Priorities of ophthalmic research.

The purpose of research is to uncover truths, that is to describe reality validly. But all truths are not equally generalizable, and all research is not equally justifiable. For example, the value of a study that requires an N of 100,000 to reach statistical significance (a presumed truth) is likely to be far less than that of a study requiring only an N of 10. Furthermore, the value of research is related to the relevance of the finding to the 'great issues'. In the field of health, the two great issues are function and feeling - the capacity to act and the quality of life. Investigators, universities, mentors, and funding sources need to consider truthfully whether a proposed research project is directed towards uncovering a relevant truth, one that has a reasonable chance of improving function and/or feeling, or leading to findings that will improve function or feeling. The development of a useless or harmful product, the publication of an irrelevant paper, the support of a 'brilliant investigator', and the development of a prestigious department are not adequate justifications for performing research. The consequences of the present system - driven by financial gain, power, and prestige - are exemplified in the comparison of the large amount of funds being expended to improve cataract surgery (which is already an incredibly successful procedure), yet at the same time almost no funds are being spent to study how to detect people with glaucoma who will go blind, fully 1% of the world's population.