On March 1, 2022, we announced the call for a new feature issue on an active area of basic science explorations and novel clinical interventions designed to reduce the global public health burden of myopia. This feature issue will be published in the fall of this year, and we are excited to bring new discoveries and clinical evidence in this field to publication.

For the first time, we have a U.S. Food and Drug Administration–approved clinical intervention designed to slow the progression of childhood myopia.1 This is an exciting moment in the arc of our history to be able to provide a fundamentally different approach for the treatment of refractive errors. There are numerous active areas of investigation to better understand the mechanisms behind ocular growth and development, and this work is not new. For more than a generation, our two former editors in chief and many others have worked tirelessly to advance the conversation among research agencies, public health organizations, and the National Institutes of Health to pave pathways for funding clinical and laboratory research in this area. That advocacy has resulted in multicenter clinical studies2–7 and observational studies that evaluated demographics and the natural history of refractive error development. More recently, funded work addresses gene and protein expression to understand signals that drive ocular growth.8,9 Although we are making progress, there is much to do.

In some laboratories, research is dedicated to understanding the visual signals that can drive ocular growth and emmetropization. Work by Earl Smith and colleagues has advanced our understanding of how powerful the visual signals can be and provided some insights on the directionality of these driving forces.10 Tom Norton and colleagues have provided insights on the effects of spectral composition and its impact on ocular growth.11 Others have focused on underlying biological mechanisms—the cellular and molecular transduction of visual signals to understand what ultimately drives ocular growth and tissue remodeling.9

While we continue exploring fundamental mechanisms, clinical interventions are under development and in clinical trials to gauge efficacy. These clinical evaluations include contact lenses that modulate retinal defocus, orthokeratology, and more. There are evaluations of novel spectacle lens designs as well. Pharmaceuticals that include atropine, novel small molecules, and biological therapeutics are all strategies under investigation.

Fortunately, the importance of this research area is gaining traction. The World Health Organization has been helpful in brining attention to the magnitude of the problem of refractive error. The epidemic of myopia is not limited to developed countries, and although myopia in Asia is common, the United States has a sizeable problem that is growing as well. Moreover, there is now wider recognition that myopic refractive error is not only a correctable functional impairment but also a risk factor for related causes of uncorrectable vision loss due to glaucoma, retinal detachments, and myopic macular degeneration.12 This broader understanding of the condition and its public health importance should ultimately benefit patients, but there is much to do between where we are now and a new paradigm that can reduce the burden of myopia and the associated visual impairment.

It is an exciting time to see so much attention and energy devoted to the problem of refractive error, and we are excited to bring this feature issue to life with an outstanding international team of guest editors and investigations from leading authors worldwide.

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