Directions for Optometry Research in India

Directions for Optometry Research in India

How can we define research?
According to Webster's Encyclopedic Unabridged Dictionary research is:
"Diligent and systematic inquiry or investigation into a subject in order to discover or revise facts,
theories or applications."

Some more definitions of research
Research means:
"Seeing what every one else has seen and thinking what no one else has thought."
"Respecting the past and building upon it."
"Looking into the future with a boldness that defies tradition."
"Finding connections between seemingly unconnected entities."

Why is research essential?
Research brings with it:
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New ideas: concepts, techniques, devices
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New collaborations: internal and external
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Respect to the institution: grants and publications
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Respect to the profession: becoming known as a "thought leader

Areas of interest

Eye care professionals can choose to do research in any of the following areas of interest
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Optics
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Optometry
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Ophthalmology
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Epidemiology
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Vision Science

How is vision science different?

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Histology or neurobiology of the retina is neither optometry nor ophthalmology. It is vision
science.
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Building a computer-aided seeing device for a robot is vision science (machine vision).
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Developing an understanding of visual perceptual illusions is vision science.
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Understanding how vitamin C helps collagen synthesis in the cornea is vision science.

Why optometrists should do research?

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Because we can make practical innovations that help clinical outcomes.
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Because we have the money and time.
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Because we are good at it in many parts of the world.
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Because our predecessors used research to reach where we are today.
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Because it is what will remain alive when we are gone.

Multiple Successes

Many eye care clinicians and scientists in India are doing excellent work in the areas of:
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Cornea and contact lens research
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Retinal research
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Glaucoma research
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Epidemiology research
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Psychophysics research
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Clinical optometric measurement and therapy
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Low vision aids and rehabilitation

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How does vision science help optometry and ophthalmology?
By connecting the clinical application with a basic science concept.

Examples:
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Understanding visual acuity by way of the modulation transfer function of the eye and
neural apparatus.
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Using LASIK to correct higher order aberrations.
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Understanding how control of accommodation and myopia is implemented by color-
opponent mechanisms that analyze longitudinal chromatic aberration.
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Understanding how macular degeneration is influenced by transaminase enzymes in the
liver or by superoxide dismutase (SOD).

Multiple Failures

In a progressive country like India, if a child develops a corneal opacity from a mild infection, it
implies:
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Failure of public sanitation systems!
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Failure of primary clinical eye care!
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Failure of preventive care (to boost the immune system of the child by nutrition)!
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Failure of political, legal, and market systems!

If a blind person is restricted to weaving baskets and making candles, it implies:
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Failure of the family support system!
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Failure of the educational system!
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Failure of human resource departments!
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Failure of innovation for assistive technology!
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Failure of corporations and economic growth!

Where have we gone wrong?
In understanding the underlying cause of the problem. Often this is not what we treat.

Examples:
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The cause of myopia is ergonomic and biochemical but we treat only with lenses.
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The cause of cataract is free radicals from ultraviolet and poor nutrition but we treat only
with surgery.
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The cause of macular degeneration is biochemical but we treat with lasers.
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The cause of underperformance in a visually impaired person is lack of will, but we
rehabilitate lack of ability.

How can we fix the problem?

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By developing "thought clusters" to understand the logic of causation based on the
literature.
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By asking the right questions and developing hypotheses.
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By designing and conducting experiments.
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By developing collaborations.
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By publishing the research in journals/ books.
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By teaching books that reflect latest research.
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By developing business, governmental and NGO partnerships to address the opportunity/
problem.




Logic of causation

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By developing "thought clusters" to understand the logic of causation based on the
literature.
Example:
* Fact: Chromatic aberration is present in all eyes because of dispersion of white light.
* Fact: Monochromatic light impairs accommodation.
* Inference: Longitudinal chromatic aberration (LCA) helps accommodation.
* Hypothesis: Color-opponent neural mechanisms in the retina and brain process LCA to
control accommodation.

From logic to experiments
1. By minimizing longitudinal chromatic aberration using an achromatizing lens,
accommodation should suffer.
2. By impairing a color-opponent mechanism, accommodation should suffer.
3. By simulating the chromatic and luminance changes in open-loop (zero feedback), one
should be able to stimulate accommodation.

Asking the right questions
For any question to become a meaningful hypothesis, it must be linked to a clinical or basic
science phenomenon.
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For example if you were to know how aerobic exercise reduces IOP, many physiological
variables would need to be investigated.
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If you were targeting an eye drop for preventing cataract, many possible mechanisms of
cataractogenesis need to be considered.

Lit. Search, Proposal, IRB & Consent
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Prior to experimental design it is essential to search the literature (e.g. Pubmed:
www.nlm.nih.gov) to determine the need, and background for the proposed research.
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A formal proposal of the research to be conducted is prepared and submitted to an
Institutional Review Board for ethical review.
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After ethical review, informed consent should be obtained from subjects prior to data
collection.




Experimental Design
A well-conceived experiment has 5 parts:
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Statement of the experimental objectives.
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Specification of the hypotheses to be tested.
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Definition of experimental units (subjects) and treatments.
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The experimental design.
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Method of analysis.

Often it is useful to gather pilot data to obtain an indication of the statistical power of the
experiment.

Developing collaborations
Very often, collaborations depend on the seeker having:
* A special skill-- such as computer programming or a deep understanding of the
literature.
* A special device-- such as a UBM or OCT.
* Access to a special population-- such as young patients with glaucoma.
* An institutional affiliation or special qualification.
* Money to support the research.

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How can we fund research?
* Ask industry to set aside a research fund for every college of optometry based on certain
criteria.
* Ask philanthropists to "invest" in research.
* Ask the college administration to set aside at least 3 grants per year, each enough to
support one faculty member and one student for one year for interesting research
projects.
* Develop focus groups to gain the attention of the public in a particular area of need (e.g.
preventing eye disease in the unborn children of anemic pregnant women).

Publishing the research
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Find a journal that has a history of publishing articles close to your topic.
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Preferably that journal should be edited by people who have similar credentials as the
first author.
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Send first to a better journal, and if rejected, send later to lesser known journals.
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Start your own journal!

Writing books
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Prefer first to publish your work in journals.
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When sufficient evidence to support your cause is published, consider writing a book
chapter.
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When the topic becomes popular in academic circles, write a book.
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Find a publisher that respects copyrights of others and offers a decent royalty.

Teaching that reflects research
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Very often what gets taught may not reflect the latest research.
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This depends on availability of the best books and current journal articles.
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While information that is 10 years old may be acceptable, information that is 20 years old
should not be accepted unless it has born out the test of time.
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Who will guide what we teach our students?

Developing partnerships
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Very often, partnerships become sour when one party is weak.
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Partnerships require competence, trust & commitment.
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Partners need to recognize each others' strengths and to complement each other to
minimize weaknesses.
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When you know the mission cannot be accomplished without both partners, cooperation
begins and success becomes likely.
In Summary
Readiness for research comes at a price. Some essentials and other "nice-to haves" include:
* Access to the peer-reviewed literature
* Time, intellectual support and financial incentives for faculty and students to engage in
generating hypotheses and testing them
* Money for equipment, consumables, and paying subjects
* Competence to edit and write well and think critically
* Funding from government, foundations and industry
* Collaborations with respected departments across the globe
References
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Dr. Philip B. Kruger, SUNY- College of Optometry: 1990-Present.
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Dr. Benjamin C. Lane, Nutritional Optometry Institute: 1998-Present.
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Dr. Karan's Vision Care: 2002-Present
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SmartAnalyst (India) Pt Ltd: 2006-Present
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Ansal Inst of Technology: 2006-Present


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