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Ophthalmic Research: Usa
EDITORIALS
price of our great progress in cataract sur gery. It is possible, of course, that we can say also that in these days the loss of an eye is a small price to pay for progress (provided it isn't your eye or mine that is lost). I am thinking particularly of the progress made in surgical cure of retinal detachment, es pecially in the basic principles involved. It is, however, the stern and unrelievable duty of the "spectaculars" to report their bad cases (as well as their good ones) as soon as possible. Better yet, not to report their cases, except for the failures, until re sults are conclusive, and best yet not to do "spectaculars" at all, if some safer and more conservative, tried and true method, will do about the same job. Let us all have reverence for sight. Any thing less than this is unforgivable. Derrick Vail.
OPHTHALMIC RESEARCH: USA OPHTHALMIC RESEARCH : U S A . By Thomas David Duane, M.D, Ph.D. A report to the Trus tees of Research to Prevent Bündness, Inc. 598 Madison Avenue, New York, New York 10022.
Research to Prevent Blindness, Inc., was established in 1960 by a former practicing ophthalmologist, Jules C. Stein, chairman of the Board of Music Corporation of Amer ica, and Robert E. McCormack, then execu tive vice-president of Olin Mathieson. They were aided by James S. Adams and Mrs. Albert Lasker, both of whom played a major advisory role in the establishment and growth of the National Institutes of Health. The initial staff work was carried out by Dr. C. J . Van Slyke, formerly deputy direc tor of the National Institutes of Health and Mefford R. Runyon, formerly executive di rector of the American Cancer Society. Re search to Prevent Blindness thus brought to ophthalmic research individuals of long ex perience in finance, philanthropy and the Federal research establishment.
945
This group commissioned Thomas D. Duane, professor and head of ophthal mology at the Jefferson Medical College to survey the state of research in ophthal mology in the United States. During 1963, Duane provided a detailed questionnaire concerning research to each of the medical colleges in the United States and some 31 additional groups such as hospitals, research institutes and the like engaged in ophthalmic research. The questionnaire was developed in consultation with the Gallup Organiza tion, Inc., and co-operation was provided by other national groups skilled in the collection and analysis of statistical data. After the re turn of the questionnaires, Duane visited nearly 100 institutions and interviewed over 600 department heads, administrators and scientists. To one concerned that the full possible potential be devoted to the laboratory and clinical studies to prevent and cure blind ness, the study is disheartening. In 1963 a total of $14 million, at a generous estimate, was channeled into visual research and training. Of the $14 million, only about $9 million may be considered as an investment in directly identifiable ophthalmic research programs. The remainder deals with studies in which mechanisms or parts of the eye are used for observation. Duane found that a total of 174 thousand square feet was used for eye research and that some 453 laboratory and 182 clinical technicians were employed. In 1963 he states there were 22 institutions with high po tential for advanced research programs, but of these, he judged only six to have ex cellent facilities and resources. To meet the challenge of 30,000 new blind a year, Duane proposes a five year goal of $188 million for ophthalmic research with $111.6 million for medical school depart ments (personnel $44.3 million; building $28.2 million; supplies and equipment $18.9 million; overhead $18.6 million; and com munications $1.6 million). This would double the available research space by 1968
946
EDITORIALS
and provide salary support for 1,300 profes sionals and 1,800 technical assistants. Pos sibly the most important recommendation is that there be established a separate National Institute of Visual Diseases and Allied Dis orders under the auspices of the National In stitutes of Health. It is interesting to contrast the needs out lined in his report with what is occurring in the support of ophthalmic research in the United States in 1965. Ten National Insti tute of Health career awards in ophthalmic research are recommended by Duane but the entire career program was discontinued in 1964. Rather than increased support of oph thalmic research and research training in 1965, there are insufficient Federal funds to support approved programs. Current recom mendations for the next fiscal year suggest that financial support for ophthalmic train ing and research will either remain static or decrease. The report is difficult to summarize inas much as it presents a large amount of data and accompanying recommendations. Super imposed upon these are a number of opin ions solicited by Dr. Duane concerning re search, medical practice, economics and sociologic trends in medicine. In his attempt to be fair he has included a wide spectrum of thought and one can find an opinion sup porting nearly any viewpoint. It seems likely, too, that to many questions, only a variety of opinions are possible: "Is there a danger of producing too many ophthalmic research ers?", "What motivates the ophthalmic re searcher?", "Is there too great a lag be tween ophthalmic research discoveries and the practical application of these to clinical patients ?", etc. Dr. Duane and Research to Prevent Blindness have carried out a huge assign ment. The question now appears to be whether the report will now be used to sup port the needs of ophthalmic research and ophthalmic care or whether the data will be ignored. Inasmuch as Duane presented a preliminary report at the 1964 Academy
meeting and ophthalmic research is cer tainly no closer to the average of $37.6 mil lion required annually during the next five years, one senses that unless positive action is taken soon Dr. Duane's labor will have been in vain. Frank W. Newell.
INTERNATIONAL S Y M P O S I U M ON B I O C H E M I S T R Y OF RETINA About 50 participants from the United States, Europe and Great Britain took part in the First International Symposium on the Biochemistry of the Retina, which was held in London during three days in September, 1964. The symposium was held under the auspices of the Institute of Ophthalmology, London University, and was organized by Dr. Clive Graymore of the Institute. It was held in the Great Hall of Temple Place, the headquarters of Smith and Nephew Associ ated Companies Ltd. An official symposium dinner was held at the Savoy Hotel, Lon don, at which the guest of honor was Sir Charles Dodds, president of the Royal Col lege of Physicians. Prof. Norman Ashton opened the sym posium and, in welcoming the participants, stated that this was the first occasion when workers engaged in the specialized study of retinal metabolism and physiology had been able to meet and freely exchange ideas. The first part of the symposium was de voted to biochemical and morphologic stud ies on the visual process and general retinal metabolism; the opening session was intro duced by Dr. Christopher Pedler of the In stitute of Ophthalmology, London, who de scribed an extensive electron microscopic in vestigation of vertebrate photoreceptors. He suggested that the classical concept of "rod and cone" no longer fits the morphologic facts and that a new description relating receptor function to electron microscopic evidence is timely. Dr. Henry Heath and Miss Rosemary
price of our great progress in cataract sur gery. It is possible, of course, that we can say also that in these days the loss of an eye is a small price to pay for progress (provided it isn't your eye or mine that is lost). I am thinking particularly of the progress made in surgical cure of retinal detachment, es pecially in the basic principles involved. It is, however, the stern and unrelievable duty of the "spectaculars" to report their bad cases (as well as their good ones) as soon as possible. Better yet, not to report their cases, except for the failures, until re sults are conclusive, and best yet not to do "spectaculars" at all, if some safer and more conservative, tried and true method, will do about the same job. Let us all have reverence for sight. Any thing less than this is unforgivable. Derrick Vail.
OPHTHALMIC RESEARCH: USA OPHTHALMIC RESEARCH : U S A . By Thomas David Duane, M.D, Ph.D. A report to the Trus tees of Research to Prevent Bündness, Inc. 598 Madison Avenue, New York, New York 10022.
Research to Prevent Blindness, Inc., was established in 1960 by a former practicing ophthalmologist, Jules C. Stein, chairman of the Board of Music Corporation of Amer ica, and Robert E. McCormack, then execu tive vice-president of Olin Mathieson. They were aided by James S. Adams and Mrs. Albert Lasker, both of whom played a major advisory role in the establishment and growth of the National Institutes of Health. The initial staff work was carried out by Dr. C. J . Van Slyke, formerly deputy direc tor of the National Institutes of Health and Mefford R. Runyon, formerly executive di rector of the American Cancer Society. Re search to Prevent Blindness thus brought to ophthalmic research individuals of long ex perience in finance, philanthropy and the Federal research establishment.
945
This group commissioned Thomas D. Duane, professor and head of ophthal mology at the Jefferson Medical College to survey the state of research in ophthal mology in the United States. During 1963, Duane provided a detailed questionnaire concerning research to each of the medical colleges in the United States and some 31 additional groups such as hospitals, research institutes and the like engaged in ophthalmic research. The questionnaire was developed in consultation with the Gallup Organiza tion, Inc., and co-operation was provided by other national groups skilled in the collection and analysis of statistical data. After the re turn of the questionnaires, Duane visited nearly 100 institutions and interviewed over 600 department heads, administrators and scientists. To one concerned that the full possible potential be devoted to the laboratory and clinical studies to prevent and cure blind ness, the study is disheartening. In 1963 a total of $14 million, at a generous estimate, was channeled into visual research and training. Of the $14 million, only about $9 million may be considered as an investment in directly identifiable ophthalmic research programs. The remainder deals with studies in which mechanisms or parts of the eye are used for observation. Duane found that a total of 174 thousand square feet was used for eye research and that some 453 laboratory and 182 clinical technicians were employed. In 1963 he states there were 22 institutions with high po tential for advanced research programs, but of these, he judged only six to have ex cellent facilities and resources. To meet the challenge of 30,000 new blind a year, Duane proposes a five year goal of $188 million for ophthalmic research with $111.6 million for medical school depart ments (personnel $44.3 million; building $28.2 million; supplies and equipment $18.9 million; overhead $18.6 million; and com munications $1.6 million). This would double the available research space by 1968
946
EDITORIALS
and provide salary support for 1,300 profes sionals and 1,800 technical assistants. Pos sibly the most important recommendation is that there be established a separate National Institute of Visual Diseases and Allied Dis orders under the auspices of the National In stitutes of Health. It is interesting to contrast the needs out lined in his report with what is occurring in the support of ophthalmic research in the United States in 1965. Ten National Insti tute of Health career awards in ophthalmic research are recommended by Duane but the entire career program was discontinued in 1964. Rather than increased support of oph thalmic research and research training in 1965, there are insufficient Federal funds to support approved programs. Current recom mendations for the next fiscal year suggest that financial support for ophthalmic train ing and research will either remain static or decrease. The report is difficult to summarize inas much as it presents a large amount of data and accompanying recommendations. Super imposed upon these are a number of opin ions solicited by Dr. Duane concerning re search, medical practice, economics and sociologic trends in medicine. In his attempt to be fair he has included a wide spectrum of thought and one can find an opinion sup porting nearly any viewpoint. It seems likely, too, that to many questions, only a variety of opinions are possible: "Is there a danger of producing too many ophthalmic research ers?", "What motivates the ophthalmic re searcher?", "Is there too great a lag be tween ophthalmic research discoveries and the practical application of these to clinical patients ?", etc. Dr. Duane and Research to Prevent Blindness have carried out a huge assign ment. The question now appears to be whether the report will now be used to sup port the needs of ophthalmic research and ophthalmic care or whether the data will be ignored. Inasmuch as Duane presented a preliminary report at the 1964 Academy
meeting and ophthalmic research is cer tainly no closer to the average of $37.6 mil lion required annually during the next five years, one senses that unless positive action is taken soon Dr. Duane's labor will have been in vain. Frank W. Newell.
INTERNATIONAL S Y M P O S I U M ON B I O C H E M I S T R Y OF RETINA About 50 participants from the United States, Europe and Great Britain took part in the First International Symposium on the Biochemistry of the Retina, which was held in London during three days in September, 1964. The symposium was held under the auspices of the Institute of Ophthalmology, London University, and was organized by Dr. Clive Graymore of the Institute. It was held in the Great Hall of Temple Place, the headquarters of Smith and Nephew Associ ated Companies Ltd. An official symposium dinner was held at the Savoy Hotel, Lon don, at which the guest of honor was Sir Charles Dodds, president of the Royal Col lege of Physicians. Prof. Norman Ashton opened the sym posium and, in welcoming the participants, stated that this was the first occasion when workers engaged in the specialized study of retinal metabolism and physiology had been able to meet and freely exchange ideas. The first part of the symposium was de voted to biochemical and morphologic stud ies on the visual process and general retinal metabolism; the opening session was intro duced by Dr. Christopher Pedler of the In stitute of Ophthalmology, London, who de scribed an extensive electron microscopic in vestigation of vertebrate photoreceptors. He suggested that the classical concept of "rod and cone" no longer fits the morphologic facts and that a new description relating receptor function to electron microscopic evidence is timely. Dr. Henry Heath and Miss Rosemary