Latest Myopia Science from IMC: Key Insights for 2025 and Beyond

The 60th anniversary and 19th International Myopia Conference (IMC) took place from September 25 to 28, 2024 and attracted a record-breaking 1,016 attendees from over 50 countries. Now held every two years, the IMC is an academic conference where the great minds of myopia research come together to share advances in our understanding of myopia, its causes, its consequences and interventions to slow its progression. This year, the conference was held in Sanya, China—a particularly meaningful location given the country’s growing concern over the rising prevalence of myopia. In 2020, myopia affected 52.7% of Chinese children, with 17.6% of high school students experiencing high myopia.¹ China is among the few countries to tackle the myopia epidemic with government-led strategies, including reforms in education, measures to reduce costs of interventions, and widespread efforts to promote awareness and prevention of myopia.² 

The conference emphasized that myopia is more than merely a refractive error by discussing real-world impacts and implications. Attendees also received a preview of the International Myopia Institute’s (IMI) upcoming 2025 white papers. 

This review, supported by CooperVision, summarizes key learnings and takeaways from the conference lectures and posters, along with a preview of the next volume of IMI papers. 

Over 400 posters featuring the latest research were presented at the IMC, exploring topics such as myopia aetiology, emerging insights on current and future myopia interventions, myopia-related pathology, and advancements in clinical practice. These presentations offered a comprehensive view of the progress being made in understanding and managing myopia, highlighting the collective efforts of researchers worldwide to develop effective strategies that can be applied in diverse clinical settings. 

MiSight® 1 day is one such intervention that has been studied across diverse populations, with the initial randomized controlled trial (RCT) conducted in Singapore, Canada, Spain, and the United Kingdom.³ Baskar Arumugam, Senior Lead Clinical Scientist at CooperVision, Inc. (pictured below) and co-authors presented interim results from the ongoing multi-center RCT of MiSight® 1 day currently underway in China. In this study, children (n = 191) aged 7-11 were randomly assigned to MiSight® 1 day (omafilcon A, CooperVision, Inc.) lenses or single-vision Proclear 1 day (omafilcon A, CooperVision, Inc.) lenses. The interim results revealed that MiSight® 1 day lenses reduced axial elongation by an average of 52% (0.13 mm) at 6 months and 51% (0.24 mm) at 12 months, with myopia progression (refraction) slowed by 57% (0.51 D) at the 12-month mark. No serious ocular adverse events were reported. These results in Chinese children surpass those observed in the original RCT, which primarily involved a non-Asian cohort.³ These findings are significant for China’s myopia efforts, showing that soft contact lenses like MiSight® 1 day are a strong addition to the current options of myopia control spectacle lenses and ortho-k. (Learn more about these findings through THIS video interview with Dr Arumugam.)

Myopia is particularly significant because it often starts in childhood, which may necessitate ongoing intervention throughout life. Therefore, assessing the long-term impact of myopia management options is essential. In a study presented by Hiu Yan Lam from Aston University in Birmingham, UK (pictured below) and co-authors, the effects of wearing daily disposable hydrogel soft contact lenses (omafilcon A, CooperVision, Inc.) on corneal health over a 10-year period were examined. The study involved 20 participants, now aged 20.6 ± 1.5 years, who began using these lenses between the ages of 8 and 12, consistently wearing them for at least 10 hours a day, 6-7 days a week. They were compared to an age-matched control group with no contact lens experience. Findings indicated no significant differences between the contact lens and control groups in critical corneal measures, such as endothelial cell density, average cell area, variation in cell area, percentage of hexagonal cells, and central corneal thickness. This suggests that, with proper lens care and follow-up, soft contact lenses do not adversely affect corneal endothelial health in children. This research helps affirm confidence among eye care professionals and parents in considering soft contact lenses as part of a comprehensive, safe approach to managing childhood myopia.

A survey of optometrists in Australia and New Zealand administered by CooperVision, presented as a poster at IMC by Joe Tanner, Professional Services Manager of CooperVision Australia and New Zealand, and co-authors, revealed a gradual adoption of myopia management with soft contact lenses being the preferred treatment option. However, the number of children managed remains low, likely due to regional myopia prevalence and urban concentration. Parental resistance was cited as a key barrier, affecting nearly 40% of practitioners’ ability to prescribe soft contact lenses. 

Chromatic manipulations were a prominent topic at IMC this year, with numerous studies presented which examined the effects of red, blue, cyan, and violet light on myopia progression. Repeated low-level red-light (RLRL) therapy has already led to commercially available devices. While these devices hold promise in myopia control, recent findings emphasize the importance of rigorous safety assessments. Lisa Ostrin, Associate Professor at the University of Houston College of Optometry, highlighted a published case report from 2023 of retinal damage associated with red-light therapy for myopia⁴ in her presentation. She explained that given the point-source laser on the retina, traditional measures like visual acuity, OCT imaging, and full-field electroretinography may not effectively detect focal damage. However, some retinal protection may be provided by natural fixational eye movements.

Josh Richards, a PhD candidate from the Indiana University School of Optometry (pictured below), presented findings on the SECONEE sky-n1201a, a sample red-light therapy device for myopia management. The device, using two 654nm laser diodes, was assessed for beam characteristics and power output. Results showed that, under typical usage conditions, retinal exposure could exceed the American National Standards Institute (ANSI) maximum permissible exposures (MPE) for both thermal and photochemical safety thresholds, especially with larger pupil sizes or extended exposure durations. To mitigate risk, the study suggests distributing light over a larger retinal area rather than focusing it directly on the fovea. These findings raise questions about the "low-level" designation for such devices, indicating a need for careful safety considerations in clinical applications. This concern is reflected in China’s recent reclassification of RLRL devices as Class III, now requiring more rigorous safety and efficacy testing before approval.⁵ 

More than 80 academic presentations were delivered over the course of the 4-day conference. The Chew Sek-Jin Memorial Lecture is a revered tradition at the IMC, proudly sponsored by CooperVision, and awarded to an outstanding myopia researcher whose work has greatly influenced the field. It honours the late Professor Chew Sek-Jin, a pivotal figure in advancing myopia research, particularly across Asia. This year the lecture was awarded to Professor Ian Flitcroft (pictured below), a Dublin-based pediatric ophthalmologist whose pioneering research has profoundly shaped myopia management. Some key points he presented in his lecture titled “Are we there yet?” were as follows.

• The need for simplification to increase adoption: While single vision correction remains widely used, myopia management needs to be simplified for broader adoption without oversimplifying the complexity of the condition.
• The importance of outdoor time: Research indicates that man-made environments—both indoors and in urban outdoor spaces—have spatial frequency characteristics similar to blurred images, equivalent to 1-2 diopters of defocus. This “spatial frequency depletion” may disrupt the eye’s growth regulation by confusing systems that detect clear retinal images, potentially triggering myopic growth. Ian suggested that outdoor time, which provides a richer spatial frequency environment, may help counteract this effect, explaining the eye health benefits of outdoor exposure.
• Anatomical factors in myopia management: Anatomical features are important to consider for effective myopia management, hence the Anatomical Equivalent Refraction (AER) was developed, which predicts refraction based on anatomical characteristics, age, gender, and ethnicity. Unlike traditional refraction, AER focuses on structural changes that could increase long-term risks like retinal damage. Anatomical mapping of myopia contributors (such as cornea, lens, axial length, and choroid) could enable targeted treatments. He referenced the Myopia Outcome Study of Atropine in Children (MOSAIC) study, which found that axial myopes respond better to atropine than refractive myopes.⁶
• Myopia as a risk marker rather than a refractive issue: Myopia levels can be compared to intraocular pressure (IOP) in glaucoma, in that myopia could serve as a marker of retinal risk rather than merely a refractive error. Just as IOP acts as an indicator of potential damage in glaucoma, myopia levels could similarly help assess long-term risks associated with myopia progression.

While progress has been substantial in slowing myopia, Ian emphasized that there is still much to be done, particularly in addressing the anatomical consequences of myopic growth. He closed with a call to action for the next generation, encouraging them to continue bridging research and clinical practice to improve patient outcomes and ensure a holistic approach to managing myopia.

The IMI Reports are a series of expert-reviewed publications that provide comprehensive guidelines and insights on various aspects of myopia (IMI Executive Director, Dr Nina Tahhan, is pictured below). First published in 2019 and with volumes 2 and 3 published in 2021 and 2023 respectively, these reports serve as valuable resources for eye care professionals, researchers, and educators worldwide. Each report addresses a specific aspect of myopia, drawing on the latest research and clinical practices to support evidence-based myopia management. Previews of the following new reports, due for publication in early 2025, were given at the IMC. CooperVision, as a donor and supporter of the IMI Reports, has contributed to advancing this important body of work.

The upcoming IMI 2025 papers present updates on definitions, classifications, and clinical management guidelines for myopia. One such update previewed was on pre-myopia. Cycloplegic spherical refraction remains the strongest predictor of future myopia,¹ reinforcing its role in early risk assessment. In 2019, pre-myopia was defined as a refractive state between +0.75D and -0.50D, with risk factors suggesting likely progression to myopia.⁷ The 2025 update introduces "low hyperopic reserve" as a marker for pre-myopia, citing a study by Chen et al., which recommends a +1.50D reserve to reduce myopia risk in Asian children—a higher, potentially ethnicity-dependent threshold.⁸

The 2025 guidelines prioritize delaying myopia onset as a key preventive strategy, with even short delays offering benefits. New treatments for pre-myopia include repeated low-level red light (RLRL) therapy and low-concentration atropine, while highly aspherical lenslet design spectacles have shown efficacy in Chinese children when worn 30+ hours per week.⁹ Emerging treatments like oral supplements, "outdoor scene classrooms" (picture a high-resolution wallpaper of trees and sky covering the classroom), and novel light therapies were also discussed. Proactive management of pre-myopia is recommended, as delaying myopia onset by a year can reduce final myopia by up to 0.75D, significantly impacting long-term eye health.¹⁰

As part of the IMI White Paper session, Tim Fricke, Director of Research and Education at the Australian College of Optometry, presented an important update on the global prevalence of myopia, revisiting the influential Holden et al. 2016 model of which he was a co-author, which has been cited over 4,500 times and been a driver for myopia advocacy, policymaking, and investments in prevention and treatment solutions. Fricke's new meta-analysis on myopia prevalence up to 2020, to be published in 2025, reveals some deviations from the projections made by Holden et al. in 2016:

• Asia Pacific High-Income, East Asia and Southeast Asia: The updated analysis suggests a lower prevalence of myopia than the original 2016 model, particularly among younger and middle-aged populations.
• Australasia, Western Europe, North America: The new data aligns closely with 2016 estimates for these regions.
• Sub-Saharan Africa, Latin America, Caribbean, Oceania: The updated analysis shows a higher prevalence than initially predicted, indicating that the 2016 model may have underestimated myopia rates.

This upcoming IMI paper will review the latest published evidence, propose reporting guidelines, and refine prevalence estimates to better inform myopia management strategies worldwide.

James Wolffsohn, Professor of Optometry at Aston University, presented insights from the latest Global Practitioner Survey on Myopia Attitudes and Practice to be published as an IMI paper, a repeated survey undertaken previously in 2015, 2019 and 2022. This new 2024 survey reveals key trends in myopia management. 

• Minimum Age of Prescribing: Daily disposable and reusable soft contact lenses are generally introduced at ages 8–9, while single-vision lenses and approved MM spectacles are prescribed earlier, around ages 6–7. Atropine is commonly initiated at younger ages.
• Perceived Effectiveness: Combination therapy and orthokeratology are perceived as the most effective options for myopia control, while undercorrection is consistently seen as the least effective. Light therapy, included in the survey for the first time, ranked lower in perceived effectiveness than other treatments, suggesting initial skepticism. Atropine 0.01% remains widely prescribed and regarded as effective, despite evidence now pointing towards effectiveness only for children of White¹¹ or White European⁶ ethnicity.
• Regional Representation: The survey captures a diverse global representation, with a substantial number of respondents from high-prevalence regions like Asia and Europe. 

Christine Wildsoet, Professor of Optometry at the University of California in Berkeley, reported on the significant expansion in myopia control treatments, to be reported on in the updated 2025 IMI Interventions Report. In addition to the latest research on optical treatments and atropine, innovative therapies will be explored such as 7-MX (a caffeine derivative), repeated low-level red light (RLRL) and blue light exposure, and surgical approaches such as posterior scleral reinforcement and macular buckling for very high myopia. Behavioural monitoring has also been included to assess lifestyle-related factors in myopia progression. Key areas of focus in this updated paper will be comparing efficacy across different interventions, understanding patient adaptation, and evaluating potential rebound effects after treatment cessation.

Kathryn Rose, Head of Orthoptics at the University of Technology in Sydney, shared insights into the upcoming IMI Report dedicated to light and myopia, which will synthesize findings from both animal and human studies. The paper will cover a range of topics related to light's impact on myopia development, including the effects of light intensity (both bright and dim), spectral composition and its relationship with sleep and device usage, and the influence of diurnal/circadian rhythms.  

Debbie Jones, lead clinical scientist at the Centre for Ocular Research & Education (CORE) at the University of Waterloo, provided a preview on the Instruments and Diagnostics IMI Report to be published in 2025. Instrumentation plays a critical role in all aspects of myopia management, from early risk assessment to monitoring long-term management outcomes and ocular health.  Topics that are included in this new paper include aberrometry and artificial intelligence, with potential clinical and research functionalities.

The IMC posters and presentations, and the overview of the 2025 IMI Reports, mark a pivotal moment in the field of myopia management. Together, they reflect the latest advancements in research, a growing consensus on effective clinical practices, and an emphasis on global collaboration to address the myopia epidemic. As these insights continue to shape practice worldwide, they offer hope for a future where early detection, comprehensive management, and preventive strategies can collectively mitigate the impact of myopia on millions.