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Dr Michael Chiang Speaks About the NEI's Involvement in AMD, Addressing Health Disparities


Michael Chiang, MD, director of the National Eye Institute, spoke about efforts to address age-related macular degeneration (AMD) as well as health disparities in clinical trials and access to treatment.

Michael Chiang, MD, director of the National Eye Institute, spoke about the organization's future plans to address the treatment of age-related macular degeneration (AMD) as well as health disparities in the ophthalmic field.


Age-related macular degeneration is known to have a significant impact on patient quality of life. How has the National Eye Institute's (NEI) research regarding this condition evolved over time and where is it headed?

There's obviously been an enormous amount that's changed with AMD. If I look at the past, I finished my residency in 2000. And as a resident, you know, what we were learning was the macular photocoagulation study, the MPS, where we were lasering the retina. And you know, within 5 to 10 years, that's all been replaced by anti-VEGF. And I'm really proud that a lot of that work was supported by the National Eye Institute. Now, that's where we've been and where we are. In terms of where we're going, there's a lot of work involving the science and the pathogenesis of AMD that's going to let us develop better treatments. And one of the issues is that, in the early 2000s, genome wide association studies [GWAS], one of the very first successful GWAS was for AMD complement factor h. And the issue is, though, that since that time, it's been 15 plus years, and we haven't really had successful clinical trials out of the knowledge from that. And so I think that where I see things headed is that we have to go from genes more toward mechanisms and understanding pathways of disease. I think that that's where we're going to be able to develop better treatments that help patients in the future.

How is the NEI working to address health disparities in the ophthalmic space, both in the need for more diverse inclusion in clinical trials and ensuring equitable access to therapies?

This is a really important topic. One of the things this pandemic exposed is that we have a lot of health disparities in this country, and that not everybody has equal access to care. And, you know, from my perspective I think that the other way to look at that is that the best scientific advances and the best clinical care that we have in the world here is really not quite as useful if it's not available to the people who need it the most. And so we're actually at the NEI trying to address these disparities in a number of ways. One of them is that, of course, we're taking great care with clinical research to make sure that we're recruiting from patients that truly do represent the breadth of the American population. And I think that we were doing a lot of initiatives, both developing them and also partnering with other people who are working on these initiatives, to diversify the vision of workforce. You know, how can we recruit and train more people from diverse backgrounds that are currently underrepresented in medicine and science, you know, to really strengthen our workforce. And another thing that we're working on is basically research initiatives to try to address some of these health disparities. For example, we're starting to work with the National Institute of Minority Health and Health Disparities, the NIMHD, to plan a workshop to really try to get the best people together who have not only expertise in eye disease, but also expertise in methodologies that are looking at health disparities, and how can we work together to solve these problems? I think I'd want to emphasize that this is not something that the National Eye Institute can do by ourselves. We've got to work with the entire community that's going to involve ophthalmologists, optometrists, it's going to involve scientists and industry and academia. But we're really looking forward to tackling this problem.

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