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With a long record of accomplishment behind him, Carl Kupfer, MD, the only person to ever serve as director of the National Eye Institute (NEI), is stepping down from his position on July 15 after 30 years at the helm of the Federal government’s leading vision research agency.
“During Dr. Kupfer’s long tenure, the NEI has been critical in the shaping of vision research in this country, and his outstanding leadership has contributed enormously to the fabric of the National Institutes of Health (NIH),” said Ruth Kirschstein, MD, acting director of the NIH. “Due to his leadership, NEI research results have made a difference in the lives of millions of Americans. His leadership has made NEI, today, the largest and most comprehensive vision research center in the world.”
After Congress established the National Eye Institute in 1968, Dr. Kupfer was appointed its first director in January 1970. He moved quickly to identify the needs and opportunities in vision research.Dr. Kupfer insisted that the area of central visual processing should be part of the NEI mission, a decision that finally was accepted by the NIH leadership. He also stressed the importance of theindividual research grant as opposed to the more accepted large, umbrella-type program project and center grants. This process resulted in the first of many five-year strategic plans that greatly accelerated the progress of vision research in the U.S. and ultimately became a model for other institutes at NIH. “Our first strategic plan identified areas in vision research that needed immediate attention,” Dr. Kupfer said. “By identifying these opportunities, the entire research process was hastened and the public’s tax dollars were used more efficiently.”
Early on, Dr. Kupfer established an Office of Biometry and Epidemiology and launched the landmark Diabetic Retinopathy Study, setting a standard for modern clinical trials in vision research. An outspoken and effective advocate for high-quality clinical research at NIH, Dr. Kupfer expanded research at the NEI by establishing laboratory programs in molecular biology, immunology, neuroscience, and molecular genetics. “These programs allow NEI scientists to move quickly into new and innovative research areas,” Dr. Kupfer said. “Our first priority has always been the highest quality research and projects that give us the opportunity for ‘lab-to-bedside’ clinical trials, where laboratory research can be conducted, and treatments quickly applied, to small groups of patients.”
During Dr. Kupfer’s tenure, the number of vision researchers nationwide has been steadily increasing. As a result, the NEI supports a growing number of vision research grants and training awards to more than 1600 investigators at universities, medical centers, and other institutions throughout the U.S. “Our nation’s investment in eye disease research has yielded substantial dividends,” Dr. Kupfer said. “Continued public support has always been crucial to achieving medical breakthroughs in eye disease treatment.”
As NEI Director, Dr. Kupfer also oversaw the development of the NEI’s innovative National Eye Health Education Program (NEHEP), a partnership of about 60 professional, civic, and voluntary organizations and government agencies concerned with eye health. The main focus of NEHEP is to conduct public and professional education programs that help prevent blindness, reduce visual impairment, and increase awareness of services and devices that are available for people with low vision. “The program helps disseminate research findings from the laboratory to health professionals, patients, and the public,” Dr. Kupfer said. “This is a natural extension of our activities in vision research, and is the final step in the research process.”
Prior to his appointment as NEI Director, Dr. Kupfer served for four years as professor and chairman of the Department of Ophthalmology at the University of Washington School of Medicine. Between 1960 and 1966, he was first an instructor, then assistant professor of ophthalmology at Harvard Medical School. He is a graduate of Yale University and received his medical degree at The Johns Hopkins School of Medicine in Baltimore. Dr. Kupfer has been awarded honorary Doctorates of Science from the University of Pennsylvania and the State University of New York, and has received numerous awards from national and international organizations, including the Lighthouse International’s Pisart Vision Award for “noteworthy contributions to the prevention, cure, or treatment of severe vision impairment or blindness;” the Public Service Award in Ophthalmology from the American Academy of Ophthalmology; the Humanitarian Award from Lions Clubs International for “outstanding humanitarian achievements;” and election to the Institute of Medicine of the National Academy of Sciences. He is a member of numerous societies and organizations, including The Johns Hopkins Society of Scholars and Academia Ophthalmologica Internationalis, and has earned the rank of Distinguished Executive in the Federal Government’s Senior Executive Service. As President of the International Agency for the Prevention of Blindness from 1982-90, Dr. Kupfer increased the collaboration among the world’s non-governmental organizations working in the blindness prevention field with the World Health Organization.
Dr. Kupfer has served for six NIH Directors and six U.S. Presidents, and has witnessed the NEI budget grow from $24 million in 1970 to more than $450 million today. He will not leave the NIH entirely; instead, he will devote his time to completing a catalogue of the Cogan Collection, a compilation of clinical cases and pathology reports of over 50,000 patients. The collection was a major career work of vision researcher David Cogan, MD, whom Dr. Kupfer fondly calls “one of the NEI’s greatest supporters and benefactors.” Dr. Kupfer will also continue to see patients as part of his clinical research activities at the NIH clinical center.
“My journey at the NEI and the NIH has been richly rewarding,” Dr. Kupfer said. “As a scientist, clinician, and administrator, I have been wonderfully blessed with experiences that have brought me to the cutting edge of vision research. One of my most satisfying achievements has been helping to shape the direction of this research during the past 30 years. We have seen great advances in treating eye disease and preventing vision loss, and as a researcher, it is immensely fulfilling to know that the sight-saving treatments we developed have helped prolong vision and improved people’s quality of life.
“I know that in the near future, NEI-funded studies and clinical trials will lead to more significant breakthroughs. These have been exciting and challenging times for vision research, and I am fortunate to have been a part of it.”
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The National Eye Institute:
30 Years of Research Achievement
When Congress established the National Eye Institute (NEI) in 1968, it made a long-term commitment to protect the vision of the American people. Today, thanks to continued Congressional and public support, this investment has yielded substantial dividends for the nation. There are many medical advances that have resulted from NEI-supported research and made a difference in the lives of millions of Americans.
As a result of NEI-sponsored laboratory and clinical research trials, researchers have discovered that:
- Laser surgery can safely and effectively treat diabetic retinopathy, a potentially blinding disease of the retinal blood vessels. Diabetic retinopathy affects between 40-45 percent of the 10.5 million Americans who have been diagnosed with diabetes. With timely laser surgery and appropriate follow-up care, people with advanced diabetic retinopathy have a 90 percent chance of maintaining vision.
- Laser surgery is a safe and effective alternative to eye drops as a first-line treatment for newly-diagnosed primary open-angle glaucoma, a disease that affects three million Americans, half of whom do not know they have it.
- New medical therapies effectively treat glaucoma while greatly reducing the number of adverse side effects.
- A potentially blinding eye disease in premature infants–retinopathyof prematurity–can be significantly reduced by briefly freezing the outerpart of the retina, a treatment called cryotherapy.
- Laser surgery can slow vision loss in some people with the “wet” form of age-related macular degeneration (AMD), the leading cause of blindness in older Americans. Prior to this finding, this form of AMD was considered untreatable.
- An oral antiviral drug significantly decreases the recurrence of herpes of the eye and reduces the rate of return of stromal keratitis, the more severe form of the disease.
- Certain forms of uveitis–potentially blinding inflammations of the inside of the eye–respond to drugs that are safe and effective.
- A purified protein, called retinal S-antigen, when taken orally, allows people with certain forms of uveitis to eliminate or reduce the need for powerful drugs. These drugs, while often effective, can cause decreased kidney function, cataracts, glaucoma, and brittle bones.
- Ganciclovir implants are effective in treating cytomegalovirus (CMV) retinitis, a potentially blinding eye disease that affects people with AIDS. The implant significantly improves the quality of life for AIDS patients with CMV retinitis.
- A combination of protease inhibitors and other anti-HIV drugs used to treat people with AIDS can prevent or delay the progression of CMV retinitis.
- Improved selection and handling of donor eyes, improved preservation, and better surgical techniques lead to an overall higher success rate for corneal transplants.
- The growth of the eye, which affects the development of myopia, or nearsightedness, is guided by visual feedback during early life. This means that scientists may be able to develop treatments for young children that can prevent or lessen this condition.
- Ambient light reduction has no effect on the development of retinopathy of prematurity in very low birth weight infants.
- Steroids given orally are ineffective in treating optic neuritis and may actually increase a person’s risk for future attacks. Doctors had long used oral steroids to treat this debilitating disease that each year strikes about 25,000 Americans, primarily women.
- A surgical procedure for nonarteritic ischemic optic neuropathy, a potentially blinding condition, is ineffective and could be harmful to a person’s vision. This led to a recommendation that doctors stop performing this procedure, called optic nerve decompression surgery.
Also, NEI-sponsored scientists have identified:
- A gene for juvenile primary open-angle glaucoma, which develops in late childhood or teenage years. This discovery opened up a new approach to understanding glaucoma in all its forms.
- The first gene associated with a form of macular degeneration.
- A number of gene mutations suspected of causing retinitis pigmentosa (RP). RP is a group of inherited, blinding diseases that affect 100,000 Americans. These findings provide the first step in developing new strategies to prevent or control RP.
- The gene that causes retinoblastoma, a rare form of eye cancer. The gene has been isolated, cloned, and sequenced. This research has implications not only for eye cancer, but also breast cancer and prostate cancer, and may one day lead to the development of better treatments for these types of cancer.
- Mutations in the Pax-6 gene that cause aniridia, a congenital malformation of the eye that occurs in 1.8 per 100,000 births. The Pax-6 gene is the first gene discovered to be essential for normal eye development.
- A “critical period” in the early visual development of cats and monkeys. This discovery has led to an understanding of how to treat and prevent amblyopia and similar visual problems in human infants.
Technological development supported by the NEI has contributed to major advances in diagnosing and treating eye disease. This includes:
- Medical lasers to diagnose and treat patients with diabetic retinopathy, age-related macular degeneration, and other eye diseases; and for correcting refractive errors of the eye, such as nearsightedness.
- A safe and effective technique to photograph the retinal blood vessels in the eye. Called fluorescein angiography, this technique allows doctors to pinpoint abnormal blood vessels that cause diabetic retinopathy. These abnormal blood vessels can then be treated with laser therapy.
- “Imaging” devices that allow doctors to more closely examine the interior of the eye. This technology permits doctors to more completely diagnose eye diseases and disorders, and gives scientists a better understanding of how eye diseases develop and progress. These include devices built on technology known as “adaptive optics,” first proposed by astronomers in 1953 and developed later by the U.S. to clear up satellite images.
- Noninvasive imaging technologies, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), that allow researchers to peer inside the brain and assess visual function.
- Major advances in microsurgical instruments and surgical techniques for treating retinal detachment, retinal hemorrhages, and other retinal disorders.
- A better understanding of how the brain processes visual information. More technically, this understanding involves the capture of light by photoreceptor cells and the initiation of electrical signals utilized by the brain.
- Progress in establishing the scientific basis for transplanting healthy cells into the retina. Further development of this technique could lead to new treatments for people with blinding diseases, such as age-related macular degeneration and retinitis pigmentosa.