eyesight-issue2-2023-Vision across borders A UK’s paediatric glaucoma fellowship journey

Glaucoma is a group of diseases which causes damage to the optic nerve. It is most common in adults, but people of any age can develop it. Childhood glaucoma can be primary (e.g. primary congenital glaucoma, juvenile glaucoma) or secondary (e.g. Uveitic glaucoma, Aphakic glaucoma, glaucoma related to Anterior segment dysgenesis) and needs to be closely monitored as glaucoma is a lifelong problem. Early recognition and treatment will enable thousands of children with glaucoma to live full lives as opposed to a lifetime of blindness without treatment.

My overseas paediatric glaucoma fellowship experience

I spent a year and a half overseas working in the United Kingdom from 2021 to early 2023. During which, I was awarded the National Medical Research Council (NMRC) Overseas Training for the first part of my fellowship which I spent in Cambridge University Hospital subspecialising in adult and paediatric glaucoma, as well as delving into virtual clinics and management of glaucoma in the community under the tutelage of Professor Rupert Bourne.

Amidst my time in Cambridge, I also undertook a Master in Philosophy (MPhil) from the University of Cambridge Department of Clinical Neurosciences with an emphasis on neuroprotection for advanced optic neuropathy under the guidance of Prince Philip Professor of Technology Professor George Malliaras and Dr Patrick Yu.

The second part of my fellowship was a full clinical fellowship in the world-renowned Moorfields Eye Hospital under the tutelage of Professor Peng Tee Khaw, Dr John Brookes and Dr Alessandra Martins – the focus of this fellowship was the clinical and surgical management of childhood glaucoma and anterior segment disorders. Moorfields Eye Hospital was the tertiary centre of paediatric glaucoma for much of the United Kingdom and some parts of Europe, hence there was a high clinical load of complex adult and paediatric glaucoma cases. Over there, I gained confidence in managing complex eye conditions in babies and young children of various ethnicities and ages, including examination techniques using special handheld devices as well as complex glaucoma surgeries such as, angle surgery, glaucoma filtering surgeries, and tube shunts. We also looked at the genetic conditions associated with childhood glaucoma and how we can individualise patient care from that. I had grown much as a doctor there- both in terms of clinical and surgical skills as well as patient interaction and management of young children.

I returned to Singapore in early 2023 armed with new sets of knowledge, skills and perspectives. Upon my return, I ran a paediatric glaucoma clinic at the Singapore National Eye Centre (SNEC), in addition to my adult cataract and glaucoma clinics. I also operate every Friday with my theatres focused on adult cataracts and glaucoma and the management of paediatric glaucoma. We are also setting up a paediatric glaucoma registry and genetic database in this part of the world to better individualise treatment as we move towards precision management. This will be in conjunction with the setting up of our paediatric ophthalmology centre of excellence in SNEC together with my paediatric cornea, retina, ocular genetics and ophthalmology colleagues.

With my research and innovation skills acquired whilst doing my MPhil at Cambridge University, we will strive to develop and bring in new and cost-effective innovative clinical and surgical tools as well as handheld devices to improve treatment and monitoring in adults and children with glaucoma.