“Myopia, Corneas, Refractive Errors and Vision”

March Optometry and Vision Science (OVS) brings you a wide range of advances in clinical research. We lead with an interesting Meta analysis by our authors that consolidates prior reports (a number in OVS) that show that orthokeratology slows down myopia progression. That article substantially increases clinicians confidence the approach can be effective in clinical practice. Earlier our OVS authors (Aller and Wildsoet, Optometry & Vision Science. 90(5):e135–e137, May 2013) wrote a Clinical Perspective that urged optometrists to adopt optical approaches to dealing with myopia, while calling for larger clinical trials to show very clearly the impact of optical approaches. That article noted earlier contact lens studies that had been reported and emphasized that published studies supported orthokeratology as a treatment that slowed myopia development. In our lead article our authors looked at 7 publications that could be subject to a Meta analysis and looked at both refractive error changes and axial length changes. They conclude, with even greater confidence following their study, that orthokeratology does certainly slow myopia progression and retard the axial length growth of the eye. We follow that article with one that perhaps surprises us about myopia. Many of our readers think of a high myopia prevalence as a generically Asian phenomenon. However our authors looked at a number of different populations in 16 different Asian countries and found not only considerable variation in prevalence from country to country (with Korean 19 year-olds with the highest prevalence at 96.5%), but also an interesting age-dependence of prevalence of myopia. There was no significant linear age group effect on the prevalence of myopia in the whole Asian population but instead there was a U-shaped relationship between both age and year of birth and the prevalence of myopia. Refractive error consequences are the topics covered by three additional manuscripts. We learn that induced astigmatic errors may reduce high contrast visual acuity twice as much as spherical blur in two different age groups (23 year olds and 57 year olds). We also learn something of the reduction of quality of life (QoL) for Indian school children who have uncorrected refractive errors. And then we report a study that discloses an association between uncorrected astigmatism identified in a screening setting, and multiple domains of academic readiness in at-risk preschoolers. As usual we also have multiple papers addressing cornea and contact lens issues of importance to clinicians and clinical researchers. Eyelids and eyelid morphology impacts on corneal shape are explored, and authors compare corneal staining assessed by photographic images to an assessment by direct clinical viewing. Another study compares the quite positive clinical performance of three daily disposable silicon hydrogel contact lenses in 51 asymptomatic and 53 symptomatic participants. The impact of corneal crosslinking is studied and found to be safe and effective in different study groups, though careful monitoring of keratoconus patients during treatments is deemed necessary for good care and avoidance of damage by ultraviolet-A light. We also learn that the recurrence of squamous metaplasia can recur even after non-complicated pterygium excision and limbal conjunctival autograft. The authors believe this might account for the high recurrence rate of pterygia. And finally, with respect to the cornea and IOP, while our authors found central corneal thickness was significantly related to IOP, it was not related to diurnal IOP fluctuations in a relatively large group of non-glaucomatous participants. And vision studies are not neglected in this issue of OVS. A Japanese study of glaucoma patients indicates that driving self-restriction, in one or more ways, is associated with a lower prevalence of motor vehicle collisions in Japanese men, but not women. And almost 500 Canadian optometrists were surveyed across the country about their provision of care for low vision (LV) patients. This is the first such Canadian survey and it shows that most optometrists are involved with LV care. Another study makes it clear that not all adult amlyopes are alike; multifocal cortical VEP latencies were significantly more delayed in anisometropic eyes than in strabismic eyes, consistent with anisometropic and strabismic amblyopes having different cortical abnormalities. Diabetes, as usual, continues to be a subject of interest for eye and vision researchers. Our authors note increased retinal arteriole tortuosity is associated with diabetic retinopathy and increased cholesterol levels. They recommend future studies examining tortuosity should focus on these arterioles since tortuosity of venules is difficult to grade consistently. We complete this March 2015 issue by drawing clinical and basic science researchers attention to a new statistical technique. Bland-Altman Analysis is a popular statistical tool amongst eye researchers and many OVS reviewers and Topical Editors ask authors to apply the tool. Bland-Altman 95% Limits of Agreement (LoAs) are used to estimate the range of measurement agreement, or measurement repeatability. Because LoAs can, themselves, be unreliable estimates especially for small sample sizes, it can be useful to calculate confidence intervals for LoAs. Our author describes a new technique for calculating exact confidence intervals for LoAs for any sample size, assuming normally distributed data. The technique is an improved tool for researchers. Next month we again provide two April issues of OVS. One is entirely dedicated to “Clinical Research and Clinical Care” and with this online-only April Supplement we take advantage of the opportunity to provide, at no cost to our authors, full color and video opportunities to accompany their articles. This special theme issue leads with an excellent Guest Editorial from our Clinical Editor, Larry J Alexander OD FAAO. Finally I remind readers that later in 2015 OVS will have two additional Feature Issues (“Dry Eye Disease” and “Revolutionary Future Uses of Contact Lenses”). Certainly enough to keep us all busy and learning. Tony Adams, OD, PhD, FAAO Editor in Chief Optometry and Vision Science

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