Glaucoma

What We Do

The Glaucoma Department is led by Associate Professor Shamira Perera (Head and Senior Consultant) and comprises 17 faculty members. It treats the full range of glaucoma conditions, including managing complex post-surgical cases from overseas.  It has developed an international reputation as well as a strong referral base from the region.

Glaucoma is an eye disease caused when high fluid pressure within the eye damages the delicate fibres of the optic nerve. The main aim of glaucoma treatment is to reduce the intraocular pressure (IOP) while maintaining the patient’s quality of life.

The department boasts the latest cutting edge medical technologies for glaucoma diagnosis and monitoring. The department’s relationship and fruitful collaborations with industry mean that they are frequently consulted during the development of new devices and will be often the first ones in the region to be using the latest equipment upgrades. Newer technologies enable the detection of glaucoma earlier and provide sophisticated management solutions with better laser and surgical options.

It offers all of the currently available options for laser procedures and has an impressive track record of research in this area. Regular audit and research enable the team to allow for quality control as well as pushing the frontiers of new developments.

The department is well equipped in the operating room too.  Recently, there has been a rapid expansion in the number of surgical procedures for glaucoma and the surgeons are well experienced to offer the most suitable options to the patients.  Advances in surgery have opened up less intrusive, faster and safer options for patients collectively named Minimally Invasive Glaucoma Surgery (MIGS) which might be suitable for some patients.

Key facts and figures about the Glaucoma Team at SNEC

• More than 40,000 glaucoma cases are managed annually (2,000 from other countries in the region), comprising both paediatric and adult patients.

• More than 600 glaucoma surgeries are performed annually.

• More than 1,300 laser procedures are performed annually to manage glaucoma.

• Glaucoma is the largest department at SNEC in terms of research trials, research patients (i.e. patients recruited for clinical trials)

•  It serves as a teaching/training centre, training up to three Clinical Fellows from a variety of countries and three to four Research Fellows annually.

• Provides education, counselling and support group services to glaucoma patients via dedicated nurses, patient education materials, public talks and screenings.

• At any one time there are over 25 research studies just within glaucoma underway. Several of these are clinical studies involving large number of patients.

  
  

Breakthroughs in technology and future developments from the Glaucoma Department

1. Novel slow release glaucoma medications for glaucoma

   a. A procedure that allows sustained delivery of latanoprost-loaded liposomes via subconjunctival injection, was jointly developed by Associate Professor Tina Wong and Professor Subbu Venkatraman and their teams from Singapore Eye Research Institute (SERI) and Nanyang Technological University (NTU). The injection, under the skin of the eyeball is delivered under local anaesthetic and takes only a minute. It contains millions of tiny capsules of glaucoma medication, which release their contents slowly over time, promising to address the non-compliance and local side effects of conventional topical medications. This work led to a President’s Award for Science for the inventors.

   b. The department has been involved with several different modalities for sustained release medications either and have been heavily involved with research in these areas which may one day be commonplace in the management of glaucoma.

   
   

2. Imaging of the anterior segment and angle

   a. Professor Aung, Associate Professor Perera, Assistant Professor Baskaran and their team have employed advanced imaging techniques to identify novel risk factors for angle closure. Angle closure glaucoma is a subtype of glaucoma which is particularly visually destructive and also prevalent in Asians. In collaboration with the Institute for Infocomm Research, Singapore, the only automated software tool for detecting angle closure from eye scans was developed for both angle photographs and cross-sectional imaging. These advancements have the potential to help clinicians provide increasingly individualised management of angle-closure disease. This work led to the team winning the Institute of Engineers Singapore’s Prestigious Engineer award.

   b. The SNEC Glaucoma/SERI team conducts leading research for angle-closure glaucoma, with many studies related to treatments, imaging, risk factors and genetics for the disease. Their strong track record of research can be evidenced below. Those highlighted are doctors who are working or have worked in SNEC and their worldwide research rankings from an independent website.
   

   
   
   
   

3. Genetics of glaucoma

   a. The glaucoma genetics research group at SNEC/SERI has identified more than 10 genetic loci associated findings of which have been published in Nature Genetics which is the highest regarded journal in the field.  Most of this ground-breaking research concerns angle closure glaucoma and will lay the foundations on which future therapies might be developed.

   b. In what can be considered as the largest study of its kind on the cause of glaucoma, an international collaboration, jointly led by Genome Institute of Singapore (GIS) and SERI spanning 36 countries and involving over 120,000 study subjects, have shown that a particular mutation in a person’s LOXL1 gene offers protection against Exfoliation Syndrome (XFS), a leading cause of open-angle glaucoma.

   
   

4. Bioengineering and device development
   NUS Assistant Professor Michael Girard has been working closely with the team to deliver expertise in artificial intelligence, image processing and the biomechanics (of the optic nerve, sclera and iris). As Co-head bioengineering and devices, his projects have won over S$3M of grant funding and collaborations with important institutions worldwide. Assistant Professor Girard is currently heading the Ophthalmic Engineering and Innovation Laboratory (OEIL) in the Department of Biomedical engineering at NUS.
   

Since 2014, clinician scientists and scientists from SERI have been deeply embedded within the Glaucoma Department.

This unique close working relationship results in rapid answers to clinical questions/dilemmas posed by the patient-facing staff.  Furthermore, a view to commercialisation powers the solving of important unmet needs in glaucoma – there are several successful examples already.

These are some of SNEC/SERI research collaborators that have led the department to bringing about innovative changes and bestow upon the department its well-deserved international reputation.

Prof Leopold Schmetterer is currently head of imaging at SERI and adjunct professor at NTU. Professor Schmetterer is a worldwide renowned specialist in ocular imaging and has long-standing experience with commercial and custom high definition systems.

Dr Mani Baskaran is a practicing clinician scientist with extensive experience in the understanding of glaucoma and in the use of imaging equipment for angle-closure and open-angle glaucoma.

Dr Monisha Nongpiur is another PhD holder who links the bench to the bedside with translational work and expertise in Genetics.

Assoc Prof Cheng Ching-Yu directs the Singapore Epidemiology of Eye Diseases (SEED) Programme, a large multi-disciplinary research program focusing on epidemiology, imaging and genetics on eye diseases in Singapore.