Contemporary Perspectives and Future Directions in Ophthalmic and Physiological Optics

As Associate Editors, it has been a great privilege to oversee this collection of reviews, inspired by previous special issues published by the journal, and contributed by internationally recognised leaders in their respective fields to commemorate the first 100 years of Ophthalmic and Physiological Optics (OPO).

Collectively, these reviews not only summarise the current state of knowledge in a range of key areas in optometry and vision science, but also highlight many of the research priorities that will shape optometry and vision science over the coming decades. We hope this special issue will serve as a valuable resource for researchers, educators and clinicians alike, stimulating new collaborations and inspiring future research that ultimately benefits patients worldwide.

Since its first publication as the British Journal of Physiological Optics 100 years ago, OPO has evolved into a leading international vision science and optometry journal, attracting a worldwide readership from a range of disciplines, including researchers and those with a clinical focus, and optometrists, clinicians and educators. Importantly, the pace of discovery in optometry and vision science has accelerated remarkably over the past decade. Advances in imaging, optical technologies, biomaterials, artificial intelligence, neuroscience and digital health are reshaping our understanding of visual function and our ability to detect eye disease and deliver eye care. At the same time, there has been a growing recognition that improving vision extends beyond correcting refractive error and treating ocular disease. Modern eye care increasingly embraces functional outcomes, patient-reported experiences, quality of life and equitable access to evidence-based interventions.

The reviews included in this special issue of Ophthalmic and Physiological Optics reflect this evolution. Together, they provide an authoritative overview of several rapidly developing areas of research while identifying key scientific and clinical questions that will shape the next generation of investigations. Although each review focuses on a distinct aspect of vision science, common themes emerge throughout: technological innovation, multidisciplinary collaboration, translation from laboratory to clinic and into the real-world, standardisation of outcome measures and an increasing emphasis on patient-centred care.

Ageing, vision loss and functional consequences

The collection begins by considering vision loss at both population and individual levels. In Global and Regional Risk Factors for VisionImpairment in 2020 and Multi-decadal Trends 1990–2020: a Meta-analysis and Visual Display based on Prevalence Data from the Global Burden of Disease Study and Vision Loss Expert Group, Bottone et al. [1] examine global and regional risk factors for blindness and vision impairment over three decades. The analysis identifies associations with healthcare access and quality, sanitation, education and pollution, while also highlighting gender differences in blindness prevalence. These findings reinforce an important principle: vision loss cannot be understood solely through ocular pathology. Reducing global vision impairment will require attention to the wider social and healthcare environment, including inequalities in prevention and access to services.

At an individual level, in Impaired Rod-Mediated Vision is the Functional Hallmark of Ageing and Early and Intermediate Age-Related Macular Degeneration, Owsley and Curcio [2] highlight the importance of functional change. Their impressive body of longitudinal research demonstrates the potential of rod-mediated dark adaptation as a functional biomarker for incident early age-related macular degeneration and disease progression. Of seven visual measures examined in ALSTAR2, rod-mediated dark adaptation was the only measure to show a clinically important change over three years. These findings raise an important question for future research: should functional outcomes play a greater role alongside structural biomarkers in defining disease progression? While imaging provides detailed information about ocular structure, patients experience disease through changes in visual function.

The same challenge is evident in older adults living with diabetes. In The Diabetes Complications in Senior Adults (DCSA) Study: A Scoping Review and a National Case Analysis from Northern Ireland, UK on Ocular Complications in Adults Aged 80 and Over Living with Diabetes, Cushley et al. [3] highlight the limited evidence available for this rapidly growing population. This review identified only seven eligible studies from 1,644 references, emphasising the scarcity of comprehensive evidence in adults aged 80 years and over. Their Northern Ireland case analysis further demonstrates the continuing importance of diabetic eye screening in older adults. As longevity increases, evidence specifically relevant to very old adults will become increasingly important, particularly given multimorbidity and changing visual and functional needs.

Evidence must keep pace with innovation

The collection also highlights a central challenge for contemporary ophthalmic research: technological innovation is advancing rapidly, but evidence and implementation do not always keep pace.

In Progress in the Synthesis of Evidence in Glaucoma: What we Know and the Gaps that Remain, Piyasena et al. [4] map the evidence from systematic reviews and meta-analyses in glaucoma, identifying substantial growth in research addressing treatment effectiveness, risk factors and genetic factors. However, important gaps remain in areas including cost-effectiveness, equitable access and context-specific evidence, particularly in low- and middle-income countries. Duplication within the evidence base and the need for stronger methodological approaches are also highlighted. The quantity of evidence, therefore, does not necessarily reflect its usefulness; future evidence synthesis must be coordinated, rigorous and connected to clinical and policy decision-making.

Artificial intelligence presents a similar challenge. In Current Trends in AI and Eye Disease Diagnostics, Cruz et al. [5] review developments in artificial intelligence across diabetic retinopathy, diabetic macular oedema, glaucoma, age-related macular degeneration and retinopathy of prematurity. Emerging foundation models, multimodal large language models and agentic approaches may further expand diagnostic and clinical decision-support capabilities. However, important barriers remain to routine implementation, including technical validation, transparency, bias, ethical considerations, economic factors and regulatory requirements. New technology should therefore be evaluated not simply on what it can do, but on whether it improves patient outcomes, performs reliably in real-world settings and can be delivered equitably.

Rethinking vision correction and management across the lifespan

The reviews on presbyopia, binocular vision and myopia illustrate how optical correction is increasingly evolving towards prevention, management and personalised care.

In Presbyopia: Current Perspectives and Prospects for Patients, Davies [6] describes presbyopia as a multifactorial physiological process involving lenticular stiffening, changes in the capsule and zonular system, and alterations in ocular optics, rather than simply a loss of accommodative amplitude. Advances in imaging and biomechanical assessment are improving our understanding of these changes, while pharmacological, spectacle, contact lens and surgical approaches continue to develop. A key challenge remains regarding the improvement of near vision while maintaining acceptable visual quality and meeting individual patient expectations.

The review by Cheloni and Barrett [7], Binocular Vision Anomalies: An Update on Prevalence, Impact, Technological and Treatment Developments and Current Challenges, similarly emphasises the importance of robust evidence. Considerable variation remains in reported prevalence and diagnostic criteria, particularly for non-strabismic binocular vision anomalies, while the relationship between these conditions and symptoms remains uncertain. Although digital technologies are creating new opportunities for detection and treatment, stronger evidence is needed to underpin clinical management rather than relying predominantly on clinical consensus.

Myopia represents perhaps one of the clearest examples of the transition from refractive correction towards disease prevention and management. In Human Myopia: Past, Present, and Future, Flitcroft [8] traces the historical development of myopia research and describes how advances in animal models, epidemiology and clinical research have transformed our understanding of myopia. Optical, pharmacological and behavioural interventions can modify the onset and progression of myopia, although their efficacy remains limited and the long-term complications associated with adult myopia remain an important challenge.

In Spectacle Lenses for Control of Myopia Progression in Children, Atchison and Charman [9] review developments in spectacle-based approaches to myopia control, including progressive addition, multisegment, annular cylinder, diffusion optics and concentric bifocal designs. Their review highlights the potential of spectacle interventions as safe and valuable approaches, while identifying the need for further research into mechanisms of action and effectiveness.

The future of optical correction may extend well beyond conventional refractive correction. In Contemporary Research Questions in the Field of Contact Lenses and Where to Next?, Jaiswal and Stapleton [10] describe emerging applications of contact lenses in myopia prevention, drug delivery, biosensing, theranostic, visual augmentation and communication. Nanotechnology and advances in drug loading and release may further expand their potential. However, successful translation will depend on standardised outcome measures as well as affordability, comfort, safety and wearer acceptance. Across these reviews, the message is consistent: innovation is valuable, but patient benefit remains the ultimate test.

From impairment to improved outcomes

Perhaps nowhere is this principle of patient outcomes more evident than in low vision and rehabilitation. In Evaluation of Functional Impacts of Vision Impairment: Progress, Challenges and Future Directions, Wood et al. [11] reflect on the vast literature that exists and examine the consequences of vision impairment for mobility, falls, driving and interactions between vision and hearing. Wearable technologies and naturalistic assessment methods especially in driving research, offer exciting opportunities to understand these functional consequences beyond conventional clinical environments.

Similarly, Recent Developments in Research to Make the World Better for People with Low Vision by Legge and Chung [12] highlights advances in reading assessment, interventions and assistive technologies. Their review illustrates how research into mobility has evolved towards a more integrated understanding of visual, motor and cognitive processes, with increasing emphasis on ecological validity and real-world outcomes.

This broader perspective is further developed in The Evolving Landscape of Vision Rehabilitation: Current Status and Future Directions, Stalin et al. [13] emphasise that vision impairment is shaped not only by ocular pathology but also by cognitive, psychological, social and environmental factors. They advocate multidisciplinary rehabilitation and outcome measures that capture participation, mental health and quality of life. A person does not experience vision impairment simply as a reduction in acuity or contrast sensitivity; they experience difficulty with reading, navigating, driving, recognising people, using technology or maintaining independence. Our research outcomes should therefore reflect these realities.

Where should research go next?

The future of ophthalmic and physiological optics lies in better connecting ocular structure with function, clinical measurements with real-world experience, and technological innovation with patient needs.

Research should focus not only on developing better biomarkers and AI, but on demonstrating that they provide meaningful outcomes and are accurate, transparent, equitable and clinically useful. Similarly, advances in myopia and presbyopia interventions should be evaluated through quality of vision, comfort, adherence and patient experience, while low vision research should prioritise participation, independence and quality of life alongside impairment.

The next century will bring discoveries we cannot yet predict. Its success, however, should not be measured simply by our ability to measure, image or automate more, but by our ability to determine which measurements matter, which interventions make a meaningful difference, and for whom.

Ultimately, the success of vision science should be judged by its ability to improve people’s lives. Achieving this will require continued integration of physiology, optics, clinical science, technology and rehabilitation, with patients and their lived experiences at the centre of research and definitions of success.

The achievements of the past 100 years give us every reason to be optimistic about the century ahead, while reminding us that the most meaningful discoveries will be those that translate knowledge into better vision, greater independence and improved quality of life.

Biographies

Professor Joanne Wood

PhD, DSc (hon), MCOptom, FAAO, FARVO leads the Vision and Everyday Function laboratory in the Centre for Vision and Eye Research, Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia. Her research focuses on the impact of vision impairment and ageing on functional outcomes, including driving performance, mobility, and falls. Joanne has made a major contribution to these fields through an extensive collection of significant research publications and conference presentations, along with the important translation of her research into transportation standards and policy. Her research excellence has also been recognised through several prestigious awards, including the Oberdorfer Award in Low Vision, the H. Barry Collin Research Medal, and the Glenn Fry Award.

Professor Shahina Pardhan

OBE, PhD, MBCO, H DHealth Brad is Director of the Vision and Eye Research Institute at Anglia Ruskin University, Cambridge, and the UK’s first female professor of optometry. A globally recognised vision researcher, she has published over 288 scientific papers and secured more than £7.5 million in research funding. Her work spans diabetic retinopathy, low vision, dual sensory loss, visual memory, and health inequalities. Working with communities and hospitals across the UK, Africa and Asia, she has co-created culturally and linguistically appropriate programmes that reduce blindness risk from diabetic retinopathy. Her achievements include the King’s OBE, Silver (Fincham) Medal, Ibn Sinha Award and Asian Women Achievement Award. She is listed as one of the Top 100 Influential People (2025). A champion of gender equity, she continues to inspire future female leaders in vision and health.

Author Contributions

JW and SP jointly wrote the editorial.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.