The Significance of Hyperopic Reserve Monitoring and Its Value for Myopia Prevention and Control

Myopia represents a critical public health challenge with far-reaching implications for future development, as global prevalence is projected to reach 49.8% by 2050 (1-2).The Chinese government has implemented comprehensive policies and proactive measures (3-6) to accelerate prevention efforts through systematic interventions.Traditional monitoring approaches have focused primarily on vision screening and diopter examination following myopia onset, thereby lacking early warning systems for tracking hyperopic reserve depletion.Commissioned by the National Disease Control and Prevention Bureau, our team has spearheaded a landmark large-scale monitoring project on hyperopic reserves among children and adolescents since 2020, encompassing ten provincial-level administrative divisions (PLADs; including Beijing, Liaoning, Zhejiang, Henan, Chongqing, Shaanxi, Guangdong, Shanxi, Hunan, and Shandong).Through a multistage cluster sampling design at each site, students from senior kindergarten through high school were systematically selected, with 67,260 individuals initially surveyed.This initiative represents a transformative measure that emerged in direct response to the developmental requirements of the new era.The hyperopic reserve monitoring framework comprises two integrated components: comprehensive questionnaire surveys and detailed ophthalmic examinations.Emphasis is strategically placed on hyperopic reserve assessment rather than conventional diopter examination alone, with cycloplegic refraction methods employed to determine visual acuity status, yielding substantially more accurate results.This advancement signifies that China's myopia prevention and control efforts are transitioning toward a more scientific, precise, and forward-looking paradigm.This special issue presents five pivotal studies that collectively advance our understanding of hyperopic reserve monitoring.Gao et al. comprehensively investigated axial length (AL), corneal radius (CR), and AL/CR ratios in children and adolescents from ten provinces and municipalities, analyzing the distribution patterns of each refractive parameter and their relationships with refractive status while evaluating the monitoring effectiveness of each parameter for refractive development (7).Luo et al. characterized different percentiles of spherical equivalent (SE) following cycloplegic refraction across children and adolescents aged 5-18 years throughout ten provinces and cities in China (8).Zhang et al. examined the association between screen exposure and insufficient hyperopic reserve in Chinese children aged 6-12 years, highlighting significant regional heterogeneity (9).Liu et al. explored the application of machine learning models to predict cycloplegic spherical equivalent in children and adolescents using non-cycloplegic measurements and ocular biometric parameters (10).These investigations collectively illuminate the critical importance of hyperopic reserve for myopia prevention and control while underscoring the substantial value of the hyperopic reserve detection initiative across ten provinces and municipalities.Specifically, this monitoring program demonstrates several prominent contributions to the field. Addressing Critical Gaps: A Strategic Transformation from "Reactive Treatment"to "Proactive Prevention"Hyperopic reserve represents the physiological hyperopia (11) naturally present during ocular development in children and adolescents -functioning as a protective "buffer zone" that mitigates myopia risk.This reserve undergoes gradual depletion as the eye matures (12).When hyperopic reserve is consumed too rapidly before achieving emmetropia, myopia onset becomes imminent or has already occurred (13).Traditional, myopia monitoring has predominantly been implemented following vision deterioration or myopia development, resulting in delayed intervention opportunities.For the first time, this groundbreaking initiative has established a comprehensive, large-scale monitoring system for hyperopic reserves in preschool and school-aged children across China CDC Weekly