Editorial

As Far as the Eye Can See: Importance of Myopia as a Pressing Public

Health Need
Mark A. Bullimore, MCOptom, PhD - Houston, Texas
Ian G. Morgan, PhD - Canberra, Australian Capital Territory, Australia
Kyoko Ohno-Matsui, MD, PhD - Tokyo, Japan
Seang-Mei Saw, MBBS, PhD - Singapore

Not long ago, myopia was generally regarded as a benign less severe than 6 diopters can account for over half of
refractive error that was readily corrected with spectacles, cases where the prevalence of myopia and high myopia
contact lenses, and, more recently, refractive surgery. The remains relatively low.24 This has led to popularized phrases
past 2 decades have seen a seismic shift in how we as an such as “there is no safe level of myopia”25 and “every
ophthalmic community view myopia.1 The reasons include: diopter matters”23 and the statement by the American
Academy of Ophthalmology that “the population-based
 its rapidly increasing prevalence due to increasingly burden of lower degrees of myopia remains considerable.”26
intensive education and increasingly common indoor Myopic maculopathy is likely to be an increasing problem
lifestyles2,3 worldwide, because it is an age-related disease, and many
 its role in increased risk of ocular disease4 and visual populations are rapidly aging.
impairment5e7 Ophthalmology Science is a journal of the American
 the emergence of evidence-based interventions to Academy of Ophthalmology, which has championed the
8 9,10
delay its onset and slow its progression importance of myopia as a pressing public health need. In
Although the sight-threatening consequences of myopia 2019, the Academy created the Task Force on Myopia in
occur later in life, interventions to delay its onset need to be recognition of the “substantial global increases in myopia
commenced early in childhood, prevalence and its associated complications.” The Aca-
and interventions to slow its pro- demy’s Board of Trustees believes
gression need to be implemented as Although progress in the field that “myopia is a high-priority
soon as possible after onset.11 The has been dramatic, there remain cause of visual impairment, war-
aim is to reduce both the overall ranting a timely evaluation and
many unanswered questions. synthesis of the scientific literature
prevalence of myopia, as well as
that of high myopia and its and formulation of an action plan
associated pathological changes. to address the issue from different perspectives. This in-
In some parts of the world, notably in East and Southeast cludes education of physicians and other health care pro-
Asia, around 80% of children completing 12 years of viders, patients and their families, schools, and local and
schooling are myopic, with around 10% to 30% highly national public health agencies; defining health policies to
myopic and at high risk of uncorrectable loss of vision later in ameliorate patients’ access to appropriate therapy and to
life, due to the increased risk of various ocular diseases. 5 promote effective public health interventions; and fostering
12
Singapore, Taiwan, and more recently, mainland China, 13 promising avenues of research.”
have developed myopia prevention and control programs. More recently, the Academy sponsored a congressional
In other parts of the world, there is some evidence that the briefing to raise awareness of the myopia crisis. Michael X.
prevalence of myopia is also increasing, but there are Repka, MD, a pediatric ophthalmologist at Johns Hopkins
limited data from the United States. The prevalence of University and Medical Director for Governmental Affairs
myopia in young adults, aged 20 to 39 years, in the most for the American Academy of Ophthalmology, and Jeffrey J.
recent National Health and Nutrition Examination Survey Walline, OD, PhD, Associate Dean for Research at The Ohio
(NHANES) survey was close to 50%, with the prevalence State University College of Optometry and President-Elect of
14
of high myopia around 7%, but these data are based on the American Academy of Optometry, spoke to lawmakers
noncycloplegic refractions that will likely lead to significant and staff on rising rates of myopia and the importance of
overestimation of the prevalence.15,16 investing in research to identify potential solutions.
Because of its link to high myopia, myopic maculopathy, or Interventions for slowing myopia progression fall under
myopic macular degeneration, has been extensively studied 17 the purview of the United States Food and Drug Adminis-
and classified. 18
It is a leading cause of visual tration. Although there is only 1 approved clinical interven-
impairment,19e21 with its impact predicted to increase tion approved to slow the progression of childhood myopia in
dramatically.22 Although the prevalence of myopic the United States, many other products are under ongoing
maculopathy increases with the level of myopia, myopia 23 evaluation, and many are approved in other parts of the world.

ª 2023 by the American Academy of Ophthalmology https://doi.org/10.1016/j.xops.2023.100438 1

This is an open access article under the CC BY-NC-ND license ISSN 2666-9145/23
(http://creativecommons.org/licenses/by-nc-nd/4.0/). Published by Elsevier Inc.
 Ophthalmology Science Volume 4, Number 1, February 2024

The Food and Drug Administration has sought the input of that can modulate ocular growth, including animal models,
many learned societies, including the American Academy genetics, and the complications of myopia. Ultimately,
of Ophthalmology, and published a report on the design of submissions should be clinically relevant, comprehensible
clinical trials investigating the effectiveness and safety of to clinicians, and have the potential to eventually impact
myopia control devices.27 clinical practice.
Although progress in the field has been dramatic, there The journal will start accepting manuscripts in January
remain many unanswered questions. Ophthalmology Sci- 2024 and open submissions through the end of December.
ence is therefore pleased to announce a Myopia Special Submissions will be subjected to the journal’s usual rigorous
Issue with the goal of spanning the basic and clinical aspects peer-review; the acceptance rate is 27%. We will reduce the
of myopia. Ophthalmology Science focuses on preclinical article processing charge by 50%. Ophthalmology Science is
and basic science, early phase I and II trials, and bioinfor- entirely online, and manuscripts will be published when
matics. Thus, all the different aspects of myopia would be accepted. Nonetheless, there will be a special issue
appropriate. We invite submissions describing original dedicated to these manuscripts, grouped according to their
research, and well-published authors could summarize or subject matter. The goal is to create 1 central place where
present new data. Reviews are welcome, but any systematic the experts in the field will provide a variety of insights into
review or meta-analysis should be unique and not duplicate myopia, a pressing public health problem.
previous efforts. Some examples include, but are not limited As guest editors, we are grateful for this opportunity and
to, studies of established or emerging methods to slow look forward to engaging actively with the scientific com-
myopia or delay its onset, visual and biochemical signals munity through this special issue.

Footnotes and Disclosures

Disclosures: M.B.: Consulting e Alcon, Buno Vision, Euclid Vision, Eyenova;
All authors have completed and submitted the ICMJE disclosures form. Consulting and speaking e Coopervision, Essilor Instruments USA, Essilor
The authors have made the following disclosures: Luxottica; Medical writing and editing e BroadcastMed.
K.O-M.: Payment to the institution e Santen; Payments or honoraria e The other author has no proprietary or commercial interest in any materials
discussed in this article.
Senju, Santen, Nikon, Chugai, NIDEK; Participation on safety monitoring
or advisory board e Topcon, Coopervision; Receipt of equipment, mate- Correspondence:
rials, or services e Santen, NIKEK. Mark A. Bullimore, MCOptom, PhD, 356 Ridgeview Lane, Boulder, CO
I.G.M.: Conference travel support e Eyerising International, Aier Hospital 80302. E-mail: bullers2020@gmail.com.
Group, Zhongshan Ophthalmic Center, Guangzhou.

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