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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]