Research for Global Blindness Prevention:

General Introduction to the Research Agenda

On this page:

• Operations Research
  
  
• Epidemiologic Risk Profile
  
  
• Basic Biologic Research
  
  
• Population Access and Appropriate Intervention

The Committee broadly divided its research priorities into three general domains:

Operations research:

Operations research responds largely to challenges posed by the fact that technology exists for preventing and treating/reversing visually impairing ocular disease and conditions, but for a variety of reasons, usually social, cultural, organizational or economic, large populations are not benefiting from this knowledge.

A classic example is cataract, the single largest cause of blindness in the world.

Operational research opportunities include ways in which to make surgical treatment less costly and more widely available.

Operational research opportunities will generally yield useful, practical knowledge in the short- to medium-term.

At present, there is little investment in operations research of visual problems, despite enormous opportunities for return on that investment.

Operations research, particularly applied to delivery of cataract surgical services, is probably the single greatest research opportunity at present, and would yield enormous benefits to global blindness prevention programs in the near term.

Epidemiologic risk profile:

Epidemiologic studies include carefully designed, randomized trials (e.g., the relative ease, success, cost and benefit of aphakic vs. pseudophakic surgery; or phacoemulsification vs. extracapsular sutureless surgery).

The benefits of such clinical studies can be expected in the short-term.

More innovative epidemiologic studies seek to identify underlying causal factors of human disease (e.g., why does blinding trachoma disappear "spontaneously" with seemingly small improvements in socioeconomic status?; or why do some, seemingly genetically similar populations suffer radically different rates of cataract?).

Such classic epidemiologic studies (migrant studies, twin studies, etc.) are powerful tools for obtaining biologically important insights. A classic example was the recognition that the use of diethylstilbesterol in mothers was responsible for the subsequent epidemic of vaginal cancer in their offspring.

Epidemiologic studies seeking to identify causal environmental/behavioral agents are generally medium-term endeavors.

Basic biologic research:

Basic "mechanistic" research seeks to understand biologic mechanisms. Fundamental research discoveries are often serendipitous, but when they occur, may provide dramatic new modalities for understanding and preventing disease.

Understanding lens physiology may one day provide insights that will permit prevention of cataractogenesis. Such research is generally of a long-term nature.

In general, the Committee considered basic, mechanistic, long-term research worth highlighting, but largely beyond its purview. The need for conducting such research is well established and will progress regardless of this Committee's attention.

The Committee spent more effort identifying opportunities in operational and epidemiologic research, which are neither well recognized nor well funded, and offer the most immediate opportunities for facilitating blindness prevention today and in the short- to medium-term.

Population access and appropriate intervention:

The Committee's greatest concern was identifying research opportunities that would benefit underserved populations of poor countries.

Some interventions, while not appropriate for mass application to the rural poor, are nonetheless applicable to wealthier segments of society with greater access to sophisticated eye care services.

Those with such access should receive appropriate care, as defined in the International Clinical Guidelines.

At this moment, research related to these issues are higher priorities for wealthier countries, though, for a variety of ethically and scientifically compelling reasons, it may be appropriate to conduct related research in poor populations.

Next: Clinical Conditions: 1. Cataract

Also see: Table of Contents of the Research Agenda for Global Blindness Prevention