​Public sector ethos has always guided the Singapore National Eye Centre (SNEC) in its efforts to provide good eye care for patients from all walks of life for more than two decades.

“Our mission is to take care of anyone in Singapore who needs eye care. Every patient who walks through our door will receive good quality, evidence-based care,” says SNEC’s medical director, Professor Wong Tien Yin.

SNEC’s team-based approach to eye care also means different subspeciality doctors may work together to manage a patient and provide the best possible care for him or her, he adds.

SNEC is the designated national eye care centre within Singapore’s public healthcare network. But as an academic and public sector institution, SNEC’s role goes beyond providing clinical care.

Prof Wong says: “Our mission includes training future generations of doctors and eye care professionals, and to conduct cutting edge research and innovation so that we can continue to provide even better care for future generations of Singaporeans.

“Singapore has an ageing population. In 20 years’ time, will they be treated with the same methods as today for the same condition? There is a demand to think beyond just providing care.”

Academic medicine: Culture of innovation

That is why SNEC has embarked on academic medicine, in which doctors and staff on the ground address clinical problems in a systematic way by having a culture of innovation and questioning the gaps that exist.

“We don’t do this in a haphazard manner; rather, we employ methods to gather evidence that a particular solution is the right way to improve care,” Prof Wong says.

He cites the example of transplanting a cornea, a process that he says is prone to failure and could lead to rejections of cornea grafts from donors.

Through a series of clinical observations and clinical trials, and with the help of bioengineering technology, a team of eye doctors at SNEC and the Singapore Eye Research Institute have developed new surgical techniques to improve the success rate of corneal transplants dramatically from 50 to 90 per cent.

Research has also helped to slow down the progression of myopia in children.

“We realised 15 to 20 years ago that myopia was going to be a huge problem in Singapore, so through a series of studies and trials, we found that low-dose atropine could reduce its progression by about 50 per cent,” Prof Wong says.

Clinical service: best possible care

SNEC also provides “best-in-class” clinical care, where it sets out to provide evidence-based, cost effective eye care, with good outcomes, in line with its academic medicine and public sector ethos.

“As a public sector institution, we do not benchmark against private sector eye care that sometimes provide a higher-end spectrum of care that may not be cost effective,” Prof Wong says.

For example, most SNEC cataract patients will get a standard lens that costs three times less than a premium intraocular lens, but is just as effective for them.

In this case, “best-in-class”, according to Prof Wong, means cataracts patients who require good vision are able to access cost-effective treatmentsin a reasonably efficient manner and time frame, with equally good outcomes.

Future: poised to innovate

In the future, however, eye care providers are unlikely to encounter patients with a single medical condition.

Prof Wong says that more patients will suffer from multiple eye-related conditions like diabetic retinopathy, glaucoma and cataract, and non-eye-related conditions like hypertension and heart disease.

“That will require teams of doctors to work together in a team-based approach to prioritise the treatment of eye diseases vis-à-vis other health problems,” he says.

To address such challenges, doctors will also need to adopt new technologies. For example, through better imaging of the eye, doctors can better predict who needs more or less frequent care, notes Prof Wong.

“SNEC will do a lot of pioneering work to develop and test these technologies,” he says, adding that it will also train more eye doctors not only in Singapore but also in the region to meet the growing demand for eye care.

“Our priority is addressing the needs of our nation first,” Prof Wong says. “However, we see ourselves as an international leader and we have the capacity and opportunity to help improve the eye care competencies of our regional neighbours through training fellowships, medical exchanges, and education courses.”