Editor,—Flitcroft’s recent commentary1 asserts “myopia clearly represents the failure of the normal emmetropisation mechanisms” but that “myopia may represent a physiological adaptation to prolonged near work with the mechanisms of the emmetropisation regulating eye growth to a state that minimises retinal image blur for near”. These two apparently contradictory views beg the question as to what is normality in the context of refractive status.

Ophthalmology has embraced the current trend in medicine towards using quality of life measures as outcome indicators. Indeed, such measures have been used to evaluate outcomes of laser correction of myopia.2 3 It is said that to become myopic has a potentially negative impact on self esteem, career choice, and ocular health.4

However, we have been unable to identify baseline studies which indicate whether myopes …