IMI—2025 Digest

As myopia research expands in scope and complexity, the International Myopia Institute (IMI) continues to provide timely, evidence-based consensus guidance through its biennial white papers and digests. The IMI 2025 Digest delivers targeted updates in areas identified for revision since the previous digest: definitions and classification of myopia, clinical management guidelines, risk factors, accommodation and binocular vision, experimental models, and onset and progression in young adults. A major focus is the evolving concept of pre-myopia, including a refined understanding of hyperopic reserve as a predictive marker, population-specific thresholds, and the distinction between risk and predictive factors. Emerging evidence supports earlier identification and targeted interventions during the pre-myopic phase to delay onset. Clinical management updates highlight that delaying onset by even 1 year may have greater lifetime benefit than multiple years of progression control. Other updates address the limited causal inference of many current risk factor studies, new molecular insights from experimental models, and evidence that a subset of young adults, particularly with high myopia, continue to progress at meaningful rates. Collectively, the IMI 2025 Digest underscores the importance of proactive, individualized myopia care, equipping clinicians with current, evidence-based guidance while supporting continued research and innovation.