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International Council of Ophthalmology Draft Meeting Minutes, July 20 - 21, 2001, Buenos Aires, Argentina

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• APPENDIX VFTF - 5: "Aspirational" Goal
  Research
  
  
• 1. Evaluative Research
  
  
• 2. Operational Research
  
  
• 3. Discovery Research

APPENDIX VFTF - 5: "Aspirational" Goal
Research

The enormous research opportunities and challenges for International Ophthalmology might conveniently (and arbitrarily) be classified into three main categories. Our success, and the benefits to society, will largely depend upon the degree to which these are implemented at the local and global levels.

1. Evaluative Research

Largely utilizing epidemiologic and statistical techniques, guided by ophthalmic concerns and insights, these endeavors would determine at national and regional (and less critically, global) levels:

• the magnitude and etiology of visual impairment;
  
  
• the available resources and programs for preventing/treating the major causes of preventable and remedial visual impairment;
  
  
• resource needs (human, financial, technological) for providing access, and mobilizing compliance, to address the gap between the existing magnitude of visual impairment and that which can be achieved if all that we know how to do was implemented and made accessible to the entire population;
  
  
• the degree to which "process" indicators demonstrate success of new and existing programs (are they operating in the ways expected to yield access and quality?);
  
  
• the degree to which "outcome" indicators demonstrate success of new and existing programs (are they achieving high quality outcomes among those they care for?);
  
  
• progress made towards meeting the needs of the population as a whole [to what degree do existing programs address visual needs of the population: preventing all visual impairment that is "preventable," treating all ocular disease that is treatable (in a timely and effective manner)]. This might be termed "Impact Research."

In essence, "Evaluative Research" establishes "how well we are doing" in using existing knowledge and technology to meet the needs of preventing and treating unnecessarily visual impairment.

2. Operational Research

There is often a large gap between high-quality, expensive, sophisticated technology and simplified, inexpensive approaches to providing essentially the same level of benefit.

By example, low-cost production of a more limited range of otherwise high-quality intraocular lenses reduced the market price of IOLs from approximately $150 - $350 to $5 - $10, making IOL surgery the accepted standard and "norm" for even the poorest countries.

Similarly, innovative pricing and marketing schemes, pioneered by the Aravind Eye Hospital, and subsequently LV Prasad and Al Noor, established market-based finance systems for sustainable high-quality outcome cataract surgery.

Albrecht Hennig, and Ruit, in two widely separated centers in Nepal, refined techniques for high through-put, high-quality, sutureless IOL cataract surgery at low cost (8 to 13 operations per hour at a fully loaded cost of $25 - $50).

Operational research provides enormous opportunities to ophthalmologists in all nations to develop innovative, high quality and impact, cost-effective techniques for refining existing approaches to the delivery and treatment and preventive services, whether for cataract, glaucoma, trachoma, or other ocular conditions.

3. Discovery Research

Virtually every cause of visual impairment would benefit from new insight into their etiology, prevention, and treatment.

• Conditions for which no interventions exist: Macular degeneration is perhaps the most crucial problem lacking effective intervention: The magnitude of this problem will grow dramatically as all populations "age"and more amenable conditions yield to treatment and prevention. Other concerns awaiting initial, successful interventions include retinitis pigmentosa and related problems.
  
  
• Conditions for which interventions exist, but their benefits are far from satisfactory: The glaucomas are perhaps the prime example, though many others exist.
  
  
• Conditions for which suitable treatments already exist, but primary prevention would be far more effective and satisfactory: cataract, diabetic retinopathy, etc.

Each of these three research domains are critical to achieving optimal vision among local and global populations.

Each is presently being pursued, but in an uncoordinated manner that is egregiously underfunded compared with past accomplishments and future promise.

The degree to which International Ophthalmology can pursue all three categories of essential visual research, it will benefit society and advance the health and well being of all peoples.

A. Sommer
Draft – 4/23/01

Next: Minutes of May 20, 2000 Meeting of International Council of Ophthalmology, Jerusalem, Israel

Also see:

• Report of July 20, 2001 Meeting on Vision for the Future
  
  
• ICO Minutes, July 20 - 21, 2001