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• W2802876629 abstract "Myopia is a global problem. The rising prevalence and the risks of sight-threatening ocular pathology associated with myopia are well documented.1, 2 By 2050, it is predicted that half of the world's population (five billion people) will be myopic, with nearly one billion at high risk of sight threatening ocular pathology.1 Myopia is now considered as a public health concern in some parts of the world and as such it now features on the World Health Organisation agenda.2 Given this backdrop there is a genuine and pressing need to understand the pathogenesis of myopia and to develop innovative solutions to ameliorate its effects on the individual and the world economy.3 The ultimate goal being to prevent the development of myopia. We are delighted that Ophthalmic & Physiological Optics has dedicated a Feature Issue to the topic of myopia, which we hope will be of interest to clinicians and researchers alike. Reflecting the multidisciplinary nature of myopia research, the original articles in this Feature Issue cover a broad base from basic science to clinical research. Elucidating the mechanisms behind the development of myopia require collaboration and The 16th International Myopia Conference4 held in September 2017 at Aston University in Birmingham was pivotal in bringing together researchers, industry partners and clinicians interested in myopia. Early basic research through to clinical trials were on the agenda. Frank Schaeffel, in his guest editorial,5 discusses his conference highlights from the array of research presented and aptly summarises the progress and trends in the field of myopia research. Schaeffel comments on the growing interest of the role of light in the development of myopia. The invited review by Chakraborty and colleagues explores this topic further.6 They suggest that given the retina's central role in entraining circadian rhythms to the light:dark cycle, as well as refractive development, a role for circadian retinal functions in regulating postnatal eye growth is supported by several lines of evidence. They present many novel points of discussion likely to generate new research ideas. Uncovering the mechanisms underlying myopia development is a recurring theme in several papers in this issue. Levy et al. investigated the biomechanics of the sclera during myopia development in a mammalian animal model.7 They found that axial elongation in myopia was accompanied by a non-reversible, biomechanical ‘softening’ of the sclera distinct from previously-identified changes in the tissue's elastic properties. These biomechanical changes could be inhibited by scleral crosslinking with the low-toxicity agent, genipin. The role of muscarinic receptors in the choroid was the focus of Sander and colleagues, who found that choroidal thickness changes caused by hyperopic defocus had a muscarinic involvement.8 These results contribute towards a better understanding of the role of the cholinergic system in the human choroid's response to optical blur. Structural differences in Schlemms canal and trabecular meshwork in high myopes compared to non-myopes have been found by Chen and co-workers.9 They suggest that this may help characterise the pathophysiological mechanisms in high myopia. At the retinal level, Martins and colleagues explored the association between the Stiles-Crawford effect of the first kind (SCE-I) and myopia.10 They identified a clear link between SCE-I directionality, uncorrected defocus, and axial eye length. They suggest that the SCE-I may play a role in emmetropisation and consequently in progression of myopia, as cone photoreceptors capture light from a wider pupil area in elongated eyes due to a geometrical scaling. New devices, techniques and strategies designed to slow the progression of myopia are set to radically alter how clinicians manage patients in primary care.11 Orthokeratology (ortho-K) has been shown in 2-year randomised controlled trials to reduce myopia progression by approximately 50%. However, the long-term efficacy of ortho-K is not known, and a key barrier to paediatric ortho-K contact lens fitting is concern about safety. Hiraoka and colleagues present 10 year data on orthokeratology in children showing that efficacy was maintained throughout the 10 year follow-up period. Importantly the safety profile for ortho-K and conventional contact lens wear was similar.12 The axial elongation responsible for causing myopia in most patients puts the eye at a greater risk of ocular pathology.13 Cruickshank and Logan explain why axial length and refractive error should not be used interchangeably, and provide both theoretical and empirical evidence that the relationship between axial length and refractive error differs in longer eyes as opposed to shorter eyes.14 The success of myopia control interventions also depends on the attitudes of individuals to myopia and its control. McCrann and colleagues explore the limited research that exists on this topic and suggest that there is a lack of understanding of myopia, its risk factors and myopia control techniques among eye care practitioners, parents, teachers and students.15 Their findings clearly indicate an acute need for educating society to the public health importance of myopia. The varying designs for optical interventions for myopia control give rise to the risk that these may alter the quality of the retinal image and affect vision. The next three papers in the Feature Issue assess the impact on image quality, vision and depth of focus of radial refractive gradient (RRG) spectacle lenses, and dual focus or bifocal contact lenses. RRG spectacle lenses have been proposed as an intervention to slow myopia progression based on the peripheral defocus theory. Barbero and Faria-Ribeiro show that unavoidable errors are introduced by RRG spectacles when used for dynamic foveal vision.16 Faria-Ribeiro and colleagues compute the effect of different inner zone diameters of dual focus contact lenses on image quality.17 Conversely, Ji and co-workers assess the impact of bifocal contact lenses on accommodation through computation.18 The authors of the three papers agree that these current treatment interventions are likely to impact image quality adversely, and they propose options for reducing these effects. The final two papers relate to the consequences of myopia, and in particular high myopia, in terms of myopic maculopathy and the differing prevalence of myopia across adult populations. Lin and colleagues report findings from the Handan Eye Study.19 Utilising a rigorous new scheme for classifying pathological myopic fundus features, ‘META-PM’, they describe the incidence and progression of myopic maculopathy in this Chinese adult population. The prevalence of refractive errors and myopia in an adult population in Southern India is presented by Joseph and colleagues.20 In contrast to high-income populations and in agreement with studies from low-income settings, these authors document a rise in myopia with increasing age reflecting the high prevalence of advanced cataract in this region. These two studies highlight the population and age-specific variations in myopia prevalence worldwide. In summary, the original papers presented in this Feature Issue of Ophthalmic & Physiological Optics provide a contemporary snapshot of the diverse research themes that are currently being pursued. Disease mechanisms, interventions and epidemiology are all well represented in this challenging and important area of vision science. We very much thank the cohort of anonymous reviewers for their help and assistance in compiling this Feature Issue. It is clear that there is no panacea for myopia control, and there are limitations in translating scientific research into clinical practice. It is against this background that myopia research moves forward in its quest to elucidate the mechanism(s) underlying myopia development. We hope that the papers presented herein will stimulate debate and ideas for future research that will contribute to this goal. Now is an exciting time for myopia research. Nicola Logan is Director of Research for the Ophthalmic Research Group at Aston University, Birmingham. Nicola organised and hosted the 16th International Myopia Conference held at Aston in September 2017. Nicola's research interest is in understanding the mechanisms underlying myopia development and progression and interventions for reducing myopia progression. Jez Guggenheim is a Professor in the School of Optometry & Vision Sciences, Cardiff University. He currently serves on the editorial boards of Ophthalmic & Physiological Optics, IOVS and TVST. His research aims to understand the causes of myopia, with particular interest in animal models, epidemiology and genetics. Chi-ho To is the Henry G Leong Professor in Elder Vision Health and Head of the School of Optometry, The Hong Kong Polytechnic University. Myopia and glaucoma are his two major research interests. Professor To applies different molecular and omics approaches to understand the biological mechanism of myopia. He is also interested in translating basic science knowledge into novel and effective clinical myopia control." @default.
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• W2802876629 title "Myopia: mechanisms, manifestations and management" @default.
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• W2802876629 doi "https://doi.org/10.1111/opo.12461" @default.
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