Speech by Dr Lam Pin Min, Senior Minister of State, Ministry of Health and Ministry of Transport, at the Joint World Health Organization-International Agency for Prevention of Blindness Western Pacific Regional Meeting on Myopia, 13 November 2018

Ms Amanda Davis
Chairperson, International Agency for Prevention of Blindness, Western Pacific and Chief Executive Officer, Brien Holden Vision Institute Foundation 

Dr Andreas Mueller
Advisor, World Health Organization Regional Committee for Western Pacific 

Professor Wong Tien Yin
Medical Director, Singapore National Eye Centre  

Professor Aung Tin
Executive Director, Singapore Eye Research Institute  

Distinguished guests 

Colleagues 

Ladies and Gentlemen

1          A very good afternoon. It is my pleasure to be here at the Joint World Health Organization – International Agency for the Prevention of Blindness Western Pacific Region Meeting on Myopia. It is good to see that the event has brought together government officials, clinician leaders, public health professionals and researchers to exchange ideas and experiences towards improving the way ophthalmology is practiced both here and around the world. To all our overseas guests, a very warm welcome to Singapore!  

Escalating Myopia Prevalence

2          As a paediatric ophthalmologist, myopia is a topic that is close to my heart.  Globally, if current incidence remains, the World Health Organization (WHO) has projected that myopia would affect a staggering 2.56 billion people by 2020¹. Uncorrected myopia is also the leading cause of vision impairment, and high myopia increases the risk of complications such as retinal damage, cataract and glaucoma. 

3          The prevalence of myopia in Singapore is among the highest in the world, with about 60 per cent of our children being myopic by 12 years of age, and 80 per cent by 18 years of age².  Early-onset myopia leads to high myopia and potentially blinding pathologic myopia in adulthood. Children who develop myopia early in life have a higher risk of high myopia as an adult.  Therefore, it is crucial that we take active steps in raising awareness, improving service delivery and continued research to reduce the disease burden caused by myopia.   

Education, Prevention and Early Detection  

4          The first line of defence against myopia is public awareness and education. This includes inculcating good eye habits from young and spending more time outdoors. Last year, the NurtureSG Taskforce, which I co-chaired with Senior Minister of State for Education Dr Janil Puthucheary, released a holistic suite of recommendations to enhance health outcomes among our children and youth. One of the key recommendations, which the Early Childhood Development Agency (ECDA) has taken up, was to enable all children in a full day preschool programme to spend at least half an hour daily outdoors or 45 minutes thrice weekly outdoors. Recognising that parents play a critical role in their child’s eye care, NurtureSG has also published a mini-booklet on “5 Habit Hacks for a Healthier Child” to educate parents on the importance of eye care and the need to devote more time to outdoor activities to prevent early onset of myopia. 

5          The Health Promotion Board (HPB) has also put in place the National Myopia Prevention Programme since 2001. Under the programme, annual visual screening is conducted for students in preschools, primary and secondary schools to allow prompt detection and correction of poor vision. Students in preschools and Primary 1 who are found to have poor vision are referred for further management at the HPB’s Refraction Clinic. 

6          Besides developing outdoor lesson plans for preschool teachers, HPB has also engaged private partners to explore innovative ways to promote good eye habits. An example is Plano – a parental management application and myopia screening tool, developed by a Singapore firm that was a spin-off from the SERI-SNEC Ophthalmic Technologies Incubator Programme. Interestingly, the Plano app features live interventions to correct unhealthy device usage such as prolonged screen time use. The app is also able to actively monitor how close the screen is to the user’s eyes, and prompts the individual to adjust his or her posture accordingly.  

Ensuring Prompt Access to Holistic Myopia Treatment 

7          Singapore National Eye Centre (SNEC) will be setting up a myopia centre in early 2019, where optometrists will play a larger role in caring for patients with the condition. This one-stop centre seeks to provide not only holistic clinical management of myopia cases, but also greater public awareness, as well as provide training and research opportunities in the area of myopia care. Trained optometrists would be able to offer a full suite of services from taking a case history, to conducting clinical eye examinations and providing refraction correction. They would also provide patient education on good eye health practices and recommend atropine treatment based on existing myopia care protocols, with the oversight and guidance of an onsite ophthalmologist.  

Support for Clinical Research and International Collaborations 

8          Given that vision disorders are the fourth leading cause of disease burden in Singapore, and the prevalence of eye-related disorders such as cataract, glaucoma and diabetic retinopathy is expected to rise with an ageing population, the Ministry of Health has identified eye diseases, as part of Neurological and Sense Disorders, as a key area of focus under the health and biomedical sciences domain in the Research, Innovation and Enterprise 2020 plan.  

9          Specifically, on myopia research, MOH supported the “Atropine Treatment of Myopia” (ATOM) trials. I am pleased to share that the first two trials, namely ATOM1 and ATOM2, have shown that atropine can reduce or slow down myopia in children above the age of six years. Given the promising results from these two trials, the project is now in its third phase and is currently conducted at both SERI and SNEC, with funding support from MOH’s National Medical Research Council. ATOM3 aims to investigate the potential of low-dose atropine to prevent and delay the onset of myopia in young children who are at higher risk of developing the condition, and reduce myopia progression in those with low myopia at a younger age. 

10        MOH has also established the National Health Innovation Centre (NHIC) to provide commercialisation assistance to the clinical research community and facilitate the translation of healthcare innovations from the publicly funded clinical research sector. The Plano app which I had mentioned earlier is one such example that received funding support from NHIC. 

Closing 

11         In closing, I hope that the discussions at this meeting will inspire all of us to collectively work towards reducing the prevalence and disease burden of myopia in Singapore and around the world. Indeed, alongside education, prevention and early detection, as well as prompt access to holistic care, clinical research will remain an important component in our search for healthcare solutions to reduce myopia onset and improve care options for our patients. Together, we can work to advance capabilities in prevention, treatment, and translational research. I look forward to more exciting developments in the future to help us achieve good health outcomes for everyone.  

12         I wish you all a fruitful and successful meeting ahead. Thank you.