Op-Ed: Congress Must Not Dismantle America's Vision Research Crown Jewel
Editor's Note: The following is an Op-Ed submitted by Stephen McLeod, MD, CEO of the American Academy of Ophthalmology (AAO), in response to a recent proposal by the Trump Administration that calls for cuts to the National Institutes of Health and consolidation of the federal government’s 27 institutes into just eight. This includes folding the National Eye Institute into a new broader institute on neuroscience and brain research. Dr. McLeod provided additional commentary on the matter on a recent EyewireTV episode.
A 57-Year Investment in American Lives and Innovation
In 1968, Congress created the National Eye Institute (NEI) to solve a critical problem: The nation was falling behind in vision research. At a time when science was advancing rapidly, too many promising, vision-saving research opportunities were being missed and left unfunded.
One can draw a direct line from that decision – to carve out and fund a special position within the organizational structure of the National Institutes of Health (NIH) – to America’s standing today as a global leader in vision research.
NEI-powered research touches countless lives with vision saved, and moves us closer to disease cures, next-generation technology and improved quality of life for all Americans.
That’s why the American Academy of Ophthalmology staunchly opposes any proposal to consolidate the NEI into a broader Institute on Neuroscience and Brain Research. Eliminating NEI as an independent institute threatens to dismantle 57 years of progress.
Vision Loss Will Impact Millions More Americans
Now is not the time to devalue vision research. As our population ages, nearly every American will personally face a visual disease or disorder.
The economic and societal costs of vision impairment and eye disease are significant and growing. By 2050, without effective interventions, the CDC estimates there will be:
- A 72% increase in diabetic retinopathy
- An 87% increase in cataracts
- A 100% increase in glaucoma
- A 100% increase in age-related macular degeneration
- An overall 150% increase in vision impairment and blindness
Adequately funding NEI can prevent billions in expenditures across Medicare and Medicaid, private insurance, and family care costs. Vision loss is expected to cost the U.S. economy nearly $200 billion in 2025 alone through direct medical expenses and lost productivity.
Proven Returns: How NEI Research Delivers Extraordinary Value
To fully appreciate the far-reaching benefits and high return on investment that NEI funding for eye research provides, take the example of ocular coherence tomography (OCT), a non-invasive imaging technology used to evaluate eye health.
OCT is a quick scan that takes only a few seconds for patients but gives a detailed look into the back of the eye that allows ophthalmologists to catch eye disease earlier when it’s easier to treat, and to guide treatment for established disease. OCT has revolutionized treatment of the three leading causes of blindness in America – age-related macular degeneration (AMD), glaucoma and diabetic eye disease.
Its uses are not confined to eye diseases. Researchers continue to push the limits of OCT, using it to detect other conditions showing signals in the eye, including heart disease, kidney disease, stroke risk, multiple sclerosis, Alzheimer and Parkinson disease, expanding opportunities for future treatments.
The National Science Foundation and NEI provided about $400 million in grants to support OCT’s development over 20 years. Those grants yielded an initial 21-fold return on investment when considering just one eye condition, age-related macular degeneration (AMD). Here’s how:
Patients suffering from AMD are treated with a class of drugs called anti-VEGFs, a treatment for which NEI funding paved the way. These are powerful drugs that stop vision loss in more than 90 percent of patients with AMD and improves vision in about one-third.
By using OCT to guide when individual patients need anti-VEGF treatment, a 2016 study showed Medicare has saved around $9 billion over a period from 2008 to 2015. Patients benefited from reduced copayments for anti-VEGF drugs, leading to savings of approximately $2.2 billion between 2008 and 2015.
OCT enables ophthalmologists to provide personalized care that not only protects countless Americans from vision loss but also saves them a lot of money.
No Time to Cede Leadership: Gene Therapy and AI Breakthroughs on the Horizon
As technology rapidly advances, NEI guidance and investment in gene therapy and artificial intelligence promise even greater returns for the American people.
NEI-supported scientists have used gene therapy to partially restore vision – for the very first time – to people with a blinding disease that begins in childhood, called Leber's congenital amaurosis. NEI-funded researchers are now moving rapidly to develop gene therapy approaches for a range of inherited retinal diseases, such as retinitis pigmentosa.
The NEI has also been an early investor in groundbreaking work to end blindness with artificial intelligence. Since 2004, it has continuously funded the work of ophthalmologist Dr. Michael Abramoff’s pioneering research. Dr. Abramoff is the first physician in any medical field to receive FDA clearance for an autonomous artificial intelligence system. The platform, LumineticsCore™ (formerly IDX-DR), can instantly diagnose diabetic retinopathy in a primary care physician’s office, a breakthrough that could prevent vision loss in thousands of people with diabetes annually.
This is just the beginning. NEI currently funds additional AI applications for a range of eye diseases and conditions, aiming to improve diagnosis, treatment, and patients’ quality of life.
This is the bargain that Congress struck 57 years ago: Invest in an independent, vision-focused institute and advance discoveries that prevent blindness, restore sight and improve American’s lives. The reasons for creating the NEI in the first place still exist, and the NEI has delivered on its promise of scientific advances that offer both hope and effective treatment for millions. The NEI has upheld it’s end of the bargain for the American people. For the sake of the sight of millions, we expect Congress to continue upholding its end.