Home > Research > Research Themes > The Eye Surgery and Innovative Technologies (EyeSITe) Programme

The Eye Surgery and Innovative Technologies (EyeSITe) Programme


Overview:

 

      The Eye Surgery and Innovative Technologies (EyeSITe) programme is led by Principal Investigator Professor Donald Tan Tiang Hwee, Medical Director of the Singapore National Eye Centre and the Singapore Eye Bank. He is also the Chairman of the Singapore Eye Research Institute where the programme is hosted. EyeSITe aims to provide new clinical therapies to aid in alleviating ocular morbidity from major eye diseases, including corneal disease, infection, glaucoma, refractive errors and retinal disorders.

       

      EyeSITe builds on the strengths of our current TCR flagship programme - TRIOS (Translational Research Innovations in Ocular Surgery), and comprises our 5 most successful programmes in terms of scientific results, clinical outcomes and commercialization potential. EyeSITE will develop novel and innovative approaches to diagnose and treat corneal diseases and glaucoma, 2 of the major causes of blindness worldwide.

       

      Corneal disease is the second commonest cause of treatable blindness (12 million cases globally) and glaucoma is a leading cause of irreversible blindness world-wide. An estimated 70 million people are affected, of whom over 6 million suffer from bilateral blindness. In Singapore, glaucoma is the leading cause of irreversible blindness. Primary angle closure glaucoma, which is more prevalent in Asia compared to primary open angle glaucoma, accounts for most of the blindness caused by glaucoma. Corneal diseases related to eye infections, inflammation, ocular trauma and genetic disorders are the major causes of blindness requiring corneal transplantation. Despite being a successful procedure, current surgical outcomes are limited due to long-term graft failure and rejection, resulting in increased morbidity.

       

      These programs, if successful, will result in better health outcomes for the above-mentioned ocular conditions, improve medical practice, and may also provide significant economic outcomes to Singapore.

 

Individual Projects:

 

      Theme 1: Antimicrobial Molecules Against Ocular Pathogens


          Infectious keratitis (corneal infections) relating to trauma or contact lens wear are a major cause of corneal blindness in Asia, with an estimated 4-6 million blind, and also a major cause of childhood blindness1-4. Indiscriminate use of broad spectrum antibiotics have resulted in resistance emerging throughout Asia, while only one topical antifungal eyedrop preparation (Natamycin) is commercially available to treat fungal keratitis. Methicillin-resistant Staphylococcus aureus (MRSA) and resistant forms of Pseudomonas have become significant issues. World-wide antibiotic resistance of gram negative bacteria and MRSAs are two of the most critical healthcare issues.  The development of new classes of antimicrobial small peptide and peptoid molecules will have a significant impact in treating corneal infections, and also for systemic infections.  Our novel antimicrobials are targeted at 3 major ocular pathogens which also have clinical significance in systemic infections:  Pseudomonas spp., especially antibiotic resistant strains, Gram positive organisms, including MRSA, and fungal/yeast infections, all of which are of major public health interest.

       

      Team Members:

       

      Name Role in Research Theme
      (e.g. PI, Co-I, Collaborator)
      Roger W. Beuerman Co-PI
      Shouping Liu Co-I
      R. Lakshminarayanan Co-I
      Knostatin Pervushin Co-I
      Chandra Verma Co-I
      Swaine Chen Co-I
      Zhou Lei Co-I
      Donald Tan Co-I
      Jodhbir Mehta Co-I
      Lakshminarayanan Rajamani

      Senior Res Scientist

      Liu Shouping

      Senior Res Scientist

      Li Jianguo

      Postdoctoral Fellow

      Bai Yang

      Research Officer

      Eunice Goh

      Research officer

      Zou Hanxun

      Research officer

       

      Theme 2: Novel Ocular Drug Delivery Systems

       

          The development of sustained drug delivery carriers to provide effective prolonged drug release without relying on patient compliance would improve therapeutic outcomes and overall healthcare and disease management in these patients who are generally elderly. This technology can clearly be applied across other ophthalmic conditions which require chronic medical treatment - our current sustained delivery platforms may be used for a wide variety of drugs and involves drug delivery to the front of the eye for a wide range of anterior segment disorders which covers corneal, glaucoma and uveitic conditions, as well as research into improved sustained delivery of drugs and proteins to the retina.

       

      Team Members:

      Name Role in Research Theme
      Tina Wong PI
      Subbu Venkatraman Co-Investigator
      Amutha Barathi Collaborator
      Jod Mehta Collaborator
      Gemmy Cheung Collaborator
      Donald Tan Collaborator
      Tien Yin Wong Collaborator
      Freddy Boey Collaborator
      Vacant

      Technologist

      Xu Wen

      Research Assistant

      Anastasia Darwintan

      Research Officer

      Vacant

      Research Associate

      Vacant

      Research Nurse

      Jayagenesh Natarajan

      Postdoctoral Fellow

      Vacant

      Senior Scientist

 

      Theme 3: The Bionic Cornea


          Corneal opacification is the second major cause of reversible impaired vision globally, estimated at 12 million patients, with over 50% of the global burden mainly sited in Asia18.  Approximately 40% of global corneal blindness may be treatable by a corneal transplantation, but it is estimated that only 150,000 transplants are performed globally due to a major shortage of corneas worldwide.  Corneal transplant survival rates also vary greatly and survival rates are estimated at 75% and 64% at 5 and 10 years respectively, mostly related to graft endothelial rejection or attrition.   Attention therefore is turning to corneal endothelial biology in an attempt to culture human endothelial cells and also to develop new surgical methods of endothelial keratoplasty, in which the corneal endothelium is selectively transplanted.

           

          The major brunt of corneal disease lies in chronic inflammatory and ocular surface diseases for which corneal transplantation is contraindicated due to a high failure rate, and for these cases, 2 artificial corneas (or keratoprostheses) currently in common use, are preferred.  However, keratoprosthesis technology is still lacking - both these devices utilize older polymers and outdated designs.  The development of a synthetic OOKP-type device not requiring a tooth will significantly improve the time to visual rehabilitation for patients requiring this surgery and simplify the surgical procedure tremendously.

       

      Team Members:

      Name Role in Research Theme
      Jodhbir Mehta PI
      Donald Tan Co-PI
      Xiao Wei Tan Co-I
      Gary Peh Co-I
      Roger Beuerman Co-I
      Evelyn Yim Collaborator
      Julie Daniels Collaborator
      Michael Khor Collaborator
      Ang Heng Pei

      Research Associate

      Seah Xin Yi

      Research Associate

      Gary Yam Hin Fai

      Senior Postdoctoral Fellow

      Vacant

      Postdoctoral Fellow

      Benjamin Lawrence George

      Research Associate

      Khadijah Binte Adnan

      Research Associate

      Vacant

      Clinical Trial Coordinator

      Melina Setiawan

      Research Associate

      Goh Tze Wei Gwendoline

      Animal Technician

       

      Theme 4: Femtosecond Laser-Assisted Ocular Surgery Systems

       

          Femtosecond ophthalmic surgical lasers are commonly used for corneal refractive surgery. Femtosecond laser technologies are now being explored to perform corneal transplants, and most recently, cataract surgery, bringing higher levels of surgical precision23. Our previous work in TRIOS focused on developing femtosecond laser-assisted corneal stromal refractive lenticules, as a by-product of a new corneal refractive procedure: Refractive Lenticular Extraction (ReLEx), a refractive procedure whereby the femtosecond laser incises a refractive lenticule to treat myopia and astigmatism, and the lenticule is removed through a pocket incision (SMILE procedure: SMall Incision Lenticular Extraction). We will investigate the concept of lenticular storage by cryopreservation, and its potential usage in 3 clinical areas: 1) personalized storage for ReLEx patients (making the procedure theoretically reversible in the event of complications, 2) storage for use in LASIK patients who have developed keratectasia, or for patients who have keratoconus, who may benefit from implantation of an allograft corneal lenticule, and 3) usage of the lenticules as biological small optic implants for the treatment of presbyopia. If it is successful, lenticular storage provides new treatment strategies for both refractive surgery patients, keratoconics and for all people over the age of forty (presbyopic age).

       

      Team Members:

      Name Role in Research Theme
      Jodhbir Mehta PI
      Donald Tan Co-PI
      Soon Phaik Chee Co-PI
      Murukeshan Vadakke Matham Collaborator
      Mario Nubile Collaborator
      Nur Zahirah Binte M Yusoff Research Associate
      Andri Kartasasmita Riau Research Associate
      Vacant Research Associate
      Liu Yu-Chi Clinical Research Fellow
      Vacant Postdoctoral Fellow

       

      Theme 5: Stratified Medicine for Primary Angle-Closure Glaucoma

       

          Primary angle closure glaucoma (PACG) is a major cause of visual morbidity and blindness in Asia, and the exact cause of this condition is still unknown. We are developing new ocular imaging techniques with the anterior segment OCT to aid in a pre-emptive diagnosis for this condition, and we have identified several novel anatomical risk factors for development of PACG, which include greater lens vault, greater iris convexity, area and thickness, and, smaller anterior chamber width, area and volume. At the same time, identification of individuals genetically at risk of PACG by a comprehensive genetic analysis scheme to detect the vast majority of the allelic spectrum of PACG disease alleles, will aid in further stratification of the population at risk. These studies will endeavor to develop new diagnostic and prognostic approaches to PACG, with a potential novel risk prediction algorithm combining ocular imaging and genetic markers to detect high risk patients (stratified medicine), which if successful, will be applicable not only in the clinic, but also at a population-wide level.

       

      Team Members:

      Name Role in Research Theme
      Tin Aung PI
      Eranga Vithana Co-PI
      Chiea Chuen Khor Co-PI
      Tien Yin Wong Co-PI
      David Matchar Co-PI
      Shamira Perera Co-PI
      Monisha Nongpiur Co-PI
      Wong Hong Tym Co-PI
      Liu Yu-Chi Co-PI
      Paul Chew Co-PI
      Ben Haaland Collaborator
      Wang Ning-Li Collaborator
      Pang Chi-PuiI Collaborator
      Jimmy S Lai Collaborator
      Park Ki-Ho Collaborator
      Paul J Foster Collaborator
      Hiroshi SakaiI Collaborator
      Ronnie George Collaborator
      Do Tan Collaborator
      Widya Artini Collaborator
      Khaled Abu-Amero Collaborator
      Visanee Tantisevi Collaborator
      Vacant Research Assistant
      Vacant Research Officer
      Vacant Clinical co-ordinator
      Li Zheng Postdoctoral Fellow
      Vacant Clinical Research Fellow