Even a perfunctory comparison between the leading American ophthalmology journals of today and those of only 25 years ago reveals striking differences. The dearth of female authors (and editorial board members) has to a great extent been redressed, and there has been a remarkable increase in the prevalence of authors with non-European surnames. Current journals are more cosmopolitan, with many valuable articles contributed from previously underrepresented regions of the world. However, one of the most important changes in content is the increased proportion of articles describing the results of collaborative, multi-institutional, prospective investigations designed to evaluate the treatment or epidemiology of specific diseases. While many treatment trials have industrial sponsors, the National Eye Institute is probably the main source of support for these large-scale prospective ophthalmic investigations. During the last 25 years, the National Eye Institute dedicated nearly $700 million (about 10% of the extramural budget of the institute) to support these studies.