Vision Health Research Perspectives for the 21st Century

A CANADIAN INSTITUTE OF VISION HEALTH RESEARCH

This document is proposed and supported by the Vision Health Research Council. It has been prepared in collaboration with the Board of Directors and the Board of Governors of the Council. The Council wishes to express its appreciation to the Canadian National Institute for the Blind and the E.A.Baker Foundation. Their recent National Consultation on the Crisis in Vision Loss and the 1998 Five Year Plan of the American National Eye Institute have provided us with many important new concepts.  Dr. Jean Réal Brunette

VISION HEALTH RESEARCH COUNCIL
 

BOARD OF DIRECTORS
Dr. Jean Réal Brunette, Sherbrooke,  President
Dr. Bruce Jackson, Ottawa, Vice President, Clinical Science
Dr. Martin Steinbach, Toronto, Vice President, Basic Science
Dr. Raymond Leblanc, Halifax, Counsellor, Ophthalmology
Dr. Jacob G. Sivak, Waterloo, Counsellor, Optometry

BOARD OF GOVERNORS
Dr. Christian Casanova,Montréal
Dr. Stuart Coupland, Ottawa
Dr. Max Cynader, Vancouver
Dr. Pierre Labelle, Montréal
Dr. Ian MacDonald, Edmonton
Dr. Jack Rootman, Vancouver
Dr. Pierre Simonet, Montréal
Dr William K. Stell, Calgary
Dr. Graham Trope, Toronto
Professional Organisations
Dr. Hélène Boisjoly, Montréal,
Presidente, Réseau de Recherche en Santé de la Vision du Québec
Dr. Alan Cruess, Kingston,
President, Association of Canadian University Professors of Ophthalmology
Invited Corporations:
Dr. Don Farrell,
Canadian National Institute for the Blind and E.A.Baker Foundation
Mme.Hélène Plante
Dr Howard Dickson
Medical Research Council of Canada
Dr Alain Rousseau
Foundation des maladies de l'oeil, Québec
M. R. David Sculati
Dr. Keith Gordon
Medical Devices Canada  
Dr. Marian Zaharia,
President, the Sherbrooke Symposium Foundation, Sherbrooke

Invitations pending: other constituents will be invited to participate. To name but a few, the Canadian Ophthalmological Society, the Retinitis Pigmentosa Foundation and certainly other stakeholders.

EXECUTIVE SUMMARY

 

An Opportunity for Vision Health Care in Canada Canada has created over the last few decades, with the help of  the Medical Research Council and other public and private support, a broad array of competencies in vision health research. It is now time to focus those efforts, to better coordinate its scientists, and to develop more collaborative projects, in order to establish an integrated research community capable of responding to the expanding health research needs of Canadian society.    This proposal offers the opportunity to bring together a large and powerful group of investigators and focus their energies on the health priorities that will face this country in the decades ahead. The investigators exist; the priorities can be identified. What is needed now is the will to identify Canada's vision health services as a priority for the 21st century — the Canadian Institute of Vision Health Research.

 

THE CHALLENGE - THE PREVALENCE OF VISION LOSS IN CANADA

The socio-economic impact of loss of visual function cannot be minimised.  Blindness affects people of all ages, from premature infants and newborns, to children of school age, to adults in full productivity with major familial responsibilities, to the elderly. Except for their blindness, these people live to a normal old age, because vision problems generally are not life threatening.  However, quality of life and productivity are both significant issues.

Although official government statistics on the prevalence of visual impairment in Canada are not available, information can be extrapolated from American statistics and from data provided by the Canadian National Institute for the Blind (CNIB).  However the CNIB statistics do not reflect the true magnitude of the problem, since registration is on a voluntary basis and we know that many patients do not register.  The extrapolations are nevertheless useful in the North American context.

The Canadian National Institute for the Blind and the American National Society to Prevent Blindness define blindness as vision less than 6/60 (20/200) in the best eye.  This level of visual impairment constitutes an impediment to many of what are considered everyday activities, not to mention employment.

Current statistics indicate that in North America, at least three persons per 1000 are legally blind.  In Canada, this represents 93,000 blind persons. It has also been estimated that in the United States 69 persons per 1000 suffer a visual loss that cannot be corrected by glasses or other similar means (Sommer, A., et al., NEJM 1991).  This level of vision precludes obtaining many jobs, or such activities as driving a motor vehicle. Extended to Canada, this represents 2,100,000 persons. It has also been estimated that 3% of the population has good vision only in one eye and represents a population at high risk of total vision loss (The Framingham Eye Study, Survey Ophthalmol, 1980). The Canadian estimate in this category is 930,000 such persons.
 

PREVALENCE OF VISION LOSS IN CANADA 93 000 legally blind  2 100 000 cases of visual incapacity  930 000 Monophtalms (1 eye only)  Total of over 3 million severely affected Canadians

There are a number of causes of vision loss—some are disease-related, others are age-related.  With the elderly segment of the population increasing, the associated problems of vision loss will grow markedly in the years ahead.
It is generally estimated that one person in nine over 65 years of age and one in four over 80 have a severe visual loss. Moreover, many severe chronic diseases, i.e., diabetes, hypertension and renal failure, seriously affect ocular tissue, often leading to severe eye disease. The CNIB reports the registration of over 10,000 new cases a year and growing.

THE SOCIO-ECONOMIC IMPACT OF A VISUALLY  CHALLENGED POPULATION - High incidence from premature infants to adulthood -  Many age-related pathologies -  Non-life threathening diseases -  Increasing longevity of population

Since vision-loss problems are usually not life threatening, they generally are less well publicized than other health problems.  However, the persons affected are often in need of life-long support, both financial and other, from their families or from society. While visual impairment does not shorten life,  it can lead to increased morbidity (i.e., falls, accidents, broken hips, etc.) and does produce long-term disability, which in turn has a considerable impact on both the individual and society.  The economic and social costs of vision loss are significant.
 

ESTIMATED ANNUAL COSTS OF EYE CARE IN CANADA
Eye Care	Spectacles	Examinations	Total
1996                         2016	675 mil.  1 bil.	1 bil.  .5 bil.	1.6 bil. 2.5 bil.

While the true costs of blindness and vision loss in Canada are not known, by extrapolating from American statistics, using an appropriate currency correction factor, the estimated costs in 1996 was $675,000,000 and it is predicted that by 2016 it will be well over $1 billion annually. The cost of spectacles and eye examination for Canadian myopes alone—almost 8 million people—adds over $1 billion more a year to the previous figures.

OPPORTUNITIES FOR IMPACT

There are at the present time a number of opportunities for vision loss research to effect a significant socio-economic impact.

Scientific breakthroughs and opportunities

Recent scientific and technological advances have provided unprecedented tools to address many of the critical vision research problems facing Canadians.

The field of genetics is at the forefront of scientific innovation, with gene isolation, linking of diseases to specific genes, and now genetic engineering/gene therapy suddenly allowing the prediction of disease and for the first time, true prevention through intervention.

The field of cellular biology has led to significant progress in helping to better understand the basic mechanisms of life.  Structural analysis of molecules and proteins has enabled pharmacologists to more rapidly and more efficiently produce a vast arsenal of new and more specific drugs to treat a wide variety of diseases, including ocular diseases.

Enhanced engineering and computer-aided design capacities have enabled the development of exciting new instrumentation that has begun to change the entire practice of medicine and surgery. The study of new biomaterials has produced a wide range of new prosthetic devices.  Microelectronics and fibre optics have provided the capacity to image the inside of the human body and organs, expanding tremendously our diagnostic capabilities.

Science is on the cusp of being able to make major diagnostic and therapeutic advances in the early part of the new millennium.

A considerable scientific work force

The capacity for international quality vision research in Canada has grown significantly over the past fifteen years.  There are now over 300 vision research scientists working in over 85 Canadian laboratories in universities and teaching hospitals from Victoria to St. John's.  These investigators come from both clinical (ophthalmology and optometry) and basic science backgrounds.  However, in some centres, vision research scientists do not constitute a critical stimulating mass.  In addition, the vast geographic and administrative distribution of vision research scientists in this country places some significant limitations on effective collaboration.

The need for a new efficient structure

Having significantly enhanced the capacity and infrastructure  for vision research in Canada over the past fifteen years, it is time to focus this resource in a more efficient and
productive way on the vision health priorities of Canadians.  The time has come to put in place a comprehensive network that will assist in coordinating the scientific efforts of the vision research community towards identified priorities, goals and objectives, while responding to specific needs of the population.  The Canadian Institutes of Health research is the vehicle to achieve this goal.

A unique new opportunity for vision health research

The time is right for the vision research community to unify and galvanize its collective strengths, and taking advantage of the major scientific and technological advances of the past, move vision research in Canada to a new plateau.

THE GOALS AND OBJECTIVES

OBJECTIVES

• To link, focus, and expand in a concerted way Canada's research effort in vision health.

• To achieve a significant advance toward reducing the impact of vision health problems on Canadian society.
 

 GOALS

• To see vision established as a health priority in Canada,

• To create a world-class environment for vision health research

• To reduce the impact of vision loss in Canada, by:

- developing collaborative research, targeted at prevalent and significant vision health problems

- promoting partnerships with a variety of sectors and organizations to address and reduce the impact of vision health problems

- promoting  and expanding technological transfer.
 

THE MECHANISM

Moving vision Research onto the National Agenda

The Medical Research Council of Canada has proposed the creation of the Canadian Institutes of Health Research in order to address more effectively the health problems of Canadians in the coming decades.  The Institutes would establish a national focus and a national concentration of researchers dedicated to addressing the health priorities of Canadians.

It is in the pursuit of  these national objectives, combined with the objective of making significant advances toward reducing the health impact of vision loss on society, that the Vision Health Research Council (VHRC ) offers its full support for the creation of a Canadian Institute of Vision Health Research ( CIVHR ).
 

The Vision Health Research Council represents a national coalition of individuals dedicated to the development and promotion of vision health research in Canada.  The Council represents the scientific interests and views of investigators from all disciplines and fields who are conducting research related to vision, as well as individuals involved in the active adminis- tration of vision research. The Council is directed by an Executive Board composed of five members, and a Board of Governors to broaden its administrative and consulting base. It  was founded and is supported by the Sherbrooke Symposium Foundation dedicated since 1987 to the developement of vision health research in Canada.

THE CANADIAN INSTITUTE OF VISION HEALTH RESEARCH

It is recommended that an Institute of Vision Health Research be one of the Institutes within the Canadian Institutes of Health Research.  It is proposed that the Canadian Institute of Vision Health Research be virtual institute, which through a national network links all existing vision research centres in Canada.

The need for a Canadian Institute of Vision Health Research

Vision health is not restricted to one organ, but rather it is much more complex, being affected by most major diseases of many other organ systems, ie. diabetic retinopathy.  As a result, research in vision health in Canada is widely dispersed in many disciplines and among many organizations.

Similarly, Canadian vision research scientists, nearly 300 in number, are dispersed from coast to coast in this vast country, and located in at least 22 Canadian universities, in more than 87 departments, schools,  research centres and institutes, university teaching hospitals, and clinics.

Although collaborative research and group projects do occur, communications are frequently reduced to encounters at professional meetings, all too often in a climate of competition for scarce resources.

It is to overcome these difficulties and to promote cooperative research that the concept of a Canadian Institute of Vision Health Research is presented.  It is anticipated that the CIVHR will achieve an effective level of concentration and collaboration amongst this diverse and diffuse group in order  to create an organizing  structure that will establish and communicate national scientific vision health priorities, command a common  effort, and  maximize the result / investment ratio of investment in vision health research.

Table 1:  DISTRIBUTION OF VISION RESEARCH LABORATORIES IN CANADA

EASTERN CANADA

St. John's  Memorial University Halifax  Dalhousie University   Ophthalmology    Pathology    Pharmacology

Psychology    Anatomy   Genetics    Neurobiology    Endocrinology    Physiology

IWK-Grace Health Centre  Dalhousie Technical    Electrical Engineering   Mount Saint Vincent University   Psychology    Pharmacology

QUÉBEC

Montréal  Univesité de Montréal   Ophtalmologie   École d'Optométrie   Pediatrics   Medicine   Génétique   C.R. Hopital Mais-Rosemont   C.R. Hopital Notre-Dame   C.R. Hopital Ste-Justine   Hopital Mais-Rosemont   Hopital Notre-Dame   Hopital Ste-Justine   École d'Optométrie, U.de M.  M.McGill University   Ophthalmology   Neuroscience

Neurological Science   Pharmacology   Psychology   Epidemiology   Biostatistics   Medicine   Neurology   Physiology   Montreal General Hospital   McGill Vision Res. Centre   McGill Research Institute   Royal Victoria Hospital   Montreal Children's Hosp.  Concordia University   Psychology Québec  Université Laval   Ophtalmologie   Physiologie

Endocrinologie   Endoc. moléculaire   Biochimie   Physiologie   Centre de Recherche U.L.   CHUL    Hopital Saint-Sacrement Sherbrooke  Université de Sherbrooke     Ophtalmologie   Centre de Rech. Clinique   C.U.S.E. Trois-Rivières  Univ. du Québec à Trois-Rivières   Photobiophysique   C.R.Photobiophysique

ONTARIO

Hamilton  McMaster University    Computer Science     Psychology  Kingston  Queen's University   Ophthalmology   Biochemistry  London  University of Western Ontario   Ophthalmology    Pathology    Anatomy    Experimental Morphology    Biochemistry    Pediatrics    The J.P.Robarts Res. Institute  Ottawa  University of Ottawa   Ophthalmology

Cellular & Molecular Med.    Chemical Engineering    Eye Institute    Ottawa General Hospital    Children's Hosp. of Eastern Ont.    Toronto  University of Toronto   Ophthalmology    Molecular Biology    Biomedical Engineering    Pediatrics    Mechanical Engineering    Nutritional Sciences    Faculty of Dentistry    Pharmacology    Zoology    Anatomy    Cell Biology    Medical Genetics

Medicine    Neurology    Banting & Best  Med Res.    Inst.  of Biomed. Engineering    Toronto Hospital, General Div.    Toronto Hospital, Western Div.    Hospital for Sick Children    Cancer Res. Inst.    Sunnybrook Health Centre    Eye Res. Institute of Canada  York University   Psychology    Centre for Vision Research  Waterloo  University of Waterloo   School of Optometry

CENTRAL CANADA

Winipeg   University of Manitoba    Internal Medicine

Saskatoon   University of Saskatchewan    Ophthalmology     Vet. Internal Medicine     Pharmacy

Nutrition     Animal and Poultry Science     Saskatoon City Hospital     Royal University Hospital

WESTERN CANADA

Calgary  University of Calgary   Ophthalmology    Physiology    Biophysics    Genetics    Psychology    Anatomy    Bioethics    Surgery    Biochemistry    Gimbel Eye Centre

Edmonton  University of Alberta   Ophthalmology    Biochemistry    Oncology    Biosciences    Cross Cancer Institute

Vancouver  University of British Columbia   Ophthalmology    Psychology    Neurology    Biochemistry    Molecular Biology    Pathology    Medicine    Pediatrics    St. Paul's Hospital School of Nursing    Neurology Seizure Clinic    Vancouver General Hospital

 

Goals of the Canadian Institute of Vision Health Research

The CIVHR will:

• Maintain and consolidate a national critical mass of vision health investigators, and expand the research effort in vision health in Canada

• Develop a unified approach to vision health needs and the research programs to address them, by:
- more closely linking basic science and clinical investigation
- furthering multidisciplinary and interdisciplinary approaches to vision health research.

Functions of the CIVHR

The Institute will be virtual in nature, linking all  research-related activities in vision health in Canada.  It will not require new buildings or major relocation of personnel.

The mission of the Institute will be to support research, training, and other programs in vision health.  It will promote research and the development of research in vision health, facilitate interdisciplinary collaboration, and provide coordination to the national vision health research effort.  The Institute will represent the consortium of researchers involved in vision health research across the country.

The finances of the Institute will be applied to research, training, interactions, communications, international liaisons, and collaboration with industry.

The Institute will provide an academic-based forum to discuss perspectives on vision health and develop a collective vision and consensus.  It will also develop unifying strategies,  thus providing for more effective management of funding for vision health research.

The Institute will  provide a point of convergence for all organizations involved in vision health research.  It will interface with other organizations interested in and related to vision research and support, collaborate with, and advise other organizations pursuing similar objectives.  It will act as a source of information about vision and vision health, disseminating vision health information and  publicizing the impact of vision disease and impairment and the benefits of vision health research.

The Institute will help bridge the gap between industry and academia, while addressing the relationship and timing between concept and product.

Budget of CIVHR

A conservative estimate is that the annual Institute budget should be at least 1% of the appropriate annual health  burden attributed to vision loss.  The estimated annual budget for the Institute is $10 million.

INSTITUTE PRIORITIES  Defining the Priorities

One of the essential functions of the Institute will be to determine the critical research priorities needed to further develop and support the best possible vision health care system to serve our nation in the future.  These priorities will cover the triad of prevention, diagnosis and treatment, and will be defined according to documented new data collected through primary clinical research in epidemiology, outcome evaluation and evaluation of new technologies. From these data clinical and basic research will be defined accordingly.

Several possible priorities are set out below in table 2.

Table 2;  PRIORITIES

-PRIMARY HEALTH DATA COLLECTING PROGRAMS   Clinical epidemiology   New technologies and devices evaluation   Health Services Evaluation Program - SPECIFIC DISEASES-ORIENTED RESEARCH   Cornea   Retina   Glaucoma   Cancer   Cataracts -CROSS-CUTTING  RESEARCH   Aging   Genetics

Developemental biology    Drug Delivery Systems    Trauma    Systemic Diseases affecting Vision    Prosthetic Materials Study Program - COMMUNICATIONS PROGRAM    Electronic communications for the institute    Telemed; care  delivery - SPECIAL PROGRAMS    Research trainee program    Research Innovations application    Public Awareness Programs

 

BASIC HEALTH DATA-BASE PROGRAMS

Clinical epidemiology
Clinical epidemiologyis the basic data collecting tool used in the study of diseases. We have already stated that Canada does not have valid well documented data on the prevalence of diseases or the cost of health services. These statistics are the basic instruments that will allow us to determine priorities. This form of data collection will also allow us to evaluate outcome analysis of diagnostic methods and treatments. It is also essential in evaluating clinically accepted  concepts and practice patterns.

New technologies and device evaluation
it is essential that new technologies, new prosthesis and new instruments used in the treatment of patients be evaluated by competent  teams of investigators free from biased, vested interests. Examples of aberrant practices in this field are multiple. Such evaluations can be extremely useful in helping Governments and Institutions in selecting equipments, evaluating indications and recommending distribution.

Health services and outcome evaluation research
The trends dictated by restricted budgetary allocation have shown that when competently implemented, new paradigms of care  can produce very favourable results simply by discarding time consecrated habits. The savings brought by the expense of buying a new instrument are frequently very positive. One example is phacoemulsification of cataracts, the advent of which has allowed surgery on an ambulatory basis, has resulted in the equivalent of closing a major hospitals of more than a thousand beds in Canada. However, the equipment was costly and it  was not easy to convince doctors to change their habits.

Clinical trials
Clinical trials are essential for evaluating all new treatments. Our Medicare system, networking as proposed by the CIVHR and a good electronic communications system are  three reasons why Canada could become a world prominent figure in vision research.

SPECIFIC DISEASE-ORIENTED RESEARCH PROGRAMS

The cornea
The ccornea  is the most exposed exterior transparent structure of the eye, and it  is involved in 2/3 of the new cases of eye disease. This represents approximately 16 / 1000 people per year or half a million people per year nationally. The most important causes of corneal disease are direct trauma and herpes simplex keratitis. Fortunately, a good proportion of cases can be treated effectively by a combination of medical and surgical means. The development of artificial corneas and other  artificial materials, endothelium studies, and advanced studies of healing processes, as well as the role of immune mechanisms, are essential areas of research in corneal disease management.

The cornea is also the site of intensive surgical laser ablation for errors of refraction, techniques which have developed only very recently. The longer term effects and benefits of these techniques must be carefully monitored in order to identify, prevent, or correct possible complications.

The retina
The retina can be affected by  a number of chronic diseases, many of them related to either aging or to vascular and metabolic diseases.  These present a major immediate challenge to our health care system. Vascular and homodynamic studies, along with developmental biology, are the key research approaches to such widely-spread pathologies as diabetes, glaucoma, and macular degeneration.  In persons below age 65, retinal damage due to diabetes is the most frequent cause of blindness.  Of persons over 75, 40% will suffer from macular degeneration.  Pharmaceuticals and genetic detection and therapy offer the opportunity for major breakthroughs in the many variations of retinal disease.

Glaucoma
Glaaucoma is a chronic disorder affecting people of all ages, but is much more common after the age of 60.  Approximately 13% of the population over the age of 60 will be affected by glaucoma. It is estimated that as many as 300,000 Canadians currently suffer from glaucoma, and that prevalence will increase significantly over the next few decades as our population ages.  Research in diagnosis, detection of progression, and follow-up of glaucoma are important and are the subjects of current research efforts.  In addition, exciting potential for research is evolving in the area of pharmaco-therapeutics related specifically to blood flow to the optic nerve, and in the field of neuroprotection. Gene detection techniques for early determination of those at risk and more definitive treatment, pharmaceuticals to improve optic nerve perfusion, and imaging technology to measure blood flow and permit earlier diagnosis and therefore less expensive follow-up are only three of the hopeful areas for further study aimed at reducing the visual impairment from glaucoma. In this disease area, as in others, competent teams of clinical epidemiology investigators are essential to more clearly delineate the issues of incidence, prevalence, and screening for the disease.

Cancer
Teams of investigators are already addressing the problem of choroidal melanoma, a deadly disease. Important results are expected in the treatment, the follow-up of cases, and the detection of metastatic activities, including diagnostic kits and treatment guidelines. Retinoblastoma has been well studied by a Canadian team, and their work has not only provided us with diagnostic gene detection but offers possibilities of insight in other types of cancer.

Lens and Cataracts
Cataracts are the most frequent cause of loss of vision for persons between the ages of 65 and 75.  As we know, cataracts can be removed with an excellent result in quality of function. The story of cataract surgery is a good example of what well-focussed and clinically-driven research can accomplish.

In 1983, 50% of cases hospitalized for eye problems were for cataract surgery. However, new techniques and instrumentation have revolutionized cataract treatment. Cataract removal is now an out-patient procedure. The approximately 25,000 cataract interventions in Québec per year correspond to a saving more or less equal to the closure of a 300 bed hospital in that province or a 1,300 bed facility elsewhere in the country. Lens implants and phakoemulsification, the basis of these changes, are examples of the benefits of eye research.

Strabismus, amblyopia and visual processing
Vision cannot be represented as a simple camera operation.  The eye is an extension of the brain, the basic organ of sight.  The visual system represents 2/3 of the fibers entering the brain. Its vast and complex neural processes provides the capacity to adapt to a diversity of tasks ranging from a stroll along a sidewalk, to piloting a jet at Mach 3.  Motility of the eyes, equilibrium, visual integration, and many other central functions are integral parts of seeing and must be studied to understand how tasks such as driving a car at night are carried out. The complex neurophysiology of vision has been the source of understanding the functioning of the whole brain.

A simple untreated disuse of the function of an eye in childhood before age 5 results in the loss of all possibility of future functional recovery, creating the risks and limitations of a life with one eye only. Strabismus is the most frequent accompanying condition. Programs of detection are essential to devise and evaluate.

Visual impairment and rehabilitation
Considering the importance of that portion of the population affected by visual loss, and taking into account that these diseases do not necessarily affect their general health condition, rehabilitation of some sort is evaluated in term of restoring autonomy. This constitutes an impressive psychological gain for the patient and a considerable socio-economic gain for society. For these reasons research in the field of visual rehabilitation of visual impairment is considered a priority.

CROSS-CUTTING RESEARCH

There are a number of disciplines and fields of research that apply to the study of many diseases. Some of the essential ones will simply be mentioned because they are tools to study the diseases already priorised.

Aging research
The progressive aging of our population has been mentioned. This physiologic process affects such common pathologies as macular degeneration of the retina,  cataracts, glaucoma and several other frequent diseases.

Genetic research
Genetics is a fundamental aspect of most diseases of the visual system.

Developmental biology and regeneration research
Regeneration of corneal endothelium, repair of retinal scars, development of cataracts and other deceases processes are based on or could be elucidated by such studies.

Drug delivery systems
Drug delivery systems are essential in the treatment of infections, glaucoma and many inflammatory or immunologic processes.

Trauma
Corneal trauma is the most frequent affliction in the active adult population. Laser surgery of the cornea for refractive errors can be compared to traumas. In all these cases the  healing process becomes the primordial element for preventing blinding scars.

Systemic diseases affecting the eye
The list of systemic diseases affecting the eye is considerable — diabetes and immune disorders, to mention but two. These affect most structures of the visual system.

Biomaterials and prostheses
A long list of these can be mentioned because the eye is subject to the use of a wide variety of prosthetic materials. Contact lenses, intraocular lens implants for cataracts, prostheses used in the surgery for glaucoma, various devices used in retinal detachment surgery are only a few obvious applications. One great expectancy is the eventual replacement of endothelium deficient corneas.

COMMUNICATION / OUTREACH PROGRAM

Electronic communications for the Institute
A  fast and comprehensive communications system provides the basis for integrating research and facilitating team work between investigators who are widely distributed across this country.  Such a system will foster major developments in teaching and in upgrading research expertise.

Electronic communications will be the tool of both clinical trials and clinical evaluative research in the future.  For example, the teams involved in epidemiological research will be constituted from individuals located in centres distant from one another and they will communicate by so-called "paperless" charts to collect data.

Telemedicine
Medical consultation across distance by electronic means, is a new tool that needs to be studied and developed if it is to realize its promise as a powerful instrument of health care. This method of dispensing medical consultation in remote areas can become a true breakthrough in our vast country.

All these avenues, as essential as they are now, are in need of urgent research and development to improve their future performance.  This research and development should occur in collaboration with industrial providers of services and equipment.

SPECIAL PROGRAMS

Research trainee program
Opportunities are needed for additional training of our young investigators, through exchange programs and training in technical specialties. These should be advanced in parallel with the ongoing effort to foster  research collaborations.  Examples of training opportunities might include teaching of new research techniques or devising protocols.

Application of research innovations
New innovations must be brought forward in a timely fashion and their timely introduction into clinical practice must be ensured.  A special program will be devised to advise and inform governments regarding the promotion and adoption of innovations developed from research. The Institute will have a technical applications group which will provide advice to investigators, practitioners and regulators concerning the latest developments in science and technology.

Public awareness
It is felt essential that a system be set up to vulgarise the very research that is being conducted, its results and discoveries. This information should be aimed at all stakeholders including the population at large and governments.

A VISION FOR VISION HEALTH RESEARCH

Benefits of the Canadian Institute of vision Health Research
One major effect of the Institute will be the network of contacts created and the resulting communication and collaboration that develops. The concept of a virtual National Institute unites the benefits of local interaction with a nation-wide network of scientific specialties. The  local clusters or centres and their affiliated institutions will provide, amongst other resources,  both research services and collaborative use of facilities.

The resulting national scientific collaborations offer opportunities for internationally recognized research based on a clear focus, concentration, and specialization. The national visibility of such an Institute would also inspire intra-and extra-networking collaborations.

The Institute will encourage collaborations through the importance it attaches to the funding of collaborative projects. For the first time, investigators will be given the means and the responsibility to collectively define options and set priorities. This, in turn, will optimize the national socio-economic investment in vision health research.

The Institute also offers the opportunity to promote partnerships with a variety of sectors and organizations and expand technology transfer.
 

The American example
The Americans have long understood the need for a concentrated  vision health research effort.  More than a quarter of a century ago, the National Eye Institute was created as part of the United States National Institutes of Health.  Today, the NIH system is widely recognized as one of the most successful health research agencies in the world.
 

An opportunity for vision health care in Canada
This proposal offers the opportunity to bring together a large and powerful group of investigators and focus their energies on the health priorities that will face this country in the decades ahead. The investigators exist; the priorities can be identified. What is needed now is the will to put Canada's vision health services on par in the 21st century with those of other developed countries.

Canada has created over the last few decades, with the help of  the Medical Research Council and other public and private support, a broad array of competencies in vision health research. It is now time to focus our efforts, to better coordinate our scientists, and to develop more collaborative projects, in order to establish an integrated research community capable of responding to the expanding health research needs of Canadian society.
 

27 october 1998

Jean Real Brunette
President,
VHRC

Top of page / Haut de la page