Ophthalmic disease is common. By the time we retire 1 in 50 of us will have developed a visual disorder - and after retirement the incidence rises sharply. The diagnosis and treatment for sight threatening ocular disease may be made too late to prevent significant visual disability, and some of the more common blinding disorders currently have no useful treatment at all. Legal blindness affects mainly the elderly and respects no one. In an ageing population there is an increasing need for research into incidence, causation and treatment of blinding eye disease. Because researchers never have sufficient resources for their perceived needs a system of prioritisation is required.

Why research into eye disease? Not only is eye disease common, but also the effects can be devastating. Loss of vision comes only second to chronic pain in the league table of patient fears. Blindness dramatically increases the risk of long-term unemployment in the young and social dependency in the elderly, both resulting in huge economic impact. Any research that minimises this effect on society must be seen to have major benefit to us all. Chapter 2 provides a brief description of the epidemiology of eye disease, drawing on work funded by the NHS and the voluntary sector. It is augmented by additional information on the risk factors for disease and the burden of visual impairment on the health and well being of the population.

The Royal College of Ophthalmologists has sought the views of researchers into eye disease for the major problems affecting the specialty and asked them to prioritise research areas for the next five years. The areas covered have been retinal diseases, cataract, glaucoma, cornea and external eye disease, ocular adnexal disease, neuro-ophthalmology and the specialised area of visual rehabilitation. These are followed by chapters on paediatric ophthalmology, squint and amblyopia. Each section has included health services, clinical and laboratory research. Each has followed the principle that the problems of diagnosis, mechanism and treatment are best addressed by combining laboratory and clinical research and are dependent on free interplay between clinical and laboratory skills. The outcomes of any research endeavour need to be looked at in terms of prevention, treatment and rehabilitation, and will be dependent upon dissemination of results throughout the community in such a way as to improve public awareness and eye health. Each chapter concludes with a set of research priorities.

The contributors to this document include patient support groups, laboratory workers, clinical scientists, ophthalmologists and other health professionals. The results are a composite of their views and priorities. The original drivers for research come from population need, and this has been set out in the following section that outlines the health burden of eye disease and the economic consequences.

As with any exercise in crystal ball gazing the research priorities that have been identified may be near the mark now, but be knocked off course by new problems or unexpected solutions developing during the five-year period of the plan. However, their ideas are combined into a national view of the directions ophthalmic research can be expected to take.

Roger Hitchings // Paul Hiscott // John Marshall