America’s vision problem

It affects more than a quarter of Americans. It isn’t a virus or a bacterial infection. It’s nearsightedness, a condition on the rise in societies across the globe as a result of modern life: people are reading more, and screen time is exploding.  

Scientific breakthroughs are required to address this new health reality. And the best bet is high-risk, high-reward research that can yield breakthroughs but rarely gets funded. While breakthrough treatments for pervasive health problems are possible, first Congress must place greater value on riskier, potentially transformative research, most immediately through passing the 21st Century Cures Act in the Senate.  

The National Institutes of Health invests nearly $30.3 billion in research every year, and Congress appears to have reached a fragile consensus it needs more resources. That represents important progress, but high-impact research with the potential to transform medicine in dramatic ways deserves greater attention and investment as well.  

NIH-funded research is incremental, building a foundation of actionable scientific knowledge. To be funded, scientists must show they have collected extensive preliminary data on the question at hand. Some researchers joke that research grants go to projects where everyone involved has a good idea of what the results will be – or where they have in fact already done the proposed work. That is certainly an exaggeration, but it speaks to the relative lack of funding for riskier research that can generate breakthroughs we might never make with an incremental approach.  

Alternative funding models do exist: the Pew Charitable Trusts and Howard Hughes Medical Institute are two private organizations that fund promising researchers, giving them broad leeway to pursue their research ideas. The payoff has been significant. Our colleague Carol Greider, for example, discovered how chromosomes are protected by telomeres and the enzyme telomerase while a Pew Scholar in the Biomedical Sciences. That finding, for which she won a Nobel Prize, opened the door to a new avenue of research into cellular aging.

But the majority of biomedical funding comes from the National Institutes of Health, which by and large takes a risk-averse approach to research funding. A long-term , incremental research approach addresses many important needs of our society, establishing a vital foundation of knowledge for further advances. Addressing some of our needs, however, requires a bolder approach.  

We look at myopia and see a disease with widening impact but inadequate means to address it. Nearsightedness affects more than one-third of Americans, nearly doubling from 25 percent in 1971-72 to 41.6 percent of the population between 1999 and 2004. It is perceived to be a fairly harmless disease, but the reality is that it is widespread with a severe form that affects about two percent of the population and can be dangerous and debilitating.  

We see potential through stem cells to treat myopia, instead of just coming up with coping mechanisms like glasses or LASIK. We believe that research could be done that accelerates stem cell therapies significantly, but we have to look for funding through mechanisms that favor safer bets. With more resources invested in new approaches to research, we could test techniques for replacing defective cells in the human eye.  

Simply stated, playing it safe may be getting in the way of a medical breakthrough. 

Myopia conveniently describes both a growing global health threat and an unfortunate political reality in Congress. Research funding is inadequate in general, including where a big bet might secure an even bigger return. Without greater support for riskier research, prioritized in the 21st Century Cures Act, in addition to more conventional research investments, some of the most impactful discoveries may never be made.   

As investigators at Johns Hopkins Medicine, we rely on research funding to open doors to discovery and innovation. We are concerned about the consequences of severe forms of myopia—but there are certainly other areas where riskier research could benefit millions, if not billions of people. As a country, we underfund research and when we do fund it, the mix of funding is too risk averse. If we expect American research to continue yielding breakthroughs in the 21st century, we need to consider ways to make some bolder bets on research.   

Handa, the Robert Bond Welch, M.D., Professor of Ophthalmology at Johns Hopkins, is an experienced eye surgeon specializing in researching and treating complex eye diseases.

Janowski is an assistant professor of radiology and radiological science and a stem cell engineer at the Johns Hopkins University School of Medicine, where his research focuses on stem cell therapy aided by noninvasive imaging. 

Walczak is an associate professor of radiology and radiological science at the Johns Hopkins University School of Medicine. Like Janowski, his research focuses on transplanting and tracking stem cells.