Tien Y Wong

Centre for Eye Research Australia, Melbourne, Victoria, Australia

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Publications (417)2690.29 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Adolescents females with type 1 diabetes (T1D) are reported to have greater risk of early microvascular complications than males. We hypothesize gender differences in retinal vascular geometry (RVG) through puberty are associated with earlier onset microvascular complications. Methods: Pre-pubertal patients(n=64, 35Male) with T1D, complication-free at baseline, were followed through to sexual maturity with detailed Tanner-staging and repeated diabetes complications assessments. RVG from digitized retinal photographs at each visit was assessed using a semi-automated computer program. Determinants of RVG measurements (pre-, during- and post-puberty) were explored using generalized estimating equations (GEE). Factors associated with time to onset of retinopathy and AER were examined using multivariable Cox regression. Results: Median follow-up was 7.2 years. Retinopathy developed in 69% and elevated albumin excretion in 56%. In multivariable GEE, female gender was associated with wider venular calibre (pre-puberty: Lowest-quartile, OR 0.40, 95%CI 0.17-0.96;P=0.04) and lower arteriolar length-to-diameter-ratio(LDRa) during-puberty(Lowest-quartile 2.87, 1.01-8.13;P=0.047) and post-puberty(2.93, 0.96-8.64;P=0.06). In Cox-regression, females developed retinopathy earlier than males(8.1 vs 9.6yrs;P=0.002). Female gender(HR 3.8, 95% CI 1.6-8.6;P=0.002) and growth-velocity (1.3, 1.1-1.5; P=0.001) were associated with earlier retinopathy. Conclusion: This is the first longitudinal study to repeatedly examine RVG through puberty in youth with T1D.Gender dimorphism was observed. Female gender was associated with lower LDRa, wider venules and earlier onset of retinopathy. These RVG patterns have been associated with incident microvascular complications but did not reach statistical significance in this study. Larger studies are needed to investigate the RVG, microvascular complications and gender associations early in the course of T1D. Copyright © 2014 by Association for Research in Vision and Ophthalmology.
    Investigative ophthalmology & visual science. 12/2014;
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    ABSTRACT: Context: Hemoglobin A1c (HbA1c) ≥6.5% (47.5 mmol/mol) has recently been included as a criterion for the diagnosis of diabetes mellitus. It is unclear whether this criterion is appropriate in Asians. Objective: To examine the relationship between HbA1c and diabetes-specific moderate-retinopathy in Asian ethnic groups. Design, setting and participants: Four independent population: based cross-sectional studies (2004-2011) in Singapore representing the three major Asian ethnic groups (n=13,170 adults aged ≥25 years, Chinese =5,834, Malays=3,596, and Indians=3,740). Main outcome: Moderate-retinopathy was assessed from digital retinal photographs and defined as level >43 using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and the area under the receiver operating characteristic curve (AUC) for detecting moderate-retinopathy were compared across ethnic groups at different HbA1c cut-points. Results: HbA1c levels were higher in Indians and Malays compared to Chinese (p<0.001). The prevalence of moderate-retinopathy below HbA1c <6.5% was <1% in all ethnic groups. At HbA1c ≥6.5%, the sensitivity for detecting moderate-retinopathy was lower in Chinese compared to Indians and Malays (75.8% vs. 86.0%, 85.3%), but specificity (89.7% vs. 71.9%, 76.3%) was higher; however, PPV and NPV were similar among Chinese, Indians, and Malays (10.5%, 12.3%, 12.4%; 99.6%, 99.1%, 99.2%). The AUCs were similar across all three ethnic groups (0.861, 0.851 and 0.853). Conclusions: Our study supports the use of HbA1c for diagnosing diabetes in Asians. Despite some inter-ethnic variation in the relationship of HbA1c and retinopathy, a cut-point of 6.5% performs reasonably well in the three major Asian ethnic groups.
    The Journal of clinical endocrinology and metabolism. 11/2014;
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    ABSTRACT: Previous longitudinal studies suggest that depression and anxiety are associated with risk for cardiovascular disease. The aim of the present study was to test whether an association between depression and anxiety symptoms and retinal vessel caliber, an indicator of subclinical cardiovascular risk, is apparent as early as adolescence and young adulthood.
    Psychosomatic medicine. 11/2014;
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    ABSTRACT: To examine the impact of glaucoma and visual acuity (VA) and visual field (VF) losses on psychosocial functioning (PF). Cross-sectional study. We compared PF between 192 participants with bilateral glaucoma with VA or VF losses and 40 controls from a tertiary eye hospital clinic in Singapore. Glaucoma was defined using the Hodapp-Anderson-Parish criteria. Four psychosocial outcomes of the Glaucoma Quality of Life 36 questionnaire were psychometrically assessed using Rasch analysis. Multivariate regression was performed to determine the independent impact of glaucoma and VA and VF losses on PF. The impact of VA and VF on PF were evaluated by restricted cubic spline analysis. Anxiety, self-image, psychological well-being, and confidence in health care. The mean age of participants was 66.2±11.0 years, and 63% were male. In the better eye, VA and mean deviation were Snellen 20/25 and -8.89±6.52 dB, respectively. In multivariate models, glaucoma patients had 63.0% greater anxiety (95% confidence interval [CI], -66.0% to -61.2%; P < 0.001), 71.0% lower self-image (95% CI, -74.1% to -68.5%; P < 0.001), 38.3% less psychological well-being (95% CI, -37.4% to -39.0%; P < 0.001), and 32.4% reduced confidence in health care than patients without glaucoma. The worst VA and VF categories had the most reduced PF (range, 26.0%-81.5%; P < 0.001 for all associations) compared with controls. With worsening VA, there was a linear increase in anxiety (P = 0.009) and decrease in self-image (P = 0.005). With worsening VF from 0 to -12.1 dB (P = 0.003), anxiety increased before plateauing. Self-image decreased as VF worsened from 0 to -10 dB (P < 0.001), and confidence in health care decreased when VF worsened from 0 to -9.3 dB (P = 0.008). However, self-image and confidence in health care actually improved at greater levels of VF loss beyond these thresholds. Glaucoma negatively affects PF. Early stage glaucoma with mild VF loss adversely affects anxiety, self-image, and confidence in health care. As VA worsens in advanced glaucoma, anxiety further increases and self-image deteriorates. Ophthalmologists and glaucoma patients need to be aware that both VA and VF losses at different stages of glaucoma negatively impact PF. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
    Ophthalmology 11/2014; · 5.56 Impact Factor
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    ABSTRACT: Purpose:To examine the associations between iris surface features with anterior chamber angle width in Asian eyes. Methods:In this prospective cross-sectional study, we recruited 600 subjects from a large population-based study, the Singapore Epidemiology of Eye Diseases (SEED) study. We obtained standardized digital slit-lamp iris photographs and graded the iris crypts (by number and size), furrows (by number and circumferential extent), and color (higher grade denoting darker iris). Vertical and horizontal cross-sections of anterior chamber were imaged using anterior segment optical coherence tomography. Angle opening distance (AOD), angle recess area (ARA), and trabecular-iris space area (TISA) were measured using customized software. Associations of the angle width with the iris surface features in the subject's right eyes were assessed using linear regression analysis. Results:464 eyes of the 464 subjects (mean age: 57.5±8.6 years) had complete and gradable data for crypts and color, and 423 eyes had gradable data for furrows. After adjustment for age, gender, ethnicity, pupil size, and corneal arcus, higher crypt grade was independently associated with wider AOD750 (β [change in angle width per grade higher] = 0.018, P=0.023), ARA750 (β=0.022, P=0.049) and TISA750 (β=0.011, P=0.019), and darker iris was associated narrower ARA750 (β=-0.025, P=0.044) and TISA750 (β=-0.013, P=0.011). Conclusions:Iris surface features, assessed and measured from slit lamp photographs, correlated well with anterior chamber angle width; irises with more crypts and lighter color were associated with wider angle. These findings may provide another imaging modality to assess angle closure risk based on iris surface features.
    Investigative ophthalmology & visual science. 10/2014;
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    ABSTRACT: Intravitreal triamcinolone acetonide (IVTA) is an effective treatment for recalcitrant diabetic macular oedema (DMO). It has been shown to improve vision with benefits persisting up to five years. The most common initial side effect of IVTA treatment is rise in intraocular pressure, occurring in approximately 50% of patients within the first 6 months of treatment. We evaluated whether there is a correlation between the development of intraocular pressure rise and improvement in vision.
    BMC Ophthalmology 10/2014; 14(1):123. · 1.44 Impact Factor
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    ABSTRACT: GWAS have identified a breast cancer susceptibility locus on 2q35. Here we report the fine mapping of this locus using data from 101,943 subjects from 50 case-control studies. We genotype 276 SNPs using the 'iCOGS' genotyping array and impute genotypes for a further 1,284 using 1000 Genomes Project data. All but two, strongly correlated SNPs (rs4442975 G/T and rs6721996 G/A) are excluded as candidate causal variants at odds against >100:1. The best functional candidate, rs4442975, is associated with oestrogen receptor positive (ER+) disease with an odds ratio (OR) in Europeans of 0.85 (95% confidence interval=0.84-0.87; P=1.7 × 10(-43)) per t-allele. This SNP flanks a transcriptional enhancer that physically interacts with the promoter of IGFBP5 (encoding insulin-like growth factor-binding protein 5) and displays allele-specific gene expression, FOXA1 binding and chromatin looping. Evidence suggests that the g-allele confers increased breast cancer susceptibility through relative downregulation of IGFBP5, a gene with known roles in breast cell biology.
    Nat Commun. 09/2014;
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    ABSTRACT: Purpose:Substantial progress has been made in identifying susceptibility variants for age-related macular degeneration (AMD) in European populations; however, few studies have been conducted to understand the role these variants play in AMD risk in diverse populations. The present study aims to examine AMD risk across diverse populations in known and suspected AMD complement factor and lipid-related loci. Methods:Targeted genotyping was performed across study sites for AMD and lipid trait-associated SNPs. Genetic association tests were performed at individual sites and then meta-analyzed using logistic regression assuming an additive genetic model stratified by self-described race/ethnicity to determine risk of any AMD. Participants included cases with early or late AMD and controls with no signs of AMD as determined by fundus photography. Populations included in this study were European Americans, African Americans, Mexican Americans, and Singaporeans from the Population Architecture using Genomics and Epidemiology (PAGE) study. Results:AMD index variants rs1061170 (CFH) and rs10490924 (ARMS2) were associated with AMD at p=3.05x10-8 and p=6.36x10-6, respectively, in European Americans. In general, none of the major AMD index variants generalized to our non-European populations with the exception of rs10490924 in Mexican Americans (p<0.05). Four lipid-associated SNPs (LPL rs328, TRIB1 rs6987702, CETP rs1800775, and KCTD10/MVK rs2338104) were associated with AMD in African Americans and Mexican Americans at a liberal significance threshold (p<0.05). Conclusions:While most associations did not generalize in the non-European populations, variants within lipid-related genes were found to be associated with AMD. This study highlights the need for larger well-powered studies in non-European populations.
    Investigative Ophthalmology &amp Visual Science 09/2014; · 3.44 Impact Factor
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    ABSTRACT: To investigate the relationship between metabolic syndrome (MetS) and its components with the risk of early- and late-stage age-related macular degeneration (AMD).
    Retina (Philadelphia, Pa.) 09/2014; · 2.93 Impact Factor
  • Pediatric Diabetes 09/2014; 15 Suppl 20:257-69. · 2.08 Impact Factor
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    ABSTRACT: Purpose This study investigated the responses of retinal vessels to flickering light in diabetic patients with various stages of diabetic retinopathy (DR). Methods This cross-sectional observational study evaluated adult subjects with diabetes mellitus. The Dynamic Vessel Analyser (DVA) was used to measure retinal vascular dilatation in response to diffuse illuminance flicker. DR was graded from retinal photography. Results There were 279 subjects in total, with a mean age of 59.9±9.2 years. The majority were male (73%) and the mean HbA1c level and mean duration of diabetes were 7.7±1.4% and 13.9±10.4 years respectively. After adjustments for age, sex, smoking, duration of diabetes, HbA1c, hypertension and hyperlipidemia, the responses of both retinal arterioles and venules to flicker stimulation decreased continuously with increasing stages of diabetic retinopathy.(p = 0.008 and <0.001 respectively). Subjects with reduced arteriolar dilation responses were more likely to have any DR [odds ratio, OR, 1.20, (95% confidence interval, CI, 1.01 - 1.45), p=0.045, per standard deviation (SD) decrease]. Subjects with reduced venular dilation responses were more likely to have any DR, moderate DR or vision-threatening DR [OR 1.27(1.04 - 1.53), p=0.02; OR1.27 (1.06 - 1.49), p = 0.007; and OR1.51(1.14 - 1.50), p = 0.002; per SD decrease, respectively]. Conclusion The responses of retinal arterioles and venules to flickering light are reduced in subjects with DR, and decrease progressively with more severe stages of DR.
    Investigative ophthalmology & visual science. 07/2014;
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    ABSTRACT: Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm.
    The British journal of ophthalmology. 07/2014;
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    ABSTRACT: Glaucoma is the leading cause of global irreversible blindness. Present estimates of global glaucoma prevalence are not up-to-date and focused mainly on European ancestry populations. We systematically examined the global prevalence of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and projected the number of affected people in 2020 and 2040.
    Ophthalmology 06/2014; · 5.56 Impact Factor
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    ABSTRACT: Purpose: To compare early age-related macular degeneration (AMD) lesion characteristics between white Australians and Singaporean Asians. Methods: Participants of the Blue Mountains Eye Study (BMES; whites, n=3508) and the Singapore Epidemiology of Eye Disease Study (SEED, Malay, n=3280, Indian, n=3400 and Chinese, n=3353) underwent examinations including retinal photography. AMD lesions were assessed following the Wisconsin AMD grading protocol by the same photographic grader. Prevalence and characteristics of early AMD lesions were compared between the BMES and the SEED. The associations between ethnicity and early AMD lesion types were analyzed using logistic regression models adjusting for age, sex, smoking status, lipids and genetic polymorphisms associated with AMD. Results: After age-standardization to the BMES population, the prevalence of distinct soft drusen was significantly higher in Singaporeans compared to Australians (23.9%, 95% confidence interval (CI) 22.9-25.0 versus 6.2%, 95% CI 5.3-7.0), with an adjusted odds ratio (OR) 4.6 (95% CI 3.4-6.0). In contrast, the prevalence of indistinct soft or reticular drusen was significantly lower in Singaporeans compared to Australians (6.5%, 95% CI 5.9-7.1 versus 8.3%, 95% CI 7.4-9.3, with non-significant adjusted OR 1.2, 95% CI 0.8-1.7). Soft drusen of any type were frequently present at the inner and outer macula (within a zone ≥500µm to <3000µm radius from the foveal centre) among Singaporeans, while among Australians soft drusen were more frequently present at the central macula (<500µm radius). Conclusion: Singaporean Asians had a milder spectrum of early AMD lesions and lesion characteristics (predominantly distinct soft drusen and non-central location) compared to white Australians.
    Investigative ophthalmology & visual science. 06/2014;
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    ABSTRACT: Diabetic neuropathy, nephropathy and retinopathy cause significant morbidity in patients with type 1 diabetes, even though improvements in treatment modalities delay the appearance and reduce the severity of these complications. To prevent or further delay the onset, it is necessary to better understand common underlying pathogenesis and to discover pre-clinical biomarkers of these complications.Retinal vessel calibers have been associated with the presence of microvascular complications but their long-term predictive value has only been sparsely investigated.We examined retinal vessel calibers as 16-year predictors of diabetic nephropathy, neuropathy and proliferative retinopathy in a young population-based Danish cohort with type 1 diabetes. We used semi-automated computer software to analyze vessel diameters on baseline retinal photos. Calibers of all vessels coursing through a zone 0.5-1 disc diameter from the disc margin were measured and summarized as the central artery and vein equivalents.In multiple regression analyzes we found both wider venular diameters and smaller arteriolar diameters to be predictive of the 16-year development of nephropathy, neuropathy and proliferative retinopathy. Early retinal vessel caliber changes are seemingly early markers of microvascular processes, precede the development of microvascular complications and a potential non-invasive predictive test on future risk of diabetic retinopathy, neuropathy and nephropathy.
    Diabetes 06/2014; · 7.90 Impact Factor
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    ABSTRACT: Common variation at the 11p11.2 locus, encompassing MADD, ACP2, NR1H3, MYBPC3, and SPI1, has been associated in genome-wide association studies with fasting glucose and insulin (FI). In the Cohorts for Heart and Aging Research in Genomic Epidemiology Targeted Sequencing Study, we sequenced 5 gene regions at 11p11.2 to identify rare, potentially functional variants influencing fasting glucose or FI levels.
    Circulation Cardiovascular Genetics 06/2014; 7(3):374-82. · 6.73 Impact Factor
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    ABSTRACT: Body mass index (BMI) is an established risk factor for diabetes. However, the association between BMI and diabetic retinopathy (DR) has been inconclusive. We aimed to assess the association between BMI and DR in a large population-based sample of multi-ethnic Asian adults in Singapore. We examined 2,278 adults aged ≥40 years with diabetes who participated in three population-based studies conducted from 2004 to 2011: the Singapore Malay Eye Study, the Singapore Indian Eye Study, and the Singapore Chinese Eye Study. Retinal photographs taken from both eyes were graded for any and vision-threatening (VTDR) using the modified Airlie House Classification. BMI (kg/m(2)) was categorized into normal/underweight (<25), overweight (25-29.9), and obese (≥30). The prevalence rates of any and VTDR in the study population were 35.1 % and 9.1 %, respectively. The prevalence of any and VTDR decreased with increasing categories of BMI (P trend <0.001 and 0.005). In multivariable models adjusted for potential confounders, compared to those with normal weight, the odds ratio (95 % confidence interval) of any DR was 0.71 (0.57-0.88) for overweight and 0.70 (0.53-0.92) for obese. Corresponding estimates for VTDR were 0.84 (0.59-1.21) for overweight and 0.58 (0.35-0.94) for obese. The inverse association between BMI and any DR was consistently present when BMI was analyzed as a continuous variable and in analyses stratified by ethnicity and age. In a population-based sample of multi-ethnic Asian adults, BMI levels were inversely associated with any DR and VTDR.
    Acta diabetologica. 06/2014;
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    ABSTRACT: Age-related macular degeneration (AMD) and chronic kidney disease both involve immune dysregulation and may share underlying pathophysiologic changes to systemic homeostasis. Hence, we aim to evaluate associations between impaired kidney function and early AMD, in a search for urinary biomarkers for AMD.
    Optometry and vision science: official publication of the American Academy of Optometry 05/2014; · 1.53 Impact Factor
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    ABSTRACT: Few studies have examined the impact of chronic kidney disease (CKD) on adverse cardiovascular outcomes and deaths in Asian populations. We evaluated the associations of CKD with cardiovascular disease (CVD) and all-cause mortality in a multi-ethnic Asian population.
    European Journal of Preventive Cardiology 05/2014; · 3.90 Impact Factor
  • Ning Cheung, Ian Y Wong, Tien Y Wong
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    ABSTRACT: Ocular anti-vascular endothelial growth factor (VEGF) therapy represents one of the most significant advances in modern medicine. The introduction and widespread use of ocular anti-VEGF therapy for age-related macular degeneration heralded a new era in the treatment of vascular and exudative diseases of the retina. Its expanding indications now include diabetic macular edema and proliferative diabetic retinopathy, two vision-threatening forms of diabetic retinopathy. It is widely anticipated that ocular anti-VEGF therapy could spark a dramatic shift in the treatment paradigm for diabetic retinopathy. However, despite its clear efficacy shown in clinical trials, the dynamic landscape of evolving medical, ethical, and economic issues related to this new treatment suggests significant challenges ahead. In this article, we provide a discussion of this topic as part of this two-part Bench to Clinic narrative. Here, our Clinic contribution provides an overview of the current evidence from clinical trials on anti-VEGF therapy for diabetic retinopathy, and highlights the hopes and fears of this new treatment from clinical and public health standpoints. In the Bench narrative that precedes this contribution, Simó et al. provide an overview of the role of VEGF in the pathogenesis of diabetic retinopathy.
    Diabetes care 04/2014; 37(4):900-5. · 7.74 Impact Factor

Publication Stats

8k Citations
2,690.29 Total Impact Points

Institutions

  • 2013–2014
    • Centre for Eye Research Australia
      Melbourne, Victoria, Australia
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
    • Queensland Institute of Medical Research
      Brisbane, Queensland, Australia
    • University of Newcastle
      • Centre for Clinical Epidemiology and Biostatistics
      Newcastle, New South Wales, Australia
  • 2012–2014
    • Duke-NUS Graduate Medical School Singapore
      Tumasik, Singapore
    • Sun Yat-Sen University
      Shengcheng, Guangdong, China
    • The Chinese University of Hong Kong
      • Department of Ophthalmology and Visual Sciences
      Hong Kong, Hong Kong
    • University of North Carolina at Chapel Hill
      • Department of Epidemiology
      Chapel Hill, NC, United States
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2008–2014
    • Singapore Eye Research Institute
      Tumasik, Singapore
    • Swansea University
      Swansea, Wales, United Kingdom
    • Monash University (Australia)
      • Department of Epidemiology and Preventive Medicine
      Melbourne, Victoria, Australia
  • 2004–2014
    • University of Melbourne
      • • Centre for Eye Research Australia
      • • Department of Ophthalmology
      Melbourne, Victoria, Australia
  • 2003–2014
    • Singapore National Eye Centre
      Tumasik, Singapore
  • 2011–2013
    • National University Health System
      Singapore
    • Massachusetts Eye and Ear Infirmary
      • Department of Ophthalmology
      Boston, MA, United States
  • 2007–2013
    • Royal Victorian Eye and Ear Hospital
      Melbourne, Victoria, Australia
    • Diabetes Australia, Victoria
      Melbourne, Victoria, Australia
  • 2006–2013
    • Westmead Millennium Institute
      Sydney, New South Wales, Australia
  • 2005–2013
    • Westmead Hospital
      • Department of Ophthalmology
      Sydney, New South Wales, Australia
  • 2003–2013
    • University of Sydney
      • • Centre for Vision Research
      • • Save Sight Institute
      • • School of Public Health
      Sydney, New South Wales, Australia
  • 2011–2012
    • Khoo Teck Puat Hospital
      Tumasik, Singapore
  • 2006–2011
    • National University of Singapore
      • • Department of Ophthalmology
      • • Singapore Eye Research Institute
      Tumasik, Singapore
  • 2003–2011
    • University of Wisconsin, Madison
      • Department of Ophthalmology and Visual Sciences
      Madison, MS, United States
  • 2010
    • University of Minnesota Twin Cities
      • Division of Epidemiology and Community Health
      Minneapolis, MN, United States
    • University of Michigan
      • Department of Biostatistics
      Ann Arbor, MI, United States
    • Odense University Hospital
      • Department of Ophthalmology - E
      Odense, South Denmark, Denmark
    • Singapore Institute for Clinical Sciences
      Tumasik, Singapore
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • Queen's University Belfast
      • Centre for Vision and Vascular Science
      Belfast, NIR, United Kingdom
    • Erasmus MC
      • Department of Epidemiology
      Rotterdam, South Holland, Netherlands
  • 2009–2010
    • University of New South Wales
      • Faculty of Medicine
      Kensington, New South Wales, Australia
    • Sydney Hospital & Sydney Eye Hospital
      Sydney, New South Wales, Australia
    • Gloucestershire Hospitals NHS Foundation Trust
      Gloucester, England, United Kingdom
    • Baker IDI Heart and Diabetes Institute
      Melbourne, Victoria, Australia
    • Tan Tock Seng Hospital
      Tumasik, Singapore
    • Princess Alexandra Hospital (Queensland Health)
      • Division of Medicine
      Brisbane, Queensland, Australia
  • 2007–2010
    • Victoria University Melbourne
      Melbourne, Victoria, Australia
  • 2006–2009
    • Imperial College London
      • Faculty of Medicine
      London, ENG, United Kingdom