Under the gaze of the lady Wisconsin, the 15-foot-tall statue that symbolises progress atop the midwestern American state’s capitol building, Wong Tien Yin hit upon an idea that could benefit millions of people with diabetes.
It would take another two decades before his dream of a national screening programme for diabetic retinopathy—a growing cause of blindness—would become a reality. While he pursued this project, he continued his academic and clinical work, making a name for himself across three continents.
Today, Wong is a household name in ophthalmology and throughout the healthcare and biomedical ecosystems in Singapore and beyond. He recently topped the growing string of awards and accolades by becoming only the third person from Singapore to be elected to the US National Academy of Medicine (NAM). Membership of the NAM, which includes more than 70 Nobel Laureates, is a highly prestigious achievement.
President of the Academy, Professor Victor J Dzau, described being elected to the NAM as an extremely competitive process whereby individuals are evaluated based on the excellence of their research and the impact their work has made to the world.
“What Tien’s been able to do is bring excellent research, clinical practice and leadership together. He clearly is a leader in his field,” said Dzau.
But to get where he is today, Wong had to blaze his own trail.
A clock begins to tick
While his early academic trajectory followed the path well-trodden by those who excel in the sciences, Wong’s vision of his future had been deeply influenced by his family life. With two academics as parents, home was a place where family and work co-existed.
“I remember stacks and stacks of exam papers,” recalled Wong. “My brother and I would be running around them, while they (my parents) were marking papers late into the night.”
More than anything, his childhood imprinted him with a desire to teach and build an academic career, a career that would allow him to make an impact on the world.
Spotting that drive, Professor Arthur Lim, then medical director of the newly established Singapore National Eye Centre (SNEC), summoned Wong when he was just a houseman, undecided about his future specialisation.
“It was quite daunting. These were the days when senior doctors had an air of inaccessibility,” said Wong. “You get called by their PA, and drop everything to meet them at the designated time and place.”
Arriving early on the morning of his appointment, Wong was left in a room with two of Lim’s younger proteges, who are now senior physicians in Singapore. When Lim joined them, the eminent and charismatic ophthalmologist shared his vision for the field, painting a future for the young specialty that inspired Wong.
“Arthur talked about his vision for ophthalmology in such a way that I was sold to ophthalmology although I hadn’t thought of doing this speciality before,” said Wong.
Making the infinity between tick and tock count
Lim introduced him to Professor Alfred Sommer, then Dean of the Johns Hopkins University’s School of Public Health, who was in Singapore on a brief visit. With Lim’s encouragement and support, Wong delayed the start of his training to complete a master’s in public health at Johns Hopkins. Upon his return, the academic seed from Wong’s childhood had flourished and Wong was not contented just being trained as an ophthalmologist. Wong was inspired by the School of Public Health’s vision: “Protecting Health, Saving Lives—Millions at a Time”.
“I am very conscious that with every day that passes, we lose that time and energy to do something impactful. I was very happy to be a doctor, but that was not sufficient. So especially during those early years, I was very keen not to lose that time,” said Wong.
Again with Lim’s support, he became a senior tutor at NUS to continue his academic dream.
As he neared the end of his clinical training, he increasingly felt that his research training was only half-finished. Deviating from the norm once again, he applied for a PhD at Hopkins.
At the time, no national scholarships for PhDs did not exist. to obtain financial support to pursue his postgraduate qualification, Wong applied for the inaugural Lee Kuan Yew Scholarship, which has since become well-known for supporting postgraduate students in all disciplines. But when Wong applied, he was rejected.
“The chairman of the scholarship committee, a senior doctor, said, ‘You’re already a doctor. What would you gain from doing further graduate degree?’” recalled Wong.
Despite this set back, Wong headed back to the US to embark on his PhD in 1999. With his drive to make an impact, it is perhaps little surprise that he also accepted a concurrent research fellowship from the American Diabetes Association at the University of Wisconsin, Madison. That meant that he had to split his time between Wisconsin and Maryland, incorporating a more than 2,500km round trip commute. While in Wisconsin, he met Lee Mong Li, now a professor with the School of Computing at NUS.
Wong with Professors Ronald and Barbara Klein at the University of Wisconsin where he completed his research fellowship that gave rise to his dream of developing a screening programme for diabetic retinopathy // Credit: Wong Tien Yin
The fellowship would go on to influence Wong’s future direction, steering him towards a focus on diabetic retinopathy and early screening using the eye. It also formed the basis for a more than two-decade old partnership with Lee and Wynne Hsu, Provost’s Chair Professor and Deputy Director at NUS’ Institute of Data Science as the three worked to realise their vision for an artificial intelligence (AI)-led screening programme.
Even though they hailed from different disciplines, working together has always been smooth, agreed Hsu and Lee. “We have a lot of respect for each other's expertise and our skill sets complement each other.”
And on the rare occasions when they don’t see eye-to-eye straight away, there is always coffee. “We typically resolve any issues over coffee,” remarked the two.
Setting a new standard for time
While Wong’s desire to study was grudgingly accepted by the system, the idea of protected time for a junior consultant to pursue research was virtually unheard of.
Squeezing his work into pockets of time here and there, over the weekend and with limited funding available, Wong knew that he had to move elsewhere. When he received a phone call from the chair at the University of Melbourne who was looking to fill a tenured associate professor position, Wong had found his ticket out.
“It was my first trip to Melbourne. I took the midnight fight, did my interview and headed back to the airport. I called my wife from there to ask whether she’d move to Melbourne,” he said.
While working in Australia brought its own challenges, Wong underwent a period of significant personal and academic growth. Experiencing a more mature academic system was eye-opening.
“The flatter structure in Melbourne meant that we could achieve more with a leaner team because everyone right down to the research assistants and students were a lot more independent, felt greater ownership and could make decisions,” said Wong, who brought this approach back with him from Australia.
Wong with his team at the University of Melbourne // Credit: Wong Tien Yin
Wong also continued to pursue his dream for a national eye screening programme for people with diabetes. Back in late 2008, Carol Cheung—now an assistant professor at the Chinese University of Hong Kong—was interviewed by Wong for a position as a research fellow to work on eye imaging and was struck by Wong’s acumen.
“He really has a good vision for eye research and knows intuitively where to place the next step,” said Cheung. “In this way, he keeps the team moving forward and motivated.”
Shaping a clinician scientist clock
Having had to blaze his way as a clinician scientist, Wong is now determined to nurture and steward an environment where future generations of clinicians feel empowered and supported to pursue an academic career.
“He takes care that everyone gets an opportunity to grow and doesn’t quibble over authorship with his collaborators,” said Cheung, “but above all, he makes you feel appreciated and trusted.”
Madam Haslina binte Hamzah, who first joined Wong’s team in 2004 as a part-time research assistant on the Singapore Malay Eye Study agrees.
“He inspires in his staff that nothing is impossible if you try hard enough. And he gives a lot of opportunities to his team to expand our capabilities and horizon. I am grateful to him,” said Haslina, who is now an assistant director managing the national screening programme’s reading centre at the SNEC.
Wong returned to Singapore in 2009 to take over the reins at the SERI. In 2014, he moved on to become the Medical Director at the SNEC, an appointment that he continues to hold alongside being the Deputy Group CEO for Research and Education at SingHealth and the Vice-Dean for Academic and Clinical Development at Duke-NUS.
With multiple hats and a thriving set of collaborations, Wong has only recently eased his gruelling schedule of 5am starts that he demanded of himself in order to fit work and family into his day.
“I’ve re-prioritised my work, and I continue to delegate much more to team members, so there are some things I no longer need to do. I also feel the need to compensate my family for all the time that I was away,” said Wong, whose time spent shuttling between Singapore and Australia meant months away from his two young boys at that time.
While he may be as demanding of his team and himself as before, Haslina believes that Wong has become a little more patient over the years: “He gives a lot flexibility on how you do things. While we agree on the goal, but how we get there, he trusts and leaves that to us.”
Following in the footsteps of his mentor, Arthur Lim, Wong inspires those around him with his vision for an academic and innovative ecosystem. And his collaborations to bring about the screening programme are the perfect example.
Today, the programme has grown from a pilot to a national screening programme. It is fully digitised and the scans that are sent in are assessed by trained readers. In October 2019, a deep-learning AI programme, based on research with Hsu and Lee, was approved for use in Singapore. Analysing the image, the AI can determine within seconds whether someone has diabetic retinopathy, glaucoma or age-related macular degeneration.
“It is very heartening that the programme has come to fruition. It wasn’t easy to do it and may not be as impactful as a vaccine for COVID-19, but for ophthalmology it is quite important and as a demonstration project for AI, it provides lessons for other fields,” said Wong. With Singapore’s rapidly ageing population and rising rates of diabetes as many as 200,000 people may have to be screened for diabetic eye diseases by 2050, double the 100,000 screened in 2017.
Despite his many achievements, Wong feels that he is nowhere near done with his work. Branching out into new technologies like AI was no small undertaking for Wong, who by that point did not need to innovate his research further. But that’s precisely the point for Wong.