The 2021 National Eye Institute Strategic Plan: Eliminating Vision Loss and Improving Quality of Life

“Plans are useless, but planning is everything.”

- Dwight D. Eisenhower

The National Eye Institute (NEI) has been a world leader in directing and funding eye and vision research since 1968, when Congress and President Lyndon Johnson established it as an independent entity within the National Institutes of Health (NIH) to manage national efforts in vision science.¹ The current annual NEI budget is $835 million. Now in 2021, the NEI is releasing a new Strategic Plan, which outlines our directions and priorities over the next 5 years and is the first comprehensive NEI Strategic Plan since 2012.²

Why does our work at NEI matter? From a clinical perspective, vision disorders can have an enormous impact on quality of life for patients. Survey data reveal that blindness is among the conditions that Americans fear the most.³ From a scientific perspective, many foundational innovations have occurred first in the visual system because it is an accessible setting for performing research, which can then be generalized to other fields. For example, the first FDA-approved autonomous artificial intelligence system was created for detecting diabetic retinopathy,⁴ the first FDA-approved gene therapy for an inherited disease targeted a retinal degeneration,⁵ and ocular imaging modalities are rapidly transforming clinical care and research paradigms from qualitative to quantitative.^6,7

Why do we need a new NEI Strategic Plan? As unprecedented advances in science and computing have occurred during the past several decades, we are rapidly moving into an era where knowledge discovery is no longer limited by technology, but only by creativity. Modalities such as genetics, molecular diagnostics, information technology, and data science are providing the vision research community with unique opportunities to improve understanding of disease mechanisms, leading to novel diagnostic and therapeutic tools. The ongoing COVID-19 pandemic has demonstrated the value of investment in research, as highly-effective vaccines were developed at an extraordinary pace due to decades of scientific investigation.⁸ At the same time, the pandemic has exposed many underlying health disparities and highlighted the importance of making scientific advances accessible to the entire population. Because of this evolving landscape in research, healthcare, technology, and public health, we found it vital to revise the NEI mission statement as part of developing the Strategic Plan (Table). This is the first revision of NEI’s mission since our founding in 1968, and begins: “The mission of the National Eye Institute is to eliminate vision loss and improve quality of life through vision research”. To address these opportunities and challenges, we have framed our new Strategic Plan around this mission.

Table. National Eye Institute Mission Statement (2021).

This was developed in collaboration with internal and external stakeholders.

The mission of the National Eye Institute is to eliminate vision loss and improve quality of life through vision research. To achieve this mission, NEI provides leadership to:

• Drive innovative research to understand the eye and visual system, prevent and treat vision diseases, and expand opportunities for people who are blind or require vision rehabilitation.

• Foster collaboration in vision research and clinical care to develop new ideas and share knowledge across other fields.

• Recruit, inspire, and train a talented and diverse new generation of individuals to expand and strengthen the vision workforce.

• Educate health care providers, scientists, policymakers, and the public about advances in vision research and their impact on health and quality of life.

How does this Strategic Plan aim to promote collaboration across fields? NEI’s core research program areas are currently organized by anatomy and disease: retina; cornea; lens and cataract; glaucoma and optic neuropathy; strabismus, amblyopia, and visual processing; and vision rehabilitation (Figure).⁹ These NEI core areas coincide with clinical divisions of most ophthalmology and optometry departments. In developing the new Strategic Plan, we hope to enhance these core research programs by layering on methodological expertise with the goals of addressing challenges across the entire visual system and facilitating translation of promising findings into clinical care and population health. To accomplish this, we have organized the plan around 7 cross-cutting areas of emphasis: genetics, neuroscience, immunology, regenerative medicine, data science, quality of life, and public health and health disparities. These 7 areas are tracks of study that resemble the structure of most university basic science programs. By identifying these areas of emphasis, we aim to highlight important perspectives and expertise that complement the existing core portfolio at NEI. Rather than replacing the existing core programs, they will underscore areas where interdisciplinary approaches can link mechanistic science with clinical applications (Figure).

Figure. Seven cross-cutting areas of emphasis (vertical bars) in National Eye Institute Strategic Plan.

These do not replace the existing core program structure (horizontal bars) but, rather, highlight evolving areas that will require interdisciplinary approaches.

How was the planning and development of the NEI Strategic Plan conducted? While beginning to develop this plan, NEI considered the National Academies of Sciences, Engineering, and Medicine report, Making Eye Health a Population Health Imperative, which called for broad groups of stakeholders to establish a common research agenda.¹⁰ Accordingly, NEI issued a Request for Information to researchers, clinicians, patient advocates, professional societies, and the general public to solicit perspectives regarding research needs. Subsequently, we invited over 150 panelists and reviewers to participate in developing the plan, with the aim of producing reports for each area of emphasis that highlighted recent progress followed by key needs, gaps, and opportunities that would benefit from NEI-supported initiatives.

Successful implementation of the NEI Strategic Plan will require the talents of clinicians, researchers, educators, and others from across a wide range of disciplines. How can clinicians contribute? Insights by experienced clinicians such as identifying gaps in real-world care or observations of unusual findings or results are invaluable. When communicated to scientists, these insights are critical for motivating basic, translational, clinical, or population-based investigations. Similarly, laboratory studies involving the eye or visual system often benefit from collaboration with clinicians to ensure they remain focused on relevant outcomes. Furthermore, many clinicians will remember being taught in school that “half of what you learn during training will turn out to be incorrect or obsolete during your career”. Because knowledge discovery in biomedical science occurs so rapidly, the standards of practice continuously evolve and lead to better therapeutic options for patients - and physicians must understand the research process to recognize which new advances should be incorporated into practice.¹¹ We hope the NEI Strategic Plan will inspire clinicians to recognize these and other areas where they can play critical roles in the scientific processes that will ultimately lead to improved patient outcomes.

What’s next for the National Eye Institute? Moving forward, NEI will develop and implement initiatives for solicited projects, using the Strategic Plan as a roadmap. Investigator-initiated research will remain NEI’s primary engine for scientific discovery. However, we hope investigators will also consider the Strategic Plan in developing unsolicited investigator-initiated projects. In a series of parallel editorials, we describe other directions that NEI will take within the framework of our mission statement and Strategic Plan: driving innovative research, fostering collaboration, promoting quality of life, and recruiting a diverse workforce.^12–15 Overall, a Strategic Plan is simply an initial step. In reference to President Eisenhower’s quotation, the advancement of knowledge and translation to clinical care will require planning and the combined efforts of a large community of scientists, clinicians, patients, and other stakeholders. We at the National Eye Institute look forward to working with the entire community to develop and refine ideas that will advance our mission of eliminating vision loss and improving quality of life for patients.