March 16, 2026
By Ashley Tucker, OD, FAAO, FSLS
Photo generated by Gemini
The rising prevalence of childhood myopia has drawn increasing attention from clinicians, researchers and health care systems worldwide. While treatment strategies have expanded rapidly in recent years, many questions remain regarding how best to understand, monitor and manage progressive myopia.
A recent Delphi consensus study published in BMJ Open Ophthalmology sought to identify the most important evidence gaps and unmet needs in childhood myopia by gathering perspectives from both eye care professionals and health care payers across Europe.
Study Design
The investigators used a modified Delphi methodology, a structured process designed to achieve expert consensus through iterative surveys and discussion.
Key elements of the study included:
- Participants: 25 experts from seven European countries
- 12 eye care professionals
- 13 health care payers or health-technology assessors
- Process: two rounds of surveys followed by a virtual consensus workshop
- Consensus threshold: ≥70% agreement among panelists
The group ultimately reached consensus on 37 statements across six domains related to childhood myopia.
Key Consensus Findings by Domain
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Disease Background
Experts agreed that childhood myopia should be viewed as a progressive ocular condition with long-term health implications, rather than simply a refractive error.
Key points included:
- Myopia prevalence is increasing globally and represents a growing public health concern.
- Age of onset is a major predictor of future myopia severity.
- Genetic factors and ethnicity influence risk and progression patterns.
- Environmental influences such as near work and limited outdoor exposure contribute to myopia development.
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Clinical Burden
The panel strongly agreed that progressive myopia carries significant lifetime ocular risks.
Consensus findings included:
- Higher levels of myopia increase the risk of:
- Myopic maculopathy
- Retinal detachment
- Glaucoma
- Cataract
- Axial elongation is the primary driver of these complications.
- Slowing myopia progression, even modestly, may reduce long-term vision risk.
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Psychosocial Burden
Experts acknowledged that myopia can affect quality of life for children and families.
Consensus points included:
- Dependence on spectacles or contact lenses may impact daily activities and sports participation.
- Children may experience social or self-image concerns related to vision correction.
- Parents often express anxiety about long-term vision risks associated with progressive myopia.
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Economic Burden
Both clinicians and health care payers agreed that childhood myopia represents a significant economic burden.
Costs include:
- Direct health care costs for:
- Eye examinations
- Optical correction
- Myopia control treatments
- Long-term costs associated with complications of high or pathologic myopia.
- Indirect costs related to reduced productivity and quality of life.
As a result, slowing myopia progression may offer long-term economic value for health care systems.
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Treatment Options
The panel recognized the expanding range of therapeutic strategies available to slow myopia progression, including both optical and pharmacologic approaches.
Optical treatments discussed included:
- Myopia control spectacle lenses
- Multifocal soft contact lenses
- Orthokeratology
Pharmacologic therapy, particularly low-dose atropine, was also acknowledged as an important option. However, the panel noted that access to treatments varies across countries, and some therapies lack regulatory approval or reimbursement pathways.
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Unmet Needs and Evidence Gaps
Despite advances in treatment, the panel identified several major gaps in current knowledge.
Key unmet needs include:
- Incomplete understanding of myopia mechanisms, including retinal signaling pathways regulating eye growth.
- Long-term safety and efficacy data for existing myopia treatments.
- More comprehensive epidemiological data on childhood myopia in Europe.
- Clearer regulatory and reimbursement frameworks for myopia therapies.
Clinical Implications
The Delphi consensus highlights an important reality in modern myopia management: Although therapeutic options continue to expand, important scientific and policy questions remain. Improving our understanding of disease mechanisms, strengthening long-term clinical evidence and addressing regulatory barriers will be essential to advancing care for children with progressive myopia.
Ultimately, addressing these gaps will require continued collaboration among clinicians, researchers and health care systems to improve both scientific understanding and long-term outcomes for children affected by myopia.
Abstract
Consensus on Evidence Gaps and Unmet Needs in Childhood Myopia: Findings From a European Delphi Study with Eye Care Professionals and Payers
Wolf Lagreze, Paolo Nucci, Matthijs Versteegh, Caroline Klaver, Jesús Barrio-Barrio, Annegret Dahlmann-Noor, Rosario Gomez de Liaño, Neema Ghorbani-Mojarrad, Line Kessel, Jan Roelof Polling, Arnaud Sauer, Alexander K Schuster, Massimiliano Serafino, Edoardo Villani, Focke Ziemssen, Yvonne-Beatrice Boehler, Stefano Capri, Fabrizio Gianfrate, Joan-Antoni Valles Callol, Olivier Wong, Ting-Yen Chen, Christina Lymperopoulou, Ioanna Palaka, Yogesh Punekar, Dorothea von Bredow, Kun Shi-van Wielink
Background/aims
Childhood myopia is a growing global concern, associated with significant burdens. This study aimed to identify evidence gaps and unmet needs in childhood myopia management through a European Delphi panel involving eye care professionals (ECPs) with expertise in childhood myopia management and payers (ie, individuals with experience in health technology assessment, healthcare funding, drug pricing and/or reimbursement decisions).
Methods
A modified Delphi method was employed, involving two rounds of online questionnaires followed by a final virtual workshop. The panel included 12 ECPs and 13 payers from seven European countries. Consensus was defined as ≥70% agreement among panellists.
Results
Consensus was achieved on all 37 statements across six categories: disease background, clinical burden, psychosocial/humanistic burden, economic burden, treatment options and unmet needs. Key findings included recognition of ethnicity and age as crucial factors in evaluating childhood myopia, as well as the minimal clinically important difference for progression reduction. The panel emphasised the need for long-term studies on the efficacy and safety of myopia treatments, especially their impact on reducing future complications. The impact of high myopia on quality of life and economic burden was also highlighted. Regarding unmet needs, despite some known factors, the exact mechanisms behind myopia development remain unclear. There is a need for comprehensive epidemiological data on European childhood myopia and regulatory-approved pharmacological treatments in Europe.
Conclusions
Consensus was reached among European ECPs and payers on the evidence gaps and unmet needs in childhood myopia management. These findings can guide future research to establish the best strategies for childhood myopia management and mitigate the burden.
Read more of the latest myopia research here
