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Visionary drive

Singapore National Eye Centre medical director Wong Tien Yin has bold ideas for the centre: to embrace the start-up way of thinking and become a top healthcare name in the world.

'You can't just have all the people trained as doctors to have innovative models; you need people with different experiences . . . Medicine should not be a constant structure or a dead structure, you should be learning as it is growing.'

IF the eyes are the windows to our souls, then Wong Tien Yin's sparkle with purpose and passion when he talks about his vision for the Singapore National Eye Centre (SNEC), which celebrated its 25th anniversary in July.

Behind that determination masks the zig-zagging of thought processes that run like the busy London Tube.

The forward-thinking 47-year-old ophthalmologist - a retinal specialist who assumed the role of SNEC medical director in August 2014 - has set his sights high : He believes that SNEC - one of the largest tertiary eye hospitals in Asia - is at a crossroads and "is within striking distance" of some of the top healthcare names in the world.

Sounds ambitious but it's a target that's well within reach, in Professor Wong's view. It is no longer enough, he points out bluntly, to provide just quality and affordable eye care to the people here, which was the initial mission when the centre began operations in 1990 under the late SNEC founder Arthur Lim, dubbed Singapore's "father of ophthalmology".

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Since then, "anyone who wants to come to SNEC to see a doctor is attended to in a reasonable amount of time for his or her condition, whether it's acute, or a simple consult, or screening", says Prof Wong.

Today, the centre clocks more than 300,000 outpatient visits and performs more than 23,000 major eye surgeries and 8,500 laser procedures every year.

This talk of chasing the blue sky may sound lofty to some, but the accomplished eye doctor with more than 15 years' professional experience under his belt certainly knows what he is talking about.

The lists of his medical credentials, academic appointments, clinical appointments, professional memberships, awards and honours, run into 10s of pages. He is one of the world's most prolific researchers - think over 900 peer-reviewed papers in the New England Journal of Medicine, The Lancet, and Journal of the American Medical Association, to name just a few - and has bagged numerous prestigious awards, making him a globally-recognised clinician scientist.

Specialising in diabetic retinopathy, age-related macular degeneration and ocular imaging, Prof Wong was named one of "Ten Outstanding Young Persons of the World" for "academic leadership in people younger than 40 years of age" in 1999, and received the Commonwealth Health Minister's award for excellence in health and medical research in 2006 and the 2014 Arnall Patz Medal from The Macula Society in the United States.

At home, Prof Wong is a rock star in his field, twice receiving the Singapore Translational Researcher Award - in 2008 and 2014. He also added the National Outstanding Clinician Scientist Award and the President's Science Award to his accolades in 2010.

Embracing change

Having had opportunities to observe leading global healthcare institutions - the latest through a three-month Eisenhower Fellowship stint in the US in 2013 - the doctor says that three elements - the strong sense of tradition and history, leaders with diverse experiences, and a culture of embracing change - are what make top American medical centres so successful.

One strength of the US medical system - and one that is lacking here, he notes - is rotation within the healthcare system, which he says is "a pity" as such postings add depth and exposure to a doctor's experience.

So one task Prof Wong has set himself within his six-year term at the centre is to achieve diversification of the SNEC management team.

"We need doctors and leaders in the next generation and certainly not just myself, to have a team with diversified experience . . . You can't just have all the people trained as doctors to have innovative models; you need people with different experiences."

To do that, he is, for example, encouraging people to do a doctorate so that they will be able to handle innovation and "understand the research part of SNEC".

"We are slowly thinking of having people do some different things such as design thinking, things related to innovation in processes, and so on."

For this to work, Singaporeans, who are typically very cautious, will have to embrace the start-up way of thinking and accept failure, Prof Wong says.

"I don't think a lot of Singapore's healthcare organisations think things that way but I think SNEC can, and other hospitals should, because that's the only way for us to do this. In fact, that's one of the concepts why we are aiming for academic medicine. We are now convinced that adding that academic aspect to medicine is quite important.

"Medicine should not be a constant structure or a dead structure, you should be learning as it is growing," he says.

Response from the younger staff have been "keen" so far, but the healthcare system is rigid and hard to break away from, admits Prof Wong, who advocates R&D partnerships to inject more creativity in the SNEC, as well as a culture for teaching and training.

Like most things, the early adoption of new ideas will set tongues wagging.

Disruptive models in healthcare are currently not clear-cut and will require seismic shifts in the mindsets of patients, families and healthcare professionals - changes that Prof Wong is acutely aware of, especially now that patients' expectations of care standards have changed.

Even so, he thinks it may be time to introduce disruptive models in SNEC, particularly against the backdrop of an affluent and fast ageing population.

"One model we're thinking of is 'can most of the post-operation care be done not even needing patients to come to SNEC?'. So we operate, see you on the first day, and the subsequent follow-ups can be a phone call or telemedicine consult. You either stay at home or see an optometrist in the community."

In this case, he wonders if the centre should have multiple satellites islandwide, to make it more convenient for patients.

The bigger picture is to compete at the global front and this will require specific and intensive resources, he states firmly.

"If we need to spend money on research laboratories, it must be seen as part of the SNEC mission; or if we feel that we need to train young people to do complex cases such as a rare congenital disease that has no treatment, that are few in numbers which may not benefit the wider public but in Asia, we're the only place that can do it."

A step in this direction is the stem cell programme that the centre is starting, says Prof Wong, adding that he is also looking at other niche, advanced surgeries that the centre may be able to offer.

The upside to differentiating itself from other eye centres in the region will go some lengths to attracting and retaining the best eye doctors in a competitive healthcare landscape.

Attracting talent aside, Prof Wong recognises that organisations also need to groom their own and he has identified at least two generations of "broad and diversified" future leaders at the centre.

Having been groomed by, among others, Dr Lim, whom he describes as "inspirational" and "supportive", Prof Wong laments that such mentorships are not widely available to the young as they should.

Back in the day when he was still undecided on his career path, Dr Lim was the mentor who instilled confidence in Prof Wong about being able to make a difference one day, and that "ophthalmology provides that kind of opportunity".

Following his motto "to take the opportunities when given and not be afraid" has taken Prof Wong far.

"When you take that opportunity and work hard, you'll find that usually it's not going to be disappointing, that it's usually fulfilling."

Given his tight schedule, it is no surprise that the father of two begins his day at about 5am so that he can split his time between work and family.

At the moment, he says, he is trying to carve out time on weekends to spend with his 14-year-old boy, his 18-year-old son who wants to study medicine, and 47-year-old wife, Ng Hsueh Mei, a family physician.

Perhaps he can look forward to spending more time with them once his SNEC term is over in five years.

By then, Prof Wong hopes he can either continue treating patients, which is what he enjoys, dive back into his research, or mentor the young.

What about a political career?

After all, his mother is former senior minister of state Aline Wong, now an adjunct professor at the Lee Kuan Yew School of Public Policy at the National University of Singapore (NUS). The Hong-Kong born sociologist stepped down from politics in 2001 after four terms in Parliament.

Prof Wong is clear about his own calling.

"If I do do something different, it has to be with the sense that it allows me to make a good contribution . . . Whatever those opportunities are, I'm happy to help, but no political things," Prof Wong says with a chuckle, adding that he wants to contribute to the community as a physician.


Medical Director, Singapore National Eye Centre (SNEC)

Vice-Dean, Office of Clinical Sciences Duke-NUS Graduate Medical School, National University of Singapore (NUS)

Born in Hong Kong in 1968

Obtained MBBS from NUS as a President's Scholar, clinical ophthalmology training at SNEC, and retinal fellowships at the University of Wisconsin, Madison, USA, and the University of Sydney, Australia. Obtained MPH and PhD from the Johns Hopkins University, USA.

Academic appointments (since 1996); most recent include:

2009-13: Executive Director, Spore Eye Research Institute (SERI)

2010-14: Chairman, Department of Ophthalmology, NUS

Since 2012: Provost's Chair Professor, NUS

2013-14: Deputy Medical Director (Research), SNEC

Since 2012: Group Director, Research,

Singapore Health Services

Since 2014: Vice-Dean, Office of Clinical Sciences, Duke-NUS Graduate Medical School, NUS

Since 2014: Medical Director, SNEC

Since 2014: Academic Chair, Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, NUS

Since 2014: Chairman, SERI

Since 2015: Consulting Professor, Department of Ophthalmology, Duke University Medical Center