Medical Innovation Key To Ageing Asia - Experts

By 2050, about one in four people in the Asia-Pacific region is expected to be aged 60 or older, placing greater pressure on healthcare systems to move beyond simply treating more patients towards detecting diseases earlier, delivering safer and less burdensome care, and preserving quality of life.

This shift is particularly evident in specialist care, where advances in surgery, diagnostics and technology are transforming the management of conditions ranging from urological cancers to vision-threatening eye diseases.

As ageing populations drive demand for specialist services, while healthcare systems across Asia vary widely in resources and infrastructure, the key question is no longer simply how advanced a treatment can be, but how effectively such innovations can benefit patients beyond the institutions where they are developed.

The writer (second from left) is among the media representatives from Malaysia who also participated in the Singhealth Media Immersion Programme held recently. Photo credit: Muhammad Basir Roslan.

These issues came into sharper focus during a two-day media immersion programme organised by SingHealth, Singapore’s largest public healthcare group, which brought together six journalists from Malaysia, Indonesia and Vietnam to examine specialist healthcare developments in Singapore.

Held alongside the Urology & Ophthalmology Conference on July 22–23, the programme featured discussions with specialists from Singapore General Hospital (SGH) and Singapore National Eye Centre (SNEC).

The delegation also visited key SNEC facilities, including its Retina Centre, Day Surgery and ward, and Glaucoma Observation Clinic, as well as selected areas of SGH, gaining a closer look at how clinical expertise, specialised infrastructure and technology are being integrated to address changing patient needs across the region.

TREATING ONLY WHAT NEEDS TO BE REPLACED

One of the clearest examples of modern eye care can be seen in the treatment of corneal disease.

According to SNEC Head of Corneal and External Eye Disease Prof Marcus Ang, patients with severely diseased corneas traditionally underwent penetrating keratoplasty, or full-thickness corneal transplantation, in which the entire cornea was replaced with donor tissue.

(From left to right): SGH Consultant Uro-Oncologist and Chairman of its Robotic Surgery Committee Assoc Prof Kenneth Chen, SGH Senior Consultant Urological Surgeon Prof John Yuen, SNEC Head of Corneal and External Eye Disease Prof Marcus Ang. Pix credit Singhealth.

However, over the past two decades, surgical practice has shifted significantly towards selective or lamellar transplantation, in which only the diseased layer is replaced.

SNEC was among the earliest centres globally to adopt and popularise techniques such as Descemet Membrane Endothelial Keratoplasty (DMEK), which replaces the diseased inner layer, and Deep Anterior Lamellar Keratoplasty (DALK), which targets affected outer layers while preserving the deeper healthy tissue.

“The cornea is essentially the ‘window’ to the eye. If it is clear, the patient can see well. With today’s medical technology, we do not have to replace the whole cornea. If only one layer is damaged, we can selectively replace that layer,” he said.

For patients, the benefits of selective procedures include less extensive surgery, faster visual recovery, reduced long-term follow-up requirements and potentially longer graft survival.

Prof Marcus described the approach as an effective way of addressing a critical challenge across Asia -- the shortage of donor corneas. By targeting specific layers, a single donated cornea can potentially benefit more than one patient.

“This also means the medical team can use the inner layer for one patient and the outer layer for another,” he said.

“You can actually help two patients at the same time.”

This principle is particularly relevant to countries with limited access to donor tissue, demonstrating that innovation is not only about technological advancement, but also about maximising scarce resources.

SNEC is also exploring alternatives such as EndoArt, an artificial endothelial implant designed to prevent fluid from entering the cornea, particularly for patients who are not suitable candidates for conventional corneal transplantation.

“However, personally, I still believe that human donor tissue remains the preferred gold standard, with artificial options serving merely as alternative pathways for patients,” Prof Marcus added.

The regional dimension is equally important.

SNEC runs a comprehensive corneal programme covering clinical care, education and research in corneal and ocular surface diseases, while offering advanced treatments such as corneal transplantation and laser refractive surgery as a regional referral hub.

Central to this effort is its 12- to 18-month Corneal & External Eye Disease fellowship, which trains ophthalmologists from countries including Thailand, India, the Philippines and Malaysia in advanced corneal surgery and disease management.

The fellowship helps strengthen regional specialist manpower, enabling ASEAN countries to expand their local corneal care capacity and reduce the need for patients to seek treatment abroad.

“This illustrates a wider principle, where innovation becomes more meaningful when expertise can be transferred and adapted according to the needs and resources of different healthcare systems,” Prof Marcus said.

 RETHINKING PROSTATE CANCER CARE

While advances in eye care demonstrate how specialist innovation can restore function, urology offers another perspective, where innovation is not only about how cancer is treated, but also how early it can be detected and how patients are supported throughout their recovery.

One of the key challenges in prostate cancer is that the disease may develop without obvious symptoms in its early stages.

According to SGH Senior Consultant Urological Surgeon Prof John Yuen, this remains an important challenge in countries where cancer screening is not routinely practised.

With Asia’s population continuing to age, he said increasing screening for urological cancers, particularly prostate cancer, should be an important priority.

“Once men with suspicious screening results require further assessment, advances in diagnosis can also play a role. At SGH, these include the co-development of the Mona Lisa robotic prostate biopsy platform, which uses a transperineal approach -- obtaining tissue through the skin between the scrotum and anus rather than through the rectum -- to perform targeted prostate biopsies,” he explained.

But innovation extends beyond diagnosis to treatment and recovery.

Prof John said robotic-assisted surgery can offer practical benefits, including less pain, reduced blood loss, shorter hospital stays and greater surgical precision, potentially supporting better functional outcomes.

His urology team has also developed a total extraperitoneal (TEP) approach for robotic-assisted laparoscopic radical prostatectomy, a technique that allows the surgery to be performed outside the main abdominal cavity.

By avoiding entry into the abdominal cavity, the approach is intended to reduce disruption to surrounding tissues and support faster recovery for patients.

As SGH performs around 300 prostate cancer operations annually, with international patients accounting for a significant proportion of cases, the hospital also reflects the role of regional specialist centres in treating patients from across Asia.

For these patients, however, specialist care does not necessarily end when they leave Singapore.

Prof John noted that postoperative care following prostatectomy is relatively straightforward, allowing appropriate follow-up to continue in patients’ home countries.

“This can extend to something as practical as catheter management. Some international patients may remain in Singapore until the catheter is removed, while others can return home earlier and have it removed by a local urologist where appropriate,” he said.

He also highlighted an increasingly important aspect of cross-border care, which is remote follow-up.

“After returning home, international patients can actually undergo blood tests locally, then they can email the results to the SGH team and receive advice and management recommendations without needing to travel back,” he said.

This illustrates a more flexible model of cross-border care, where continuity of specialist oversight can be maintained through a combination of local healthcare services and telemedicine, he added.

 BUILDING A SAFER ROBOTIC SURGERY ECOSYSTEM

As robotic surgery becomes increasingly established across Asia, another question is emerging alongside technological advancement: How can healthcare systems ensure surgeons and their teams are adequately trained before new technologies are introduced into routine patient care?

For SGH Consultant Uro-Oncologist and Chairman of its Robotic Surgery Committee Assoc Prof Kenneth Chen, the answer lies in moving beyond traditional surgical apprenticeship towards a more structured, competency-based approach.

He explained that SGH’s training combines dedicated robotic systems with simulation, as well as animal and cadaver models, allowing clinicians to develop technical skills in controlled environments.

This philosophy was put into practice when SGH became the first centre outside Japan to introduce the Hinotori Surgical Robot System in 2024.

Before performing any patient cases, the entire urology team underwent tutorials, hands-on simulation sessions and proctored cases, ensuring that everyone was familiar with the new platform’s console, instruments and safety features.

“Robotic surgery is a team sport, not an individual sport. By sharing structured training pathways, outcomes, and implementation experience, institutions can eventually shorten learning curves and avoid repeating one another’s mistakes,” he said.

SGH has also applied this approach in its regional engagement with neighbouring countries, including through training and knowledge exchange involving a medical team from Malaysia.

The programme included doctors, nurses and anaesthetists, reflecting the importance of developing robotic surgery as a coordinated team capability rather than an individual skill.

The need for structured preparation becomes even clearer during emergencies.

Prof Kenneth cited an incident involving robotic surgery during a recent earthquake in Bangkok as an example of the unexpected situations surgical teams may face.

“At SGH, crisis algorithms (predefined procedures for responding to emergencies) and simulation exercises are used to prepare teams for dire situations where communication, coordination, and rapid decision-making become far more critical,” he said.

He also compared robotic surgery training with aviation, where competency requirements are clearly defined before pilots are allowed to operate different aircraft.

Healthcare, he said, could similarly benefit from more consistent approaches to training, credentialing and accreditation.

He viewed platforms such as Hinotori as a model for how new robotic systems can be introduced safely through structured, team-based training rather than ad hoc learning on real patients.

 BUILDING A MORE CONNECTED FUTURE FOR ASIAN HEALTHCARE

Looking ahead, Assoc Prof Kenneth envisions a model of healthcare in Asia that is more preventive, precise and patient-centred, with treatment decisions increasingly tailored to both the disease and the individual.

“For urologic cancers, this means earlier detection, distinguishing cancers that require aggressive treatment from those that can be safely observed, and matching therapy to tumour biology, patient fitness and personal priorities,” he said.

The author with media friends during a visit to SNEC, Singapore. Pix credit: Muhammad Basir Roslan.

He also sees Asia’s diversity as an opportunity for healthcare systems to learn from one another.

Some countries may have extensive experience managing super-ageing populations, while others have developed high-volume specialist centres, sophisticated digital infrastructure or efficient models of care despite resource constraints.

Such differences, he said, could help generate evidence and approaches better suited to Asian populations.

But he stressed that innovation cannot simply be transferred from one healthcare system to another.

Affordability, accessibility and local healthcare realities must be considered when new interventions are introduced, as an approach that produces excellent results in one setting may not necessarily be practical or sustainable elsewhere.

“This should be a reciprocal partnership. Every healthcare system has expertise to contribute, and solutions must be adapted to local realities rather than transferred without context,” he said.

Prof John similarly envisions a future where every patient in Asia has access to high-quality, evidence-based and personalised specialist care, regardless of geographic differences.

Continuous innovation in Artificial Intelligence (AI), precision medicine and minimally invasive surgery, combined with regional partnerships in education, research and clinical care, could also help deliver more equitable healthcare, he added.