All eyes on man with clear vision

The work of Professor Wong Tien Yin from the Singapore National Eye Centre and his team has been translated into international guidelines on how to manage diabetic retinopathy.
PHOTO: All eyes on man with clear vision

Professor Wong Tien Yin, 46, is group director of research at Singapore Health Services, vice-dean of clinical sciences at Duke-NUS Graduate Medical School, senior consultant and deputy medical director of research at the Singapore National Eye Centre as well as provost chair professor at the National University of Singapore.

A retinal specialist, he balances clinical practice in ophthalmology - focusing on macular and retinal diseases such as diabetic retinopathy and age-related macular degeneration - with a broad-based research programme comprising epidemiological, clinical and translational studies of Asian eye diseases. He has also pioneered the use of retinal imaging to predict disease risk.

Q: You and your team were recently ranked among the world's most prolific researchers in two major eye diseases, age-related macular degeneration (AMD) and diabetic retinopathy (DR). Why are these conditions so important?

These two conditions are considered "retinal diseases of ageing" and affect nearly 500 million people globally.

AMD - where the eye's macula (light-sensitive tissue) breaks down - is the leading cause of blindness in elderly people.

By 2040, global projected AMD cases could balloon to 288 million, with close to half the cases in Asia.

DR causes abnormal blood vessels to grow over the retina and optic nerve, which then leak and damage them.

It affects younger people, is a major cause of vision loss in working adults and is estimated to affect nearly 100 million people worldwide.

Over the past decade, our team at the Singapore National Eye Centre (SNEC), Singapore Eye Research Institute (Seri) and the National University of Singapore has led major global studies on the epidemiology, risk, factors, population and patient impact and clinical treatment of these conditions, and our work has been translated into international guidelines on how to manage them.

Q:So what needs to be done?

For AMD, we need greater awareness of this condition, so our elderly population do not assume vision loss is simply due to age. There are now some effective therapies for AMD, but they work best when detected early.

Our studies on DR have shown that controlling blood glucose, blood pressure and cholesterol in diabetics can reduce the risk of developing retinopathy and slow its progression.

Timely treatment can prevent almost all vision loss. Also, since vision loss may not be present in the earlier stages, regular screening of people with diabetes is essential for early intervention and to prevent blindness.

Q:What are some key findings of your research?We have shown that smoking increases the risk of AMD but more importantly, if someone is a heavy smoker (more than five packs a week), the risk increases threefold.

We have also found an increased risk of AMD in people with hypertension and kidney disease.

We now suggest a major paradigm shift in our thinking of AMD - that it is not just an eye disease, but a manifestation of systemic disease.

Our studies also suggest that in some forms of Asian AMD, a combination of laser treatment and eye injections results in good outcomes.

This is now the standard of care for Asian AMD.

This contrasts with the Western type of AMD where eye injections alone are effective.

With DR, for example, we've now rolled out a national programme with the National Healthcare Group Eye Institute to implement a faster and better way to screen for DR in the polyclinics via telemedicine platforms.

When this is fully rolled out, patients will have results much faster, and can be referred earlier to eye clinics for appropriate treatment.

Q:What's the situation like in the region?

We were one of the first to highlight the significance of AMD in Asia.

All along, we thought it was not common, but this was a false premise because Asia simply had a large young population.

In fact, total numbers in Asia will probably be worse than in the West. Seri is leading a group studying 2,000 cases of AMD in Asia, to look at the genetics of the disease in the region.

The work is ongoing, but it looks as though there may be some specific Asian genes for the condition.

Another large global study we are leading on DR involves 25,000 people. In Singapore, our studies show that AMD is seen in 5 to 8 per cent of those aged 40 to 80 years, and is more common in Chinese.

And among those with diabetes, about one in three suffers from DR, with the highest rates in Malays and Indians.

Q:You and your team developed a non-invasive scan of the blood vessels at the back of the eyeball, which can predict the risk of disease years before symptoms appear, and before other diagnostic tests can detect diseases ranging from stroke to diabetes and high blood pressure. Now you are using the same technique on dementia. What have you found out?

We are now in the process of improving the automation of non-invasive scans of blood vessels so it can be used by general practitioners and optometrists outside of specialised settings.

In dementia, the initial results have been very promising.

What we've found so far is that if we find vascular damage in the eyes, a patient is more likely to have vascular dementia, where the blood flow to the brain is inadequate. If there is less damage, it's more likely to be Alzheimer's disease. This is important since the treatment options are different for these two forms of dementia.

Q:How can you tell that your research is on the right track?

Early on, we were very good at diseases that Singapore has an edge on, like myopia.

But now, we're getting good at diseases where research is led by big names like Harvard, Johns Hopkins and so on. We're taking on the major diseases that, a decade ago, no one would have thought Singapore would have any hope of making an impact in.

Q: As one of Singapore's pioneering doctor-scientists, how have you seen the research landscape change here?

The first generation of clinician-scientists, which include people like Professors Donald Tan (SNEC medical director) and Aung Tin (Seri's executive director), had to do everything much on their own.

We've trained a second generation who are now leading teams made up of junior researchers.

We have 10 to 15 of these third-generation clinician-scientists at Seri, which is quite an achievement.

We've walked the walk, now we can guide them.

Q:What's your advice to aspiring researchers?

First, you have to be patient. Success in the biomedical sciences doesn't come so quickly, and it cannot be rushed.

Second, you have to be focused. You can only make an impact if you work hard and long on a single specific condition.

Third, you have to work as a team. No one is an island in the global world of research.

Q: You start your day writing grants and answering e-mails at 5am before seeing patients at 9am, and your day generally ends at 7pm. How much free time do you get, and what do you do?

I am trying to spend time interacting with my kids before they become adults. I have rediscovered squash which I now enjoy playing with my two boys.

ailien@sph.com.sg


This article was first published on June 8, 2014.
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