Health Services Research

Overview

The Population Health Research (PHR) unit is the translational eye research unit at SERI. Led by Prof. Ecosse Lamoureux, the unit is focused on the epidemiology and risk factors of age-related sensory decline in Singapore; patient-centred outcomes research; and Patient-Reported Outcome Measurement (PROM) development. The unit also focuses on translating clinical research into improved real-world management and treatment strategies of major eye diseases, particularly Diabetic Retinopathy (DR), Glaucoma, and Age-related Macular Degeneration (AMD). As such, PHR is strategically placed to interface with health research, clinical practice, and health policy.

Our Vision

To improve patient-centred outcomes and quality of life of Singaporeans living with vision loss and other age-related sensory impairments.

Our Mission

Through our integrated programme of research, we aim to:

Detect and prevent sensory deterioration
Develop and validate novel instruments to accurately measure patient-reported outcomes
Implement evidence-based interventions and new models to improve access to care, disease management, ocular health, and patient-reported and behavioural outcomes
Inform eye health care practices and guidelines
Inform policies to improve eye care in Singapore

About the Population Health Research Group

Established in April 2013, PHR comprises a passionate group of scientists, research coordinators, and research administrators from a diverse range of scientific backgrounds, including ophthalmology, psychology, psychometrics, and public health. Under the oversight and mentorship of Prof. Ecosse Lamoureux, the group is headed by a Core Team of four clinical research fellows, two research associates, a biostatistician, an administrator, and more than 20 clinical research coordinators who support three major programmes of research.

Programmes of Research

Ageing and Sensory Decline

Our clinical epidemiology and ageing research programme aims to investigate the clinical, biological, anthropomorphic, neurological and psychosocial phenotypes of contemporary elderly Singaporeans to enhance our understanding of the epidemiology, risk factors, economic burden, patient-centred consequences and complex mechanisms underlying age-related sensory i.e., vision, hearing and olfactory decline in elderly Malay, Indian and Chinese Singaporeans.

An innovative and patient-centric research programme targeting the ageing Singaporeans: The PopulatION HEalth and Age-Related SEnsory Decline PRofilE (PIONEER) study.
Investigate the role of the ageing visual function system on functional health in elderly Singaporeans.
Establish a reliable and clinically feasible single diagnostic criterion of age-related muscle mass loss using Deuterated Creatine (D3Cr) in a Contemporary Cohort of Elderly Singaporeans.
Validation of a new diagnostic tool to evaluate any cognitive impairment and dementia in elderly Singaporeans with sensory loss.
Development and validation of a Healthy Ageing Index in elderly Singaporeans.

Instrument Development

Our world-class programme of patient-reported outcomes research aims to develop, validate, and implement cutting-edge PROMs that assess the impact of diseases and treatments from the patients’ perspective. Our computerized adaptive test (CAT) suite provides comprehensive and precise measurement of quality of life in under 2 minutes per domain, making it ideal for use in clinical care, research trials and busy health care settings. Several of our CATs have been successfully implemented in tertiary eye care centres in Singapore and overseas. Some of the current projects include:

Development and validation of glaucoma quality-of-life Item Banks and Computerized Adaptive Testing systems in Singapore (GlauCAT).
Development and validation of quality-of-life item banks and Computerized Adaptive Testing systems for AMD (MacCAT).
Development and validation of quality-of-life item banks and Computerized Adaptive Testing systems for myopia and treatments (MyoCAT).
Development and validation of quality-of-life item banks and Computerized Adaptive Testing systems for type 2 diabetes (DiabCAT).
Feasibility and effectiveness of implementing quality-of-life CATs for vision impairment (IVI-CAT) in cataract clinics at the Singapore National Eye Centre.
Feasibility and effectiveness of implementing GlauCAT in glaucoma clinics at Mass. Eye & Ear Hospital, US.

Clinical and Interventional Research

Our clinical and interventional research primarily focuses on the optimisation of eye screening models at primary care level, and the development of novel interventions to improve clinical, patient-centred, behavioural, psychosocial, and economic outcomes in various populations. In addition, we aim at estimating the healthcare burden of individual eye diseases, understand their impact on patient-centred health outcomes (e.g., sleep and adherence to treatment), and identify the factors associated with poor outcomes. Here, we conduct multi-site observational studies and randomised controlled trials in both tertiary hospitals and the community to evaluate the efficacy of our interventions for them to be implemented in the real-world settings.

Diabetic Retinopathy Eye Screening Eye Study (DRESS)
Understanding Non-Adherence to Diabetes Complications Screening (UNADS)
PRoblEm SOlviNg treAtment for diabeTEs to lower blood glucose levels (RESONATE)
Intervention to improve adherence to IVT treatment in patients with AMD
Understand the economic costs and determining the national productivity losses from vision impairment and its major causes
Estimate the eConomic And sLeep iMpact of AMD (CALM)
Understand barriers and facilitators to Adherence to IVT Injections in patients with AMD (A-IVTI)

Collaborations

Aging Centre, Duke University, USA
Centre for Ageing Research and Education, Duke-NUS (CARE)
Centre for Eye Research Australia, University of Melbourne, Australia
Centre for Healthy Aging, National University Hospital Singapore
Centre of Quantitative Medicine, Duke-NUS School of Medicine
Clinical Nutrition Research Centre (CNRC), Singapore
Department of Nuclear Medicine & PET, Singapore General Hospital
Department of Otolaryngology, Head & Neck Surgery Singapore
Ethereum Zurich, Switzerland
Gloucestershire Eye Unit, UK
Health Services System Research, Duke-NUS School of Medicine
International Consortium of Health Outcomes Measurement (ICHOM)
MAPI Research Trust
Mass. Eye & Ear Hospital, USA
Modus Outcomes
National Dental Health Centre, Singapore
National Neuroscience Institute, Singapore
Novartis, Spain
Queensland University of Technology, Australia
Saw Swee Hock School of Public Health, National University Singapore
Sensory Nutritional Science
Singapore Institute of Clinical Sciences
Singapore National Eye Centre (SNEC)
SingHealth and National Healthcare Group Polyclinics
The Singapore Advanced Imaging Laboratory for Ocular Research (SAILOR)
The University of Cambridge, Psychometrics Centre
Toho University School of Medicine, Japan
University of California, Berkeley
University of Sydney, Australia
Wilmer Eye Institute, Johns Hopkins
Yong Loo Lin School of Medicine, National University of Singapore

Publications (Selected)

Lamoureux EL, Tai ES, Thumboo J, Kawasaki R, Saw SM, Mitchell P, and Wong TY. Impact of diabetic retinopathy on vision-specific function. Ophthalmology. 2010 Apr;117(4): 757-65.
Rees G, Leong O, Crowston J, and Lamoureux EL. Intentional and unintentional nonadherence to ocular hypotensive treatment in patients with glaucoma. Ophthalmology. 2010. May;117(5):903-8.
Chiang PC, Zheng Y, Wong TY, Lamoureux EL. Vision impairment and major causes of vision loss impacts on vision-specific functioning independent of socioeconomic factors. Ophthalmology. 2013. 120(2): 415-22.
Man REK, Sabanayagam C, Chiang PP, Li LJ, Noonan JE, Wang JJ, Wong TY, Cheung GCM, Tan GS, Lamoureux EL. 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.
Fenwick EK, Man RE, Lamoureux EL. Velocity of visual field progression implicated in falls. JAMA Ophthalmol. 2016. Aug 1;134(8):886-7.
Fenwick EK, Ong PG, Man REK, Cheng CY, Sabanayagam C, Wong TY, Lamoureux EL. 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 EL. 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 REK, Ong PG, Sabanayagam C, Gupta P, Cheng CY, Wong TY, Lamoureux, EL. 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 EK, Ong PG, Tey ML, Tapp R, Cheng CY, Cheung GCM, Aung T, Wong TY, Lamoureux EL. 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 EL. Cost-effectiveness of a national telemedicine diabetic retinopathy screening program in Singapore. Ophthalmology. 2016. Dec;123(12):2571-2580.
Fenwick EK, Man REK, Cheung CMG, Sabanayagam C, Cheng CY, Neelam K, Chua J, Gan ATL, Mitchell P, Wong TY, Lamoureux EL. 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 EL., 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 EL; 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 EL. Is corneal arcus independently associated with incident cardiovascular disease in Asians? Am J Ophthalmol. 2017. Nov;183:99-106.
Gupta P, Aravindhan A, Gand ATL, Man REK, Fenwick EK, Mitchell P, Tan N, Sabanayagam C, Wong TY, Cheng CY, Lamoureux EL. 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.
Tan GS, Gan A, Sabanayagam C, Tham YC, Neelam K, Mitchell P, Wang JJ, Lamoureux EL., Cheng CY, Wong TY. 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.
Fenwick EK, Gan ATL, Man REK, Gupta P, Sabanayagam C, Cheng CY, Chen CLH, Cheung CY, Wong KH, Venketasubramanian N, Xu X, Hilal S, Chong EJY, Tham YC, Wong TY, Lamoureux EL. Vision, vision-specific functioning and mobility, and their relationship with clinically-assessed cognitive impairment. Age and Ageing. [Accepted 17 Nov 2020].
Fenwick EK, Loe BS, Khadka J, Man REK, Rees G, Lamoureux EL. Optimizing measurement of vision-related quality of life: a Computerized Adaptive Test for the Impact of Vision Impairment questionnaire (IVI-CAT). Qual Life Res. 2019. 29(3): 765-774.
Fenwick EK, Bansback N, Ratcliffe J, Burgiss L, Wong TY, Lamoureux EL. Validation of a novel diabetic retinopathy utility index using discrete choice experiments. Br J Ophthalmol. 2020. 104(2):188-193.
Ang GS*, Fenwick EK*, Constantinou M, Gan A, Man REK, Casson R, Finkelstein E, Goldberg I, Healey P, Pesudovs K, Xie J, Macintosh R, Crowston J^, Lamoureux EL^. Selective laser trabeculoplasty versus topical medication as initial treatment for glaucoma: results of the glaucoma initial treatment study multi-centre randomised controlled trial. Br J Ophthalmol. 2020. 104(6):813-821.
Fenwick EK, Man REK, Kumari N, Wong C, Gan ATL, Aravindhan A, Gupta P, Wang JJ, Mitchell P, Wong TY, Cheng CY, Lamoureux EL. Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population. Br J Ophthalmol. 2019. 103(9): 1314-19.
Fenwick EK, Khadka J, Pesudovs K, Rees G, Wong TY, Lamoureux EL. Diabetic retinopathy and diabetic macular edema quality-of-life item banks: development and initial evaluation using computerized adaptive testing. Invest Ophthalmol Vis Sci. 2017. 58(14): 6379-6387.
Fenwick EK, Man REK, Ramulu P, Aung T, Lamoureux EL. Beyond intraocular pressure: optimizing patient-reported outcomes in glaucoma. Prog Retin Eye Res. 2019. 76:100801.
Baird PN, Saw SM, Lanca C, Guggenheim JA, Smith Iii EL, Zhou X, Matsui KO, Wu PC, Sankaridurg P, Chia A, Rosman M, Lamoureux EL, Man REK, He M. Myopia. Nat Rev Dis Primers. 2020 Dec 17;6(1):99.
Gupta P, Man REK, Fenwick EK. Rationale, methodology, and preliminary data of a multi-ethnic population-based study in elderly Asians: the PopulatION hEalth and Eye disease pRofile in elderly Singaporeans study [PIONEER]. Ageing and Dis1ease. 2020 Dec; 11(6): 1444–1458.
Gupta P, Lamoureux EL, Sabanayagam C, Tham YC, Tan G, Cheng CY, Wong TY, Cheung N. Six-year incidence and systemic associations of retinopathy in a multi-ethnic Asian population without diabetes. Br J Ophthalmol. 2021 Jan.
Gupta P, Gan ATL, Man REK, Fenwick EK, Sabanayagam C, Mitchell P, Cheung CY, Cheung N, Wong TY, Cheng CY, Lamoureux EL. Association between diabetic retinopathy and incident cognitive impairment. Br J Ophthalmol. 2019;103(11):1605-9.
Gupta P, Liang Gan AT, Man REK, Fenwick EK, Kumari N, Tan G, Mitchell P, Sabanayagam C, Wong TY, Cheng CY, Lamoureux EL. Impact of incidence and progression of diabetic retinopathy on vision-specific functioning. Ophthalmology. 2018;125(9):1401-1409.