Currently the Scientific Director and Head of Ocular Imaging at SERI, Prof Leopold Schmetterer has published more than 420 publications and given more than 22 keynote lectures. He has been awarded approximately S$21.5 million (in Singapore) and more than €15 million (in Europe) in research grant funding for the last 10 years. A native of Austria, his research interests span the gamut of imaging — from the development of novel technologies to applications in preclinical research and clinics. He is also interested in clinical trials and is involved in many studies in retina, glaucoma, cornea and dry eye.
As the Head of Ocular Imaging at SERI, what has been the research focus of your lab?
In Singapore, Ocular Imaging research has always been strong, but limited to software solutions and clinical applications. With the setup of the SERI-NTU Advanced Ocular Engineering (STANCE) programme, we try to extend this research towards hardware development. Obviously, this cannot be achieved in a short time frame, but I truly believe that we are on the right path.
What do you think are your most significant contributions in the field of Ocular Imaging?In my early days, I mainly worked on ocular interferometry, which revolutionised ocular imaging and led to the development of optical biometry (IOL master) and Optical Coherence Tomography (OCT). I have a strong interest in ocular perfusion and how it contributes to ocular disease. We have done some fundamental work on blood flow autoregulation and neurovascular coupling, and have elucidated how this may be involved in glaucoma and diabetic retinopathy pathophysiology.
I’ve also been interested since the late 2000s in ultra-high-resolution OCT and imaging of the anterior segment. We did some fundamental studies on the imaging of the tear film. Here in Singapore, my main focus is on functional OCT; we have also done some work on myopia that is yet unpublished, but may have important implications for clinical care.
As a person who has been working in the dynamic field of Ocular Imaging for so long, what are some of the most profound changes you have witnessed in your career to date?Ocular Imaging is the field in ophthalmology that has seen the most pronounced changes in the last 30 years. The introduction of OCT has revolutionised all subspecialties. Nowadays, the field is moving towards functional imaging, which is extremely exciting, and will allow us to obtain novel insight into the pathophysiology of disease. It will also bring clinical care to the next level. The rapid development of Artificial Intelligence (AI) also plays an important role here.
How challenging is it to run a research lab during these pandemic times?It is challenging for several reasons. On the one hand, the recruitment of patients has slowed down significantly. On the other hand, social distancing has made it difficult to get the lab work done sufficiently. Work from home is another issue. Whereas this is relatively easy for me, who lives alone here in Singapore, it is a big issue for those who have children, particularly when they are small. As such, it is also more of a challenge for female co-workers, a fact that is not sufficiently acknowledged in Singapore.
It is also a major issue for all foreigners who are working in SERI. My belief is that the position of SERI as a world leader in eye research can only be maintained if we also heavily rely on foreigners in the future, given that we are faced with international competition. I would prefer that my team members who have their family abroad could travel home for a couple of months and work from their home country. This would also reduce the mental stress for our co-workers, which is not sufficiently taken care of at the moment.
Since you’ve worked in Europe as well as Singapore, can you share some perspectives on how each of these countries can learn from the other with respect to the way research is done, research is translated, and ease of doing research?I moved to Singapore in 2016 because I thought that I had been in Europe for a long time; also, at the end of my career, I needed a novel challenge. I do not regret joining SERI; I’ve learnt a lot here, and it has also expanded my personal horizon. I wanted to better understand Asian thinking and culture, and indeed I have learnt a lot and can better appreciate Southeast Asian culture nowadays.
In terms of research environment, Singapore in general and SERI in particular have some major advantages over other settings. The most significant is that the country has made research a national priority, and invests significantly in this field. This path is groundbreaking, and one of the reasons for the country’s enormous economic success in the last 55 years. This is also reflected in media coverage: research outcomes are regularly covered, as opposed to Europe. The visionary investment of S$25 million in research funding over the next five years announced at the end of last year is another sign of this dedication. I truly believe that this type of response to the COVID-19 crisis would also be required in Europe; unfortunately, I don’t see any such signs within the European Community.
In SERI, I’ve found a spirit for research that’s truly inspiring. Most importantly, it’s the passion of the faculty to develop SERI as a world leader in the field and the general spirit that I appreciate. Because Asian societies tend to be less hedonistic than Western societies, they facilitate and support the setup of such projects. The standard of work ethic is very high at SERI, and the vast majority of people work very hard to achieve this goal.
I do, however, also see challenges in the Singapore environment that mainly relate to outcomes and KPIs. There is a strong emphasis on publication output. Some people may even think that getting published is the goal of our research — this is wrong. The goal of our research is to make novel discoveries and, at the end of the day, to improve patient care. Getting published is a by-product of these efforts.
Neither impact factor, nor h-factor, nor boosting of the career can be a sufficient motivation to do research. Research in Singapore is, to a large degree, financed by the public sector. Society does not invest in us to foster our own careers, but with the goal to change the fate of people who are affected by ocular disease. This translational aspect of research is underdeveloped in Singapore compared to Europe. The country is lacking companies that play a role in the international device and pharma environment. I truly believe that this needs a change in mindset — it is occurring, but not at the required pace.
Another issue relates to hierarchy in Singapore institutions. It reminds me of the conditions in Western universities in the 1950s and early 1960s. Truly innovative research can only develop from the group up; it’s never a top-down process. Young scientists here are too adapted to such hierarchical structures. Those who made the biggest contributions to scientific development in the 20th century — such as Marie Curie, Albert Einstein and Max Planck — were revolutionaries who would have had a tough time in Singapore’s research environment.
Comparing this to Europe is not easy, because no single country in Europe invests comparable amounts of money in research. Switzerland may be the closest to Singapore in this respect, because it invests considerably, is comparable in size, and has world-class universities. I have quite a bit of experience with this country because I did my post-doc in Switzerland in the 1990s, and currently hold a visiting professorship at the University of Basel. Since 1990, Switzerland has won six Nobel prizes in physics, chemistry and medicine; Singapore has gotten none. This is a clear sign that there is a need for structural changes in Singapore to allow for innovation at research institutions. For SERI, this means that we need less top-down and more bottom-up research.
Finally, I would like to talk about administration. This is a problem in Europe, and it’s even more so in Singapore. Hiring, procurement and other administrative tasks take too long and are too complicated. With all the complex regulations in place, we tend to forget what is really important: patient safety and animal welfare. In the complex framework of ordinances, you risk losing sight of the essentials. Again, the most successful scientists will not be the ones who comply, but the ones who oppose. As such, decisions need to be driven by scientific reasons and not by administrative power.
Can you explain the importance of mentorship in furthering one’s career? How has it helped you? Who are your mentors? Mentorship is of utmost importance. I am very grateful to all my mentors, and those who have helped me to develop my career. This started with my parents, and the academic spirit that I experienced at home. I then have to mention Adolf Friedrich Fercher, who introduced me to the field of Optical Imaging. He was a pioneer of modern biomedical optics, and I stayed connected with him until his death in 2017. Charles Riva was the host of my post-doc stay in Switzerland. From him I learnt the importance of performing a solid experiment and looking at the data critically. I am honoured by the friendship he has offered me that now has lasted for more than 25 years. Finally, I must mention Hans-Georg Eichler, who introduced me to the world of clinical research and translational approaches. He also played a key role in teaching me how to navigate the politics in a department.
The SERI mentor-mentee programme is outstanding. I have never experienced a better approach to this problem. The willingness of the senior faculty to develop the next generation of scientists is amazing, and I am proud to be part of this. The vast majority of mentors understand that this programme does not aim to foster their career, but to foster the career of the mentee.
Any advice for the current generation of scientists and clinician-scientists?The motivation for research comes from passion and the medical need. This must be the only driver for our work. The career may develop as a consequence of this passion, but is secondary. The opportunity to do research in a professional environment is a big privilege that only the minority are given.
Be critical against the senior leadership and the ideas that are transmitted by the authorities. It is a virtue to listen to those who are more experienced, but science does not develop if we follow the rules of what is established. We need to challenge common thinking. We need to oppose because a patient’s hope does not come from confirmation of the doctrine, but from scientific revolution and breakthrough.
We don’t want to reproduce what others have already done; we want to come up with new concepts that have the potential to bring our knowledge to a different level. This is more important than fulfilling all the KPIs or getting another professional title.
You are an international expert in Ocular Imaging, but what is the one thing that you would like to be remembered by?It’s not important whether I’m remembered for something related to my professional work. I hope that I can contribute to something meaningful — whether this is connected to me as a person is irrelevant.
In this context, it’s important to understand the difference between competition in research and in sports. In sports, the goal is always to be the fastest, strongest or most skilful. Once you win an Olympic gold medal, the final aim has been achieved, and you will be remembered for this. In research we have competition for a different reason. Society has figured out that, with a certain degree of competitiveness, the output per invested dollar is better. Medical research, in particular, is a service to society and not a means to fulfil personal vanities.
9. What do you do to unwind? What are some of your hobbies?My family is and has always been the centre of my life. I unwind most when I can spend time with my wife and my kids. I am also grateful that they agreed to my Singapore adventure. Friends are also extremely important, and the many friends I have found here in Singapore have become very important to me; particularly during these difficult COVID times, this gives me the support to cope with the current situation.
Music has also been of utmost importance for me since young. My parents were both playing the piano and we all learnt instruments. I could not imagine life without music; a day without listening to music and think about it is a lost day for me. I also love visual arts and literature. Visiting museums and exhibitions and reading, particularly in the late evening, are among my favourite leisure activities. This does not mean that I don’t like to hang out with my friends — I enjoy playing cards until late into the night!
Another major passion in my life is collecting old toy trains. Unfortunately, this collection could not accompany me to Singapore. But it is waiting in Austria, and brings me enormous joy when I go back.
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