A new horizon for myopia research?

I would first like to thank Professor Christine Dickinson, her Associate Editors and international advisory board for their excellent management of Ophthalmic & Physiological Optics (OPO) over the last 10 years. The tremendous 300+ page, September 2010 special issue with the International Colour Vision Society was a very fitting end to Christine’s tenure. In addition, I would like to thank the College of Optometrists for their unstinting support of research and its publication, thus ensuring that the profession continues to develop in an appropriate evidencebased manner. You may have noticed the change to the front cover of the journal, which also heralds a few other changes inside. Journal editorial duties nowadays require a large team in support of the editor-in-chief. Playing a particularly important role in the new editorial team are six Associate Editors including three previous editor-in-chiefs in Neil Charman (OPO, 1980–1987), Bernard Gilmartin (OPO, 1987–2000) and Mark Bullimore (Optometry & Vision Science, 1996–2004), plus experts from Psychology in Nottingham (Paul McGraw), Vision Sciences at Aston (Richard Armstrong) and Optometry in Indiana (Larry Thibos). In addition, we have a new editorial board (listed on the inside front cover of the journal and on our website), with leading authorities from all over the world and from many areas of research and I thank them very much for agreeing to join us. The format of the journal pages has also changed, with a switch to the Vancouver referencing system made to align with the recommendations of the International Committee of Medical Journal Editors. We include the editorial for our first virtual issue in the following pages. Virtual issues are a collection of papers from previously published issues of the journal that all relate to a particular theme. They are typically fronted by an editorial from an eminent scientist in the area that introduces the topic and summarises the current position. Virtual issues are only available online and usually all the papers are made freely available. Often the theme is something that has become a ‘hot topic’ because of some new finding. Our first virtual issue is entitled ‘‘Myopia: its prevalence, origins and control’’ and it has been collated by of one of our Associate Editors, Professor Neil Charman. We are keeping this virtual issue ‘open’, so that subsequently published papers in OPO that significantly add to the story can also be included to keep the virtual issue relevant and useful to both scientists and clinicians. The virtual issue collates papers that are linked to a hot topic in optometric research at present, namely the possibility that relative peripheral hyperopia (i.e. relative to central refractive error) may somehow disrupt the emmetropisation process and lead to increasing myopia. Of course, this creates the possibility that correcting this relative peripheral hyperopic error could reduce or even prevent myopia progression. Very recently, a clinical trial of a selection of spectacle lenses designed to reduce relative peripheral hyperopic defocus found no significant difference in myopia progression over one year in groups of Chinese children compared to a control group. However, they reported a small but significant reduction in myopia progression in a subgroup of subjects who were younger and whose parents had myopia. The authors concluded that ‘‘The finding of reduced progression of myopia with type III lens design in younger children with parental myopia needs to be validated in a more targeted study, i.e. they accepted that the significant myopia reduction results were due to ‘cherry-picking’ from the data and should only be used to direct future studies. However, despite this rather weak evidence, these Zeiss ‘‘Myovision’’ lenses are already commercially available in Asia; with adverts suggesting a 30% reduction in myopic progression. This no doubt reflects an enormous demand for some form of myopia reduction treatment in Asian countries, where myopia has a huge prevalence in children and young adults. Based on a different underlying theory of reducing accommodative demand at near, Essilor Myopilux Pro varifocal design lenses are also commercially available in Asia, with claims of a 38% efficacy for myopia reduction, but based on similarly weak effects in clinical trials of a related lens (0.20D reduction over three years; the authors of the COMET study that evaluated the Essilor varilux comfort lenses concluded that ‘‘The small magnitude of the effect does not warrant a change in clinical practice’’). Other clinical trials of progressive addition lenses and bifocals have generally found similar weak effects. Indeed, respected researchers in the field are now suggesting that near work and reading may not be closely linked with myopia progression and that genetics and lack of outdoor activity (which would otherwise provide signals that inhibit myopia progression) may be the culprits. The one recent clinical trial to find a clinically useful reduction in myopia (0.85D over 2 years) used Executive bifocals with 3 prism dioptre base-in prism in the near segment of each lens. These lenses appear to be the same as or similar to the Essilor Myopilux Max. Note that the research paper indicates that these lenses should be Ophthalmic & Physiological Optics ISSN 0275-5408