The Next Nobel Prize in Vision Science

Awarded for foundational scientific discoveries since 1901, the Nobel Prize has been given for discoveries related to vision several times. Allvar Gullstrand, awarded the prize in 1911 for his work on the optical and anatomical principles of the eye, was the first vision-related awardee. Prizes were subsequently awarded for elucidation of phototransduction biochemistry and neural processing of visual signals in the brain. It seems that each of the visual system's critical elements has now received due recognition. One might wonder, what is left to discover. The most prevalent visual problem in the world is uncorrected refractive error. The estimated prevalence of myopia in the United States is 42%, up significantly from 25% in 1971.1 In some Asian countries, the prevalence is greater than 90%, with projections of 50% prevalence worldwide by 2050.2,3 Despite generations of research to understand the biological, environmental, behavioral, genetic, optical, and other potential mechanisms for myopia, we are still searching. Animal models have given us insights, but not clear answers. Patient trials have shown efficacy in curbing myopia progression, but understanding prevention still eludes us. Perhaps a significant advance in our understanding of this condition, its causes and prevention would merit the next Prize. This year, a renewed effort by the National Academies of Sciences, Engineering, and Medicine to address this research priority has launched, but this effort was preceded by an earlier effort in the 1980s. The National Academies of Sciences, Engineering, and Medicine acts under its congressional charter to be an adviser to the federal government. Their charge is to identify critical issues related to medical care, research, and education. In 1984, the National Research Council's Committee on Vision, a working group within the National Academies, was tasked to address a growing problem, myopia prevalence and progression among military aviators. Membership for the Committee on Vision and the Myopia Working Group tasked to address this problem is provided in Table 1. The Working Group was asked to address three questions: TABLE 1 - 1984 Membership of the National Academies of Sciences, Engineering, and Medicine: Committee on Vision and Working Group on Myopia Prevalence and Progression Committee on Vision Anthony J. Adams (Chair), School of Optometry, University of California, Berkeley Irving Biederman, Department of Psychololgy, University of Minnesota Randolph Blake, Cresap Neuroscience Laboratory, Northwestern University Robert Boynton (NAS), University of California, San Diego Anne B. Fulton, Children's Hospital, Boston Donald Hood, Department of Psychology, Columbia University Chris A. Johnson, Department of Ophthalmology, University of California, Davis James Lackner, Provost, Brandeis University Suzanne Mckee, Smith-Kettlewell Eye Research Foundation, San Francisco Aziiel Rosenfeld, Center for Automation Research, University of Maryland Robert Shapley, Department of Psychology, New York University Louis Silverstein, Honeywell, Inc., Phoenix, Arizona Pamela Ebert Flattau, Study Director Carol Metcalf, Administrative Secretary Working Group on Myopia Prevalence and Progression Anthony J. Adams (Chair), School of Optometry, University of California, Berkeley William R. Baldwin, College of Optometry, University of Houston Irving Biederman, Department of Psychololgy, University of Minnesota Brian J. Curtin, Manhattan Eye and Ear Clinic, New York Sheldon M. Ebenholtz, Institute for Vision Research, State University of New York, New York David A. Goss, College of Optometry, Northeastern State University George B. Hutchison, Harvard School of Public Health Johanna M. Seddon, Massachusetts Eye and Ear Infirmary, Boston Joshua Wallman, Department of Biology, City University of New York What demographic and confounding variables must be evaluated in comparing older myopia prevalence data with current data? Are there variables by which changes in refractive error can be predicted for an individual? What agenda for future research would substantially increase our knowledge of myopia prevalence and progression? Their final report, Myopia Prevalence and Progression, was released in 1989 and is available from the National Academies.4 Their product is a thorough, high-quality, evidence-based review of the best published studies on myopia from their time. In a summary of their own work, the committee stated: This report considers the issues surrounding the occurrence, progression, and predictability of myopia, with special emphasis on the 10–20-year-old population. The report is based on an analysis of findings in the available literature and represents in itself an important contribution to the literature base by virtue of the efforts of the working group to identify and review only the most pertinent published research in this area. The observations and recommendations arising from the efforts of this working group will undoubtedly be of considerable interest to vision scientists and clinicians alike. Furthermore, they added: …the most useful application of our efforts was considered to be the formulation of appropriate hypotheses and suggested guidelines for future research. What is needed is considerably more research targeted to answer specific questions, designed so that results of different investigators can be compared and so that relatively small numbers of cohorts can be studied over an extended time. In the following years, some investigators chose to pursue this line of investigation and worked to better understand the basic demographics of myopia.5 Others investigated the growth and development of ocular components.6,7 Still others pursued the progression of adult myopia.8 Recently, teams have begun exploring the efficacy of optical interventions on myopia progression using contact lenses in children.9,10 We are still a long way from understanding cause and effect, but we are making progress. Recently, the National Academies launched another initiative relevant to myopia, its causes and rising incidence.11 A committee has been formed, and the proposed membership is listed in Table 2. This committee's charge is to assess our current understanding of the underlying mechanisms of myopia and the reasons for its increased prevalence. The committee is further charged to identify knowledge gaps in related research as well as any barriers to progress. Finally, the committee is to develop a research agenda to further our understanding of the biological and environmental factors driving the worldwide increased incidence in myopia. TABLE 2 - 2023 Committee membership of the National Academies of Sciences, Engineering, and Medicine: Focus on Myopia—Pathogenesis and Rising Incidence Kevin D. Frick, Co-Chair Terri L. Young, Co-Chair Afua O. Asare David Berson Richard T. Born Jing Chen Jeremy A. Guggenheim Anthony N. Kuo Daphne Maurer Tony Movshon Donald O. Mutti Machelle T. Pardue Ramkumar Sabesan Jody A. Summers Katherine K. Weise The project website lists specific questions to be addressed by the committee: “… Given the key findings to date from experimental models of emmetropization and myopia, what are the gaps in knowledge and/or barriers to progress in understanding the link between known risk factors for myopia development in children and the cellular and molecular biology controlling eye growth? Epidemiological data indicate changes in environmental factors (e.g., amount of time outdoors or near work) explain the rapid increase in myopia prevalence. What are the limits in interpreting these data? What experimental studies can address mechanistic drivers? How can these findings inform preventive and counteractive measures? What are the unique characteristics of electronic devices that contribute to the rapid increase in myopia? What additional research is needed to inform potential design changes to make electronic devices safer? Despite the existence of effective interventions, uncorrected refractive error (for myopia and hyperopia) is the leading cause of vision impairment. What are the socioeconomic barriers to diagnosis and refractive correction in underserved populations? What research efforts might lead to innovative and effective methods for mitigating and overcoming these issues?” It is encouraging to see growing support and a coordinated effort to make myopia a public health priority among research funding agencies, industries, research institutions, public policy organizations, and clinical practitioners. This synergy will be required if we are to make meaningful progress. Michael D. Twa, OD, PhDEditor in ChiefOptometry and Vision ScienceUniversity of Houston College of OptometryHouston, TX