Global challenges for lens and cataract research.

The lens is sadly too often dismissed as a less important tissue within the eye, but this neglects to appreciate the role it plays in the wellbeing and quality of life of individuals, the economic burden lens pathologies place on society and the true biological wonder it is! A normal healthy lens in isolation, looks like a jewel, formed from biological glass. The lens is made of cells enveloped in a soft collagen shell. No blood supply, no nerves. There is slow cell growth that occurs progressively over a lifetime and little cell death takes place. Furthermore, the lens is not a static system and has to quite literally accommodate and manage ongoing mechanical changes due to shape-changing accommodation. Despite these challenges, lens cells are orchestrated to perfect harmony to generate an anatomy conducive to transparency, refraction and accommodation. Pathologies of the lens compromise wellbeing. Congenital and early onset cataract can lead to blindness in tens of thousands of people, while in later life age-related cataracts lead to visual deterioration and blindness in tens of millions. The only treatment for cataract is surgery with intraocular lens (IOL) implantation. Cataract surgery is the most common operation in the world and IOLs the most common medical implant. Despite the success of cataract surgery, wound-healing responses lead to secondary visual loss, known as posterior capsule opacification, in approximately 20% of patients. This can be resolved by Nd: YAG Capsulotomy, but this is not without risk; this is the second most common operation in the world. In addition, presbyopia commonly present in middle age and affects billions, impacting personal wellbeing and ability to perform specific roles. Collectively, these conditions compromise individuals and place significant financial burdens on healthcare providers. The need to undertake lens and cataract research therefore remains a key health priority. As a community the lens field faces both medical and political challenges that need to be considered, appreciated and addressed. In the current article the lens and cataract research landscape is assessed and evaluated with potential strategies proposed to build on existing strengths and address areas of underused potential to continue advancing knowledge and impact on the health and wellbeing of millions and potentially billions of patients.