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Indication of exciting times
The progress of ophthalmology in Asia has paralleled much of its socioeconomic evolution. During the early years of a nation‘s development, scarce resources of a country were usually concentrated on building the basic healthcare infrastructure and services needed to cater for the general population. Over time, with increasing affluence and improved health care, resources could be channelled elsewhere towards developing other goals. One such development is the emergence of ophthalmic research in Asia. As in Western societies, clinical and basic science research is increasingly seen as being an integral component of a well balanced portfolio in many Asian healthcare institutions. This is reflected by the increasing number of high quality publications in leading eye journals that originate from Asia.
Although there are several clinical meetings in ophthalmology held on a regular basis in Asia, there are few large forums in this region that bring together vision and ophthalmic scientists to share their work. It was with this in mind that the Singapore Eye Research Institute (SERI), in direct collaboration with the Association of Research in Vision and Ophthalmology (ARVO) in the United States, organised the SERI-ARVO Meeting in Singapore in February 2003. The meeting covered both clinical research in ophthalmology and basic research in the visual sciences, with specific emphasis on eye diseases relevant to Asians. Several papers in this issue of the BJO are expedited presentations from the SERI-ARVO meeting.
In addition to the scientific symposia, pre-SERI-ARVO meeting workshops were held to provide an introduction to research methodology. These included a workshop on “Understanding basic science research,” which covered principles of basic science research and an introduction to common techniques used in genomics, proteonomics, molecular biology, stem cell research, and ocular immunology. Another workshop, “How to design and conduct clinical research,” introduced the clinical investigation method, with a focus on the design, conduct, and analysis of clinical trials, surveys, and other epidemiological studies relevant to ophthalmology. The third workshop, “How to write a successful grant and scientific paper,” provided a broad overview of practical skills in writing a research grant, getting the paper published, ethical issues, and the evidence based approach. These workshops were well attended by both junior and senior ophthalmologists and vision scientists in the region.
Causes of blindness and the spectrum of eye diseases in Asia appear to be different, which suggests that traditional approaches to treatment may not be appropriate
The success of the SERI-ARVO Meeting is an indication of exciting times for ophthalmic research in Asia. However, several key issues challenge its continued development. What are these? Firstly, one of the current problems faced by many Asian countries is that most institutions and departments, and their heads, still place the highest priority on clinical service, and emphasise high clinical volume and subspecialty expertise as key prerequisites for staff promotions. Thus, the importance of clinical service and teaching frequently consigns research to a low priority on the hospital and departmental agenda. Some clinical heads do not appreciate the effort that a publication in a top journal entails, and feel that research can be done during the lunch hour or after seeing a full load of patients. The concept that high impact research can be performed as a “part time hobby” must change. Asian institutions and hospitals must realise that a well regarded research programme adds incalculable value to their department‘s reputation and brand name and may, in fact, drive their clinical service. Patients flock to famous ophthalmic institutions in the United States (for example, Wilmer Ophthalmological Institute) and Europe (for example, Moorfields Eye Hospital) partly based on their high impact, leading edge research.
A second problem is the lack of a core nucleus of clinician-scientists interested in pursuing high quality ophthalmic research, particularly basic science research, in most Asian institutions. This may be somewhat surprising because in the past few decades, many young ophthalmologists in training in Asia are sent overseas to the United States or Europe for further fellowship attachments. These trainees are often required to conduct research as part of their clinical training, and will have been exposed to the rigorous research methods in their supervisors‘ laboratories, and may come home having published in prestigious journals. However, although young Asian ophthalmologists clearly have the ability to perform high quality research in the right environment overseas, their productivity diminishes when they return home. The reasons for this infertile research soil in Asia are multifaceted and complicated. One aspect could be a lack of protected time wherein young potential clinician-scientists are overwhelmed by demands of patient care and clinical responsibilities on their return. Budding junior ophthalmologist-researchers are also given the impression that research may be “professional suicide” by their clinician colleagues. The clinician-scientist route is not yet perceived as a viable and sustainable career track. In this aspect, Asian countries should look into the success of young faculty and investigator schemes in Western countries (for example, the K awards from the National Institutes of Health in the United States and the Wellcome Trust Career Development Programmes in the United Kingdom).1
Finally, in Asia, the ethical conduct of research remains erratic.2–4 It is not clear that the informed consent, the foundation of ethical human clinical research, is properly administered appropriately in all countries.5 New problems raised by the increasing use of large scale human tissue sample collection for genetic research will pose a serious challenge in Asia, as it has been for many years in the West. Issues relating to human rights, privacy, intellectual property rights, and appropriate relationship between academia and commerce will have broad implications for the conduct of biomedical research. Another source of concern is the issue of animal rights in Asia.6 These and other problems must be quickly and decisively addressed by the leaders of the ophthalmic research community in Asia for the future development of research in this region.
Asia offers unique opportunities for ophthalmic research. The two most populous countries in the world, China and India, still have one of the higher rates of blindness and visual impairment.7 Additionally, the causes of blindness and the spectrum of eye diseases in this region appear to be different, which suggests that traditional approaches to treatment may not be appropriate. For example, myopia8,9 and angle closure glaucoma10,11 are more common in east Asians than in similarly aged people in the West. Thus, Asia offers researchers the clinical material to focus on these diseases. Ultimately, this will afford a clearer understanding of the aetiology, pathogenesis and natural history, and novel strategies for treatment and prevention of the major blinding diseases in Asia.
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Indication of exciting times