New International Myopia Guidance Urges Early, Personalized Care
The International Myopia Institute (IMI) has published its 2025 Digest, delivering the latest evidence-based guidance on myopia. The Digest, released in Investigative Ophthalmology & Visual Science and summarized in an accessible clinical summary, reflects a global expert consensus on the definitions, risk factors, prevention, and management of myopia in children and young adults.
Myopia as a Global Health Priority
Myopia affects a growing proportion of the world’s population, especially in East and Southeast Asia, where up to 80% of young adults may be affected. Its increasing prevalence has serious long-term implications, from vision impairment to heightened risk of retinal detachment and myopic maculopathy later in life. In response, the IMI continues to unify international research into clinical recommendations.
One of the standout themes in the 2025 Digest is an enhanced understanding of pre-myopia. Researchers now emphasize hyperopic reserve (the amount of farsightedness in a young child) as a key predictive marker for future myopia. Children with lower hyperopic reserve are more likely to become myopic, and evidence supports early identification and targeted interventions to delay onset.
Importantly, simple lifestyle modifications such as increased outdoor time continue to emerge as one of the strongest protective factors against myopia onset, reinforcing public health strategies that encourage outdoor activity for children.
Updated Clinical Management Guidelines
The Digest highlights a shift toward proactive and personalized management of myopia:
Delaying onset may be more impactful in long-term outcomes than treating progression later—each year of delayed onset equates to multiple years of progression prevention
Optical interventions such as dual-focus contact lenses and peripheral defocus spectacle lenses are supported by long-term studies demonstrating sustained safety and effectiveness
Clinicians are encouraged to customize treatment based on individual risk profiles, quality-of-life considerations, and patient preferences
The IMI also emphasizes the importance of ongoing monitoring of axial length (the eye’s front-to-back growth) because it’s strongly linked with long-term risk of ocular complications. Regular retinal surveillance, even in younger children, is recommended due to evidence of early retinal changes in high myopia.
Risk Factors and Emerging Insights
The 2025 Digest reinforces our understanding of environmental and behavioral influences:
Educational exposure—especially intensive near-work and academic demands—has a more substantial link to myopia development than chronological age alone.
Outdoor activity remains the most reliable protective factor, with robust evidence connecting higher levels of outdoor time to reduced myopia risk.
While screen time and sleep patterns have been studied, their direct causal role remains less clear compared with outdoor exposure.
At the biological level, animal studies continue to widen the scientific foundation of myopia development, including investigations into light-sensitive proteins and molecular pathways that could inform future therapies.
Contrary to traditional belief that myopia stabilizes after adolescence, the Digest reports that some young adults continue to experience meaningful progression, particularly those with higher degrees of myopia or intensive visual demands. This finding underscores the need for continued eye care into early adulthood rather than assuming refractive stability.
Originally published online on Eyewire+.