Highlights from Ophthalmology Futures Forums Singapore 2017
The second Ophthalmology Futures Asian Forum in Singapore was a success and attracted delegates, physicians, corporate leaders and investors from around the globe and from a wide spectrum of clinical and business specialties. Summaries of each of the seven panel discussions are highlighted below.
We are also grateful to Dr Flemming Ornskov, CEO of Shire for agreeing to provide a very insightful interview on his perspectives on innovation and Shire. A video of the interview can be viewed below.
> Beyond anti-VEGFs: Surviving the injections
Anti-vascular endothelial growth factor (VEGF) therapy remains a major success story in the treatment of retinal disease. Current agents are effective and “hard to beat”.
New agents should modify and alter disease cause or treat only markers of disease activity (eg. VEGF levels), rather than treat visual symptoms or optical coherence tomography signs.
There are no ideal animal models for retinal angiomatous disease or macular oedema, challenging the drug discovery pipeline. Multiple animal models need to be used.
Adnan Tufail Consultant Ophthalmologist, Moorfields Eye Hospital, UK
Tien Yin Wong Medical Director, Singapore National Eye Center, Singapore
Caroline Chee Head and Senior Consultant for Surgical Retina, National University Hospital, Singapore
Chuck Holmes Director, Strategic Marketing, Bayer, USA
Timothy Lai Honorary Clinical Associate Professor, Department of Ophthalmology and Visual Sciences, Coordinator of the Medical Retina and Uveitis Service, Hong Kong Eye Hospital, China
Xiaoxin Li Professor and Director, People Eye Research Institute, Peking University and Director, Ministry of Health State Key Laboratory for Trauma and Repairing, China
Lin Lu Professor and Director, Fundus Disease Center, Zhongshan Ophthalmic Center, Sun Yat-sen University, China
Paisan Ruamviboonsuk Assistant Director, Rajavithi Hospital and President of the Royal College of Ophthalmologists, Thailand
Naveed Shams Head of Global Research and Development, Chief Scientific Officer, Senior Corporate Officer, Santen Pharmaceutical Co. Ltd., USA
Eli Zangvil Global Brand Medical Director, Novartis, Switzerland
> Developing and taking a new idea to market
There is an opportunity for greater commercialisation in ophthalmology. Few academics commercialise their research so greater incentives are required for academics to commercialise.
The opportunity for technology transfer varies globally. Israel and Singapore are advanced ecosystems, while countries in which English is not widely used are at a disadvantage with respect to globalisation.
Singapore is a good location for technology transfer. Intellectual property, funding and governmental support are well-developed. However, private sector involvement is lacking.
Boris Malyugin Professor of Ophthalmology, Department of Cataract and Implant Surgery, Deputy Director General, S. Fyodorov Eye Microsurgery State Instituition, Russia
Steven Myint Adjunct Professor at Duke-National University Singapore, Center for Technology, Enterprise and Development, Singapore
Jonathan Agmon Partner, Head Singapore Office, Soroker Agmon Nordman, Singapore
Danny Belkin Technology Development and Commercialisation Director, Singapore Eye Research Institute, Singapore
Duncan Bishop Programme Director, Cambridge Consultants Ltd., UK
Thong Yuen Poon Board Director and Chief Investment Officer of Zicom Medtacc Pte Ltd., Singapore
Leopold Schmetterer Professor of Ophthalmology and Head of Ocular Imaging, Singapore Eye Research Institute, Singapore
Theodore Tan Managing Director, The Biofactory, Singapore
> The Asian investment climate
The Asian and South East Asian ophthalmology investment ecosystem is still nascent, but is promising. There is an increasing number of venture capitalists, strategics and investors who are interested in this space.
Opportunities and interest exist in both medical device and therapeutics, with no preference for either.
As part of the financing strategy, companies with relatively more mature technology (e.g. from the United States or Europe) could explore the use of local partnerships in order to access large, underserved Asian markets that have similar clinical needs.
Hai Ping Choo Senior Vice-President, Investments and Operations, CapBridge, Singapore
Fay Xing Partner, Wuxi Healthcare Ventures, China
Takashi Hibi Head of Global Business Development at Santen Pharmaceutical Co. Ltd., Japan
XiangQian Lin Founder and General Partner, ESCO Ventures, Singapore
Ken Noonan Chief Executive Officer, Lightstone Ventures Pte. Ltd., Singapore
Jeong Shing Ong Investment Director, VentureCraft, Singapore
> Trends in glaucoma devices and drug delivery in Asia
Despite the significant number of glaucoma patients in Asia, the availability of new glaucoma devices in Asia is limited. The regulatory environment for these devices may be challenging in certain countries e.g. China.
The significant cost of new glaucoma devices and technologies may be prohibitive for most Asian glaucoma patients, as the reimbursement climate in Asia differs from the West and most patients are self-financed.
Many Asian glaucoma patients present with advanced glaucoma, and may not be suitable candidates for certain micro-invasive glaucoma surgery devices which are less appropriate for patients with advanced glaucoma.
Keith Barton Consultant Ophthalmologist, Moorfields Eye Hospital, UK
Xinghuai Sun Professor and President, Eye and ENT Hospital, Fudan University and Director, Department of Ophthalmology, Shanghai Medical School, Fudan University, China
Robert Ang Senior Ophthalmologist, Refractive Surgery and Glaucoma Service, Asian Eye Institute, Philippines
Seng Kheong Fang Consultant Ophthalmologist and Chairman Medical Board, ISEC Healthcare Ltd, Malaysia, Honorary Secretary of Asia-Pacific Glaucoma Society
Dexter Yu-Lung Leung Honorary Consultant & Specialist in Ophthalmology, Department of Ophthalmology, Hong Kong Sanatorium & Hospital and President Hong Kong Ophthalmological Society
Chelvin Sng Consultant and Assistant Professor, National University Hospital, Singapore
Tetsuya Yamamoto Professor and Chairman, Department of Ophthalmology and Director of Glaucoma Service, Gifu University School of Medicine, Japan
> Market access for femtosecond laser cataract surgery and premium IOLs in Asia
The most important factor that has prevented widespread uptake of femtosecond laser-assisted cataract surgery in Asia is the cost, which is often perceived to outweigh the potential benefit.
Cost is also a major obstacle to the use of premium intraocular lenses in Asia, as most patients are self-financed.
Other barriers to the adoption of these new premium services include the lack of patient awareness / demand, extended chair-time due to the need for extensive pre-operative counselling and limited access to training for the ophthalmologist.
David Chang Clinical Professor, University of California, San Francisco, USA
Soon-Phaik Chee Senior Consultant and Head of Cataract and Ocular Inflammation and Immunology Service, Singapore National Eye Center, Singapore
Miguel Bernabeu Global Head Market Access, Pricing and HEOR, Alcon Laboratories, Inc., USA
Boris Malyugin Professor of Ophthalmology, Department of Cataract and, Implant Surgery, Deputy Director General, S. Fyodorov Eye Microsurgery State Institution, Russia
Joe Redner Head of Sales, Ophthalmic Devices APAC, Carl Zeiss Meditec Inc., Australia
Xudong Song Professor and Director, Cataract Surgical Center, Beijing Tongren Eye Center, China
Clement Tan Head and Senior Consultant at the Department of Ophthalmology, National University Hospital, Singapore
Mark Wilkins Consultant Ophthalmologist, Moorfields Eye Hospital, UK
Danying Zheng Professor, Deputy Director, Department of Ophthalmology and Optometry, Zhongshan Ophthalmic Center, Sun Yat-Sen University, China
> The future of anti-microbials: Enough of our -cins?
The development of new anti-microbial agents is hampered by the tremendous cost involved in drug development, the difficult regulatory pathway and the existence of much cheaper and effective alternatives.
Despite the increasing prevalence of systemic and ocular fungal infections both in Asia and globally, anti-fungal agents are limited. New anti-microbial agents are also needed to combat drug-resistant microbes.
The high prevalence of ocular infections in Asia makes it an ideal setting to conduct trials which study the pathogens and investigate the effect of anti-microbial agents.
Donald Tan Professor, Singapore National Eye Center, Singapore
Roger Beuermann Professor, Ophthalmology, Cell Biology and Anatomy, Louisiana State University Eye Center, New Orleans, LA and Singapore Eye Research Institute, Singapore
David Chang Clinical Professor, University of California, San Francisco, USA
Xiaofeng Lin Professor and deputy director, Zhongshan Ophthalmic Center, Sun Yat-Sen University, China
Paul Anantharajah Tambyah Senior Consultant, Division of Infectious Diseases, National University of Singapore, Singapore
> Will laser refractive surgery bring a SMILE to Asian ophthalmologists?
In order to bring about a revival in the refractive market, improved patient education and experience is required to raise awareness about the safety of refractive surgery. There is also an opportunity in emerging markets (many of which are in Asia) to improve on this as economies are developing.
Training in refractive surgery is lacking in residency programmes, and it is only taught during fellowship. Improving the understanding of refractive surgery will improve its efficacy and therapeutic value, and reduce complications in the long-term.
New technologies, including SMILE and Contura, can help re-invigorate the market, but it is important to ascertain the safety of any new procedures in this precocious market.
Jodhbir Singh Mehta Associate Professor, Head and, Senior Consultant of Corneal and External Eye Disease Department, Singapore National Eye Center, Singapore
Marcus Ang Consultant and Assistant Professor, Singapore National Eye Center, Singapore