The 2021 National Eye Institute Strategic Plan—Relating Vision to Health and Quality of Life | Ophthalmology | JAMA Ophthalmology | JAMA Network
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Editorial
November 1, 2021

The 2021 National Eye Institute Strategic Plan—Relating Vision to Health and Quality of Life

Author Affiliations
  • 1National Eye Institute, National Institutes of Health, Bethesda, Maryland
JAMA Ophthalmol. 2021;139(12):1263-1265. doi:10.1001/jamaophthalmol.2021.4774

The National Eye Institute (NEI) has been a world leader in directing and funding eye and vision research since 1968, when Congress and President Lyndon Johnson established it as an independent entity within the National Institutes of Health (NIH) to manage national efforts in vision science.1 The current annual NEI budget is $835 million. Now in 2021, the NEI is releasing a new Strategic Plan, which outlines our directions and priorities over the next 5 years and is the first comprehensive NEI Strategic Plan since 2012.2

Why do we need a new NEI Strategic Plan? As unprecedented advances in science and computing have occurred during the past several decades, we are rapidly moving into an era where knowledge discovery is no longer limited by technology, but only by creativity. Modalities such as genetics, molecular diagnostics, information technology, and data science are providing the vision research community with unique opportunities to improve understanding of disease mechanisms, leading to novel diagnostic and therapeutic tools. The ongoing COVID-19 pandemic has demonstrated the value of investment in research, as highly effective vaccines were developed at an extraordinary pace due to decades of scientific investigation.3 At the same time, the pandemic has exposed many underlying health disparities and highlighted the importance of making scientific advances accessible to the entire population. Because of this evolving landscape in research, health care, technology, and public health, we found it vital to revise the NEI mission statement as part of developing the Strategic Plan (Box). This is the first revision of NEI’s mission since our founding in 1968, and begins: “The mission of the National Eye Institute is to eliminate vision loss and improve quality of life through vision research.” To address these opportunities and challenges, we have framed our new Strategic Plan around this mission.

Box Section Ref ID
Box.

National Eye Institute Mission Statement (2021)

  • The mission of the National Eye Institute is to eliminate vision loss and improve quality of life through vision research. To achieve this mission, the National Eye Institute provides leadership to:

  • Drive innovative research to understand the eye and visual system, prevent and treat vision diseases, and expand opportunities for people who are blind or require vision rehabilitation.

  • Foster collaboration in vision research and clinical care to develop new ideas and share knowledge across other fields.

  • Recruit, inspire, and train a talented and diverse new generation of individuals to expand and strengthen the vision workforce.

  • Educate health care providers, scientists, policy makers, and the public about advances in vision research and their impact on health and quality of life.

One component of our mission is to educate health care professionals, scientists, policy makers, and others in the public about advances in vision research and how these advances relate to health and quality of life. To most eye care professionals, the value of eyesight seems obvious. But are eye and vision health viewed as critical to a one’s overall health? As an ophthalmology resident, I was taught to consider evaluating some nonurgent inpatient consultations within the outpatient clinic after hospital discharge. The rationale seemed logical: equipment needed to address the vision complaint was available only in the clinic. Furthermore, for nonurgent vision complaints, an ophthalmologist at the bedside might interfere with managing systemic conditions that necessitated the hospital admission. Having worked in academic medical centers for 20 years, I saw these same lessons passed along to generations of trainees.

Ultimately, do these actions send an unconscious message that eye problems are somewhat less important? Since beginning my clinical practice in 2001, I have developed some insight about the personal value of vision, as a pediatric ophthalmologist working 5 to 10 hours each week in neonatal intensive care units (NICUs) fulfilling clinical duties and research interests regarding retinopathy of prematurity (ROP). Parents in NICUs are under enormous stress as their critically ill premature infants continuously face life-and-death scenarios, and often have multisystem diseases with lifelong neurologic, cardiac, or pulmonary sequelae. For these patients, intravitreal anti–vascular endothelial growth factor agents became an option for treating severe ROP after initial publications suggested improved ophthalmic outcomes compared to laser photocoagulation.4 Nevertheless, there remains uncertainty about long-term risks, such as neurodevelopmental disease.5,6 During many discussions with parents about risk-benefit trade-offs of anti–vascular endothelial growth factor injection for their infants with severe ROP, they often say: “We understand there may be other risks, but want you to do everything to help our baby grow up being able to see.”

After reflecting on experiences such as those in the NICU, I no longer question how deeply people value good eyesight, or the importance of the ophthalmology consultant at the hospital bedside. From a clinical perspective, we know vision disorders can have an enormous impact on quality of life for patients. Survey data reveal that blindness is among the conditions that individuals in the US fear the most.7,8 Vision loss is associated with increased risk of social isolation, depression, and accelerated dementia.9-12 From an emotional perspective, eyesight is a key way we experience the world. For example, I will never forget the excitement of watching my daughters taking their first steps, or how it made me feel, at 16 years old, to see the Grand Canyon for the first time. From a practical perspective, vision loss often results in diminished independence and mobility, inability to drive or read, and difficulty in communicating with or recognizing others. In our revised mission statement, we relate vision to “quality of life” to emphasize that our research is not merely focused on fighting eye disease. Instead, at NEI, we aspire to address the patient as a whole—regardless of whether they have normal vision requiring screening and health maintenance, treatable disorders requiring intervention, or currently incurable diseases requiring vision rehabilitation.

How is this important for the NEI Strategic Plan? The importance of eyesight and the chance to save or restore vision can be a motivating factor for clinicians and researchers searching for a meaningful career. The most capable investigators are likely to have many potential career pathways. We need to recruit and inspire talented people from diverse backgrounds to undertake innovative work highlighted in the Strategic Plan. With regard to a larger message to a broader community, we need to educate and inspire the public and policy makers to understand and value vision health and to support and amplify research that results from the NEI Strategic Plan. One of the first steps in communicating this message to the larger community is for our community to embrace it fully.

How does this Strategic Plan aim to promote collaboration across fields? NEI’s core research program areas are currently organized by anatomy and disease: retina; cornea; lens and cataract; glaucoma and optic neuropathy; strabismus, amblyopia, and visual processing; and vision rehabilitation (Figure).13 These NEI core areas coincide with clinical divisions of many ophthalmology and optometry departments. The new Strategic Plan may enhance these core research programs by layering on methodological expertise with goals of addressing challenges across the entire visual system, facilitating translation of promising findings into clinical care and population health. To accomplish this, we have organized the plan around 7 cross-cutting areas of emphasis: genetics, neuroscience, immunology, regenerative medicine, data science, quality of life, and public health and health disparities. These 7 areas are tracks of study that resemble the structure of most university basic science programs. By identifying these areas of emphasis, we aim to highlight important perspectives and expertise that complement the existing core portfolio at the NEI. Rather than replacing existing core programs, this emphasis underscores areas where interdisciplinary approaches can link mechanistic science with clinical applications.

Figure.  Seven Cross-Cutting Areas of Emphasis (Vertical Bars) in the National Eye Institute Strategic Plan
Seven Cross-Cutting Areas of Emphasis (Vertical Bars) in the National Eye Institute Strategic Plan

These areas of emphasis do not replace the existing core program structure (horizontal bars) but, rather, highlight evolving areas that will require interdisciplinary approaches.

In each of the Strategic Plan’s areas of emphasis are examples where innovative approaches may result in progress toward eliminating vision loss. We are moving beyond identifying genetic risk factors for ocular disease toward developing tools to decipher complex disease mechanisms that may lead to novel therapies. Advances in neural connectomics are creating opportunities to focus on plasticity, ability of neurons to reconnect after damage from injury or disease. The eye has its own specialized immune cells that maintain balance between activation and regulation. This mechanistic science may lead to corticosteroid therapy alternatives without adverse effects such as cataract or glaucoma. In regenerative medicine, we are starting to translate research in induced pluripotent stem cells and gene therapy into treatment strategies for patients with inherited retinal dystrophies, age-related macular degeneration, or other disorders. The unprecedented availability of “big data” supports a revolution in artificial intelligence for diagnosis and creating new paradigms for knowledge discovery. Understanding social determinants of vision care and eye health, and their relationship to clinical and genetic factors, may help improve health equity and access to care. While vision research is often focused on preventing or reversing disease, the Individual Quality of Life area of emphasis aims to empower patients as partners and to expand the NEI behavioral and social science portfolio. For example, there is growing recognition about the value of incorporating patient perspectives in vision-related quality-of-life assessments for clinical research studies and patient-reported outcomes for measuring quality of care. For individuals with low vision, mobile technologies using cameras, data analytics, and computer vision to identify objects in the environment may expand accessibility options and improve education, employment, and safety.

Overall, our NEI Strategic Plan is intended to not only stimulate vision research, but also communicate its impact to a broad audience including scientists, clinicians, trainees, policy makers, and others in the general public. We particularly hope to communicate that vision has a substantial impact on quality of life, and highlight our focus on individuals as a whole—beyond their disease. A series of parallel articles discusses other aspects of the NEI Strategic Plan.14-17 We hope every clinician, researcher, and stakeholder group member will review this plan,2 recognize and advocate for the importance of vision, and consider how they can contribute to the mission of eliminating vision loss and improving quality of life.

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Article Information

Corresponding Author: Michael F. Chiang, MD, National Eye Institute, National Institutes of Health, 31 Center Dr, MSC 2510, Bldg 31, Room 6A03, Bethesda, MD 20892 (michael.chiang@nih.gov).

Published Online: November 1, 2021. doi:10.1001/jamaophthalmol.2021.4774

Conflict of Interest Disclosures: Dr Chiang previously received grant funding from the National Institutes of Health, National Science Foundation, and Genentech, was previously a consultant with Novartis, and was previously an equity owner with InTeleretina, LLC.

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