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EDITORIALS

The 2021 National Eye Institute Strategic Plan: Fostering Collaboration in Vision Research and Clinical Care

Chiang, Michael F. MD

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doi: 10.1097/OPX.0000000000001821
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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 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 NEI Strategic Plan since 2012.2

Why do we need a new NEI Strategic Plan? Because 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 coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of investment in research, because highly effective vaccines were developed at an extraordinary pace owing 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 (Table 1). This is the first revision of NEI's mission since our founding in 1968 and begins as follows: “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.

TABLE 1 - NEI mission statement (2021)
The mission of the NEI is to eliminate vision loss and improve quality of life through vision research. To achieve this mission, NEI 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, policymakers, and the public about advances in vision research and their impact on health and quality of life.
This was developed in collaboration with internal and external stakeholders. NEI = National Eye Institute.

One component of our mission is to foster collaboration in vision research and clinical care to develop new ideas and share knowledge across other fields. So why is this important for the NEI Strategic Plan? I am fortunate to have seen the impact of collaborative research throughout my career at the interface of pediatric ophthalmology and biomedical informatics. While developing projects in retinopathy of prematurity, telehealth, artificial intelligence, and data science, I had the privilege of assembling teams including ophthalmologists, optometrists, informaticians, computer scientists, neonatologists, qualitative researchers, economists, computational biologists, geneticists, and nurses. From working with these teams on a daily basis, I have seen firsthand that novel insights can occur when people from different academic backgrounds approach problems together from different perspectives. That said, I have also recognized that meaningful interdisciplinary collaborations require longstanding commitment and thoughtful, deliberate teamwork between scientists and clinicians. At NEI, we hope to find ways to promote and incentivize this depth of collaboration.

How does this strategic plan aim to promote collaboration across fields? National Eye Institute'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 (Fig. 1).4 These NEI core areas coincide with clinical divisions of many ophthalmology and optometry departments. In developing the new strategic plan, we hope to enhance these core research programs by layering on methodological expertise with the goals of addressing challenges across the entire visual system and facilitating translation of promising findings into clinical care and population health. To accomplish this, we have organized the plan around seven cross-cutting areas of emphasis: genetics, neuroscience, immunology, regenerative medicine, data science, quality of life, and public health and health disparities. These seven 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 NEI. Rather than replacing the existing core programs, this emphasis underscores areas where interdisciplinary approaches can link mechanistic science with clinical applications (Fig. 1).

F1
FIGURE 1:
Seven cross-cutting areas of emphasis (vertical bars) in National Eye Institute Strategic Plan. These do not replace the existing core program structure (horizontal bars) but rather highlight evolving areas that will require interdisciplinary approaches.

Within each of the strategic plan's areas of emphasis, there are key methodological advances that may be applied in the visual system to improve fundamental knowledge discovery, clinical care, or population health, but what drives the strongest collaborations between scientists, or between scientists and clinicians? Of course, there are many factors. From an intellectual perspective, one key factor is the novelty of the work to each collaborator. My observation is that many proposed projects are not regarded as methodologically innovative by one partner (e.g., scientific technique is considered routine or “off-the-shelf”), despite being considered novel by the other (e.g., technique previously has never been applied to the eye). Many of the most capable researchers will be motivated by the opportunity to innovate methodologically, and we need to attract these investigators to the vision field by communicating the potential for scientific innovation and the impact of work that leads to improved outcomes for the visually impaired. My experience has been that long-standing collaborations thrive when the work is novel for all of the partners.

There are many examples of such collaborations leading to seminal innovations within the eye and visual system first, because it is an accessible setting for performing research, which can then be generalized to other areas. For example, the first Food and Drug Administration–approved autonomous artificial intelligence system was created for detecting diabetic retinopathy,5 the first Food and Drug Administration–approved gene therapy for an inherited disease targeted a retinal degeneration,6 and ocular imaging modalities are rapidly transforming clinical care and research paradigms from qualitative to quantitative.7,8 The first successful genome-wide association study that identified a variant of complement factor H conferred a risk for age-related macular degeneration.9 Subsequent genomics studies, for example, in glaucoma and myopia, have involved large consortia of clinicians, geneticists, and data scientists.10,11 It is important to recognize and highlight that research in the eye and visual system can have enormous, broader scientific impact.

Each area of emphasis in the strategic plan includes significant collaborative research potential, either by applying methodologies from other fields to the visual system or by developing novel methodologies within the visual system that can be generalized more broadly. Development of methods to integrate and analyze multimodal data sets including genetics, imaging, omics, functional testing, and clinical, environmental, and social determinants of health data has potential to yield insights about disease mechanisms and treatments in multifactorial disorders such as age-related macular degeneration, glaucoma, and myopia. The plan outlines strategies such as centers and challenge grants to bridge the gap between biomedical and data science that will evolve the fields together. Fundamental research in connectomics and neuroplasticity may result in strategies to address conditions such as amblyopia or cerebral visual impairment, which will require collaboration with colleagues from pediatrics, neuroscience, occupational therapy, education, and many other fields. Studying the specialized immune cells within the eye that maintain balance between activation and regulation may lead to applications for therapies that restore tissue homeostasis in ocular inflammatory disease. As the clinical significance of the microbiome in regulating chronic ocular inflammatory diseases becomes clearer, collaborations with microbiologists from other fields may expedite new ocular treatments. In regenerative medicine using cell-based or gene-based approaches, methodological innovation in areas such as adaptive optics, gene delivery vectors, engineering and manufacturing technologies, tissue integration, and clinical and regulatory protocols will be required. Novel advances in drug delivery, nanotechnology, microelectromechanical systems, computer vision, and artificial intelligence will facilitate development and evaluation of novel prosthetics and accessibility technologies for people who require vision rehabilitation.12

This NEI Strategic Plan aspires to empower clinicians and researchers to recognize these and other areas where they can play essential roles in the scientific processes through collaborations that will ultimately lead to improved patient outcomes. A series of parallel editorials discusses other aspects of the NEI Strategic Plan.13–16 We hope that every clinician, researcher, and stakeholder group member will review this strategic plan and consider how they can work together toward the mission of eliminating vision loss and improving quality of life for patients.2

Michael F. Chiang, MD
National Eye Institute
National Institutes of Health
Bethesda, Maryland
[email protected]

REFERENCES

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13. Chiang MF, Tumminia SJ. The 2021 National Eye Institute Strategic Plan: Eliminating Vision Loss and Improving Quality of Life. Ophthalmology 2021 [in press].
14. Chiang MF. The 2021 National Eye Institute Strategic Plan: Driving Innovation in Eye and Vision Research. Invest Ophthalmol Vis Sci 2021 [in press].
15. Chiang MF. The 2021 National Eye Institute Strategic Plan: Relating Vision to Health and Quality of Life. JAMA Ophthalmol 2021 [in press].
16. Chiang MF. The 2021 National Eye Institute Strategic Plan: Recruiting and Training a Diverse New Generation. Am J Ophthalmol 2021 [in press].
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