ity for researchers in our academic departments of ophthalmology to conduct the kind of research in vision and eye disease that you have heard about from the other two witnesses this morning.

Also, I want to talk about the construction of laboratories for eye research. The National Institute was funded in 1968, and since that time requests have been made for construction funds for eye research laboratories; but only $15 million has been provided for such construction. I know you realize that research, no matter how well it is funded, cannot be done appropriately unless there is at least adequate research space.

Research to Prevent Blindness conducted a survey of 80 academic departments of ophthalmology. This survey was done just in the last year. What was found was that there is a need for research space of approximately 1 million square feet of space to conduct the eye research that is there to be done at a cost then of this construction $300 million. All our citizens' proposal is requesting is $10 million, a small sum but a sum that could be very helpful in providing the space that is needed to perform the research that needs to be done.

We know in the academic departments of ophthalmology that the Government cannot support all the research that is needed. In fact, our organization, the Association of University Professors of Ophthalmology, just completed research to survey our departments and to see where the money was coming from to support eye research.

In fact, we found that 55 percent of basic science research in vision and eye comes from sources other than the National Eye Institute. About 68 percent of clinical research dollars comes from these outside sources, including departmental funds, endowments, private philanthropy, and so on. So we are not asking the committee to give the vision research community all of the money it needs, but the NEI is, in fact, the single most important source of funds. So we are trying to do our job to obtain funds elsewhere to support this vision research effort.

PREPARED STATEMENT

Mr. Chairman, I want to thank you for the opportunity to provide this testimony, and I will be pleased to answer any questions you might have.

[The statement follows:]

STATEMENT OF DR. PAUL R. LICHTER

I am Dr. Paul R.

Mr. Chairman and Members of the Committee: Lichter, Chairman of the Department of Ophthalmology at the University of Michigan, and Director of the University's W.K. Kellogg Eye Center. I am pleased to offer testimony in support of the Citizens' Fiscal Year 1992 Budget Proposal for the National Eye Institute under the aegis of Research to Prevent Blindness, and on behalf of the Association of University Professors of Ophthalmology (AUPO), of which I am President.

Vision is a key factor in learning, mobility, human interactions and perceptions.

It is important not only to the quality of life, but to an individual's ability to be a productive participant in the economy. Three Gallup surveys conducted at tenyear intervals have shown that blindness is among the three or four major afflictions that Americans fear most.

The National Eye Institute (NEI) will soon publish its fourth five-year plan, Vision Research - A National Plan 1992-1996, designed to foster NEI program development in the areas of greatest need and opportunity. The plan represents an extraordinary consensus, incorporating the contributions of the National Advisory Eye Council and leading scientists from all major areas of vision research. The Citizens' Committee request of $342.1 million for the NEI in Fiscal 1992 is a realistic extension of research priorities established in the five-year plan.

The Citizens' request provides for additional support for NEI clinical trials, as well as for investigator-initiated RO1 research grants. The total number of RO1 eye research grants and their funding levels have been reduced substantially in each of the past three years by 9%, 11%, and 10.3% in 1989, 1990, and 1991, respectively. Representing, as I do, the leaders of ophthalmology departments around the country, I can tell you that these cuts have severely restricted the ability of vision scientists, particularly young researchers, to perform the studies which they have proposed. The Fiscal Year 1992 Citizens' request would allow for the further development of productive university-based basic and clinical research that is adding to our understanding of the underlying process of blinding eye disease, and thereby advancing our ability to prevent blindness.

Included in the Citizens' Committee request is a $10 million appropriation for the construction and renovation of eye research facilities to keep pace with the sophisticated technology that now has become essential for advanced vision research. In a survey of more than 80 departments of ophthalmology throughout the country conducted by Research to Prevent Blindness in 1988, it was determined that the need for construction of laboratory space exceeded one million square feet at an estimated cost of $300 million. Federal support for eye research construction has only amounted to $15 million since 1968 when the National Eye Institute was established. I strongly urge that the construction needs of eye research be considered in your deliberations over NEI appropriations for Fiscal 1992.

The eye research community is aware that the government cannot bear more than its reasonable share of support for research into eye diseases and improvements in their detection, treatment, and management. As you know, the bulk of eye research is accomplished in academic departments of ophthalmology. A recent survey of those departments and their scientists by the Association of University Professors of Ophthalmology found that support for the majority of their research comes from non-governmental sources. While the NEI is the single most important source of funds for vision research in the nation's academic institutions, 55% of basic science research

and 68% of clinical research support in the departments surveyed comes from such non-governmental sources as departmental funds, private grants, industry grants, private practice funds, and endowments.

Nevertheless, ophthalmology department chairmen report a severe, chronic problem in the retention of physician-scientists, and an inability to carry out essential planned research programs, without an increased level of NEI support. NEI-sponsored research also has an indirect impact on the outreach programs operated by many departments of ophthalmology across the country. Retention of qualified research faculty enhances the development of public health and community service programs that provide the latest and best in eye care to underserved and indigent populations.

With additional funding in the coming year, the NEI and academic departments of ophthalmology can continue to pursue confirmation of important research findings that have the potential to improve the eye health and quality of life for thousands of Americans each year. The National Eye Institute is prepared, for example, to expand on the advances resulting from a multi-center clinical trial on the effective treatment of retinopathy of prematurity (ROP), a disease that affects low-birthweight infants who must be given oxygen for survival.

ROP is the leading cause of blindness among premature babies, and destroys the sight of 500 of these infants each year in the United States. In this disease, blood vessels in the retina increase in number and branch excessively, sometimes leading to hemorrhage and scarring. With improvements in neonatal care over the past two decades, more premature infants, including an increasing number of high-risk, very low-birthweight babies, are surviving and the incidence of ROP has increased.

The NEI-supported Cryotherapy for Retinopathy of Prematurity clinical trial has resulted in a major advance that halts progression of ROP and reduces by one-half the risk of blindness from the disease. The savings to the government made possible by this clinical trial is estimated to range between $20 million and $60 million per year for each group of 25,000 premature babies weighing 1500 grams or less.

Three new clinical trials have been designed to evaluate other procedures that could expand our ability to successfully treat and manage ROP, but these trials cannot be implemented without an increase in funding for the National Eye Institute.

My particular area of professional expertise is glaucoma, a common sight-threatening disorder that is often quite difficult to control. Approval of the Citizens' request is crucial for the conduct of high priority clinical and epidemiological glaucoma studies to determine risk factors associated with this disease.

Glaucoma is the second leading cause of blindness in the United States and the leading cause of blindness among black Americans. Two million Americans have glaucoma, and surveys suggest that another one million citizens may have the disease without being aware that they have it. Glaucoma typically affects middle-aged and older people, and is frequently characterized by an increase in the normal fluid pressure within the eye. As intraocular pressure rises, the optic nerve may be damaged with resulting serious visual impairment or blindness.

A recent NEI-support study has shown that chronic open-angle glaucoma, the most common form, is four to six times more likely to occur in black Americans than in whites. Importantly, blacks are nearly eight times more likely to go blind from glaucoma than are

whites, and the greatest difference in the prevalence rate is in the 45-64 age population. In that group, blindness from glaucoma is 15 times higher in blacks than it is in whites.

Medical treatments are available to control increased pressure in the eye, but these medications may cause undesirable sideeffects and are not always effective. In 1990, the NEI-funded Glaucoma Laser Trial (GLT) demonstrated that, after two-years of study, argon laser therapy may be as safe and effective as eye drops for newly-diagnosed, open-angle glaucoma patients. If longterm studies support these promising results, argon laser therapy could be used as an effective alternative to eye drops in the initial treatment of glaucoma.

There remains a desperate need to find even more effective treatment modalities that will free glaucoma patients from the daily self-care routines that most of them must follow, and which all too often are forgotten in the press of their daily lives. Additional funds must be made available for basic and clinical studies to derive a better understanding of the mechanisms that initiate glaucoma, and to devise more permanent solutions to control this insidious disease.

In concluding, Mr. Chairman, I encourage this Committee to consider carefully the inestimable returns in improved quality of life and individual productivity that have already resulted from the federal investment in vision research, and I most strongly urge your support for the Citizens' Budget Proposal for the National Eye Institute. I thank you for the opportunity to present this statement, and I would be pleased to answer any of your questions.

Senator ADAMS. Last year the committee set aside approximately $15 million for construction grants. Do you think that that is adequate; that if you were to receive a portion of that, at least you would begin to start getting the necessary space for your eye research opportunities?

Dr. LICHTER. Mr. Chairman, I know we are all on the same team here. You wish you had more money to give, and we wish we could find more money to use. The problem is that the money that was provided to the Director of the National Institutes of Health is used and spread over all of the institutes.

I can speak personally at my own university, having receive some Eye Institute construction money, several hundred thousand dollars. It amounted to the cornerstone in building an eye institute that costs a minimum of $15 million when all was said and done.

This kind of money that comes from the National Eye Institute in construction money can be multiplied many fold in terms of the development of research laboratories and then a program to conduct that kind of meaningful research, because if we do not have the facilities we cannot attract the scientists to do the work.

We were able at our university, the University of Michigan, to do this. The amount that the Eye Institute got from the $15 million was just a few hundred thousand dollars to be spread across the entire country. What we have shown you by a survey that was well done is that really we need $300 million to fulfill all of the needs in vision research laboratory space.

Now we, of course, do not hope to get anything like that, but the Eye Institute has had only $15 million since its inception in 1968. What we are asking for is special allocation, a separate allocation in the budget for the National Eye Institute to recognize the need

to provide this laboratory space for our vision research community. If we do not receive this kind of an allocation, I think the amount will not go the kind of distance we need it to go in establishing these laboratories.

Senator ADAMS. Thank you very much, Doctor. We appreciate your testimony.

STATEMENT OF DR. A. SONIA BUIST, OREGON HEALTH SCIENCES UNIVERSITY, ON BEHALF OF AMERICAN LUNG ASSOCIATION, IUATLD, AND THE AMERICAN THORACIC SOCIETY

Senator ADAMS. Our next witness is Dr. A. Sonia Buist, I would pronounce it, from the Oregon Health Sciences University, American Lung Association, and IUATLD. Senator Hatfield regrets that he cannot be here this morning. He particularly wanted me to welcome you from the State of Oregon. I, being in the neighboring State, am pleased to do that for Senator Hatfield.

Welcome, and we look forward to your testimony.

Dr. BUIST. Thank you very much, Mr. Chairman.

My name is Sonia Buist, and I am testifying today in my role as President of the American Thoracic Society, the medical arm of the American Lung Association. In my written testimony I have listed our recommended funding level for biomedical research in the area of lung disease. In my oral testimony I would like to focus on a lung disease which is becoming an increasing problem. The lung disease is asthma, the condition in which the airways are unusually sensitive or responsive to a variety of stimuli.

Asthma at any one time affects 4 to 5 percent of adults in the United States and up to 10 percent of children, so it is a very common condition. We are concerned that the problem of asthma is increasing, its severity appears to be increasing, it is responsible for an ever-increasing number of hospitalizations and a slowly increasing number of deaths. Unfortunately, the burden of asthma falls disproportionately on minorities, especially African-Americans, and on the economically disadvantaged.

I suggest it is very important that we find out why the numbers for asthma are all going in the wrong direction because asthma is a very expensive disease for the individual, for the family, for the employer, and for the country. For such a common condition, we know surprisingly little about it. From excellent research done over the past 10 to 20 years, we know a lot about the basic mechanisms but very little about the cause or causes and not merely enough about appropriate or optimal treatment.

How can we reverse the trends? First, I believe we need to find the cause or causes of asthma. Then we will be able to make some headway with prevention and rational treatment. This has been identified as the top priority by my organization, the American Thoracic Society.

Second, we need to determine what constitutes optimal care. This means clinical trials. One large trial is in the early stages but will only include children ages 5 to 9. It will do nothing to answer the question about treatment in adults. This is particularly important at this time because of the increasing evidence that the way we treat asthma may in some way be responsible for the increase in hospitalization and the increase in deaths. This is an awful thought.