It has been an eventful year in science with new challenges, many new advances and, the maturation of trends that are continuing to build and shape our world. On the global stage, China has been an emerging power in research and discovery for decades. Globally, the total number of citable documents published has flattened out at 2.5 M since 2014. In January, 2018 the US National Science Foundation (NSF) reported that China has overtaken the United States in the total number of scientific publications. Nevertheless, the United States remains the most important producer of new knowledge, ranked 1st in h-index (2077 articles cited 2077 or more times) followed by many European countries, Canada, and Australia (848). China ranks 13th in h-index (712). The United States also remained the top destination for students seeking advanced research training (PhD and post-doctoral students). Investments in research and development by the US are estimated at $500 billion (and holding steady) with China at $400 billion and climbing.
Federal research funding in the United States has been a source of lively debate and much uncertainty. Despite presidential promises to severely reduce research funding and radically changing the structure of the National Institutes of Health, none of these proposed structural changes were implemented. With strong support from congress, federal health research has seen modest increases for the National Eye Institute for each of the last two years. While funding has risen, the NIH continues to grapple with how best to interpret the definition of a clinical trial. The push for additional accountability for federally funded clinical trials is a reasonable goal. Nevertheless, including almost all clinical research in the expanded definition of what research activities constitute a clinical trial is an unfortunate overreach creating confusion and needless inefficiency at all levels.
In 2018, scientific advances in biomedicine continued to be dominated by discoveries in cell biology and genetics. In an animal study, vision researchers were able to induce retinal glial cells to become rod photoreceptors that successfully integrated into the retina and brain. Retinal organoids, tissues grown in a dish that can mimic the structure and function of normal retinal tissue, have been a high priority for the NEI for the past several years. This initiative is now beginning to reap rewards as investigators are successfully demonstrating cultured retinal tissues that can develop and differentiate into the full range of short, medium, and long wavelength sensitive cones. Stem cell transplant therapies are being developed to treat retinal degenerations and other neurological diseases including spinal cord injuries and multiple sclerosis.
Gene editing using the CRISPR-Cas system is rapidly becoming an important strategy in biomedical research. This technique for editing (insertion and removal of specific genetic sequences) has been widely used to modify genetic material as a way to repair or silence mutations. A group at Oregon Health Sciences has reportedly edited genes of human embryos treating a genetic defect, but this claim is still disputed. Another group in China first reported genetic editing in human embryos in 2015 and this technology has already been used in animal models, raising important ethical concerns and debates. Elsewhere in science, the NIH launched its precision medicine initiative: All of Us (https://journals.lww.com/optvissci/Fulltext/2017/06000/Precision_Medicine_and_the_Future_of_Health_Care.1.aspx). The initiative will recruit 1,000,000 participants over the coming years for the purpose of linking genetic information to clinical, social, behavioral, and environmental factors.
In vision science, this past year, we have seen a number of important advances. Arthur Ashkin, Gérard Mourou, and Donna Strickland were awarded the Nobel Prize in Physics for groundbreaking work in laser physics that was directly responsible for pulse amplification used in modern surgical lasers and many other applications. Optical coherence tomography continues to develop as an essential imaging technology as additional non-invasive angiography platforms were approved for clinical use. For the first time since 1996 a new class of medications was approved for the treatment of glaucoma. Latanaprostene bunod (Vyzulta) is a dual mechanism drug combining the proven benefits of a prostaglandin analog with a nitric oxide element to facilitate aqueous outflow through the conventional pathway. Also, netarsudil (Rhopressa) was approved as the first Rho kinase inhibitor which acts to increase outflow by the trabecular meshwork.
There were several advances and innovations in dry eye therapy from TrueTear, an intranasal stimulator of tear production, to several pharmacological compounds that came to market. This area continues to gain momentum and we should expect to see additional developments targeting novel supplements and biologicals over the coming years.
In contact lenses, designs for myopia are an area of active development as clinical interventions become more widely practiced despite the need for additional evidence regarding mechanism and best practices. Success with scleral lenses continues to influence how we treat keratoconus, transplants, post-surgical corneas and even anterior segment rehabilitation. Innovations in lens materials and design are further improving patient comfort, and experience.
This list of advances and discoveries is far from complete, but it underscores some of the exciting areas that we will continue to bring to you over the coming year. This is only possible because of the hard-working Editorial Board, our distinguished reviewers, and most importantly, our authors. We have some new members joining the Editorial Board in January and I will be happy to introduce them to you next month. For now, allow me to express my thanks and sincere appreciation to Algis Vingrys, Lakshman Subbaraman, who will be leaving the board this month. Their hard work and dedication to advancing the journal by setting high standards and providing sage advice has been a valuable asset for our community.
To each of you who takes the time to carefully and thoughtfully consider the work of your peers, to those who make it a priority to participate in the peer-review process despite all the other responsibilities that you may have, to those of you who serve your patients, the profession, the American Academy of Optometry, and the larger community of scientists and clinicians, thank you for your service to the Journal. 2018 has been a great year and we are looking forward to an even better one in 2019.
Michael D. Twa
Editor in Chief