Buchan, John C

Burton, Matthew J

Dean, William H

Ramke, Jacqueline

English

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LSHTM Research Online

1  Title: The Inverse-Research Law of Global Eye Health 1 Running Title: The Inverse-Research Law  2 Authors: John C Buchan1,2, William H Dean1, Jacqueline Ramke1,3, Matthew J Burton1,4 3 1: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK 4 2: Leeds Teaching Hospitals NHS Trust, Leeds, UK 5 3: School of Optometry and Vision Science, University of Auckland, Auckland, NZ 6 4: Moorfields Eye Hospital, London, UK 7  8 BUCHAN John Cameron (corresponding author) 9 Assistant Professor 10 International Centre for Eye Health, London School of Hygiene and Tropical Medicine 11 Keppel Street, London, WC1E 7HT 12 Tel: 0113 2433144 13 Email: john.buchan@lshtm.ac.uk 14 No author has any financial or other conflict of interest in the work presented. 15 Funding:  16 JCB is supported by a grant from the Queen Elizabeth Diamond Jubilee Trust through the 17 Commonwealth Eye Health Consortium. WHD is supported by grants from the British Council for the 18 Prevention of Blindness, Ulverscroft Foundation and CBM. JR is a Commonwealth Rutherford Fellow, 19 funded by the UK government through the Commonwealth Scholarship Commission in the UK. MJB 20 is supported by the Wellcome Trust (207472/Z/17/Z).  21   22 2  Dawson et al recently observed that, relative to the burden placed on health care services in the UK, 23 some sub-specialty areas of ophthalmology are under-represented in the patient-centred research 24 efforts supported by the National Institute for Health Research.[1]  25 At the global level, however, we propose that there is an even larger disparity between the magnitude 26 of the major causes of blindness and the amount of recent research addressing these. Here we use 27 wordclouds (wordcoulds.com; Vianen, The Netherlands) to illustrate this disparity, with the font size 28 proportional to relative frequencies. The relative magnitude of causes of blindness globally is 29 illustrated in Figure 1, using data from the Global Vision Database.[3] Cataract and uncorrected 30 refractive error dominate, yet countries struggle to identify implementation approaches that work 31 well. In contrast, the global ophthalmic research focus is depicted in Figure 2. This was quantified by 32 the frequency of Medical Subject Headings (MeSH terms) in articles published in 19 core ophthalmic 33 journals in the 5 years to 2014.[2]  34 These figures suggest there is an “inverse-research law” in global eye health research, with the leading 35 causes of blindness receiving little attention. This is analogous the inverse-care law, which highlights 36 the well-established observation that those with the greatest health needs often have the least access 37 to services.[4] 38 Low- and middle-income countries carry disproportionately high levels of blindness. These countries 39 invariably have to develop national eye health programs informed by very little context specific 40 evidence to guide implementation of effective approaches.[5]  41 There is clearly a justification for acting in the national self-interest when setting priorities for publicly 42 funded research programmes. However, given the UK’s commitment to the United Nations 43 Sustainable Development Goals, with the headline aspiration of "leaving no one behind", we believe 44 the UK has a role to play in supporting low- and middle-income countries to generate the evidence 45 they require to improve eye health in their populations. To achieve this, we call for research funding 46 allocation to aspire to better reflect the causes of the global burden of eye disease. 47 3  References 48  49 1. Dawson SR, Linton E, Beicher K, Gale R, Patel P, Ghanchi F et al. Ophthalmology research in 50 the UK's National Health Service: the structure and performance of the NIHR's 51 Ophthalmology research portfolio. Eye (Lond) 2019; 33(4): 610-618. 52  53 2. Boudry C, Denion E, Mortemousque B, Mouriaux F. Trends and topics in eye disease 54 research in PubMed from 2010 to 2014. PeerJ 2016; 4: e1557. 55  56 3. Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV et al. Global 57 causes of blindness and distance vision impairment 1990-2020: a systematic review and 58 meta-analysis. The Lancet Global health 2017; 5(12): e1221-e1234. 59  60 4. Bastawrous A, Hennig BD. The global inverse care law: a distorted map of blindness. Br J 61 Ophthalmol 2012; 96(10): 1357-1358. 62  63 5. Ramke J, Zwi AB, Silva JC, Mwangi N, Rono H, Gichangi M et al. Evidence for national 64 universal eye health plans. Bull World Health Organ 2018; 96(10): 695-704. 65  66   67 4  Titles to figures 68 Figure 1 - Relative magnitude of causes of blindness globally 69 Figure 2 – Relative frequency of MeSH terms from core ophthalmic journal articles 70 

The inverse-research law of eye health.

https://researchonline.lshtm.ac.uk/id/eprint/4653472/5/Buchan-etal-2019-The-Inverse-Research-Law-of-Global-Eye-Health.pdf

The inverse-research law of eye health.

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