Myopia: From Research to Practice.

I f youwant a big opportunity, find a big issue to address.Myopia is one such issue. Myopia has become a global problem, being particularly prevalent in the urban areas of East and Southeast Asian countries. It is now more important than ever to facilitate the exchange of information and ideas in relation to this condition to further its research and study. For this reason, the Asia-Pacific Journal of Ophthalmology has gathered leading international experts to contribute to this special issue on myopia. Moreover, this special issue on myopia is published in conjunction with the Asia-Pacific Myopia Society. The Asia-PacificMyopia Societywas formed earlier this year, with FrankMartin as its founding president, to promote research and public health education in the prevention and treatment of myopia, including its associated complications, in the Asia-Pacific region and beyond. The past decade has been an exciting period for myopia research regarding its epidemiology, etiology, prevention, and treatment. The existence of an epidemic of myopia in the developed countries of East and Southeast Asia has been so well documented that myopia research has reached the pages of Nature Genetics through a series of papers on myopia genetics, Lancet as a commissioned review, and Nature itself through a news story, which has brought the issue of myopia to the attention of the international scientific community. Progress in research has brought myopia to a new era, that of translational research andmyopia prevention, marked by the publication of successful clinical trials of schoolbased prevention, including in JAMA. The prevalence of myopia in young adults in some developed countries of East and Southeast Asia is now over 80%, and as the older, less myopic generations are replaced by younger, much more myopic generations, the population prevalence of myopia in adults will gradually approach this figure. Increased economic development and more intensive school systems are bound to lead to increases in the prevalence of myopia in many other countries. Thus, high myopia and associated age-related blinding pathologic lesions may be a looming threat. This poses the challenge of ensuring that all those who need corrections through glasses, contact lenses, and refractive surgery have access to them. This is a particular problem in less developed countries. Further investigation into better methods for correction and how to deliver them is an important area for future research. An even greater challenge for the future comes from the fact that the prevalence of high myopia has now reached over 20% in these same populations of young adults, and again, this prevalence will gradually become that of the entire adult population. This poses a major problem because of the increased risks of cataract, glaucoma, and vitreoretinal degenerations associated with high myopia. The pathological outcomes associated with high vitreoretinal degenerations are well known, ranging from an increase in the incidence of retinal detachment that starts in young adulthood to myopic macular pathologies, such as chorioretinal atrophy, choroidal neovascularization, epiretinal membrane, macular hole, maculoschisis, and so on. Myopic maculopathy has become a major cause of irreversible blindness in many countries. In a recent study in China, myopic maculopathy was found to be the leading cause of blindness for people aged 45 years or older. Vitreoretinal complications of high myopia are currently difficult and costly to treat. Advances in treatment are essential, but for the moment, prevention appears to be the most effective approach. The broad origin of this crisis is now clear. Because the rate of change in the prevalence ofmyopia is far too great to be explained by genetic change, environmental factors must play an important role. Countries with a poorly developed education system always have a low prevalence of myopia, and more educated people are more likely to be myopic, which means that education is a major risk factor. However, this is not likely to be easily modifiable. Howmuch time children spend outside has also been identified as a major protective risk factor, which is more likely to be useful for prevention. The epidemic of myopia is characterized by increasingly early onset, combined with high myopia progression rates. Early onset of myopia leaves more time for progression at higher rates and provides