Health Services Research

Overview

The Health Services Research (HSR) is the translational eye research unit at SERI. Led by Professor Ecosse Lamoureux, the unit is focused on the epidemiology and risk factors of major eye diseases in Singapore, patient-centered outcomes research, low vision outcomes and rehabilitation. The unit also focuses on translational clinical research on eye diseases, particularly diabetic retinopathy, glaucoma and AMD.

About the HSR Unit

Established in April 2013, the HSR Unit is strategically placed to interface with health research, clinical practice and health policy. Therefore, it is able to improve the utilisation of research knowledge and evidence to efficiently and effectively inform on:

Eye health care practices
Implementation of complex interventions to improve adherence to ocular disease management, ocular health, self-efficacy and quality of life
Guidelines and ocular program development
Policy development related to improving eye care in Singapore
Optimal assessment of patient-reported outcomes

HSR Vision

To improve the quality of life of Singaporeans living with eye diseases and vision loss.

HSR Mission

Through our integrated program of research, we aim to:

Detect and prevent eye diseases and vision impairment
Implement interventions and new models to improve access to care, disease management and patient outcomes
Develop and validate novel instruments to accurately measure patient-reported outcomes
Be the HSR research arm of SNEC
Inform policies to improve eye care in Singapore

Projects

Major Projects

Ocular Epidemiology in The Elderly and Underprivileged

The Epidemiology, PReventiOn and interVentIon for Eye Diseases in the Elderly (PROVIDE)
The Epidemiology of Sensory Impairment in Residential Care (ESIRC) Study

Prevention, Detection and Early Intervention

Diabetic Retinopathy Eye Screening Eye Study (DRESS)
Understanding Non-Adherence to Diabetes Complications Screening (UNADS)
Predictive Model for Non-Adherence to Tertiary Ophthalmology Referrals in Persons with Diabetic Retinopathy (PM-OR)
The Mobile Eye Clinic – Community Screening for the Frail Elderly

Novel Intervention Models

New Models of Care for Nursing Homes and Underprivileged Population (Res CARE, Buddy CARE)
Diabetic Retinopathy-Specific, Intensive & Personalized Eye Care (DR-IPCP) Model

Instrument Development

Development and validation of glaucoma quality of life Item Banks and Computer Adaptive Testing systems in Singapore (GLIBQoLS)
Improving Diabetes and Health Outcomes: Development and validation of the Singapore Diabetic Retinopathy Health Literacy (SDRHL) scale for Patients with Diabetes and Diabetic Retinopathy
Validation of Computer Adaptive Testing systems to measure quality of life item banks for diabetic retinopathy (RetBank)
Development and validation of quality of life item banks and Computer Adaptive Testing for AMD (MacCAT)
Development and validation of Glaucoma Utility Index-S (GUI-S) in Singapore
Development and validation of the first diabetic retinopathy-specific utility instrument (DRU) using a mixed method approach and discrete choice experiment (DCE) methodology
Development and implementation of the Brief Impact of Vision Impairment (B-IVI) Computer Adaptive Testing System

Body Composition

Investigate the contribution of body composition parameters to the risk of severity of DR and DME
Sarcopenia, frailty, and bone health
Link between impairment in sarcopenia (i.e., muscle mass, muscle strength, and physical performance) and deterioration in bone mass and texture leading to an increased risk of poor functioning, mobility, falls, fractures, hospitalisation, morbidity, QoL and mortality.
Establish Singapore reference norms for sarcopenia and frailty subtypes in our three ethnic groups
Identify mechanisms and biomarkers of sarcopenia and frailty

Collaborations

Health Services System Research SRP, Duke-NUS School of Medicine
Centre of Quantitative Medicine, Duke-NUS School of Medicine
Lions Home for the Elders
SingHealth and National Healthcare Group Polyclinics
The Singapore Advanced Imaging Laboratory for Ocular Research (SAILOR)

Yong Loo Lin School of Medicine, National University of Singapore
Singapore National Eye Centre (SNEC)
Department of Family Medicine and Continuing Care, Singapore General Hospital
Centre for Eye Research Australia, University of Melbourne, Australia
Aging Centre, Duke University, USA
University of Sydney, Australia
Queensland University of Technology, Australia
Gloucestershire Eye Unit, UK
Singapore Institute of Clinical Sciences
National Dental Health Centre, Singapore
Sensory Nutritional Science
Clinical Nutrition Research Centre (CNRC), Singapore
Department of Otolaryngology, Head & Neck Surgery Singapore
Saw Swee Hock School of Public Health, National University Singapore
Centre for Ageing Research and Education, Duke-NUS (CARE)
Centre for Healthy Aging, National University Hospital Singapore
Department of Nuclear Medicine & PET, Singapore General Hospital
The University of Cambridge, Psychometrics Centre
Wilmer Eye Institute, Johns Hopkins

Publications (Selected)

Lamoureux, E.L., Tai, E., Thumboo, J., Kawasaki, R., Saw, S, Mitchell, P., and Wong, T., Impact of diabetic retinopathy on vision-specific function. Ophthalmology, 2010 Apr;117(4): 757-65.
Rees, G., Leong, O., Crowston, J., and Lamoureux, E.L. Intentional and unintentional nonadherence to ocular hypotensive treatment in patients with glaucoma. Ophthalmology, 2010. May;117(5):903-8.
McAlinden, C., Gothwal, V., Khadka, J., Wright, T., Lamoureux, E.L. and Pesudovs, K A head to head comparison of 16 cataract surgery outcome questionnaires. Ophthalmology 2011. Dec;118(12):2374-81.
Finger RP, Fenwick E, Pesudovs K, Marella M, Lamoureux, E.L., Holz FG. Rasch analysis reveals problems with multiplicative scoring in the macular disease quality of life questionnaire. Ophthalmology. 2012 Nov;119(11):2351-7.
Ding, J., Cheung, C.Y., Ikram, M.K., Zheng, Y., Cheng, C.Y., Lamoureux, E.L., Tai, E.S., Subramaniam, T., Wong, T.Y. Early Retinal Arteriolar Changes and Peripheral Neuropathy in Diabetes. Diabetes Care. 2012. 35(5):1098-104.
Chiang, P.C., Zheng, Y., Wong, T.Y., Lamoureux, E.L. Vision Impairment and Major Causes of Vision Loss Impacts on Vision-Specific Functioning Independent of Socioeconomic Factors. Ophthalmology. 2013. 120(2): 415-22.
Constantinou, M., Jhanji, V., Jing, X., Lamoureux, E.L., Boffa, U., Taylor, H. R., Vajpayee, R.B. A Randomized, Single-Center Study of Equivalence of 2 Intraocular Lenses Used in Cataract Surgery. Ophthalmology. 2013. Mar;120(3):482-8.
Sabanayagam C, Foo VH, Ikram MK, Huang H, Lim SC, Lamoureux, E.L., Tai ES, Wong TY. Is chronic kidney disease associated with diabetic retinopathy in Asian adults? J Diabetes. 2014. Nov;6(6):556-63.
Kaidonis G, Burdon KP, Gillies MC, Abhary S, Essex RW, Chang JH, Pal B, Pefkianaki M, Daniell M, Lake S, Petrovsky N, Hewitt AW, Jenkins A, Lamoureux, E.L., Gleadle JM, Craig JE. Common Sequence Variation in the VEGFC Gene Is Associated with Diabetic Retinopathy and Diabetic Macular Edema. Ophthalmology. 2015. Sep;122(9):1828-36.
Burdon KP, Fogarty RD, Shen W, Abhary S, Kaidonis G, Appukuttan B, Hewitt AW, Sharma S, Daniell M, Essex RW, Chang JH, Klebe S, Lake SR, Pal B, Jenkins A, Govindarjan G, Sundaresan P, Lamoureux, E.L., Ramasamy K, Pefkianaki M, Hykin PG, Petrovsky N, Brown MA, Gillies MC, Craig JE. Genome-wide association study for sight-threatening diabetic retinopathy reveals association with genetic variation near the GRB2 gene. Diabetologia 2015. Oct;58(10):2288-97.
Chua J, Koh JY, Tan AG, Zhao W, Lamoureux, E.L., Mitchell P, Wang JJ, Wong TY, Cheng CY. Ancestry, Socioeconomic Status, and Age-Related Cataract in Asians: The Singapore Epidemiology of Eye Diseases Study. Ophthalmology. 2015. Nov;122(11):2169-78.:
Wong CW, Teo BW, Lamoureux, E.L., Ikram MK, Wang JJ, Tai ES, Sethi S, Wong TY, Sabanayagam C. Serum Cystatin C, Markers of Chronic Kidney Disease, and Retinopathy in Persons with Diabetes. J Diabetes Res. 2015;2015:404280. IF=8.7.
Gupta P, Cheung CY, Baskaran M, Tian J, Marziliano P, Lamoureux, E.L., Cheung CM, Aung T, Wong TY, Cheng CY. Relationship between Peripapillary Choroid and Retinal Nerve Fiber Layer Thickness in a Population-based Sample of Non-Glaucomatous Eyes. Am J Ophthalmol. 2016. Jan;161: 4–11.
Man RE, Sabanayagam C, Chiang PP, Li LJ, Noonan JE, Wang JJ, Wong TY, Cheung GC, Tan GS, Lamoureux, E.L. Differential Association of Generalized and Abdominal Obesity With Diabetic Retinopathy in Asian Patients With Type 2 Diabetes. JAMA Ophthalmol. 2016. Mar;134(3):251-7.
Islam FM, Chakrabarti R, Islam MT, Wahab M, Lamoureux, E.L., Finger RP, Shaw JE. Pre-diabetes, Diagnosed and Undiagnosed Diabetes, their risk factors and association with Knowledge of Diabetes in a Rural Bangladesh: The BPDES. J Diabetes. 2016. Mar;8(2):260-8.
Fenwick EK, Man RE, Lamoureux, E.L. Velocity of Visual Field Progression Implicated in Falls. JAMA Ophthalmol. 2016. Aug 1;134(8):886-7.
Ng WY, Teo BW, Tai ES, Sethi S, Lamoureux, E.L., TY Wong, Sabanayagam C. Cystatin C, chronic kidney disease and retinopathy in adults without diabetes. J Intern Med.. 2016. Sep;23(13):1413-20.
EK Fenwick, PG Ong, REK Man, C-Y Cheng, C Sabanayagam, TY Wong, Lamoureux, E.L. Impact of vision impairment and major eye diseases on mobility and independence in a Chinese population. JAMA Ophthalmology. 2016. Oct;1;134(10):1087-93.
Fenwick EK, Ong PG, Man RE, Cheng CY, Sabanayagam C, Wong TY, Lamoureux, E.L. Association of Vision Impairment and Major Eye Diseases With Mobility and Independence in a Chinese Population. JAMA Ophthalmol. 2016. Oct;1;134(10):1087-1093.
Fenwick EK, Man RE, Ong PG, Sabanayagam C, Gupta P, Cheng CY, Wong TY, Lamoureux, E.L. Association of Changes in Visual Acuity With Vision-Specific Functioning in the Singapore Malay Eye Study. JAMA Ophthalmol. 2016. Nov;1;134(11):1299-1305.
Sabanayagam C, Fenwick E, Ong PG, Tey ML, Tapp R, Cheng CY, Cheung GC, Aung T, Wong TY, Lamoureux, E.L. Visual Impairment in Old and Very Old Community-dwelling Asian Adults. Ophthalmology. 2016. Nov;123(11):2436-2438.
Ngguyen HV, Tan GS, Tapp RJ, Mital S, Ting DS, Wong HT, Tan CS, Laude A, Tai ES, Tan NC, Finkelstein EA, Wong TY, Lamoureux, E.L. Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore. Ophthalmology. 2016. Dec;123(12):2571-2580.
Foo V, Quah J, Cheung G, Tan NC, Lin MZ, Chan CM, Lamoureux, E.L., Wong TY, Tan G, Sabanayagam C. HbA1c, Systolic Blood Pressure Variability and Diabetic Retinopathy in Asian Type 2 Diabetes. J Diabetes 2017. Feb;9(2):200-207.
Fenwick EK, Man RE, Cheung CMG, Sabanayagam C, Cheng CY, Neelam K, Chua J, Gan ATL, Mitchell P, Wong TY, Lamoureux, E.L. Ethnic Differences in the Association Between Age-Related Macular Degeneration and Vision-Specific Functioning. JAMA Ophthalmol. 2017. May 1;135(5):469-476.
Xie J, Ikram MK, Cotch MF, Klein B, Varma R, Shaw JE, Klein R, Mitchell P, Lamoureux, E.L., Wong TY . Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2017. Jun;1;135(6):586-593.
Lamoureux, E.L; Taylor H, Wong TY. Frequency of Evidence-Based Screening for Diabetic Retinopathy. N Engl J Med. 2017. Jul;13;377(2):194-195.
Wong MYZ, Man REK, Gupta P, Lim SH, Lim B, Tham YC, Sabanayagam C, Wong TY, Cheng CY, Lamoureux, E.L. Is Corneal Arcus Independently Associated With Incident Cardiovascular Disease in Asians? Am J Ophthalmol. 2017. Nov;183:99-106.
Ting DSW, Cheung CY, Lim G, Tan GSW, Quang ND, Gan A, Hamzah H, Garcia-Franco R, San Yeo IY, Lee SY, Wong EYM, Sabanayagam C, Baskaran M, Ibrahim F, Tan NC, Finkelstein EA, Lamoureux, E.L., Wong IY, Bressler NM, Sivaprasad S, Varma R, Jonas JB, He MG, Cheng CY, Cheung GCM, Aung T, Hsu W, Lee ML, Wong TY. Development and Validation of a Deep Learning System for Diabetic Retinopathy and Related Eye Diseases Using Retinal Images From Multiethnic Populations With Diabetes. JAMA. 2017. Dec;12;318(22):2211-2223.
Gupta P, Aravindhan A, Gand ATL, Man REK, Fenwick EK, Mitchell P, Tan N, Sabanayagam C, Wong TY, Cheng CY, Lamoureux, E.L. Association Between the Severity of Diabetic Retinopathy and Falls in an Asian Population With Diabetes: The Singapore Epidemiology of Eye Diseases Study. JAMA Ophthalmol. 2017. Dec;1;135(12):1410-1416.
GS Tan, A Gan, C Sabanayagam, YChung Tham, K Neelam, P Mitchell, JJ Wang, Lamoureux, E.L., CY Cheng, TY Wong. Ethnic differences in the Prevalence and Risk Factors of Diabetic Retinopathy: The Singapore Epidemiology of Eye Diseases Study. Ophthalmol. 2018 Apr;125(4):529-536.