Singapore Integrated Diabetic Retinopathy Programme (SiDRP)

SORC MISSION STATEMENT To be tthe premier innovator in providing industry partners and research collaborators with cutting-edge computer-aided imaging, reading and analysis of ocular images and other related service through a state-of-the-art IT infrastructure. cture.

The eye offers an exceptional opportunity for advanced imaging technology to document, monitor and study human diseases. Major retinal diseases, glaucoma and age-related macular degeneration are common causes of blindness, and may also indicate major diseases elsewhere in the body. Ocular imaging has progressed significantly in the last three decades, with various techniques developed to measure in a non-invasive manner, not only structural changes seen in the eye but also functional changes. At the same time, computer science has progressed to allow measurement of retinal vascular changes from photographs, altering the way in which we can understand and study human vascular diseases. The SNEC Ocular Reading Centre (SORC) provides a comprehensive range of services in ocular imaging and grading for healthcare institutions, clinicians and industrial players. It aims to become the leading ocular imaging and grading centre in the Asia Pacific. Its activities focus on reading for pharmaceutical clinical trials, public health programmes, outsourced reading for other international reading centres and training. Known for its high quality standards, SORC is already a service provider for a number of clinical trials as well as national level public health ocular imaging programme in Singapore.

Professor Wong Tien Yin Professor & Medical Director, Singapore National Eye Centre Director, SNEC Ocular Reading Centre Senior Principal Clinician Scientist, Singapore Eye Research Institute

SNEC Ocular Reading Centre The SNEC Ocular Reading Centre (SORC) provides evaluation and interpretation (grading) services of ocular pathology from fundus photographs, fluorescein angiograms, optical coherence tomography scans or other imaging modalities. SORC serves as a Tele-Ophthalmic Ocular Reading Centre, a hub that ensures effective and prompt service delivery by streamlining and automating the entire process, from image capture on site to the electronic transfer of the image via a dedicated conduit to the reading centre.

What We Do 1. Provide clinical trial standard reading services for industry partners and collaborators on different eye diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma and cataract with strict quality assurance. 2. Provide accurate measurement of vascular structure from retinal images using computer-aided programmes such as SIVA (Singapore “I” Vessel Assessment). 3. Provide certification of equipment and photographers according to industry standards and maintain high quality imaging throughout the duration of trials. 4. Perform centralized grading for the national diabetic screening programme in Singapore – Singapore Integrated Diabetic Retinopathy Programme (SiDRP) 5. Conduct training workshops, mentoring sessions and accreditation for a spectrum of ocular imaging techniques. Our vast ocular imaging database and tele-ophthalmology platform are supported by a robust and well-equipped IT infrastructure.

The Diabetic Retinopathy Screening Programme at SORC Background Diabetic Retinopathy (DR) is a microvascular complication that affects more than 3 million people in the world. Vision loss from DR is preventable with early diagnosis and proper treatment.

Global Projections for Diabetes 53.2 64.1 21%

28.3 40.5 43%

24.5 44.5 81%

46.5 80.3 73%

10.4 18.7 80%

16.2 32.7 102%

1 in 3 diabetic patients has DR; 1 in 10 has vision-threatening DR

67.0 99.4 48%

WORLD

(Cheung, Mitchell, Wong, Lancet 2010)

2007 = 246 million 2025 = 380 million Increase 55%

Source: Sicree, Shaw, Zimmet. Diabetes Atlas. International Diabetes Federation (IDF), www.idf.org. 2006

Traditional DR Screening DR screening is the main method used to identify patients suffering from DR at an early stage. However, current DR screening models in many countries suffer from substantial limitations, including: 1. Delay in diagnosis and referral of patients with DR 2. Inconsistencies in the grading outcomes with no standardised protocol

A normal retina

3. Evidence of high over-referral rate to tertiary eye care (i.e, substantial levels of false positive cases and ensuing high treatment costs at tertiary centres) 4. Cost-ineffective as primary care doctors are made to assess DR when this can be performed by trained technicians 5. Large

proportion

of

patients

with

diabetes

who

visit

private

endocrinologists may be excluded

GPs

and

A retina showing signs of Diabetic Retinopathy

National DR Screening Programme in Singapore Singapore Integrated Diabetic Retinopathy Programme (SiDRP) aims to improve on the traditional DR screening with the establishment of a comprehensive screening programme based on ‘real time’ assessment of DR from photographs by a centralised team of trained and accredited technicians, supported by a national tele-ophthalmology IT infrastructure. Patients’ retinal photographs are graded within an hour, allowing immediate feedback on DR status to be given during the same primary care visit together with, if necessary, a referral to an ophthalmologist.

Singapore Integrated Diabetic Retinopathy Programme (SiDRP) Overview • ‘Real time’ assessment of diabetic retinopathy and other eye conditions, by trained and accredited technicians, from digital photographs submitted to SORC. • Patients and physicians receive recommendation and feedback within one hour during the same clinic visit. Where necessary, patients are referred for further assessment by an ophthalmologist.

2010

July 2010 Outram Polyclinic

August 2010 Bukit Merah Polyclinic

2011

January 2011 Pasir Ris Polyclinic

2012

January 2012 Diabetic Society of Singapore

2013

November 2012 SATA Commhealth

September 2012 Novartis GP-Optical Shop Partnership

June 2013 SGH Diabetes Centre

January 2013 Jurong East CHC (SATA)

March – June 2013 Paris Miki Eye Screening Roadshow

April 2013 Frontier Family Medicine Clinic (FMC)

2014

2015

March 2014 CGH Diabetes Centre

June 2014 Tampines and Bedok South Community Health Centres (CHCs)

July 2014 NUH Endocrinology Clinic, Geylang Polyclinic, KKH Children Clinic

November 2014 NHG CHC Mobile Van February 2015 Tiong Bahru CHC

May 2015 Marine Parade Polyclinic

2016 & Beyond

September 2014 Bedok North and Chinatown FMCs

Bedok, Queenstown, Sengkang and Tampines Polyclinics as well as other local and regional screening centres

SiDRP Workflow

IMAGE CAPTURE SITES • Polyclinics • Hospitals • Medical Centres • Optometrist • General Practitioners • Mobile Clinics

4

TRANSMIT TO READING CENTRE

1

Images are transmitted to the imaging laboratory via a secured web-based platform.

TELE-CARE REPORT TO CLINICIANS Referrals are made by the doctors during the same visit.

2

IMAGE GRADING Images are graded by a centralised team of trained and accredited technicians. Reports are generated and transmitted within 1 hour.

3

Value Proposition for Healthcare Systems Since its operation in July 2010, SiDRP has seen over 51,000 patients and delivered outstanding value to clinical centres, healthcare practitioners and the overall healthcare system: 1. SORC’s DR screening activity has reduced the rate of

2. Traditional DR screening model is limited by a

referral to tertiary centres to 23%, with only 14% for DR

delay in diagnosis and referral of patients with DR

with sensitivity and specificity accuracy of 90%. There are

as doctors require a longer turnaround time (up to

no reported figures on the referral rate prior to the model

one month) due to their busy schedules. Patients

being implemented; however, only 38% are truly positive

are also required to visit the primary care centre

for DR.

twice for referral to tertiary eye care.

SORC has introduced a new pathway of 6 months

However, 99% of the reports within SORC’s DR

re-screen where an estimated 8% of the patients screened

screening framework are generated and sent

with mild symptoms of DR are re-photographed at the

within one hour. 95% of respondents in our patient

primary care level, instead of being referred to the tertiary

satisfaction survey preferred to receive their report

eye centre.

within one hour or less.

The screening framework can thus significantly reduce

The improved grading turnaround time saves

excessive referrals to tertiary eye centres based on false

patients one additional visit to the primary care

positive results or due to uncertainty on the part of the

centre, and thus translates to savings in time

physician. This translates to savings in cost, time and

and

resources; and a corresponding increase in productivity.

healthcare system.

The reduction in false positive results improves waiting time at the tertiary eye centres, with only patients who require medical intervention being seen in these centres.

cost

for

both

the

patients

and

the

Key Benefits: 1. Faster. SORC’s DR screening programme, featuring a one-hour turnaround time is significantly faster than traditional DR screening systems. This saving in time will benefit patients (obviating the need for a second visit to the primary care setting) and allows faster referral to tertiary eye care, if needed. This translates to time and cost savings to patients and to the healthcare system. 2. Better. SORC’s DR screening programme considerably enhances the current system via the use of dedicated trained and accredited technicians. They have shown to produce grading quality which is at least equivalent to that of ophthalmologists. 3. Cheaper. Reduction in tertiary eye care referrals result in tangible savings to health systems due to reduced levels of reimbursement with lower number of referrals – savings in cost, time and resources. SORC’s DR screening programme is a comprehensive, quality-assured and cost-efficient solution to the DR problem in countries throughout Asia and globally. This system has demonstrated effectiveness in early detection of DR and resulting in better clinical management of this eye disease.

CONTACT DETAILS Director Prof Wong Tien Yin For further information or query, please contact: Ms Soundaram Jaganathan Singapore National Eye Centre 11 Third Hospital Avenue Singapore 168 751 [email protected]