The Scope is Not Limited

As noted in my December 2010 Editorial, Optometry and Vision Science (OVS) will feature three issues, each dedicated to a single theme, in 2011. Last month (January), we highlighted 20 articles on “Glaucoma,” including five historical perspectives and the newly announced guidelines for perimetry. Next month (March), the entire issue covers “Myopia” and brings the complete proceedings of the 13th International Myopia Conference held in Tübingen, Germany, in July 2009. Then in April, we bring our readers 14 clinical research articles on “Cornea and Contact Lenses.” However, as our regular readers know, OVS covers a wide range of eye, vision, optometry, and ophthalmology topics—far beyond those three topics. In this month's OVS, you will find an impressive range of research reported with far reaching clinical implications. Our readers will learn that when parents express concern for the general development of their preschool child, there is likelihood that there is also a refractive error that ought to be addressed. We also learn of a new test of face recognition that may enable clinicians to assess the effectiveness of their vision rehabilitation intervention in patients with low vision. A separate team of authors show that low vision causes difficulty in judging traffic gaps at street crossings, thus making street crossing more treacherous for those patients. Prism treatments for visual field loss are also reported in this issue. Even the elderly, with normal visual acuity, but some loss of contrast vision with normal aging, can have difficulties. We have learned that adaptive gait, as is needed in stepping up stairs with a new prescription, can be altered critically. However, as our authors discover, it turns out that it is magnification, not image blur from an out of focus image, which causes problems in climbing steps! And we learn more about progressive addition spectacle lenses. In one study, our authors propose a more efficient and useful way to describe the entire spectacle lens surface. Here, it is defined and expressed as the sum of Zernike polynomial terms, instead of most previous approaches in which a lens is described as an array of subapertures. They propose it for defining and designing progressive addition lens (PAL) surfaces. In a randomized, controlled, double-masked cross-over trial, other authors found that customized free-form PAL spectacles are rated higher, subjectively, than standard non-free form PALs, even in the absence of significant differences between them with standard clinical vision tests. From a number of published articles, many in OVS, there is gathering evidence that the correction of refractive error of the peripheral retina can influence the development of axial length and myopia in the developing eye. (see, for example, next month's OVS issue). With clear implications for preventative myopia and myopia progression interventions, there is the optical challenge of correcting peripheral refractive error. For spectacle lens design, there is the special challenge of dealing with a moving eye scanning the lens. Our author's work suggests that lenses designed to correct peripheral refractive errors produce large errors when used with foveal vision and a rotating eye. He proposes that it might be worthwhile to correct power errors of the rotating eye out to some acceptable viewing angle, after which the emphasis could be on correcting peripheral relative hyperopia as a strategy for myopia interventions. Animal models have been incredibly important in enlightening and influencing human myopia research, especially in documenting the way in which refractive error and deprivation impact the growing eye. Most yield remarkably clear evidence for an impact on the axial length of eyes through vitreal chamber length changes. Experimental myopia in animals is typically induced rather than from an innate or spontaneous occurrence. Our authors note that a naturally occurring dog model of myopia may be useful in exploring interventions for myopia and that previous work has identified three breeds with a high prevalence of myopia. Unfortunately, their extensive ocular biometry for these dog breeds shows that the myopia in the English Springer Spaniel, Collie, and Toy Poodle is more refractive from the crystalline lens than axial. Visual acuity and its measurement are constantly being refined, and the introduction of computer and pixel-based letter acuity formats raises its own special set of questions. Our authors demonstrate that there is more freedom in the pixel design of letters than we might have imagined. Issues of research in eye health and eye disease are routinely addressed in OVS, and in this current issue, one study advocates a wide biomarker profile for use in diabetic retinopathy progression. In the search for sensitive biomarkers of early stages of complication onset, our authors note that increased oxidative stress and depleted antioxidant status are often found in diabetic patients. They argue that these biomarkers may play an important role in the development of diabetic complications, including retinopathy. In their cross-sectional descriptive baseline study, for a subsequent longitudinal study, the authors present a wide biomarker profile, incorporating measures of oxidative stress and antioxidant balance as well as more traditional markers. In a separate article, other authors studied Goji berry (high in antioxidants) intake in healthy elderly subjects and found that plasma zeaxanthin concentrations and antioxidant capacity increased. Based on this result in healthy subjects, the authors suggest that Goji berry supplementation may have benefit in people at risk for age-related macular degeneration. A number of researchers are interested in issues that impact pediatric eye and vision care. Among the most challenging are the issues of refractive error and accommodation and vergence eye movement relationships, the relationship between eye coordination characteristics and reading, and the treatment of amblyopia and suppression related to strabismus. Our readers learn a great deal almost every month on these pediatric challenges. This month we learn of the surprising lack of ability to identify a child's overall ability in reading comprehension by the popular developmental eye movement (DEM) test. However, the test certainly does identify children with slow reading rates. In pediatric research, the relationship between ciliary body dimensions and other ocular characteristics, such as refractive error and accommodative microfluctuations, is quite important. However, the needed ciliary body dimensions cannot be made with ultrasound biomicroscopy. But non-contact imaging of the ciliary body is now possible with Optical Coherence Tomography. Our authors appear to have successfully developed a semi-automatic algorithm for segmentation and morphological assessment of the dimensions of the ciliary muscle in Visante Anterior Segment Optical Coherence Tomography images. Separately, we learn that in determining the alignment of the eyes, the color of the iris can impact that assessment, with the discovery that for blue irises, small differences in pupil centration made surprisingly large differences in the perceived directions of monocular, but not binocular, gaze. Finally, another team of authors describe a new compact clinical device for the measurement of interocular suppression for binocularly treating amblyopia using antisuppression training. It consists of a headmounted display for the presentation of controlled dichoptic stimuli and an abbreviated clinical measurement procedure. In completely different areas of research, we learn that optometrists suffer characteristic work-related physical discomfort that can, and should, be addressed. In an interesting development that would not surprise many readers, we see that the Smartphone of today and of the future can be used to provide superior research data from patients enrolled in clinical trials. Importantly, it allows assessment of the quality and quantity of compliance in these trials. A contact lens trial is described as an example of what we can expect in the future with our patients. Just when you thought that issues of color vision and occupational relevance had faded from the journal scene, we learn of a practical and important observation. Our authors show how regulation sunglasses have caused the color of critical Canadian railway signal lights, needed by railroad workers, to move out of “range” in their color specification. Finally, we bring two articles that deal with retinal disease problems. The first highlights how immune recovery uveitis is currently one of the most common causes of new vision loss in patients with HIV/AIDS. In the second we learn of the downside of insufficient preoperative patient discussions on macular hole surgery, and how it can impact surgical outcome. All in all, this issue covers a broad landscape of traditional and emerging optometry. I hope you find that breadth impressive and reassuring. I do! Anthony J. Adams Editor-in-Chief Berkeley, California

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