I learned that there were more people with ocular diseases and visual disabilities than any other serious physical defect. More than 10 percent of all patients in the nation’s medical hospitals were eye patients. It could be predicted that half a million Americans would become legally blind in the next decade. Millions more were blind in one eye, had chronic eye disease, or had so little sight they could not read a newspaper, even with glasses. More than 56 million schoolchildren under age 15 had visual problems, while almost all people in their later years faced the threat of serious visual loss.
When I asked what was being done to reverse this tragic, remorseless toll of disability, there were no acceptable answers. Blindness was so widespread that it seemed to be accepted as an act of fate. When the facts began to emerge, it was evident that neither fate nor accidents played a major role. The cause of almost all blindness was—and continues to be—eye disease. There were names for these diseases—cataract, glaucoma, retinal degeneration, uveitis, retinitis pigmentosa—too many to mention here. But the fact was that very little was known about them, and most could not be prevented. I asked what was being done about research, and I learned that the total national investment in vision research from all sources averaged less than $7 million a year—less than half of one percent of what it cost to care for the blind. We were spending far less on eye research than we were spending for eye wash. Obviously, neither government nor disinterested philanthropy were doing much to deal with the basic causes of blindness.
It became clear to me—and my wife insisted upon it—that my organizational abilities and knowledge of ophthalmology might serve a useful purpose in attacking this massive, and obviously neglected, health problem.
A new kind of public foundation was created, with Mr. McCormick as president and myself as chairman. Mr. McCormick had lost much of his vision through retinal detachments and had been among the first to encourage my interest. We called the new organization Research to Prevent Blindness, Inc. (RPB) to leave no doubt as to where our interests lay. We gathered about us as trustees a small group of the most highly qualified people in business and philanthropy, including Mary Lasker. Our scientific advisory panel was composed of ten outstanding leaders in biomedical research and education. One already had won the Nobel Prize for Medicine and two others have since been so honored. To these we added what is undoubtedly the smallest but most effective professional staff among all major national health organizations. And we went to work.
Drawing upon our long experience in successful business administration, the trustees approached the problems of blindness just as a profit-making organization would approach a marketing problem. One of our first steps was to survey the entire field of eye research through site visits and comprehensive questionnaires to departments and divisions of ophthalmology. It took a full year to produce and distribute the penetrating survey report, “Ophthalmic Research: U.S.A.” But that survey became the Flexner report of ophthalmology.
It authenticated for the first time a state of almost total neglect of the needs and unlimited opportunities for productive eye research. Promising work was impeded by lack of adequate attention. Ophthalmology was too often considered an adjunct of surgery. Full-time researchers were all but non-existent. The amount of laboratory space for eye research was pitifully small; even the renowned institutes at Johns Hopkins and Harvard suffered from cramped, obsolescent quarters. The new technological tools of biomedical research, so costly but so necessary to advanced studies, were largely denied to the ophthalmological investigator. There was little money, little recognition and little hope for the aspirations of those who wished to study the eye and its diseases.
We felt we should know something about public attitudes toward visual failure, so RPB sponsored a nationwide Gallup opinion survey. It disclosed that fear of blindness among the American people was second only to fear of cancer. Yet, even at the National Institutes of Health, the voice of ophthalmology was almost unheard. It took its direction from the Institute of Neurological Diseases, to which “and Blindness” had been added almost as an afterthought. Somehow the golden wand of the health research boom had never touched ophthalmology.
We made a major policy decision—we decided that RPB must become a catalyst. It would not be another fundraising colossus, raising money for the sake of raising it. We decided against a general public fundraising campaign. That made us unique to begin with—and in all its 15 years, RPB’s fundraising costs have remained at less than two percent.
We made other unique decisions. We realized that it was not enough to make project grants. The entire eye research environment had to be reinforced. So we elected to give annual grants of unrestricted funds to be used by heads of ophthalmology in any way that would strengthen their research programs. The key factor in our selection of grantees was that the head of the department have the talent to attract, train and inspire investigators of the highest caliber.
Research directors are convinced that this is the most valuable money received by their departments. It has financed everything from the initial adaptation of the laser for ophthalmology to salary support for laboratory technicians. It has stimulated creativity, encouraging activities for which project funds are not available. Time and again, RPB unrestricted grants have generated pioneering studies which later qualified for extensive support from the National Institutes of Health.
We think this is what voluntary organizations should be doing, this is how public contributions should be spent, because we believe it impractical, uneconomical, and wasteful to engage in costly fundraising campaigns. Adequate financial support of biomedical research on mammoth health problems must necessarily involve the federal government. On the other hand, it is the responsibility of the public voluntary foundation to do those things that government cannot and should not do—to act not only as a spur to research, but as an alert watchdog to assure that the health interests of the people are well served and their tax money is used to maximum advantage.
Probably the greatest single achievement of RPB has been its successful fight for the creation of a separate National Eye Institute, giving vision research autonomy within the National Institutes of Health. This is now beginning to produce the broad financial base necessary for the establishment of solid, well-rounded programs of eye research at our medical schools. At the same time, this imposes a further responsibility upon us as a catalytic agent to continuously represent the interests of the scientific community and the public. We must remain alert and responsive to political and economic trends, so that this government support may be effectively utilized and increased without danger to scientific independence. Through the coordination of expert testimony before Congress and informative contacts with legislative leaders, RPB provides an authentic public voice which is heard and respected.
The role of the catalyst has many facets. It must reach deep into the private sector of our society, seeking out individuals, corporations and foundations which have not only the capacity for financial support, but the interest to make that support effective. RPB has generated that interest through unique programs that have no counterpart in the voluntary health field.
A dramatic example is the growth of eye research laboratory space over the past decade as a result of an imaginative construction plan that RPB makes available to selected institutions. To meet the critical need for modern facilities, RPB sponsors construction campaigns in which it underwrites campaign costs, providing the services of professional development personnel, so that institutions are relieved of the heavy administrative burdens and often inordinate expense of raising building funds. In ten years, RPB has channeled more than $20 million in private funds into the construction of major eye research centers across the nation at a fundraising cost of less than two percent. It has more than tripled the amount of eye research space in the United States.
Among the new institutions is one of which I am especially proud—the Jules Stein Eye Institute at the University of California, Los Angeles. It embodies all the enormous capabilities of modern ophthalmology to diagnose conditions that once went unrecognized; to restore sight and preserve vision in people who once would have become blind; to train outstanding physicians and scientists who will perform still greater miracles of therapy in the future; and to pursue those advanced concepts in research that make the saving of sight possible.
Four such RPB-sponsored centers are in operation today—at UCLA, at Johns Hopkins University, Columbia University and the University of Louisville. Two others are under construction at Baylor College of Medicine and the Medical College of Wisconsin. In each case, RPB has received not one cent of the funds contributed. Such gifts are made directly to the institutions. What is reflected in our financial tables is a cost, rather than income—the two percent cost of running those campaigns. That small amount represents a saving of millions of dollars in unproductive expenses, and it is speeding the timetable on eye research throughout the entire world.
If we had unlimited time, I might explain to you that this catalytic quality has done in terms of attracting and holding the highest caliber of scientists to eye research. RPB Eye Research Professorships, Manpower Awards, Scholars Programs, and other inducements have vastly increased both the numbers and the competence of ophthalmic investigators. But I think it more appropriate to let the record speak for itself, to list just a few examples of research accomplishments which have evolved out of this renaissance of eye research.
For those of you who are young enough to be unimpressed by today’s medical achievements, let me provide a little background from the past. When I left the practice of ophthalmology in 1925, a cataract operation was an extremely dangerous procedure. We broke up the lens with a needle and scratched out whatever part of it we could reach. Patients were immobilized for weeks, their heads between sandbags. If they were lucky enough to avoid post-operative infections that might have destroyed their sight, they were required to wear beer-bottle lenses that not only were ugly, but distorted the world around them.
A retinal detachment almost always led to blindness. We had no way of reattaching the tissue, and fewer than 4 percent of detachment patients recovered their sight. We knew little about treating glaucoma, about the control of pressure inside the eye. Corneal transplants had no place in standard eye surgery. There were no eye banks to provide clear, healthy, tissue; no means of tissue preservation; no drugs to control infection and limit the rejection process; no microinstrumentation for the precise work necessary. The simple eye infection of today once blinded thousands because our medications were of only limited value.
Consider now the results of eye research.
Four hundred thousand cataract operations are performed each year in the United States with 98 percent success. Today, the lens is reached through a tiny incision, removed by freezing techniques or emulsified by ultrasound and siphoned out through the same instrument. The next day the patient is out of bed and in a few days is home with no extraordinary restrictions on his movements. Millions of dollars are saved in hospital costs. New drugs prevent post-operative infections. Contact lenses—both hard and soft—or other cosmetically acceptable eyeglasses are available to correct the patient’s vision.
We have witnessed the dramatic results of vitraectomy—a new surgical procedure which already has restored the sight of some who were blind for years from blood hemorrhaging into the normally clear vitreous. The vitreous is the gel-like substance that fills the eye’s inner cavity, and through all the centuries no safe way had been found to remove it without danger of the eye’s total collapse. With help from RPB, a pioneering researcher has developed a surgical instrument which permits entry into the center of the eye through a very small incision. Used under the operating microscope, the device safely cuts away vitreous strands, chops them up and siphons them out through its hollow needle, at the same time replacing the vitreous with a clear fluid. If the retina is still operative, sight is restored. The success of vitraectomy with those already blind has encouraged extensive studies of its potential effectiveness in early diabetic retinopathy, the most rapidly increasing cause of blindness in the United States.
About a dozen years ago, an RPB grantee used his unrestricted funds to begin exploring the use of the laser beam in ophthalmic surgery. Today the laser is standard equipment, its beam spot-welding detached retinas with 95 percent success and sealing off the hemorrhages and proliferating blood vessels in the eyes of thousands of diabetics. Its use in many new areas of therapy, diagnosis and research is continuously being explored with important results. One RPB grantee has devised a method employing a weak laser beam for accurate measurement of the critical flow of blood and oxygen in the living retina, without touching the patient.
Corneal transplants are being carried out by the thousands in every part of the world. Research has developed practical methods for storing and transporting donated eye tissues. Modern surgical techniques fit pre-cut and pre-measured discs of donated corneal tissue exactly to areas where damaged tissue has been excised. When human tissue cannot be transplanted, clear, plastic buttons have been devised which may be fastened permanently into a small hole in the corneal surface.
Ophthalmic pharmacology is progressing phenomenally. Last month a large RPB award was made to a brilliant woman scientist to begin human trials of Ara-AMP, a new drug that promises control of devastating herpes viruses that are the major cause of corneal blindness in the United States. In the success of this drug may also be found an answer to herpes II genital infections, the nation’s most prevalent and incurable form of venereal disease. Another drug, 6-HD, developed under an RPB grant, is demonstrating its effectiveness in controlling numerous cases of previously intractable glaucoma.
With the advent of new and more effective drugs, ingenious delivery systems are being devised to simplify treatment and make maximum use of the smallest possible dosage. A small, pliable wafer, saturated with medication, may now be inserted comfortably behind the lower eyelid and left there over a period of days—even weeks—to gradually release its drug, making frequent daily administration unnecessary. The potential value of such a system in controlling glaucoma, trachoma and infectious diseases such as herpes simplex keratitis is incalculable.
We are experiencing a technical explosion in the diagnosis of eye disease. Fluorescein photography, ultrasound, optic disc mapping, 180-degree retinal observation—a listing of all the important new diagnostic tools alone would fill pages. We have at last begun to observe ongoing processes of this magnificent, complex organ that were invisible to the ophthalmologist just 15 years ago, and which were undreamed of in my days of practice, 50 years ago.
Given this unprecedented opportunity to see and to understand, the potential of tomorrow’s eye research staggers the imagination. Beyond all the clinical results that are being attained, a whole new generation of basic scientists is reaching into the structure and nature of the millions of cells that comprise the visual system. Their work in cell biology, immunology, pathology and other basic disciplines will some day lead to causes, and knowledge of the causes will lead inevitably to cures and preventives for eye diseases that continue to threaten the entire human race. And some day, someone will stand as I am standing here today, and smile at the primitive nature of today’s achievements.
It will not happen through the activity of any one segment of society. It will happen because each segment—scientific, political, philanthropic, public, industrial—has contributed its own special expertise and resources to achieve a desirable end. And there will have been a catalyst, bringing these seemingly diverse interests together; pointing out the needs; devising the plans; and boldly utilizing these forces to solve what may now seem to be insurmountable problems.
If my work in the prevention of blindness merits this Award, it is because I have served as such a catalyst. If I have been useful in bringing progress in eye research to this exciting point of productivity, then I have lived a satisfactory life as I approach my 80th birthday—one that is pleasing to me and, I hope, to those who have given my life meaning. I am grateful for this Award and for the opportunity to address you, and I sincerely thank you.
