Glaucoma is the second leading cause of blindness in the world after cataract. However, while cataract is reversible with surgery, glaucoma is incurable.
What senior healthcare executive Mr Goh Kim Soon, 61, thought would be a routine visit to the optician for a new pair of prescription glasses ended with the optician being unable to measure the degree of his vision. Suspecting that Mr Goh had developed cataracts, the optician advised him to seek medical attention. A check-up at the Singapore National Eye Centre (SNEC) revealed that Mr Goh had glaucoma in both eyes, and cataract in one.
Mr Goh was fortunate that his glaucoma was detected at an early stage, where vision impairment was not severe. Further deterioration could be avoided with proper management of the disease — in his case, with the regular application of eye drops. However, vision that has been lost cannot be restored.
“Worldwide, by 2040, 111.8 million people are projected to suffer from this blinding disease that is usually linked to ageing, with the numbers expected to increase as the world’s population ages,” said Professor Aung Tin (above), Chief Executive Officer, SNEC. “Despite significant progress made in glaucoma research and treatment, some 10 to 20 per cent of glaucoma patients go blind.”
To lower the blindness rate caused by glaucoma in Singapore in the next 10 years, a multi-institution and multidisciplinary programme, titled TAckling & Reducing Glaucoma Blindness with Emerging Technologies (TARGET), has been launched. With Prof Aung as Lead Principal Investigator, the programme has received a $25 million grant from the National Medical Research Council’s Open Fund – Large Collaborative Grant.
TARGET focuses on five broad themes:
1 Understanding the pathobiology of glaucoma using a precision medicine approach
There is currently no way to distinguish which patients are at highest risk of blindness and who will end up with a stable form of the disease. A team of researchers led by Adjunct Professor Khor Chiea Chuen, Senior Principal Investigator, Genome Institute of Singapore, A*STAR, hopes to use human genetic studies to better understand the pathobiology of glaucoma in order to develop new treatments. The team will prioritise studying how alterations in certain critical proteins lead to blinding glaucoma and evaluate their use in identification of patients most at risk of rapid, severe blindness.
2 New technologies to screen undiagnosed glaucoma and monitor the disease in the community
Glaucoma in the early stage has few to no symptoms, as was the case with Mr Goh. Fortunately for him, his optician managed to spot a problem. Most people do not seek medical help until the disease has progressed to the late stage, where vision loss has already occurred and is irreversible. An estimated 72 per cent of people with glaucoma are undiagnosed. The researchers hope to develop better community-based screening strategies to diagnose early-stage glaucoma. “We will make use of artificial intelligence (AI) to develop simple, sustainable tools that can be used by non-specialists, such as general practitioners, opticians and at polyclinics,” said Professor Cheng Ching-Yu, Principal Clinician Scientist & Head Ocular Epidemiology Research Group and Data Science Unit, Singapore Eye Research Institute (SERI).
3 New technologies to better identify rapid progressors
There is currently no technology that can reliably predict which glaucoma patients are likely to go blind and how quickly they will deteriorate. The team led by Associate Professor Michael Girard, Co-Head, Bioengineering & Devices Research Group, SERI, believes that several strategies — advanced eye imaging technology such as Optical Coherence Tomography, novel visual and stress tests that patients can conduct at home to monitor vision loss, and ‘digital twins’ that can help predict cell behaviour over time, among others — linked together by AI “might help us discover new trends and biopathologies” to improve detection of disease progression.
4 Novel technologies to circumvent the problem of poor adherence
Most glaucoma patients start off with eye drops before escalation to laser treatment and surgery, but poor adherence can lead to irreversible loss of vision.
The team led by Professor Tina Wong (above), Head and Senior Consultant at the Glaucoma Department, SNEC, and her colleague, Associate Professor Shamira Perera, Senior Consultant, are working on drop-free treatments such as:
These are less reliant on patients’ adherence and allow the most appropriate intervention at each stage of a patient’s glaucoma journey to keep the condition stable.
5 Targeting Age-associated Metabolic INsufficiency in Glaucoma with Nicotinamide (“TAMING Glaucoma Trial”)
Glaucoma can deteriorate even with adequate reduction in eye pressure. However, results of experimental studies indicate that vitamin B3 (nicotinamide) may serve as neuroprotection to slow vision loss in glaucoma. The team led by Associate Professor Victor Koh, Head & Consultant, Department of Ophthalmology, National University Hospital, is studying whether vitamin B3 can provide an alternative to therapies dependent on lowering eye pressure, or eye drops. He cautioned, however, that a properly designed study needs to be completed to establish the right dosage of the vitamin (likely to be high and unavailable at retail pharmacies) and the level of benefit, as well as to observe whether there are any side effects.
With this unified multidisciplinary approach, Prof Aung is confident the TARGET programme is well-positioned to contribute towards reducing the “societal burden of ageing” caused by glaucoma in Singapore and beyond.
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