In research, bigger is not always better. One ophthalmic research foundation has found that even small, more targeted studies can have significant, more profound impacts for both patients and professionals.
The not-for-profit Future Vision Foundation (FVF) was established in 2021 by Vision Eye Institute (VEI) to drive research that enhances outcomes for patients undergoing eye surgery while advancing innovation and best practice across the ophthalmic industry as a whole, ultimately raising the standard of care and the patient experience.
Since that launch and its first round of research funding released in 2022, it has funded nearly 40 projects.
Projects involving not only ophthalmologists but also nurses, orthoptists, optometrists and other support staff, both internal and external to VEI, many of whom have never undertaken research previously.
The foundation has two key aims – to advance patient care and outcomes; and also, to support the careers and clinical education of often young eyecare professionals who may either be intimidated by research or unsure how to advance an idea.
Those two key aims are encouraged by many within VEI, but three people in particular are integral to the foundation’s impact and evolution.
The board chair
Associate Professor Tim Roberts doesn’t want to put people on the moon.
The VEI cataract and glaucoma subspecialist, clinical associate professor at the University of Sydney and consultant ophthalmic surgeon at Royal North Shore Hospital, certainly understands the value of such aims.
In fact, he’s contributed to some of that lofty study himself, during a decades-long career in ophthalmology research, teaching and academia.
But he also understands the value of research with a smaller, tighter, more practical focus, which was why VEI sought out his services, after committing to more funding and resources for ophthalmic research.
He now leads a board with a range of clinical, commercial and research skills.
As Prof Roberts points out, the foundation has a good understanding of its strategy, and it’s not about “putting people on the moon.”
That is for other bigger funding institutions whose focus is high-level, multi-million-dollar research.
“We thought, how can we develop some niche skills, because a big part of all of our practices has been to put time and money that we generate as surgeons back into patient care and research,” he says.
“So, it was a natural extension of that across the group.”
That group is not just the ophthalmologists, many of whom may be familiar with research.
“We’ve got over 500 staff, including a lot of clinical optometrists and orthoptists who work with us,” says Prof Roberts.
“And one of the things that came through loud and clear was that many technical staff see the surgeons doing a lot of research. They’ve had no experience in it, but they would love to actually learn how to conduct a study.”
So, the foundation encourages those staff to come up with clinical study proposals that are focused around patient care and improving processes.
“We’ve done some studies on understanding consent for refractive surgery, for different ways of discussing treatments, alleviating anxiety and more.”
In the previous round of funding, projects supported included assessment of how augmented and extended reality might enrich the patient and family educational experience, a review of how household energy optimisation strategies may have a secondary impact on dry eye, and an investigation of the patient discharge process to understand the current gaps in knowledge and improve this aspect of the patient journey.
They may not be at the same level as big randomised controlled trials, but they’ve been “incredibly valuable for patient care, and they’ve also been really valuable for teaching our broader clinical colleagues, optometrists and orthoptists research skills, how to come up with a study, how to design methodology, etc”.
Another person at VEI has played an important part in that.
The research co-ordinator
Dr Chris Hodge is chair of the foundation’s advisory committee. His committee makes recommendations to the board on which projects to fund and pursue.
Often those projects start as little more than ideas and observations, from people with little or no experience of research.
As VEI’s research co-ordinator, where necessary, Dr Hodge works with the applicant to “flesh out” the idea and ensure there is scientific rigour in both the proposal and the research process.
“I’ve become the liaison between the applicants and the advisory committee and then the board, so I follow the research right through,” he says.
“It’s really starting that discussion. A lot of them come together with an idea but they don’t really quite know how to take it through, identify the endpoints and a proper pathway. It’s a little bit nebulous in their mind.”
Those with ideas from outside VEI are also encouraged to develop their proposals and collaborate with institute staff, but the goal is always to share results with the wider ophthalmic community through presentations, posters and published data.
That is something the board is keen to see, as part of its role in overseeing the prudent use of the foundation’s funds and the return of investment in its research.
That means Dr Hodge must work with applicants to ensure the science and methodology is robust and appropriate.
He believes that return includes improved patient outcomes, a growth of knowledge that goes beyond the FVF, and simply the development of better healthcare professionals.
“The research makes you ask better questions, and I think that makes you a better clinician,” says Dr Hodge.
“At its heart, all of these projects have to benefit our patients; if we can introduce something that even makes a small difference, somehow, that’s a fantastic outcome.”
Those “small differences” have led to tangible advances in understanding the role of many treatments for patients, better analysis of eye disease, and changes to how people approach conditions like keratoconus and corneal disease.
It has led to tangible advances for the researchers as well.
“The first successful grant can lay a foundation for the next, larger grant – track record is key and FVF can play a role here. We have been proud to see researchers develop current projects into larger ideas and succeed in further grants and then take on new roles. This is really exciting to support.”
One person at VEI understands that evolution and the trepidation that can come from considering research as a young professional.
The CEO
Ms Amanda Cranage began her career as an orthoptist, before moving into operational management and, eventually, the top leadership role at VEI.
“In my early days as a clinician, I’ll admit I found research somewhat intimidating,” she says.
“I would have valued the kind of mentorship that helps bridge the gap between clinical practice and research.”
Mentorship and financial support, because much of the research is done outside of the applicant’s important day job.
“A key part of this has been championing early-career researchers, providing them with funding, mentorship, and resources that are often difficult to access in the early stages of a career.”
Like Prof Roberts and Dr Hodge, CEO Cranage sees the value of encouraging such research projects, for the patients, the professionals involved, and the institute.
“From the start, a core pillar of our approach has been the belief that a better understanding of research leads to better clinicians,” she says.
“Modest, targeted grants can generate valuable clinical and practical outcomes, whether that’s improving patient pathways, exploring new diagnostic approaches, or addressing service gaps that might otherwise be overlooked.
“We see these grants as both impactful in their own right and as stepping stones to larger opportunities, with early support providing the opportunity for researchers to move into new areas, secure further grants, or even progress into the ophthalmology program.”
For potential applicants, the message is clear, she says.
“Smaller, well-focused studies can be transformative, and the foundation is here to support that journey.”
