Dr. Michael Chiang talks about the NEI’s involvement in AMD, addressing health disparities


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 ophthalmology.


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 on this condition evolved over time and where is it headed?

There is obviously an enormous amount that has changed with AMD. Looking back, I completed my residency in 2000. And as a resident, you know, what we learned was the macular photocoagulation study, the MPS, where we ordered the retina. And you know, within 5 to 10 years it was all 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 were and where we are. In terms of where we are headed, there is a lot of work involving the science and the pathogenesis of AMD that will allow us to 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 problem, though, is that it’s been over 15 years since that time, and we haven’t really had successful clinical trials from that knowledge. And so I think that where I see things going is that we need to go from genes more to mechanisms and understanding pathways of disease. I think this is where we will 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 in ensuring equitable access to therapies?

This is a very important topic. One of the things that this pandemic has exposed is that we have a lot of health disparities in this country, and that not everyone has equal access to care. And, you know, from my perspective, I think the other way to look at it is that the best scientific advances and the best clinical care that we have here in the world really aren’t quite as useful if they’re not available to the people who need it most. And so we are actually at the NEI to address these disparities in a number of ways. One is that we’re obviously very careful with clinical research to make sure that we’re recruiting patients that really represent the breadth of the US population. And I think that we’ve done a lot of initiatives, both developing them and working with other people 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 address some of these health disparities. For example, we’re starting to work with the National Institute on Minority Health and Health Disparities, the NIMHD, to plan a workshop to really try to bring together the best people who not only have expertise in eye disease, but also expertise in methodologies that go after health disparities, and how can we work together to solve these problems? I guess I want to emphasize that this is not something that the National Eye Institute can do on its own. We have to work with the whole community that’s going to involve optometrists, optometrists, it’s going to involve scientists and industry and academia. But we’re really looking forward to tackling this problem.