsucceed.


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Milestones

FormationofSingaporeEyeFoundation(SEF).

1986

1988

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9119

90

1970

s

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WeeklytutorialsatArthurLim’sprivateclinicatMtElizabethHospital—moreclinicalteachingrelatingtoresearchworkinSingapore.ThemainthingwastoformSNEC.

EstablishmentofDepartmentofOphthalmology,NationalUniversityHospital.

1987

MeetingwithMrMichaelFord(VicePresident,NationalMedicalEnterprise,USA)atMountElizabethHospital,tobuildamajoreyecentreintheprivatesector.

LettertoKhawBoonWan,ExecutiveDirector,NUHNationalEyeInstitute.

DecisionmadetoestablishSNEC.

ShawFoundationdonated$1million.

WorldCongress(26thInternationalCongress of Ophthalmol-ogy)heldinSingapore.

SingaporeNationalEyeCentre(SNEC)wasestablished.

1983

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1993

1997

BirthofSingaporeEyeResearchInstitute(SERI).

Theincorporationasacom-panyownedbySNECundertheSingaporeCompaniesActwascompleted.AimsofSERIasacompanyweresetup.ProfArthurLimassumedtheroleofChairmanandDirectorofSERI.

DrChewSekJin,whowaslaterpromotedtoAssocProfinNUS,becameitsDeputyDirector.

AssocProfChewSekJinpassedaway.

1998

1stNationalEyeResearchmeetingwasheld.

DrDonaldTanwasappointedasActingDeputyDirectorofSERI.

ProfFouldswaspersuadedtoacceptatemporarypositionasCo-DirectorofSERI.

Mettopophthalmicresearchersandbio-statisticianstodiscussresearchdirectionsforSNECandpotentialcollaborativestudies.

ProfFouldsflewtoNewYorktoagreewithDrChewonarevisedplanforSERI,incorporatingmaterialfromthetwoplansthathadbeenprepared.Laterthatyear,afinalisedsubmissionforSERIwasproduced.

TheSingaporeEyeResearchInstitute(SERI)wasincorporatedasacompanyandasawholly–ownedsubsidiaryofSNEC.

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2ndNationalEyeResearchMeetingwasheld.

ProfTan’sappointmentasSERI’sDirectorwasconfirmed.

ProfFouldsappointedasCo-Director.

ProfBeuermanappointedasHeadofLaboratories.

2000

2001

FirstSingaporeEyeResearchInstituteInternationalMeetinginconjunctionwiththe3rdNationalEyeResearchMeeting.

IncommemorationofProfChewSekJin,thefirstofhislectureswasgivenasakeynoteaddressduringthemeeting.

TheSERInewfacilities,occupyingtwofloorsoftheSNECbuilding,wasofficiallyopenedbytheMinisterofHealth,MrKimHngKiang.

SERIenteredintostemcellresearchunderthedirectionsofA/ProfLeeSengTeikandA/ProfDonaldTan.

2002

SERIwasrecognisedbytheSingaporeauthoritiesasacharityundertheSingaporeCharitiesAct.

SecondSERI-ARVOMeetingonResearchinVisionandOphthalmology.

ProfDonaldTanpromotiontoProfessorofOphthalmologyinNUS.

2005

2007

Asia-ARVOMeetingonResearchinVisionandOphthalmology.

SERI10thAnniversary

FirstSERI-ARVOMeetingonResearchinVisionandOphthalmology.

TheformalrecognitionofSERIbyNUSasanAffiliatedResearchInstitute,thusconferringuniversitystatusonSERI.

2003

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Singapore National

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SingaporeNationalEyeCentre

By Charity Wai

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

Singapore, a country of fourmillion people and a short history of 40 years ofindependence, has made laudable achievements in diverse fields such ascommerce, industry, telecommunications, and information technology. Inophthalmology,aworld-classeyedevelopmentwasconceivedoutofanaspirationmorethanadecadeagotocreateacentreofinternationalexcellencenotonlyinSingapore,butalsointheregionandbeyond.

How It All BeganThe tremendous potential for ophthalmology to be aworld-class developmentwasfirstrecognisedbyProfArthurLim,aneminent,internationallyrenownedeyesurgeoninprivatepractice.Hemootedtheconceptofanationaleyeinstituteasearlyasthe1980s.Manyroundsofproposals,discussions,andcorrespondencewith senior officials ensued, and these eventually led to the government’sdecisiontocommitS$17million(US$10million)tosupporttheestablishmentofanationaleyecentrein1989.

Despitetheprotractedmeetingsandnegotiationsovermorethanfiveyears,thefinal agreement was said to be sealed with a simple handshake between ProfArthur Lim and Dr Kwa Soon Bee, the then Permanent Secretary, Ministry ofHealth.ProfessorLimwasalsoasked tomeet the thenMinisterofHealth,MrYeoCheowTong,togivehispersonalassuranceofcommitmenttothesuccessof theproposednationaleyecentre.Hisappointmentas the foundingMedicalDirectorcameshortlythereafter.Theseeventstookplaceinearly1989.Atthattime,theplanningoftheXXVIIn-

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ternational Congress of Ophthalmology, the largest medical congress beingorganisedinSingaporeatthattime,waswellunderway.Thecongresseventuallyattracted7,600participantsfrom94countriesworldwide.Anumberofkeystaffintheorganisingteam,suchasCharityWaiandKathyChen,wentontoworkwithProfLimonthenationaleyecentreproject.

A flurry of activities followed, the first of which was the incorporation of theSingaporeNationalEyeCentre(SNEC)on3March1989.Thedouble-barrelname(Singapore National) did not come about by accident. It was discussed andagreedtobyapaneloffivepermanentsecretaries.ItwasfeltthatnamingitasNational Eye Centrewas not quite adequate should its name be published orusedininternationalcircles.Hence,thename“SingaporeNationalEyeCentre”(SNEC)cameintobeing.ThespeciallogocommissionedfortheSNECalsode-picteditsglobalmission.

ThedilapidatedSurgicalAandBblocksonthecampusoftheSingaporeGeneralHospitalwasthesiteearmarkedfortheSNEC.Asthestructureofthebuildingwasstillsound,thedecisionwasmadenottodemolishandrebuild,buttoretrofitthebuildingfortheneweyecentretosavetimeandcost.

The Pioneering TeamWithin10months,thetwoblocksweretransformedintoanultra-modernambulatoryeyefacility,andthepioneerteamofstaffattendedtotheirfirstpatientsinOctober1990.Ninepioneeringstaffmadeupthecommissioningteam.DrPeterTsengandDrHengLeeKwang,whowerebothSeniorRegistrarsatthattime,workedcloselywiththeAdministrator,CharityWai,whowasassistedbyKathyChenandKatherineLeong, thenFinanceandAdministrationManager.Thenursingteamwas ledbythe lateMatronEstherLim,supportedbynursingsistersLimMeinChee,MargaretTan,andTanJoonFong,whowerejoinedbySisterLorSiewNgimseveralmonthslater.TheteamtoiledandlabouredtogetSNECoperationalinthestart-upphase,andthisentailednumerousplanningandcoordinationmeetings.SinglenessofpurposeandclosecamaraderieboundtheteammemberstogetherinaneffectiveteamundertheleadershipofourfirstMedicalDirector.

TheCentrereceiveditsfirstpatientson15October1990.Afterthreemonthsofsoftlaunch,theofficialopeningoftheSNECtookplaceon18January1991,withthethenMinisterforHealth,MrYeoCheowTong,asourguestofhonour.The

Singapore National Eye Centre

The congress organising team all ready for action

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The dilapidated Surgical A and B blocks on SGH campus

inaugural Board of Directors consisted of Dr Kwa Soon Bee, then PermanentSecretaryoftheMinistryofHealthandChairmanofHealthCorporationofSinga-poreandMrKhawBoonWan.The Years of Spectacular GrowthTherehasbeennolookingbacksincethen.ThegrowthofSNEChasbeenphe-nomenal.Fromtheoriginalteamof9staff,theCentrenowhasastaffstrengthof446,comprising45seniorconsultantsandconsultants;4associateconsultants;15 registrars; 8 trainees; 133nursing staff; 56paramedical staff; 65 administra-tivestaff;and120clerical,secretarial,andancillarystaff.Ourpatientloadattheendofourfirstyearofoperationwas38,000.Today,weattendtoover250,000outpatientvisitsayearandperform14,000majoreyesurgeriesand16,000laserproceduresannually.ThelevelofclinicalactivitiesplacestheSNECamongstthehighest-volumeambulatoryeyecentresintheworld.

InJanuary1996,SNECandtheNationalUniversityHospital(NUH)cametogethertoformastrategicpartnershipforthejointprovisionofservicesattheNUHEyeDepartmentunderthedirectiveofthethenMinisterofHealth,MrGeorgeYeo.Forcloseto5years,theophthalmologistsoftheNUHEyeDepartmentalsobe-camefull-timestaffoftheSNECuntiltheformationofthetwoclusters,SingaporeHealthServicesPteLtdandNationalHealthcareGroupPteLtd,in2000.

Overtheyears,theCentrehasalsodevelopedfromasinglevenuetoanetworkofservicesspreadingacrossseverallocations:theMtAlverniaHospitalBranch(March 1998–present); KKWomen’s and Children’sHospital (February 1999–present), Changi General Hospital (December 1999–present), and AlexandraHospital(November1998–September2000).

Inthelast16years,ophthalmologyhasdevelopedintoavibrant,world-classdis-cipline inSingapore.SNECstrives in itsmissiontoprovideSingaporeanswithhigh-qualityandcost-effectiveeyecare.TheCentreservesasafocalpointfortheconvergenceofophthalmologistsfromthevarioushospitals,theuniversity,andtheprivatesectortoworktogetherasacohesiveunitdevelopingthethreecoreareasofservice,research,andeducation.

Service DevelopmentThe greatest achievement in clinical service development was the establish-mentoftheninemajorsubspecialtieswithcapabilitiesofdiagnosis,specialised

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treatment, andmanagement of a whole range of eye conditions: cataract andcomprehensive 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 fewcentresintheworld.

Alongwithsubspecialisationwasthe inculcationofaqualityculture,anendur-inglegacyfromourfoundingMedicalDirector.ProfessorArthurLimintroducedthequalityassurancesystemintotheSNECandwouldnotcompromiseon itsimplementation.Intheearlydays,asexpected,therewereintensereactionsandresistancefromsomeofthestaff;butintheend,hisgoodjudgementandcoun-selprevailed.Today,thereisnodisputeabouttheenormousbenefitsSNEChasreaped from these twosingularlymost importantdevelopments inour clinicalservice.

Education, Research, and International ActivitiesTheCentreplaysanactiveroleineducation,supportingtheundergraduateandpostgraduateteachingprogrammesoftheUniversityaswellasorganisingmanysubspecialtycoursesandinternationalconferencesregularly.Formorethanade-cade,thousandsofparticipantshavejoinedourvariouseducationalprogrammesandconferencesfromcountriesintheregionandbeyond:Malaysia,Indonesia,thePhilippines,Thailand,Vietnam,Myanmar,India,Bangladesh,Nepal,SriLanka,HongKong,People’sRepublicofChina,Japan,Korea,Taiwan,UnitedKingdom,Germany,theNetherlands,Spain,theUnitedStatesofAmerica,etc.The Singapore Eye Research Institute (SERI)SERIwasestablishedin1997asawhollyownedsubsidiaryoftheSingaporeNa-tionalEyeCentre,withtheobjectiveofconductingbasicandappliedresearchinmyopia,glaucoma,diabetic retinopathy,andotherophthalmicdiseasesuniquetoAsia.SERIalsoaimstoprovideaninfrastructuretocomplementandfacilitatetheclinicalresearchatSNECandotherinstitutionsinvolvedinthestudyofvisualdisorders.Inaddition,theInstitutesetsandmaintainsscientificandethicalstan-dardsforclinicalandbasicresearchinophthalmologyinSingapore.

The Institute’s firstDirectorwas the lateProfChewSek Jin,who spearheadedmajormyopiaresearchprojectswhilehewaspursuinghisPhDintheRockefellerUniversity in theUSA.Hisunexpecteddemise inDecember 1998wasamajor


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setbackforSERIuntilProfDonaldTanassumedthe leadershipof theInstituteinFebruary1999.Underhim,thecoreoflocalandforeignresearchershasbeenmakingfurtherforaysintovisionresearch,withanemphasisonnewareassuchasmoleculargenetics,molecularandcellbiologyofeyediseases,tissueengineer-ing,proteomics,visualpsychophysics,ocularepidemiology,andbiostatistics.

Further Expansion — Phase 2Withthetremendousgrowthachievedsinceitsinception,theproposalforaPhase2newwingwasput to theSNECBoardasearlyas1992.Numerousroundsofboarddeliberationsthenfollowed.Theproposalssubmittedrangedfromamereextensionofspacewithaprojectcostof less thanS$6million toa full-fledgedmulti-storeynewwingthatwouldsubstantiallyboosttheexistingfacilities.Aftersixyearsofdiscussions,numerousdesignsproposedbytwoarchitecturalfirms,22boardmeetings,3DPCpapers/revisions,andmanyroundsofhigh-levellobbying,theSNECPhase2wasfinallyapprovedin1997asanew,purpose-built,8-storeyfacility,addinganother15,000sqmtoSNEC’sexistingareaof6,500sqmatatotalprojectcostofS$50million(US$30million),fundedbytheMinistryofHealth.

The Centre’s Phase 2 expansion was successfully completed in October 2001.Phase 2 provided 28 new outpatient consultation rooms, 5 operating theatres,anexpandeddayward,a150-seatauditorium,twodedicatedfloorstohousetheSingaporeEyeResearchInstitute’sresearchclinics,laboratoriesandadministrativeoffices,aswellascomprehensiveancillaryandsupportfacilities.People: Our Human CapitalSNECplacesgreatimportanceinmanagingitsmostvaluableasset:ourhumancapital.ThesuccessoftheSNECischaracterisedbythepresenceofmanygroupsof highly educated, highly qualified professionals— the doctors, nurses, andparamedicalandadministrativestaff.Weareveryproudofthefactthat,inthelast16years,wehaveretainedalmostallofourseniorconsultantsandotherseniormembersofstaff.

AsSNECadvancesintothenewknowledgeera,itwillconfrontaborderlessworldwhere top talent is extremely mobile. The competitive advantage belongs toorganisationsthatareabletoattract,develop,andretaintalent.Thekeyliesintheabilitytoharnessthefullpotentialofthetalentintheorganisation.

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Emergence of the Second-Echelon LeadershipAfteradecadeatthehelm,ProfArthurLimdecidedtostepdowninDecember1998tomakewayforthesecondgenerationofleadershipwhohadbeenhand-pickedandnurturedbyhim,despiterepeatedappealsforhimtoremain.

AssociateProfessorVivianBalakrishnan,whowasappointedDeputyMedicalDi-rectorayearearlier,tookoverthebatonfromProfLiminJanuary1999inanemo-tionallychargedchanging-of-the-guardceremonywitnessedbyallSNECstaffandmanyofourchallengersinthemedicalfield.

Associate Professor Vivian Balakrishnan immediately set about shaping thefuturedirectionof theSNEC.Heenvisionedastrategicallianceofeyecentres,with SNEC being the ophthalmic hub in Asia. He led a SNEC delegation ofseniorstafftoJulesStein,JohnsHopkins,andHarvardintheUSA;MoorfieldsEyeHospitalinUK;andtheLionsEyeInstituteinAustralia.Thevisitsculminatedinthesigningofvariousmemorandaofunderstandingthatwouldformthefoundationof a strategic alliance. He also initiated a strategic review of the Centre andmapped out major initiatives for the SNEC in its next phase of development,includingacriticalreviewofSNEC’sroleasthenationaleyecentreinthenewlyrestructuredpublichealthcaresectordistributedbetweentheSingaporeHealthServices(SingHealth)andtheNationalHealthcareGroup(NHG)networks.

The Strategic Review 2000 helped to identify critical core competencies anddevelop the necessary roadmaps for the further development of our staff andenhancement of our talent pool. The team-building sessionwith seniormedi-cal,administrative,nursing,andparamedicalstaffmadea tremendous impactorganisation-wide.

In June2000,SNECwascompletely takenbysurprisewhenAssocProfVivianBalakrishnan was asked to assume the position of Chief Executive Officer ofSingapore’s largestacutecarehospital, theSingaporeGeneralHospital.Givenhisoutstandingtalents,acceleratedcareermoveswerenotunexpected,buthisdeparturefromtheSNECafterjustoveroneandahalfyearswastoosoon.

Infact,AssocProfVivianBalakrishnanwentontojoinpoliticsin2001,andwasmadeanofficeholderasMinisterofStateforNationalDevelopmentandalsolaterforTradeandIndustry.In2005,hewasmadefullMinisterinchargeofCommunityDevelopment,YouthandSportsand2ndMinisterforTradeandIndustry.


Source: Extracted from leading

lights in the Asia-Pacific, 2006.

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AttheChangeoverofLeadership (1999)By Assoc Prof Vivian BalakrishnanIncoming Medical DirectorSingapore National Eye Centre

IneverfullyappreciatedtheenormityofthistaskuntilIsaworheardProfLim’sspeech justawhileago,as JulieGoh(ProfLim’ssecretary) leanedover tomeandsaid,“Thisishisbaby.”Thisbuilding,everyonedownhere,thesystem,thepatients,everythinghererepresents—inaconcreteorhumanform—hisideas,hisideals,andhisachievements.

Charity (ouradministrator)and Ihavepreparedawholecitation to read,but Ithinkit’sreally,reallyunnecessary.Itwouldnotdohimjustice,anyway.Theonlythingwhich I think Iwant tosay is thatnoneofus, certainlynot I,willbebigenoughtofillhisshoes,andIhavegotnoillusionsaboutthat.Forthoseofyouwhoknowme,knowthatIcallaspadeaspade.

IcategoricallyassureyouthatIamprettysurethatIcannotfillhisshoes.Never-theless,wehaveaninheritedteamdownhere,workinghandinhand.Itissome-thingthatisobviouslytooprecioustodrop,mindfulofProfLimandourdutytoourcountry.IthinkweneedtomakethisCentreworld-class,notjustbecausewewantglory,notevenforProfLim’sglory.

Weneedtobecause,firstofall,ourpatientsdemandit.Secondly,thoseofuswhointendtospend,hopefully,therestofourprofessionallivesdownheredemandthat.Thirdly,evenifyoudidnotwantto,thefactisthatcompetitioniscoming,anyway.

Howarewegoingtodothat?Becausewecan’tclonehimandweagreedthatnoneofusareinhiscategory.IthinktheonlywaywecanmakeSNECworld-classisbyworkingasatemandasagroup.Andtorealisethat,we’vegottobuildonwhatIcallinstitutionalexcellence.

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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.

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

It’snotgoing tobe inpocketsof individualexcellenceor individual fame,as Ithinkthetimehaspassedforthat,butratherforallofus,asagroup,tobemuchstronger thanwe could be in our individual capacities. I hope that Iwill havethesupportofalltheteammembersdownhereandthatwedoitnotforselfishreasons,butfirstly forourpatients,secondly foreachother,andthirdly for thecountry.

AsforProfLimhimself,youwouldhavenoticedthatwehavemadeaquickamend-ment.OnSaturday, he finally agreed to be appointedEmeritus SeniorVisitingConsultant.Someofus, includingDonaldandCharity,willknowthatwespenthoursovertheweekendtryingtocoerce,persuade—cannotbribehim,threateneven—toforcehimtotakeupsomerolehere.

AndItoldhimthatitisnotforhissake,butitisreallyforoursakebecauseweneedhissupport,influence,andadvice,hisconnections,andhispresence,whichonlyhecanprovideuswith.Iamgladthathehasacceptedthat.We’vegotafewmorethingsinmind,butwethinkwewilltakeitonestepatatime.

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Conclusion

TheBestisYettoCome

By Prof Arthur Lim

Having achievedworld-class standards in ocular research, there is a tendencyto rest on our laurels and be contented with what we have achieved. But ifophthalmic research in Singapore is to continue to produce outstanding re-sultsandbefeaturedinleadinginternationalpublicationswecannotaffordcosyindifference. We must seize every opportunity. This is the fascinating andchallengingtaskforDonaldTanandhisteamin2007andbeyond.

Thebestisyettocome.Letusneverforgetourpioneerswhocommittedthem-selves to research at a timewhen therewas little interest and almost nothingavailableinSingapore.

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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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

Prof Wallace S Foulds

Prof Lionel Lee

Prof Arthur Lim, Chairman, sERI

Prof Tan Chorh Chuan

Professor Wong Tien YinMBBS, 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

2

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

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.

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

1

1

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

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

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