The five-year multi-institution and multi-disciplinary programme has five themes including new technologies to screen undiagnosed glaucoma.

A new glaucoma research programme by the Singapore Eye Research Institute (SERI) aims to significantly bring down the rate of blindness caused by glaucoma in Singapore in the next 10 years. The five-year multi-institution and multi-disciplinary programme, titled TAckling & Reducing Glaucoma Blindness with Emerging Technologies (TARGET), is being funded by a S$25 million grant by the National Research Foundation (NRF) and the Ministry of Health’s National Medical Research Council (NMRC).

Along with colleagues from the Singapore National Eye Centre (SNEC), National University Health System (NUHS), Duke-NUS Medical School, the Agency for Science, Technology and Research (A*STAR), Nanyang Technological University (NTU), and Changi General Hospital (CGH), the researchers have developed five themes under TARGET:

THEME 1: Understanding the pathobiology of glaucoma using a precision medicine approach – Despite current best treatment, over half of glaucoma patients continue to suffer progressive visual damage. The pathobiology of glaucoma is still poorly understood, and presently, there is no way to distinguish which patients are at highest risk of blindness and which will end up with stable disease. The researchers hope to use human genetic studies to better understand the pathobiology of glaucoma to address this, and also enable the development of new treatments.

THEME 2: New technologies to screen undiagnosed glaucoma and monitor the disease in the community – Glaucoma has little to no symptoms in the early stage and many in the local community are undiagnosed (over 70 percent). Once they start noticing symptoms and seek medical help, the disease would have progressed into the late stage, where vision loss has already occurred and is irreversible, and burden of care increases exponentially for patients. The researchers hope to develop better community-based screening strategies to diagnose early-stage glaucoma.

THEME 3: New technologies to better identify rapid progressors – Current clinical practice adopts a one-size-fits-all approach and has limitations in predicting future disease progression and thus, there is an inability to identify patients who are most at risk of blindness. The researchers aim to develop and deploy new imaging-based technologies to improve detection of disease progression.

THEME 4: Novel technologies to circumvent the problem of poor adherence – Despite advances in laser and surgical therapies, eye drop medications are the mainstay of treatment for glaucoma patients. However, patient adherence to medications is found to be extremely poor. Patients with low adherence rates tend to develop worse visual field loss. The researchers aim to develop new surgical and medical technologies to replace the need for daily eye drops.

THEME 5: Targeting age-associated metabolic insufficiency in glaucoma with nicotinamide (“TAMING Glaucoma Trial”) – Glaucoma treatment focuses mainly on reducing intra-ocular pressure. Yet, a significant proportion of patients still go blind despite being under active care. There is growing evidence to suggest that a new therapy approach – oral administration of nicotinamide – can slow down the progression of glaucoma. The researchers aim to further explore this approach to determine if the short-term improvements from the nicotinamide therapy will translate into long-term delay in vision loss.

Glaucoma, a progressive neurodegenerative disease of the optic nerve, is the leading cause of irreversible blindness in the world. It was estimated to affect about 64.3 million people in 2013, and this number is projected to increase to a staggering 111.8 million by 2040, with the majority of afflicted patients residing in Asia. It is an incurable disease, but with treatment, many patients are able to maintain their vision. Unfortunately, approximately 20 percent of patients with glaucoma go blind. Population-based studies in Singapore have found that glaucoma is a major cause of visual impairment and blindness.

With a focus on reducing the rate of glaucoma-linked blindness, the researchers hope that efforts from the TARGET programme will bring about better quality of life for seniors even as they age. A 2000 study among selected residents in the Tanjong Pagar district in Singapore found that the prevalence of glaucoma was three to four percent and glaucoma contributed to 60 percent of bilateral blindness. In another Singapore Epidemiology of Eye Diseases study, glaucoma was among the top three causes of bilateral blindness. Advancing age is one of the key risk factors for glaucoma, and as Singapore navigates a rapidly ageing population, there will be an increasing healthcare burden of neurodegenerative diseases such as glaucoma in the coming years.

(** PHOTO CREDIT: Singapore National Eye Centre)

Professor Aung Tin, CEO, Singapore National Eye Centre, and lead principal investigator for TARGET, giving an overview of the programme.