In 1996, Tim Stout was the self-described “most junior faculty member” at Doheny Eye Institute in Los Angeles. Energized to set up his own lab and grow both his clinical practice and research agenda, Stout, MD, PhD now Director of the Cullen Eye Institute at Baylor College of Medicine, was soon confronted with the stark realities of time management and limited resources. While he had some startup funding from the Doheny Eye Institute, Stout’s mentors urged him to seek additional funds to jump-start his research efforts. “I was a faculty member for less than a year when I first learned about and applied for the Career Development Award,” Stout recalled. His application was successful. “It was nothing short of transformative—for an assistant professor in those days, that amount of money was like hitting the jackpot,” he said. Over the next four years, Stout honed his expertise identifying and developing viral vectors that would ultimately be used in gene therapy techniques to treat proliferative ocular disease as well as a host of other diseases.
Stout is one of 203 recipients of the Research to Prevent Blindness (RPB) Career Development Award (CDA), founded 30 years ago as one of the few private sources of funding aimed specifically at early-career vision researchers. What began in 1989 as a $120,000, 4-year grant has grown into a $300,000 award that, as Stout and other awardees describe, often serves as a critical “accelerant” for other grant-seeking efforts. CDA grantees are a diverse group of clinicians, researchers and clinician-scientists, which encompasses every field of vision research, from age-related diseases of the eye to regenerative medicine, visual neuroscience, genetics and gene therapy, infectious disease, ocular oncology and dozens of others. CDA awardees have gone on to make breakthrough discoveries, chair many of the top ophthalmology departments in the nation, serve as editors of leading ophthalmology research journals and lead some the field’s premier research organizations. In the years following their CDA grants, the group has collectively obtained more than $1 billion in government and private research funding, an astounding return on a $40 million investment from RPB.
In the years following their CDA grants, the group has collectively obtained more than $1 billion in government and private research funding, an astounding return on a $40 million investment
Launched, But Not Yet Landed
Newly launched from the world of medical and research fellowships, early-career researchers and physician scientists often have no choice but to hit the ground running, learning how to build a lab, care for patients and apply for funding as they go along. They become caught in a catch-22: struggling to juggle the tasks of grant applications with producing the kinds of research data that make those applications successful. The consequences of failure are significant both individually and on a societal level: “If you don’t get enough funds to get going, hire people and then get more funds, great ideas will never make it to patients,” Stout said.
Present-day graduate students and postdoctoral researchers may be surprised to learn that the importance of supporting the work of early-career scientists was not always widely recognized. Even a cursory search for funding opportunities for “young” scientists today will reveal hundreds of results in dozens of scientific disciplines, ranging from prizes aimed at the best and brightest high school science students to awards for researchers under age 40. While overall competition for funding is more intense today than it was when RPB first introduced the Career Development Award, new faculty researchers in prior decades had far fewer places to turn for early-career support.
According to Michael F. Chiang, MD, the Knowles Professor of Ophthalmology and Medical Informatics and Clinical Epidemiology at Oregon Health & Science University and Associate Director of the OHSU Casey Eye Institute, “One key reason that clinician scientists don’t get off the ground is because of lack of time and lack of resources to focus and start to build a niche of expertise.” Chiang, who received the Career Development Award in 2005 while at Columbia University, recalls the pressure of attempting to build a clinical practice while pursuing research that could form the basis of a coveted R01 grant from the National Institutes of Health. “It’s a very difficult time,” he said. “We all want to make a difference in the field, but getting started in a department with all the other academic and service tasks makes it tough to protect your time and get work done.” For Chiang, the CDA provided vital resources to begin a data and image collection process that would not only shape his career path but would impact the lives of infants and influence the entire field of ophthalmology.
Thanks to RPB support, Chiang was able to enlist the help of a research coordinator who assisted in compiling a database of retinal images from infants affected by the most common cause of childhood blindness, retinopathy of prematurity (ROP). At that time, the popularity of telemedicine was on the rise, and Chiang was interested in developing methods for using the technology to diagnose ROP—an already complex task that proved even more challenging due to a high degree of subjectivity in image interpretation. His timing was fortuitous, however, for those years were also marked by a surge of interest and innovation in areas of artificial intelligence that are particularly well-suited to medical image analysis. Chiang’s repository of images proved the perfect training ground for him, along with collaborators, to develop some of the first deep learning algorithms for medical image analysis in ophthalmology. After more than a decade of evolution, the present-day iteration of those algorithms can outperform physicians in correctly identifying ROP, making top-notch diagnostics available in areas where this level of expertise is not always available.
Creating a Cycle of Excellence
The trailblazing clinicians and researchers that comprise the community of CDA awardees are not only shaping their research fields and transforming patient care, they are also influencing the next generation of researchers. Recipients of the Career Development Award are nominated by senior faculty members who mentor and supervise their progress over the course of the grant period. Over the course of 30 years, RPB has received many applications on which the mentors are CDA recipients themselves. Fifty-three of these applications have been successful in securing CDA funding. “It’s the award that keeps on giving,” said RPB President Brian F. Hofland, PhD, noting that some awardees have subsequently nominated and mentored as many as five CDA awardees over the course of their careers.
Mentorship is so essential in the early years of a clinical or research career that, as Hofland explained, CDA applicants are evaluated both on their own merit and potential as well as the quality of the senior faculty that guide them. “We’re betting almost as much on the institution and on the mentors as we are on the researchers themselves,” he said. “We make sure there are people on the faculty who have the expertise to help them get through the difficult spots and grow intellectually, while at the same time encouraging them to become independent,” he explained. “During the four years, our awardees step out of the shadow of their mentors and emerge as very distinguished researchers in their own right.” Terri Young, MD, MBA, the Peter A. Duehr Professor of Ophthalmology and Chair of the Department of Ophthalmology and Visual Sciences at the University of Wisconsin-Madison, says that success for early-career clinician-researchers often rides on a full spectrum of support department-wide. “It has to be a wholehearted, full-force commitment by the department chair and senior faculty members to truly support that person’s ambitions,” she said.
Letting Science Lead the Way
In an environment where a lab’s sustainability is directly tied to both resources and results, the Career Development Award provides a core of funding that affords recipients one benefit that transcends any dollar value: time to focus on their passions. “The CDA buys early-career researchers some time to truly explore a particular topic,” said Hofland. “They don’t have to chase every other funding opportunity that presents itself.” CDA awardees provide annual research progress updates to RPB, and as Hofland said, the organization both expects and values the unpredictability inherent in the process of scientific discovery. “There are twists and turns along the way, and there are often unexpected and exciting findings,” he said. “When these things come up, we’re very flexible—we want our awardees to pursue them.”
In addition to the funding, the award validated my research direction, and it gave me the courage to pursue my ideas as a young faculty member
Terri Young believes this flexibility played a role in the choice to award her a Career Development Award in 1996—her first grant in vision research, and one that she describes as a “leap of faith” on the part of the RPB Scientific Advisory Panel, a committee of renowned scientists from a variety of disciplines that review all RPB grants. In the first years of her clinical career at the University of Minnesota, Young was particularly struck by a cohort of clinic patients who presented with high-grade myopia, a severe form of nearsightedness associated with serious comorbidities such as retinal detachment, glaucoma and cataracts. Many patients also had relatives with the same condition. “I thought to myself, ‘there has to be more to this,’ and at that time, there was enough information in the literature to suggest that there might be a heritable basis for myopia,” she said.
Inspired by the Human Genome Project and the promise of someday being able to identify genes associated with specific conditions, Young sought additional training in laboratory molecular genetics—a field in which she had no previous experience. She applied for a Career Development Award to pursue a line of research that she characterized as somewhat risky and ahead of the curve at the time: discovery of gene variants associated with a complex disorder rather than those that are Mendelian (a type of biological inheritance). The grant proved foundational to the rest of Young’s research career and started her on a path that has subsequently yielded insights into multiple gene mutations involved with non-syndromic myopia and other ocular conditions (childhood glaucoma, corneal and retinal dystrophies, as examples), in various populations.
“The Career Development Award provided the necessary start-up funds to establish a comprehensive database and repository of multiple ascertained pedigrees along with their DNA, which I still use to this day,” Young said. “In addition to the funding, the award validated my research direction, and it gave me the courage to pursue my ideas as a young faculty member who had to balance lab time with clinical responsibilities.”
With federal funding for scientific research trending downward over the past decade, support for researchers and clinician scientists is more important now than ever. As Michael Chiang said, “I remember being told during the first day of medical school that half of what I learned would be outdated by the time I started practicing. I know now that it’s true, and the reason it’s true is because of discoveries and advances that push the field forward. The process requires time and support, and it’s ultimately how we take the best care of patients.”
Seeding the Future
Looking ahead to the future of the award program, Hofland would like to expand the number of young researchers accepted into the CDA community. Each year, RPB’s Scientific Advisory Panel selects six CDA grantees from among the applicants. Hofland aims to increase that number to eight in the years to come and hopes to raise the annual award amount from $75,000 to $100,000 (for a total of $400,000 per researcher over the course of the 4-year grant) for even greater impact.
As he reflects upon the monumental achievements of the hundreds of CDA recipients on the cusp of the program’s 30th anniversary, Hofland fondly draws on a parallel from his own personal history growing up on a farm in the Midwest. “I think of the Career Development Awardees as being almost like our seed corn,” he said, referencing the top-quality seeds that corn farmers save and replant each year to guarantee future crops. “They’ve put down roots in this field and have provided a huge crop of research findings, expertise and leadership in so many ways. They are such a precious group that assures the future bounty of the vision science field.”
April 25, 2019
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