Industry funding for eyecare research is less than that of public support from the NEI, but it increased at a much higher rate between 2014 and 2020. Photo: Getty Images.

Characterizing industry/ophthalmology collaborations in research can highlight current areas of focus in product development, improve transparency and identify potential sources for conflicts of interest. A research team recently assessed the trends and characteristics in research payments reported from industry to ophthalmology from 2014 to 2020 and noted a 203% increase in industry funding over that period, for a cumulative value of $825,417,233. Comparatively, total National Eye Institute (NEI) research funding during the same period increased just 6.6%; however, the NEI does fund ophthalmology at a higher overall level—roughly $5 billion over the study period. The share of all medical research funding from industry directed toward ophthalmology research increased from 1.2% to 3.2% in those six years.

The study, published in JAMA Ophthalmology, assessed the value and distribution of payments, sponsoring manufacturers and research products. Changes in aggregate and per individual-level funding were characterized using formal trend analysis. The researchers used data from the Centers of Medicare & Medicaid Services (CMS) Open Payments database, which contains public records of payments between industry and physicians, to identify all ophthalmologists who received industry payments for research purposes between 2014 and 2020. CMS differentiates between general payments and research payments. General payments are all forms of payment not related to research, such as food, speaking fees and consulting fees.

Over the study period, 2,102 ophthalmologists were reported to have received $825,417,233 in industry research payments. Industry funding per year increased 203% from $62,924,525 in 2014 to $190,714,508 in 2020. The distribution of industry payments was skewed, with the top 15 of 108 manufacturers accounting for 93.9% of funding. The top 10% of ophthalmologists (210 individuals) were reported to have received 65.7% of all research dollars ($542,299,121).

The mean value of industry-funded research payments reported per ophthalmologist across all years was $392,681. The single year with the highest mean payment ($186,062) was 2020. However, the median (range) funding per ophthalmologist across all years was $71,027 ($6 to $19,219,146). Although both the reported mean and median funding increased from 2014 to 2020, there was year-to-year variation and thus no trend was observed for either measure.

The highest funded research products were development of anti-VEGF agents, glaucoma treatments and intraocular lenses. Genentech distributed the highest aggregate spend with $239,188,537 (29% of total research funding) funded to 389 (18.5%) ophthalmologists, a mean payment of $614,880. Following Genentech in total funding, Allergan distributed $145,255,760 (17%) to 752 (35.8%) investigators, a mean payment of $193,159. Allergan paid a higher number of principal investigators than any other manufacturer.

Anti-VEGF agents Beovu (brolucizumab, Novartis), Eylea (aflibercept, Regeneron) and Lucentis (ranibizumab, Genentech) were the three highest funded products, receiving research payments of $68,713,321 (8.3%), $58,288,833 (7.1%) and $56,288,833 (7.1%), respectively—about 22% of overall funding. Funding for anti-VEGF research had increased 268.7% by 2020. Other highly funded products were associated with the management of glaucoma, cataracts and inflammatory eye conditions.

“Although unequal in distribution, industry-funded research in ophthalmology is extensive and increasing in scope,” the researchers wrote in their paper. “Although industry-ophthalmologist interactions are crucial to the development of improved treatments, they may present ethical challenges to clinicians who must still base their practicing patterns on individual patient means and needs.”

Table 1. Top Five Manufacturers Reporting Research Payments to Ophthalmologists

Data obtained from the Centers for Medicare & Medicaid Services Open Payments database.