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Realisation of a Big Dream


Dr Daniel Ting, SingHealth Ophthalmology Residency Alumnus, and currently an Associate Consultant at the Singapore National Eye Centre (SNEC) and Assistant Professor at Duke-NUS Medical School, grew up wanting to pursue the prestigious 2017/2018 Fulbright US-ASEAN Visiting Scholar Award. His dream became reality when Prof Wong Tien Yin, SingHealth Deputy GCEO (Research & Education), encouraged him to pursue the scholarship, with strong support by Prof Ivy Ng SingHealth GCEO, Assoc Prof Lim Boon Leng DIO, SingHealth Residency and SNEC Senior Management - Assoc Prof Ian Yeo, Adj Assoc Prof Edmund Wong and Prof Aung Tin .

In 2017, Daniel became the first doctor in Singapore to be awarded the Fulbright US-ASEAN Visiting Scholar Award. This prestigious scholarship is highly sought after by many across various fields and industries, and each year, only one scholarship is awarded.

Read on as Daniel recounts his experience during his attachment at the Johns Hopkins University School of Medicine after receiving the scholarship.

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1. Congratulations on winning this prestigious scholarship! Share with us your experience at the Johns Hopkins University School of Medicine.

I spent a total of four months at Wilmer Eye Institute, working closely with the Applied Physics Laboratory (APL) on my Artificial Intelligence (AI) project. My mentor, Prof Neil Bressler, is an internationally renowned retinal specialist and the past chairman of the world's largest diabetic retinopathy clinical research network (DRCR.net). He is the current chair for the retina division at John Hopkins University (JHU), editor-in-chief for the Journal of American Medical Association (JAMA) Ophthalmology and an editorial board member for JAMA.

Despite his busy schedule, we routinely had one to two research meetings a week. Whenever possible, I would join his clinic sessions to learn the United States' (US) preferred pattern practices for different retina conditions. Given the strict APL regulation in view of many confidential US Government projects, I was given a restricted pass to hold regular meetings with the AI team (which consisted of three computer scientists) in the staff lounge.


2. What is one challenge you faced during the attachment?

One of the toughest challenges was leaving my wife and three-month old son in Singapore. Though I communicated with my family on a daily basis, it wasn't the same as being physically present. Since my return, I have tried spending most of my time with them to make up for the lost time. Maintaining a balance between work and family is always challenging, but family will always be my top priority in life.

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3. Describe you most memorable experience during the attachment.

We met Prime Minister, Mr Lee Hsien Loong, at the Singapore Embassy in Washington DC, when he visited the President of the USA, Mr Donald Trump, in October 2017. It was the first time I was meeting Mr Lee and my first impression was – "Wow, he is tall!". Despite the long haul flight and preparation to meet Mr Trump, Mr Lee still made the effort to meet the Singaporeans and the Fulbright community. It was a joyful night as we mingled with the other ministers discussing Singaporean cuisines – Laksa, Satay, Kueh Dadar and my favourite dish from the night, the durian puff!


4. Tell us more about what you have learnt at John Hopkins University. How will it benefit your clinical work?

With Singapore having an estimated 600,000 diabetics aged 18 to 69 (www.moh.gov.sg, 2011), about 180,000 have Diabetic Retinopathy (DR). The Ministry of Health in Singapore has declared 'war on diabetes' to rally the nation in an effort to reduce the burden of diabetes in our population and keep Singaporeans healthy as we age.

Currently, the most effective way to prevent DR-related vision loss is annual screening for DR, a universally accepted practice and recommended by American Diabetes Association and the International Council of Ophthalmology (ICO). To address this problem, the Singapore Integrated Diabetic Retinopathy Program (SiDRP), was set up in 2017, to screen 100,000 persons with diabetes across 18 primary care clinics in Singapore. However, SiDRP relies mostly on 'human grading' of the retinal photographs by a large team of trained professional graders or optometrists. Given the rising prevalence of diabetes, SiDRP and other DR screening programs are challenged by availability, training and retention of professional graders and optometrists, long-term financial sustainability and access. DR screening remains patchy globally as a result of these challenges.

The JHU visit has further deepened my understanding on the use of AI not only in Ophthalmology, but also in other medical fields such as radiology. For DR screening, it will be useful if we can automate the DR screening for the primary eye care community to save cost and improve efficiency of the healthcare system, allowing ophthalmologists to focus on treating only DR cases that require treatment. In collaboration with 30 co-investigators globally, we have reported clinically acceptable diagnostic performance of our AI system to detect DR, Glaucoma Suspect and Age-related Macular Degeneration in a multi-ethnic population with diabetes. This is the world's first AI system that can detect all 3 sight-threatening conditions and this paper was newly published in the JAMA journal of 12 December 2017. It could potentially reduce total workload by 50–70 percent simply by removing non-referable images and allowing human graders to focus on the retinal images that need more attention. An established AI system could also be useful in conducting lifelong monitoring.

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5. What did you enjoy most about this attachment?

I enjoyed meeting new people during my time in the US. I met many Hopkins Residents, fellows and young faculties who shared similar mindsets about the future. Outside work, we had regular dinners, outings and drinks, although most conversations always ended up 'work- and AI-related'. Many people are fearful about 'singularity' where the AI could potentially result in unfathomable changes to human civilisation. In fact, 'Sophia', a female robot, has passed the Turing's test and become the first robot citizen a few months ago (October 2017) in South Africa. Although there are many 'fearful' thoughts about what the future holds, AI is highly unlikely to have the 'human touch' and make complex medical or surgical decisions like doctors routinely do in the clinical practice. As a clinician, I think it is important for us to embrace AI early to help rectify the pressing manpower and financial constraints due to the ageing population worldwide.

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6. Lastly, share with us one key takeaway from this experience

AI is deemed to be the 4th industrial revolution in human history. In healthcare, we need to embrace this technology earlier to improve work efficiency, while maintaining the high standard of clinical care. In Singapore, there were some recent concerns about the insufficiency of specialists or subspecialists jobs. Perhaps, the young medical students or Residents should explore diving into the booming AI field that possesses many opportunities in research or start-ups, with appropriate guidance and mentoring.

Albert Einstein once said "The true sign of intelligence is not knowledge, but imagination. You never fail until you stop trying". It is important to keep innovating to make the world a better place to live in. I just want to end this piece with my favourite quote from President Theodore Roosevelt:

I want to see you game boys,
I want to see you brave and manly,
And I also want to see you gentle and tender.

Be practical as well as generous in your ideals.
Keep your eyes on the stars and keep your feet on the ground.
Courage, hard work, self-mastery and intelligent effort are all essential to successful life.
Character, in the long run, is the decisive factor in the life of an individual and of nations alike.

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