Our request contemplates expenditures in the following categorical program areas: for Retinal and Choroidal Diseases, $137,960,000; for Corneal Diseases, $44,076,000; for Cataract, $22,769,000; for Glaucoma, $27,713,000; and for Strabismus, Amblyopia and Visual Processing, $59,487,000. We also recommend an appropriation of $40,166,000 for Intramural Research, Management and Program Services. Proposed expenditures in all categories are specified in the Financial Tables appended to my statement. Finally, Mr. Chairman, it has been noted recently that the high cost of not doing research is measured not only in savings foregone, but also in the diminished economic well-being of a nation that should be, and wishes to be, at the forefront of science-based business enterprise. Human health is the backbone of our worldwide leadership in biotechnology. Visual loss is an enormous human calamity, and research to combat eye disease must be supported at a level that is in proportion to the funds appropriated for other major life-disrupting national health problems. I am grateful to have the opportunity to present this statement and shall be pleased to respond to any questions. Thank you. Attachment B A SELECTION OF RECENT ACCOMPLISHMENTS IN VISION RESEARCH о NEI intramural scientists have developed the first animal model for proliferative diabetic retinopathy, providing vast new opportunities for investigators to devise therapeutic methods for controlling this diabetic retinal disease in humans. о NEI intramural investigators have determined the precise biochemical composition of a defective crystallin protein that causes hereditary cataracts in two animal models, the first time that crystallin mutations have been shown to cause cataracts. • NEI-supported scientists last year identified mutations in the gene that causes one form of retinitis pigmentosa (RP). These represent clues that could lead to the clinical management of this currently untreatable degenerative disease. о Researchers have halted the degeneration of sensitive retinal photoreceptor cells in animal models of retinitis pigmentosa by transplanting retinal pigment epithelium cells, and, more recently, by injecting the retina with a substance known as a growth factor. о A rapid and precise diagnostic test for acanthamoeba eye infections has just been devised by vision scientists, greatly improving the prospects of early treatment an accomplishment that will help avert the need for a corneal transplant operation that arises when the disease progresses to an advanced stage. о Photoablation with the excimer laser has been demonstrated to have considerable promise in the removal of superficial scars of the cornea, a development that could make up to ten percent of corneal transplant operations unnecessary. о Epidemiological studies have found evidence that blood pressure may play a significant role in diabetic retinopathy, and in age-related macular degeneration, suggesting that control of systemic hypertension may be an essential in the care of these diseases. O Dopamine has been demonstrated to affect ocular development, and new studies support the suggestion that dopamine-enhancing drugs may control the elongation of the eye which causes nearsightedness. Scientists isolated the gene that, when damaged or deleted, causes retinoblastoma (Rb), a life-threatening childhood ocular tumor. Subsequent studies have shown that the gene is not eye-specific, but can cause cancers elsewhere in the body. Last year, another NEI-supported scientific team successfully inserted a healthy Rb gene into human prostate cancer cells in culture, causing them to divide normally. More recently, research at Johns Hopkins has found that a functioning Rb gene introduced into ocular tumors in the laboratory markedly inhibits their growth. $977,852 $1,064,954 $1,156,932 $1,212,187 $1,339,082 $1,379,383 $1,448,731 $1,494,120 $1,553,925 $1,641,184 623,057 100,068 795,946 843,771 912,757 940,651 1,007,640 1,028,622 1,083,551 1,164,256 WIDE. 71,958 79,267 88.593 100,591 101,570 114.698 122,447 126,885 130,789 142,422 154,021 NIDDK. 368,191 413,492 464,026 543,576 569,340 510,629 531,403 556,210 574,905 609,366 652,060 MINDS. 265,870 296,380 334,373 395,717 431,927 486,540 446,659 459,230 473,182 525.231 565,803 NIAID. 235,598 269,906 299,980 347,692 320,176 399,763 415.157 430,982 438.081 473.666 517,372 NIGNS 339,862 369,813 415,937 482,260 514,765 565,496 630,452 673,019 695.949 744,423 816,660 NICHO 226,309 254,324 276,046 313,295 320,396 362,018 379.650 403,214 415.203 447,940 485.918 216,384 221,117 226.439 230,950 247,561 266,278 197,478 209,078 211,770 219.489 224,481 236,512 249,730 NIA. 81,903 93.996 115,292 144,521 156,491 177,497 194.385 222,386 238,077 322.845 347,551 MIANS. 130,613 147.118 159,347 167,325 191,612 203.061 MIDCD. 75.691 94.687 117,342 134.286 145,615 311,833 315.935 295,680 291,009 287,759 210,744 NCNR. ... 20.000 22.778 20.434 32.526 36.865 40.711 28.230 59.538 07.418 110,487 FIC. 9,205 10,147 11,336 11,728 11,551 11.420 11.146 9,510 10,750 12.168 14,300 1/ No enacted appropriation. Authorized under a continuing resolution. 2/ Reflects transfer of National Toxicology Program between NCI and NIEHS. 3/ Reflects adtrative reduction of $3,000. 4/ The Arthritis intitute and the National Center for Nursing Research established in FY 1907. 5/ The Institute on Deafness and Other Communication Disorders was established in FT 1988. 6/ The National Center for Human Genome Research was established in 1989. Senator ADAMS. Doctor, as I understand glaucoma, it is a pressure within the eye, and you have developed treatments that can both suspend the effects and I do not want to say cure it but which certainly have an impact on it. Is that correct? Dr. GOLDBERG. It certainly is. There are many new treatments developed, both pharmacologic, laser treatment, and also surgical treatment. Not that the problem is licked by any means, but there have been major inroads in the past few years. Senator ADams. Now what about macular? You have indicated glaucoma was a major effect and the other was macular degeneration. Dr. GOLDBERG. Yes, sir. Senator ADAMS. Do you have anything comparable in that? Dr. GOLDBERG. Once again, there have been major inroads, Senator, primarily through the use of lasers to spot weld abnormal bleeding blood vessels in the center of the eye to take away one's sharp vision. What we can do with laser treatment is to cut the rate of blindness in half, but there remains a definite large percentage of patients who cannot be helped even by laser treatment. The only way to improve upon what has been a major achievement is to continue the research effort in that important group of diseases. Senator ADAMS, I ask those questions again from the interest that I have in the Subcommittee on Aging, because the effects on vision are so devastating in terms of the ability of our senior citizens to function that we consider this a very important part of a treatment program to try to maintain the viability of our senior citizens for as long as possible. Dr. GOLDBERG. I certainly agree. Senator ADAMS. Thank you very much for your testimony. We appreciated it. Dr. GOLDBERG. Thank you, sir. STATEMENT OF DR. PAUL R. LICHTER, PRESIDENT, ASSOCIATION OF UNIVERSITY PROFESSORS OF OPHTHALMOLOGY Senator ADAMS. Our next witness is Dr. Paul Lichter, Association of University Professors of Ophthalmology. Doctor. Dr. LICHTER. Thank you very much, Mr. Chairman. It is a privilege to be here to speak to you and the committee on behalf of the Association of University Professors of Ophthalmology of which I am president, and particularly to support the citizens' budget under the auspices of Research to Prevent Blindness. You have my written statement, but I wanted to emphasize just two or three areas that are in that statement with regard to the citizens' budget request. The first is that the individual research grants that have been sponsored by the National Eye Institute have been cut over the last 3 years both in number and in amount of funding, roughly 9, 11, and 10.3 percent over the last 3 years, 1989, 1990, and 1991. In my capacity as the president of the Association of University Professors of Ophthalmology representing the leaders of ophthalmology departments around the country, I can emphasize and confirm to you that these budget cuts in terms of RO-1's, individual research grants, and their funding levels severely impact the abil |