Developing global research collaborations a priority for India

Las Vegas-India is now considered a model in the development of international research collaborations in the field of ophthalmology. Its success is based on the ability of individuals to cooperate through mutual respect, transparency, humor, and friendship, said R.D. Thulasiraj, MBA, here at the American Academy of Ophthalmology annual meeting held in conjunction with the Association for Research in Vision and Ophthalmology.

"The term 'model' implies that we know how research collaboration works and that the model can be replicated," said Thulasiraj, executive director, Lions Aravind Institute of Community Ophthalmology-Aravind Eye Care System, Madurai, India.

"Some opportunities for research are very specific to our country and not replicable; the remainder of the opportunities are immensely replicable based on the local context," he said.

India has invested in the development of human resources and now has what one would consider a mature ophthalmic industry, he continued.

"There are now more than 12,000 ophthalmologists in the country, with 1,000 more added each year through residency programs and ophthalmic schools," Thulasiraj said. "Many of the eye-care centers that have been established in the government and non-government sectors can do clinical research. India also used community-outreach programs to gain access to patients."

India is highly committed to eliminating needless blindness and was one of the first countries to establish a national program to control blindness about 3 decades ago, he said. This program was based on public and private collaborations.

"More recently," Thulasiraj said, "Vision 20/20-Right to Sight India was formed as a platform to bring together all the non-government organizations."

Many efforts have been made to ensure that clinical research can occur throughout India, Thulasiraj said. Importantly, the agencies promoting research in the country have developed guidelines that are accepted worldwide.

"We now have a single point approval for exchange of biological materials, which previously had been a huge problem," Thulasiraj said. "Duties on imported therapeutic agents and equipment have been cut back. There is more financial support for research projects and for setting up centers of relevance and excellence."

Research institutions

India has more than 20 basic research institutions, and several of them are devoted to ophthalmic research. The country also has forged research collaborations with several countries through their diplomatic establishments. National, state, and local ophthalmology organizations have been formed, and the ophthalmic subspecialties have their individual organizations. Recently, the three major eye research organizations in India have begun to collaborate on eye research projects, Thulasiraj said.

"Many of the institutions have formally approved institutional review boards following the guidelines of the National Institutes of Health and the India Council of Medical Research," he said.

Thulasiraj said he believes that the attitude of basing interventions on evidence-based medicine was responsible for spearheading research in India.

"The formation of the National Program of Control of Blindness in 1976 was based on the results of a 1974 survey, which estimated the prevalence of blindness at 1.4%," he said.

When the survey was repeated 12 years later with the finding that the problem of blindness actually had increased, India borrowed $120 million from the World Bank to mount an intervention focused on cataract, which accounted for most of the blindness. In early 2000, the prevalence of blindness and the outcomes of the cataract interventions were assessed. Clinical trials relating to IOLs funded by the National Eye Institute (NEI) also were undertaken. Both actions resulted in the formation of some strong policies on quality, Thulasiraj said.

Many collaborative projects have resulted in advancing ocular knowledge as it relates to patients in India. Collaborations are ongoing with France, Germany, the United Kingdom, and the United States.

Thulasiraj provided an example of collaboration between NEI and the Department of Biotechnology in India, which began with strong commitments from both government agencies to promote research through collaboration.