The Singapore Eye Research Institute conducts clinical trials to combat myopia in children and other eye diseases

Mr ADRIAN Raj Angappan (right), 49, and his teenage son, Nikhil, 14, can see things better after they went through clinical trials conducted by the Singapore Eye Research Institute (Seri).A corneal inlay implanted in Mr Angappan’s left eye four years ago corrected his blurry near vision. After the free implant, the marketing lecturer did not have to wear glasses to teach his students, read newspapers, text messages and price tags.

The corneal inlay implant treats presbyopia in people who are 40 years and older and wear reading glasses to focus on near objects. Nikhil, a Secondary 2 student, wears eye glasses because he is myopic.

He is a participant in Seri’s clinical trials which use atropine eye drops to slow down the progression of myopia in children. He has been putting a drop of atropine in each eye every night for two years since the age of nine.

As a result, the myopia in his left eye dropped from 225 degrees to 125 and in his right eye from 250 degrees to 150.

The myopia in his left eye rose to 200 degrees and in the right to 225 degrees after he stopped using atropine for two years following his 11th birthday.

There was a sharp decline to 150 degrees for the left eye and 175 degrees for the right eye after the atropine treatment was resumed late last year.

Nikhil did not have to pay a cent for the atropine. He says: “I am happy to be in the Seri programme. I can see better now and I hope to stop wearing my glasses permanently.”

Seri aims to be the first in the world to generate new knowledge of common and rapidly emerging eye diseases in Asia.

Finding the genes that cause two afflictions
— myopia and diabetic eye disease
— is a key target for the institute, which strives to be one of the top five eye research centres in the world by 2015.

Singapore has one of the world’s highest myopia rates. The numbers rise from 20 per cent to 30 per cent among children in Primary 2 and Primary 3 to 80 per cent of male teenagers aged 18.

Seri’s director, Professor Wong Tien Yin, says that the myopia gene may confirm whether this most common eye problem in Asia is transmitted from parents to the growing number of children who are short sighted.

Diabetic eye disease affects one in three of 400,000 people here and it is the most common cause of blindness among obese working Singaporeans between the ages of 20 to 60.

The numbers are even higher across Asia — in China alone, 100 million people suffer from diabetes, which can damage blood vessels in the eye’s retina.

The identification of the genes can help those who are prone to myopia and diabetic eye disease get the early treatment they need.

To find the genes responsible for diabetic eye disease, Seri is analysing the blood samples of people with and without diabetes and diabetic eye disease, to see if there are differences in their genetic structures.

In the early stage of diabetic eye disease, laser photocoagulation will seal leaking blood vessels in the retina. More complex surgery is required in the later stages when patients face the danger of losing their vision.

Seri’s researchers are also trying to find out why many Singaporeans with diabetes do not go for regular eye examinations.

Are they afraid to go for the check ups? Are they ignorant about the disease? Or is it difficult for them to get access to the services they need?

“If we know the reasons, we can address the problems,” Prof Wong says.

Seri has also set up an advanced imaging laboratory in collaboration with Agency for Science, Technology and Research’s Institute For Infocomm Research.

This imaging system helps scientists to detect diabetic eye disease, glaucoma damaging the optic nerves, and diseases in other parts of the body. Changes in retinal blood vessels, says Prof Wong, can be an indication of potential strokes, kidney and heart diseases.

Tapping the skills of experts in different fields and countries to achieve a cost cutting synergy will speed up the results of Seri’s projects.

A comparative study finds that only 3 per cent of students in Australia who spend two of their daily school hours in outdoor activities are myopic.

The rate is tenfold at 30 per cent among students of the same age in Singapore who spend less time outside their classrooms.

Seri is working with the schools here to determine whether children who spend more time outdoors are less likely to be myopic.

Prof Wong says: “If we achieve all the results and details we need, we can have the first myopia prevention programme that is easy to implement.”

New frontiers
The Singapore Eye Research Institute (Seri) was set up in 1997 as the research arm of the Singapore National Eye Centre.

Seri’s achievements include the world’s first cornea stem cell transplant, which uses stem cells from a healthy eye to grow tissue for the cornea — the transparent front part of the eye covering the pupil and the surrounding white area.

Damage to this eye surface is the second leading cause of blindness in the world, after cataracts.

Seri also carried out Asia’s first tooth-in-eye surgery. This complex procedure involves implanting the
patient’s tooth — in which a hole has been drilled — into the eye socket. A plastic cylinder is placed in the hole to focus light onto the retina at the back of the eye.

This procedure is suitable for people with eyes that have been damaged by disease or injury but whose optic nerves are still intact.

Says Prof Wong: “We want to be the focal point in Asia. We will be the first place to generate new knowledge of eye diseases that are important in the region.”

Singapore is the most productive producer of scientific papers on eye research, according to an independent article in the International Ophthalmology journal published in November 2008.
 
The article noted that from 2002 to 2006, Singapore produced 20.49 publications for every one million people, placing it in the top spot, ahead of research heavyweights in Britain and the United States.

Some 95 per cent of the research here in fields such as myopia, glaucoma, corneal blindness and diabetes-linked blindness, was carried out by Seri.