Vision Research and Care : Where A re We Now?

Vision Research and Care: Where Are We Now? Kevin D. Frick, PhD Professor and Vice Dean for Education

Funding • Research to Prevent Blindness provided funding for the work led by Kevin Frick, PhD, The Johns Hopkins Carey Business School. • The findings do not reflect the opinions of RPB, its staff, its Scientific Board, or its Board of Trustees.

Methods Institutional Review Board approval received from The Johns Hopkins University Convenience sample informed by funding provided by Research to Prevent Blindness Recruitment Letter • RPB sent information to potential participants • Study sent letter to potential participants

Methods: Survey • Audio calls of 60 minutes or less recorded with permission from the interviewee • All calls transcribed • Qualitative

Objective To delineate the Strengths, Weaknesses & Needs of the system of U.S. vision research related to: • Blindness prevention • Sight restoration • Provision of eye care and vision services

What Was Asked About? • Clinical Areas of Research • Basic Science Areas of Research • Strengths of Top Ophthalmology Departments • Overall System of Vision Research • The System of Care

What Was Asked About? Clinical Areas Three most important Basic Science Areas Three most important

What Was Asked About? Top Ophthalmology Departments In thinking about the top ophthalmology departments, what are the… • Strengths of faculty • Strengths of infrastructure • Strengths of staff • Strengths of research organization • Other strengths

What Was Asked About? Overall System of Vision Research • Is it strengthening? • What are some weaknesses? • Are there external threats?

What Was Asked About? The System of Care • Can we reorganize care provided by ophthalmologists to improve outcomes? • Can we reorganize care more broadly to improve outcomes? • Are there threats to care to prevent blindness? • Are there threats to the care of those who are blind?

Findings: Vision Research • Top Clinical Areas • Top Basic Science Areas • Faculty Strengths • “Infrastructure”Strengths • Staff Strengths • Challenges to Research System Improvement • Signs the System May Be Strengthening • Top Research Weaknesses • Top External Threats

Findings: Vision Research Top Clinical Areas • Macular degeneration • Glaucoma • Diabetes • Also gathered information on… • Whether the problem can be solved in the next decade in the US? • Why or why not? • If not, how about world in the next decade?

Findings: Vision Research Top Basic Science Areas • Gene therapy • Stem cell • Other genetics • Neuro-protection • Also gathered information on… • Whether the problem can be solved in the next decade in the US? • Why or why not? • If not, how about world in the next decade?

Findings: Vision Research Top Faculty Strengths • Clinical scientists • Basic and clinical science • Basic science • Critical mass • Hard working • Training • Infrastructure mentioned as contributing to faculty strength

Findings: Vision Research Top “Infrastructure” Strengths • Core facilities • Financial resources (general) • Collaboration outside ophthalmology is seen as a part of the research infrastructure

Findings: Vision Research Staff Strengths About Staff Members • Commitment to excellence/success • Includes clinical scientists • Experience working with basic scientists • Expertise for research efforts • Quality and well educated • Statistics knowledge • Quantity makes a difference

Findings: Vision Research Staff Strengths What they do • Protecting time of investigators • Collaborate with faculty • Focus on the tripartite mission (teaching/ research/ patient care) • Hard working

Findings: Vision Research Challenges to Research System • Money • Lack of funding in general • Lack of funding specific to government • Lack of margin in the clinic to subsidize research • Difficulty for young scientists • Lack of coordination in research • Peer review process leads to a lack of new ideas • Universities seeing ophthalmology as less important

Findings: Vision Research Signs that the System May be Strengthening • The lack of funding forces focus • Ability to attract top talent • Opportunity to team up with industry • Knowledge • Incredible increase in scientific knowledge • Significant improvements in gene therapy and genetics

Findings: Vision Research Top Research Weaknesses (Each of these was also listed as a reason that the research system is not strengthening.) • Funding or lack of funding • De-emphasis on ophthalmology • Lack of clinical dollars to subsidize research

Findings: Vision Research Top External Threats • Three were listed in other areas • Funding—comes up in so many ways • Attracting scientists • Feeling that ophthalmology is de-emphasized • Also the challenges of healthcare reform

Findings: Vision Care • Improving Provision of Care Outcomes • Improving the Overall System of Care • Other Threats to Optimal Outcomes

Findings: Vision Care How can care provided by ophthalmologists be changed to improve outcomes? • Integrate care • Standardize protocols • Make a transition to population health focus

Findings: Vision Care How can we improve the overall system of care? • Pushing care to lowest qualified provider focusing on scope of practice issues • Telemedicine • Screening

Findings: Vision Care What are other top threats to optimal outcomes? • Many were responses to earlier questions • Money—Reimbursements, & Funding • Perceived devaluation of eye services • Population Issues—Diabetes, Obesity, Aging

Findings: Vision Care Threats to optimal system operation for those who are blind • Money—Funding, reimbursement, and cost • The current system is poor or non-existent • Difficulty with access • Variation by state • Lack of referral, to social services especially • Scope of practice issues

Conclusions • More agreement on what are the top clinical issues than on top basic science issues • Collaboration between basic & clinical or across institutions-key to future • Devaluation of ophthalmology • Resources are key • Ability to attract future talent is a concern • Lack of coordination is critical • Scope of practice issues affect care • Increasing need for a population health focus

Where Do We Need to Go? • Assure monetary and talent resources • Seek translational opportunities • Re-engineer system to allow for more coordination and collaboration in research and care

Vision Research and Care : Where A re We Now?