News and Events
NEI FY2003 Budget Request--Congressional Testimony Statement before the Appropriations Subcommittees on Labor-HHS-Education
Dr. Paul A. Sieving, Director
National Eye Institute
U.S. House of Representatives
March 13, 2002
March 21, 2002
Mr. Chairman and Members of the Committee:
I am pleased to present the President's budget request for the National Eye Institute (NEI) for FY 2003, a sum of $631.8 million, which reflects an increase of $49 million over the comparable Fiscal Year 2002 appropriation.
It is my pleasure to testify today as the new Director of the NEI. I am grateful for the opportunity to assume this role during a time of unparalleled growth, progress, and opportunity in biomedical research. The National Eye Institute and the scientists it supports are committed to reducing the threats to our vision and to improving the visual health of our citizens. The research that they perform in this pursuit touches upon every area of scientific endeavor and every facet of the visual system. Vision scientists have advanced our knowledge of and improved treatment for a number of eye diseases during this past year, and they stand ready to seize the new opportunities and meet the challenges that await us in the field of vision research.
RETINAL DISEASE RESEARCH
The retina is the transparent, light-sensitive tissue that lines the back of the eye. Diseases and disorders of the retina and its blood vessels account for much of the blindness and visual disability in this country. In the U.S., the most important of these include macular degeneration, diabetic retinopathy, retinitis pigmentosa and related disorders, retinal detachment, uveitis, and glaucoma.
NEI-supported scientists have made important progress in treating a form of childhood blindness. A genetic disorder called Leber's Congenital Amaurosis (LCA) causes blindness in children by mechanisms similar to those in retinitis pigmentosa. Scientists demonstrated successful gene transfer to restore vision in an animal model of this disease. Treatment was performed by introducing normal copies of the gene to replace the mutated gene. Exciting work lies ahead of us to determine whether this approach has potential as a sight-restoring therapy in humans. It is our best hope that this research will lead to a safe and effective means to restore vision or prevent vision loss in patients with LCA and provide a roadmap for the development of therapies for people with a variety of similar diseases.
Researchers also released major findings related to the prevention of macular degeneration. The Age-Related Eye Diseases Study, called AREDS, demonstrated that high levels of antioxidant nutrients and zinc reduced the risk of advanced age-related macular degeneration. Other NEI-sponsored scientists continue to conduct laboratory and clinical studies on the developmental, molecular and cellular biology, the molecular genetics, and metabolism of the photoreceptor cells that capture light; the initial neural processing of information that is transmitted to the visual centers of the brain; the pathogenesis of diabetic retinopathy; and a variety of other sight-threatening eye diseases and conditions. The ultimate goal of these studies is to develop effective therapeutic or preventive measures where none currently exist or to improve those treatments that are currently available.
CORNEAL DISEASE RESEARCH
The cornea is the transparent tissue at the front of the eye that plays an important role in refracting or bending light to focus visual images sharply on the retina. Because the cornea is the most exposed surface of the eye, it is especially vulnerable to damage from injury or infection. The leading causes of corneal blindness are herpes simplex virus (HSV) infection and other infections, corneal opacification or clouding, and inherited and degenerative diseases. Recent results from NEI-sponsored studies have provided important information about the spread of HSV and have suggested that rapid systemic treatment may be more effective than topical antivirals in treating acute, primary infections. Scientists have also learned more about the immune mechanisms involved in corneal transplant rejection and have suggested a means to increase transplant success.
The NEI supports a variety of other laboratory and clinical studies, including: the regulation of genes that express proteins unique to corneal tissue; investigation of the use of adult corneal stem cells to treat corneal damage due to disease or injury; the mechanisms that maintain corneal hydration and transparency; improvement in the diagnosis and treatment of dry eye; the physiologic basis for autoimmune disease involving the cornea; and corneal wound healing. These studies should ultimately improve our ability to limit or prevent damage to corneal clarity caused by injury, infection, or other disease processes.
A cataract is an opacity of the eye's normally clear lens that interferes with vision. Cataract may develop at any time during life, although it is most often associated with advancing age. In addition to aging, cataract may be a consequence of diabetes and other metabolic disorders, trauma, exposure to ionizing radiation, or it may be inherited. Although cataract treatment in this country is one of the most successful of all surgical procedures, development of non-surgical approaches to preventing or treating cataracts remains a research priority.
NEI investigators have recently reported that women on estrogen replacement therapy are less likely to develop cataracts. Additionally, scientists have found that a subunit of a major protein component of the lens is highly effective in protecting cells from stress-induced cell death but may become overwhelmed, leading to cataract formation. These results suggest additional avenues of research that may lead to non-surgical therapies to prevent or delay cataract formation. NEI-sponsored research continues on the development and aging of the normal lens of the eye; the identification of the molecular and cellular components that maintain the transparency and proper shape of the lens; the control of lens cell division and differentiation; and the impact of continual oxidative insult on the lens.
Glaucoma leads to blindness from damage to the optic nerve of the eye. Glaucoma is often, but not always, associated with increased pressure within the eye caused by inadequate drainage of aqueous humor, the fluid within the eye that nourishes the cornea and lens. Although glaucoma is primarily a chronic disease of aging, it may occur at any age. It can occur as a primary disorder or it can be secondary to other ocular or systemic conditions. Glaucoma is a major health problem and the number one cause of blindness in African-Americans. Glaucoma research is a primary focus for NEI's research on health disparities. More than two million Americans have definite glaucoma and it is estimated that another two million are unaware that they have the disease. Nearly 120,000 are blind from this disease.
In the past few weeks, NEI-funded investigators identified a new gene mutation on chromosome 10 that caused a form of adult-onset glaucoma. The gene codes for a protein that normally protects nerve cells from damage. Scientists have also recently identified a molecular marker of glaucoma in the trabecular meshwork, which forms the tissue that regulates the exit of aqueous humor from the eye. This same substance is the earliest marker for the buildup of fatty deposits in the linings of blood vessels damaged by high blood pressure. Other markers that are usually associated with oxidative stress and inflammatory reactions were also identified in cells from glaucoma patients. Such studies offer insights and hope for new and more effective therapeutic interventions.
STRABISMUS, AMBLYOPIA, AND VISUAL PROCESSING RESEARCH
Childhood vision loss most frequently results from strabismus, a misalignment of the eyes and the development of amblyopia, or lazy eye. Strabismus results in diseases in which visual processing is abnormal. Amblyopia can result from this misalignment or from unequal refraction between the eyes. Research on strabismus and amblyopia encompasses a broad range of clinical and laboratory studies on the structure and function of the neural pathways from the retina to the brain, the central processing of visual information, visual perception, the control of ocular muscles, and refractive errors.
Important new results from the Amblyopia Treatment Study are being released March 13. This study began recruiting patients in April 1999 to compare two different treatments for amblyopia--eye patching or administration of a single eye drop of atropine per day. These exciting findings will change clinical practice in this country. NEI research support continues for a broad range of other preventative, therapeutic and laboratory studies that are concerned with the development and function of the neural pathways from the eye to the brain; wiring of the visual system of the brain during the young years of development; the central processing of visual information; visual perception; optic neuropathies; eye movement disorders; and the development of myopia.
HEALTHY PEOPLE 2010
Healthy People 2010 is a national initiative to prevent disease and promote health issues sponsored by the U.S. Department of Health and Human Services. Vision objectives, codified as Healthy Vision 2010, are highlighted in this initiative. The NEI coordinates the workgroup activities designed to accomplish these objectives. This vision focus area addresses visual impairment due to eye disease and refractive error; regular eye examinations for children and adults; vision screening for pre-school children; and injury prevention. Initial activities include collecting baseline data on eye disease prevalence, so that progress can be monitored in treating the visual disabilities that lead to low vision and impair the productivity and quality of life of our citizens.
HEALTH EDUCATION AND COMMUNICATION
The National Eye Health Education Program (NEHEP) was mandated by Congress and implemented by the NEI to increase awareness among health care professionals and the public of scientifically based health information that can be applied to preserving sight and preventing blindness. NEHEP works through its partnership of over 60 professional and voluntary organizations to implement three formal education programs covering glaucoma, diabetic retinopathy, and low vision.
The newest of these programs is the Low Vision Education Program, designed to increase awareness of low vision and its impact on quality of life. As a part of this program, the NEI launched a multi-year nationwide shopping center tour of THE EYE SITE--A Traveling Exhibit on Low Vision. The exhibit consists of five colorful kiosks and features an innovative interactive multimedia touchscreen program. The exhibit is targeted to all people over age 65, and Hispanics and African Americans of any age. These groups, their families, and friends are the primary audience for the exhibit.
Another NEHEP program theme highlights a new Medicare benefit for glaucoma detection, which became effective in January. The Medicare benefit includes coverage of a dilated eye examination with an intraocular pressure measurement for people at highest risk of developing the disease, including African Americans over age 50, people with diabetes and those with a family history of the disease. This new effort is being coordinated with other Federal agencies, including the Center for Medicare and Medicaid Services.
GOVERNMENT PERFORMANCE AND RESULTS ACT
The NIH budget request includes the performance information required by the Government Performance and Results Act (GPRA) of 1993. Prominent in the performance data is NIH's second annual performance report which compared our FY 2001 results to the goals in our FY 2001 performance plan.
Mr. Chairman that concludes my prepared statement. I would be pleased to respond to any questions you or other members of the committee may have.