Corneal blindness is a major but deeply neglected cause of preventable vision loss, disproportionately affecting people in low- and middle-income countries (LMICs). Corneal infections alone cause an estimated 2 million new cases of blindness each year, often affecting young and working-age patients and resulting in permanent vision loss, surgery, or loss of the eye. Corneal transplantation is also the most commonly performed forms of transplantation worldwide, underscoring the global reach of corneal disease. Yet despite this high morbidity, research investment and therapeutic innovation for corneal blindness remain disproportionately limited.

The opportunity to change this is unusually tractable. Many of the field's most important unanswered questions do not require enormous new institutions or decades of scientific discovery. The promising innovations, clinical expertise, and patient volume already exist. What's missing is relatively modest investment in the research infrastructure needed to connect them, test promising interventions rigorously, and translate discoveries into better outcomes. In a field that has received so little sustained investment, even targeted resources can fundamentally change what is possible.

We also believe corneal blindness can serve as a proving ground for better models of 21st century scientific progress. Many neglected diseases share the same underlying problem: substantial disease burden and clinical expertise exist in LMICs, yet the research infrastructure needed to turn those advantages into scientific discovery and better treatments does not. If the IMPACT model can overcome these barriers in corneal blindness in some of the historically hardest environments to conduct clinical research, then we belive its principles and infrastructure can also provide a replicable blueprint for accelerating research across other high-burden neglected diseases.

Too often, global health research begins with questions, priorities, and study designs developed at institutions in high-income countries and then implemented in populations elsewhere. IMPACT is designed around a different model. Research priorities originate from the disease burden, clinical problems, and unanswered questions encountered every day by clinicians at participating low- and middle-income country (LMIC) centers. Studies are developed collaboratively, using the scale, expertise, and patient populations of these institutions to answer questions that are both locally important and globally relevant.

IMPACT is also designed to modernize how evidence is generated. We prioritize digital-native data collection, standardized imaging, AI-enabled workflows, and contemporary trial methods that can make studies faster, more scalable, and less dependent on cumbersome legacy infrastructure. Over time, the network is intended to support more rapid and adaptive trial designs that can evaluate multiple interventions efficiently as new diagnostics and therapies emerge.

Just as importantly, IMPACT is intended to build durable research capacity rather than a series of externally driven projects, with increasing scientific leadership, authorship, and ownership by LMIC investigators over time. The goal is not simply to conduct research in LMICs, but to build a research network increasingly led from within them.

Corneal blindness remains a major cause of vision loss worldwide. Corneal infections are by far the leading cause of corneal blindness and are estimated to cause blindness in roughly 2 million new patients each year. Yet innovation in diagnosis and treatment of corneal infections has been remarkably limited. Few new antimicrobial therapies have reached patients in decades. The last major antibiotic classes now used for bacterial keratitis were introduced 30 years ago, while natamycin, still the principal FDA-approved drug of choice for fungal keratitis, was first approved in 1978. When managing infections, physicians making consequential treatment decisions still frequently rely on small studies, retrospective data, or expert opinion. This barren innovation landscape stands in stark contrast to many other major eye diseases and infectious diseases that have benefited from sustained research investment, pharmaceutical development, and mature translational and clinical trial infrastructure.

A similar imbalance exists in corneal transplantation. Most of the transformative innovations of recent decades have centered on endothelial keratoplasty, which is principally used to treat Fuchs dystrophy and other endothelial diseases that predominate in high-income countries. By contrast, penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK), which are disproportionately important for infection, scarring, and advanced corneal disease in low- and middle-income countries, have seen very little innovation.

IMPACT is designed to close these gaps by building the research infrastructure needed to generate stronger evidence and accelerate new diagnostics, therapies, and surgical approaches for neglected but high-burden corneal diseases and surgeries.

IMPACT's unique advantage is the ability to generate rigorous clinical evidence at a speed and scale that can fundamentally accelerate innovation in corneal disease. Our partner hospitals see extraordinary volumes of corneal infection and transplantation, allowing studies that might require years of enrollment elsewhere to potentially be completed in months. Combined with harmonized research infrastructure across our sites, this creates unusually rapid translational throughput. Our prospective studies can generate the clinical data, images, samples, and scientific insights needed to move promising preclinical ideas through the translational and clinical research pipeline. This includes discovering biomarkers, validating diagnostic tools and algorithms, evaluating novel therapeutics, and conducting evidence-generating clinical trials.

Individual studies answer individual questions. A standing research platform can answer many questions for years. IMPACT invests in reusable infrastructure including trained clinical teams, longitudinal cohorts, standardized data collection, imaging systems, regulatory processes, biostatistical capacity, and active working relationships maintained across high-volume institutions.

Each new project can therefore build on infrastructure that already exists rather than recreating it from scratch. As the network grows, the same platform can support observational research, translational studies, diagnostic validation, and increasingly efficient clinical trials. This becomes especially valuable as the pace of biomedical innovation increases, because promising diagnostics and therapies are only useful if there is a practical way to evaluate them rapidly and rigorously in the populations that need them most. The objective is for each dollar invested in infrastructure today to lower the cost and time required to generate the next piece of evidence.

IMPACT is designed to become less dependent on its founders as it succeeds. From the beginning, the consortium is building the local scientific leadership, digital infrastructure, governance, and institutional capacity needed to operate independently over the long term. Our aim is for an LMIC investigator to co-lead the network by approximately year 5 and for leadership to transition fully by around year 10.

This is not merely a succession plan, but a deliberate model for building durable research infrastructure that compounds over time: a network that can generate evidence, run increasingly sophisticated trials, train new investigators, and attract new funding while becoming more deeply anchored in the institutions closest to the disease burden. The intent is to create a scientific platform with the resilience, capacity, and leadership depth to thrive well beyond any one individual or institution.

Traditional scientific peer review can take 6-18 months from submission to publication. When answering clinically important questions or describing novel technologies for corneal blindness, we consider such delays to be unacceptable. IMPACT uses preprints to make findings available as soon as they are scientifically ready, with formal peer review and publication continuing in parallel. This allows useful evidence to reach clinicians, researchers, and partners sooner without sacrificing the value and rigor of independent peer review.