Vision Research Capacity for a Vision Research Institute

INDEX

SUMMARY

Part 1: Considering the Situation 

1. Vision health research capacity 
2. National impact of vision health and disease 
3. A new mandate for research agencies 
4. A supporting stakeholders'  organisation 

Part 2:  Why a Vision Institute

1. Scientific reasons 
   The determination of national priorities 
   Dicouncil dichotomy 
   Control of redundancy and relevance 
   The question of repatriating  investigators to a vision institute 
   A  key to cross cutting inter-institutes  collaboration 
2. Strategic impact of vision research
   A visual world 
   Telemedicine 
3. Impact on cliniical research 
4. Impact on health care providers training 
5. Impact on relationships with NEI

CONCLUSION: Inventing the future

Tables:
Table 1 - Medical Research Council Grants
Table 2 - NSERC Operating Grants
Table 3 - NSERC Compound Annual Sums
Table 4 - Operating Grants from Other Agencies
Table 5 - Fellowships and Training Grants
Table 6 - Distribution of Funded Research in Canada

SUMMARY 
The reality of what Vision Research represents has been obscured by the wide scatter of its investigators, its colonisation by other specialties and the consequent lack of identity within Granting Agencies.  We have identified 232 investigators funded in a 4 year period by $17.5 $M of MRC grants, $22.6M NSERC grants, $9.8M from other Agencies and $6.5M for Fellowships for a total of $56.5M or an average of $14M a year.

Only the creation of a Vision Institute will achieve what is expected by one canadian in ten, the blind and visually impaired.  The objectives are major: correct the effects of our wide scatter, choose priorities and control duplication and relevance, in other words provide a sound administration of public funds.  It is the only way of building up a valid clinical research infrastructure. A united research force is the key to a quality academia and the training of the best possible care providers.  Only in this context will we be able to achieve our international collaborations particularly with the U.S. National Eye Institute] (NEI).

We have the existing structure able to provide the vast stakeholders cooperation expected in the new Institutes.  We have the firm conviction that our request for an Institute, our needs and our workforce provide exactly what the Government expected  when it created the CIHR.  It is the only way of creating unity amongst investigators isolated as they have been in the past in separate Granting Agencies.

Part 1: CONSIDERING THE SITUATION  

1 - VISION HEALTH RESEARCH CAPACITY

The Research Capacity of Vision Research has been stated to be 30 funded investigators.  This contradicted the clear impression in our experience of the existence of a much larger Vision Research community. It would appear that only part of MRC funded individuals were counted and that quite evidently no consideration was given to funding fom other sources excluding even support from other Granting Agencies like NSERC, although a major contributor to Vision Research.   We have investigated the situation and can now document  the importance of this  Vision Research Capacity.

Material and Methods
We take it for granted that,  in the context of the CIHR in which all health research is to be concentrated and the administration of which includes by its very founding charter all three Councils, that Research Grants from one Council only can not be used to define the Research Capacity of any given sector.  This is essential in Vision Research where NSERC grantees are practically double those of MRC.

It is also essential to search adequately the data banks available to really identify all of Vision Research.  Vision has never been granted clear categories for classification.  It has never had the advantage of any specific Evaluating Committee. Data banks were sifted by titles of grants, department of investigators, disciplines, techniques  and key words as numerous as possible including both French and English which do not yield the same resuts.  For all Granting Agencies, titles of grants were read and evaluated in the best of our knowledgeas to being related to vision.

There is no easily accessible data bank.  For instance MRC data from AHRIS (Automated Health Research Information System) do not cover NSERC grants and vice-versa. Their modes of presentation and classifications differ.  Budgeting is different, MRC functioning on a varying fiscal year basis and NSERC on a fixed annual amount  term budget.  We were not able to align statistics for the exact same period for the two agencies using those sources.  Further more the methods of listing have changed with the years.

We used extensively AHRIS for all funding sources except NSERC.  The annual Grant allocation figures of NSERC were used instead.  Much information was used from the CNIB (Canadian National Institute for the Blind) document "Crisis in Vision Loss".  All grants that were reasonably related to eye or vision were selected independently of the discipline of the investigator or the category of its classification.  All grant titles of all lists available were evaluated.

Grants generally are term grants and we have chosen to work on 4 year periods in order to obtain a more stable evaluation.  Since the data from AHRIS and NSERC can not easily be fused they are presented separately.  We have used different  4-years periods for the two.  NSERC Grants, except in a few cases of 5 and 1 year which cancel out, are granted for a 4 year period.  We did not have the possibility of accessing the grants of 1993-1995.  We used the mean grant value multiplied by the minimal number of annual grantees to obtain data comparable to the MRC 4 year data. This does not present a problem since only an approximation of the total annual research  is to be determined.  Only general conclusions will be given here but all the documentation we have used is provided and accessible in the annex.  Some 700 grants are listed. (See note page 7) References  will be given in the text.  

Results
MRC funded investigators
In the 4 year period provided by AHRIS, 79 principal investigators were funded per year . In this 4 years period, the   total amountperiod amounts to $56 540 990.  (Fig. 1)

Back to top of MRC Operating Grants is $14 191 221. These investigators also obtained Collaborative Grants as principal investigators for a total of $3 336 210.  The combined total of funding obtained by these investigators from MRC is $17 527 431. ( Table 1 and Fig. 1)

VISION RESEARCH GRANTS: 4 YEARS

Summary

NSERC funded investigators
We have identified 141  principal investigators doing Vision Research funded by NSERC. The statistics available cover 4 years from 1996 to 1999.  The Operating Grants represent a total amount of $22 638 765. The operations used to complete the table are shown in Table-2 and -Table3.  Only 17 individuals received grants from both MRC and NSERC.

Other known sources of investigators funding
Some 58 investigators have obtained from other funding agencies in the 1993-94 to 1996-97 period a global amount of grants of $9 800 945.  All these agencies are recognised by MRC and listed in AHRIS and include sources like FRSQ and the RP Foundation.  (Table-4)

Scholarships and training grants
We have added to operating grants Scholarships and training grants awarded to trainees under the tutorship of Vision Investigators for the same 4 year periods.  Grants from MRC total $2 313 464  for  125 awards and those from other sources $4 260 365 for 142  awards.  (Table 5)

The global picture of Vision Research funding
Taken globally, some 232 independent investigators have collected Operating Grants from public and private agencies for a gross total of $49 967 141.  We could add to this a sum of $6 573 849. identified as funding for Scholarships and training grants.  The total amount of research funds received by the investigators in a 4 year

2 - NATIONAL IMPACT OF VISION HEALTH AND DISEASE

Vision loss in Canada
This document concerns all canadians.  There are reasons to be preoccupied by the following facts.  One in ten amongst us, 3 million canadians, are either blind, visually impaired or at risk for having only one good eye.  To be visually impaired implies a vision that precludes obtaining a driver's permit and of course many jobs.  10 000 new persons declare themselves spontaneously as blind to the Canadian National Institute for the Blind annually and numbers are increasing. One third of the population suffers from a serious refractive error now treatable with recent technological advances.

Many eye diseases are familial or hereditary.  The numbers affected increase with age.  Many other diseases, both ocular and systemic affecting the eye are degenerative and also increasing with age.  We are all aware of the shift of age in the population.  The conclusions are easy to draw.

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  ( 1 in 10 ) severely affected Canadians

Fig. 2

3 - A NEW MANDATE FOR RESEARCH AGENCIES

Government has clearly endorsed the need for a reorientation of health research agencies.  It has insisted on the necessity of making research  collaborative, inclusive and open to all stakeholders. These concepts were promoted by the initiators of the CIHR.   In this context, the new investments and the changes in structure of the research funding agencies give us hope that a renewal is at hand if we want Government to keep on funding the CIHR model.

4 - A SUPPORTING STAKEHOLDERS' ORGANISATION
For the first time in Canada Vision Research has been given a voice, the Vision Health Research Council (VHRC).  It represents investigators of all disciplines working in the field of Vision.  The VHRC is backed by over 600 persons involved in vision research across Canada.  It is also endorsed by a wide range of stakeholders in Vision Health, patients organisations, academics in all disciplines, industry, health and research administrators. (Fig. 3)

VHRC is the infrastructure wished for as the public support of an Institute and has been asked, in 1998,  to present a Canadian Institute of Vision Health Research Project in support of the creation of the CIHR.
 

Board of Governors Vision Health Research Council Patients; the Canadian National Institute for the Blind (CNIB), the National Coalition for Vision Health (NCVH),  Care providers;  the Canadian Association of Optmetrists (CAO) the Canadian Ophthalmological Society (COS),  Academia; : the Association of Canadian University Professors of Ophthalmology (ACUPO), and the Schools of Optometry of Montréal and Waterloo,  Private  Foundations;   the Baker Foundation, la Fondation des Maladies de l'Oeil, the RP Foundation,  and the Sherbrooke Symposium Foundation,  Industry; Medical Devices Canada (MEDEC),  MD Management  Investigators; the Medical Research Council (MRC), and the Réseau de Recherche en Santé de la Vision du Fonds de recherche en santé du Québec (FRSQ) and finally.  VHRC has mobilised 600 canadian investigators and collaborating members.

Fig. 3

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Part 2:  WHY A VISION INSTITUTE

1 - SCIENTIFIC REASONS

The wide scatter of vision research
This work force should be a considerable asset.  However, Vision research suffers of an incredibile dispersion of its activities which handicaps its productivity.  We have made an inventory and found Vision Research in 96 departments and schools of 31 Universities and institutions, in 27 specialties across Canada and reported here.  Without the creation of a concertation such as that created by an Institute it is impossible to think of preventing duplication, of creating specialised critical masses of investigators, defining  priorities or promoting cross cutting collaborations in any significant national manner. The distribution of vision  researchers  in Canada is described in Table 6.

The determination of national priorities
No mode of funding research is infinite.  It is expected from the mandate of  CIHR that priorities will be determined as a paralled pathway to free Investigator Initiated Research (IIR).  It is utterly impossible to think in such terms given the widely dispersed situation of Vision Research without an infrastructure such as an Institute provides.  The contribution of  stakeholders as requested by the mandate of CIHR would have no target, no structure to address itself to otherwise.

Priorities determined freely by a variety of disciplines without the containment of an Institute would most assuredly not be in the best interest of Vision Health but rather be selfserving to the scientific interests of the discipline or for their "grantmantship virtues".

Dicouncil dichotomy
At best, during an interim period during which unity of funding for health research can be accomplished by CIHR, Councils will maintain some operating independence.  In this context an Institute will be able to at least provide national priorities.  Part of these separate Research budgets could be attributed as "Priority Oriented Research" (POR) Grants in all Councils and be awarded using Relevance to Priorities Criteria. Even this would allready be an excellent accomplishment.  These same criteria could be transported to Private Agencies.  Again valid Vision Health Relevance to Priorities Criteria  will never be adequately established unless Vision Research is concentrated in an Institute.

Control of redundancy and relevance
Multiple agencies or unrelated granting committees  funding Vision Research will lead to redundancy and lack of relevance to real priorities. Well articulated specialties  dominate and disparities of developement in between specialties  develop.  Again, only a focused Institute can forecast and prevent these losses of orientation.

The specificity of vision research
No Institute foreign to vision health care will give the specific problems of vision health and disease the attention it requires.  Lost in the strong representation of another domain specific problems like cataracts, corneal healing, glaucoma have very little chance to receive anything but little attention.  If ever they were taken seriously it would only be if there were an adequate representation of Vision in many Institutes and this is less than probable.

The question of repatriating  investigators to a vision institute
The internal brain drain
Investigators go to structures that wield funding power and this power resides in the big departments.  Ophthalmology for instance has suffered from this in a major way, losing its critical mass to other specialties.  It has progressively been deprived of the possibility of recruiting to the point of being drained of its intellectual vitality. The dulling of its milieu has left it prone to defection to financial temptations.

Vision Research must be made to relate to the health care providers in order to generate contacts, reciprocal influence and interest. And this can be accomplished only if the health care providing milieu has the funding power to become again the driving core of the system by being able to attract and generate curiosity-driven research.

The Institutes are to be virtual by nature. The repatriation that has been evoqued is also virtual.  We do not expect any massive shift in the departmental affiliations.  The localisation of investigators will follow smoothly the lines of maximal productivity for the benefit of all without crisis.  Reshuffling the funding pattern should produce the desirable effects.  We must consider that multi-Institute affiliation of investigators and Investigator Initiated Research will remain stabilising elements.

A  key to cross cutting inter-institutes collaboration
Vision is by definition a highly multi-faceted  domain covering just about all clinical and physiological aspects.  it ranges from optics to medical and surgical preoccupations and to the most sophisticated neurophysiology and genetics.  Cross cutting through all disciplines is what CIHR is all about.  Vision left without an Institute is handed over to narrow self-interests while properly nurtured it precisely becomes a key to cross cutting multidisciplinary inter-Institute collaboration and cross-fertilisation.

This is made possible because a Vision Institute is not an organ or a one disease or pathological process Institute.  It ranges wide and far beyond
narrow targets and is per se an inter-relational agent.

Vision addresses extremely important human vital concerns. It touches life long disabilities with considerable socio-economic impacts.  These concerns have to be woven into our National Priorities and proposed to investigators in social and humanitarian disciplines.

2 - STRATEGIC IMPACT OF VISION RESEARCH

A visual world
We will  increasingly live in a visual world dependent on screens, video technology and visual perception skills.  The instrumentation we will deal with will have exacting visual requirements. Be it sufficient to give as example the piloting of jets at mach 3 and helicopters at night.  All of the modern advancements will require reinventing a new physiology for visual learning, eye movements, perception, image recognition and many other features.  This will need concentration, collaboration and very serious collective planning in so many domains again unthinkable without the infrastructure of a Vision Institute .

Telemedicine
Providing health care diagnosis and consultation at a distance is a necessary evolution in a country as immense as ours. This is eminently the instrument of the future for an image dependent domain like eye diseases. It is the first domain to have flourished in countries like Australia.  The developement of this new technology will come from the eye care specialties collaborating with other disciplines.  Again, a need for concentration and orientation on a national basis.

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3 - IMPACT ON CLINIICAL RESEARCH

Clinical epidemiology
We really have no national statistics on Vision health and disease.  Our regular mode of functioning is to apply american data proportinate to our population.  The differences in population are major: our aboriginal populations differ, the origins of our populations differ.

New technologies evaluation
We have no valid structure to evaluate new tecnologies.  We have been subjected to abuse such as found in third world countries in the promotion and use of certain instruments and technologies without any national structure available to evaluate these.  Only a reliable research national structure will provide first the means to act and second the clout necessary to impose valid conclusions.

Communications
Only a national structure will conceive and create the network of communications absolutely necessary in a vast country with such a dispersed population as ours.  Otherwise there can never be created a critical mass essential to clinical research.

4 - IMPACT ON HEALTH CARE PROVIDERS TRAINING

Research is not only about discoveries.  Research is a state of mind and it is a necessity for creative individuals.

Research and Academia
An Academic milieu that does not provide the research facilities and recruitment needed  to attract and keep such individuals is running a downhill slope. How can such milieu be created if the funding and the recruitment of investigators is colonised by other specialties as is the case of vision.  Reunification in and around a national  Institute could rectify the actual situation.

Research and the training of care providers
Having given Academia its intellectual vitality Research will have created a milieu of higher quality.  Better knowledge and better teaching train better care providers.  We only have to evaluate the impact of a faculty in a small town to know that the level of care is elevated.

5 - IMPACT ON RELATIONSHIPS WITH NEI

Needless to say that way back in the sixties the US National Institute of Health (NIH) believed in the necessity of regrouping all vision research in the National Eye Institute (NEI).  NIH and NEI perceive a special vocation for canadian vision reserach be it only due to the particular medical care system that exists here.  This commands specific research that could coordinate effectively with theirs.  Collaborations do exist but will never flourish without the equivalent structure of a Canadian Institute of Vision Health Research to be addressed to.

ARVO opportunity
The Association for Research in Vision and Ophthalmology (ARVO), an american society made up of clinical and basic vision investigators  is extremely supportive of our efforts in creating an Institute.  We have almost 400 canadian members  in ARVO.  At the last meeting an assembly called by a simple Email message sent through ARVO listing gathered 100 canadian investigators.  Some 220 papers and posters were canadian.

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CONCLUSION

Inventing the future
The IGC of the CIHR is in the difficult position of inventing the future rather than reconsecrating the past.  It is clear that we, the investigators, the administrators, the academics, have not done quite our share to show the true figure of Vision Research.  The patients organisations, the private Foundations have not done much either to create a national awareness of Vision either.

However, at this moment of particular national creativity in Health Research, we do hope that we will have been clear even at this late moment to prove the importance of Vision Health Research on the one hand and its unacceptable actual situation, a legacy of the past on the other.  

NOTE: A complete list of some 700 Vision Research Grants used in our statistics is provided in an  ANNEX. It lists for each Grant: Name of Grantee, University, Department; Granting Agency, Type of Grant, Amount and Term.
This 50 pages document will be available for consultation on request from  the authors.  

Tables

Table 1 - MEDICAL RESEARCH COUNCIL GRANTS

		93-94	94-95	95-96	96-97	TOTAL
PERSONAL OPERATING GRANTS
	n. GRANTS	58	63	76	79	276
	Grants $	3 604 039	3 130 691	3 828 121	3 628 370	14 191 221
COLLABORATIVE GRANTS
	n. GRANTS	8	4	9	8	27
	Grants $	638 931	543 571	834 100	1 319 608	3 336 210
TOTAL
	n. GRANTS	64	67	85	87	303
	Grants $	4 242 970	3 674 262	4 662 221	4 947 978	17 527 431

Table 1: Number of GRANTS and sums  funded by MRC per fiscal year.
Refer to Annex , MRC Operating Grants for full disclosure of Grants. (Source  AHRIS )
 
Table 2 - NSERC OPERATING GRANTS

	1996	1997	1998	1999
n. Grants	35	105	32	40
Grants $	827 316	3 545 072	829 463	1 155 359

 Table 2: Number of investigators and amounts funed by NSERC annually.
 Refer to Annex, NSERC Operating Grants for full disclosure of Grants. (Source: NSERC )  

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Table 3 - NSERC COMPOUND ANNUAL SUMS FUNDED FOR 4 YEAR GRANT TERMS

		1996	1997	1998	1999	TOTAL
NSERC 1996
	n. Grants	35	35	35	35
	Grants $	827 316	827 316	827 316	827 316
NSERC 1997
	n. Grants	(35)	105	105	105
	Grants $	(980 000)	3 545 072	3 545 072	3 545 072
NSERC 1998
	n. Grants	(35)	(35)	32	32
	Grants $	(980 000)	(980 000)	829 463	829 463
NSERC 1999
	n. Grants	(35)	(35)	(35)	40
	Grants $	(980 000)	(980 000)	(980 000)	1 155 359
TOTALS
	Grants $	3 767 316	6 332 388	6 181 851	6 357 210	22 638 765

Table 3: We used the mean grant value multiplied by the minimal number of annual grantees
to approximate  data to compare with  MRC 4 year data. Such values are in brackets.

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Table 4 - OPERATING GRANTS FROM OTHER AGENCIES

		93-94	94-95	95-96	96-97	TOTAL
FRSQ
	n. GRANTS	4	5	6	6	21
	Grants $	113 150	99 869	169 948	193 034	576 001
RP FOUNDATION
	n. GRANTS	9	3	6	6	24
	Grants $	413 664	171 500	318 500	332 730	1 226 394
OTHER SOURCES
	n. GRANTS	20	16	16	14	66
	Grants $	1 125 123	1 020 426	1 083 618	842 781	4 071 949
COLLABORATIVE GRANTS
	n. GRANTS	2	4	5	5	17
	Grants $	307 656	1 048 969	1 140 755	1 234 321	3 728 701
TOTAL
	n. GRANTS	35	28	33	32	128
	Grants $	2 001 893	2 383 064	2 755 121	2 660 866	9 613 045

Number of grants and amounts granted by  other sources than  MRC and NSERC per fiscal year.
Refer to annex , OTHER  OPERATING GRANTS for full disclosure of grants. (Source AHRIS )

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Table 5 - FELLOWSHIPS AND TRAINING GRANTS

		93-94	94-95	95-96	96-97	TOTAL
MRC
	n. awards	39	35	24	27	125
	Grants $	720 295	530 954	510 279	551 936	2 313 464
OTHERS
	n. Awards	23	36	32	49	142
	Grants $	770 786	974 485	1 099 957	1 415 437	4 260 365
TOTAL
	n. Awards	62	71	56	76	265
	Grants $	1 490 781	1 505 439	1 610 236	1 967 373	6 573 829

Table 5: number of grants and amounts granted for felloships and training per fiscal year.
Refer to annex , FELLOWSHIPS AND TRAINING GRANTS  for full disclosure of grants. (Source AHRIS )

Table 6 - DISTRIBUTION OF FUNDED VISION RESEARCH IN CANADA

Departments, Schools  96
Universities, Institutions 31
Specialties:   27
Investigators:   232
(Numbers in bracket refer to number of investigators in that particular Department or School)

EASTERN CANADA Acadia Psychology Dalhousie  Computer Science, Faculty of (DalTech) Math., Stats. and Computing Science  Ophthalmology Psychology    6

Memorial Computer Science Psychology   2 Moncton Psychologie Mount Allison Psychology  Mount Saint Vincent Psychology New Brunswick Faculty of Computer Science

 

QUÉBEC  Concordia  Electrical and Computer  Engineering  Psychologie    3  McGill  Biology       2  Electrical Engineering  Neurology and Neurosurgery    3  Ophthalmology       7  Physiology  Psychology     7  Montréal  Education physique  Gnie lectrique & gnie informatiq  Kinanthropologie  Ophtalmologie      3

Optométrie    9  Orthophonie/audiologie, école d' Pathologie  Pédiatrie  Psychologie     6  Sciences biologiques    2  Radiologie Laval  Physiologie   2  Psychologie  Québec-Trois-Rivières  Chimie-biologie  Psychologie  Sherbrooke  Mathématiques-informatique  Ophtalmologie

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ONTARIO Lethbridge  Psychology  McMaster  Biology  Biomedical Sciences     2  Computer Science and  Systems  Kinesiology    2  Psychology   5  Ottawa  Information Technology and Engineering,  Ophthalmology     3  Psychiatry  Queen's  Physiology  Psychology     7  Science  St. Francis Xavier  Psychology  Toronto  Anatomy   and Cell Biology    2  Computer Science    2  ImmunologyandCancerResearch,  Life Sciences - Scarborough

Mechanical Engineering  Medicine  Neurology Hospital (Toronto Western Division)  Ophthalmology    5  Pediatrics  Pharmacology  Physiology     4  Psychiatry  Psychology    8  Speech Pathology  Zoology  Waterloo  Computer Science  Electrical & Computer Engineering  Kinesiology      2  Optometry     8  Psychology     4 Western Ontario  Electrical Engineering  Physiology/Ophthalmology    2  Psychology        5  York  Computer Science      2  Psychology       11

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WESTERN CANADA  Alberta  Biochemistry  Biological Sciences   2  Ophthalmology   2  Psychology       3  British Columbia  Biochemistry and Molecular Biology  Computer Science     5  Ophthalmology   6  Psychology    4  Calgary  Anatomy       3  Biochemistry Medical  Clinical Neurosciences   2

Computer Science  Physiology Medical  Psychology   6  Regina  Psychology  Saskatchewan  Psychology  Simon Fraser  Computing Science     3  Psychology  Victoria  Biology  Psychology     2

Jean Réal Brunette MD
Professor of Ophthalmology, University of Sherbrooke
Martin Steinbach PhD
Professor, Department of Ophthalmology, University of Toronto
Professor, Department of Psychology, York University