The International Myopia Institute\'s (IMI) mission is to advance research, education, and management of myopia to decrease future vision impairment and blindness associated with increasing myopia. Its approach is to bring together scientists, clinicians, policymakers, government members, and educators into the field of myopia to stimulate collaboration and sharing of knowledge. The latest reports are on pathologic myopia, the impact of myopia, risk factors for myopia, accommodation and binocular vision in myopia development and progression, and the prevention of myopia and its progression. Together with the digest updating the 2019 International Myopia Institute white papers using the research published in the last 18 months, these evidence-based consensus white papers help to clarify the imperative for myopia control and the role of environmental modification initiatives, informing an evidence-based clinical approach. This guidance includes who to treat and when to start or stop treatment, and the advantages and limitations of different management approaches.

OBJECTIVE: To determine the rate of myopia progression in children fit with a commercially available extended depth of focus (center distance) multifocal soft contact lens with attributes theoretically expected to slow the progression of myopia.
METHODS: A retrospective case series analysis of 32 patients (ages 6-19 years, mean 10.98±2.95) from 10 practice locations was performed. At initial presentation, 44% wore spectacles, 37.5% spherical soft contact lenses, 15.6% a different soft multifocal contact lens, and 3% orthokeratology lenses. All participants showed progression of at least -0.50 diopter with current corrections and were fit with an extended depth of focus (center distance) multifocal soft contact lens (NaturalVue Multifocal 1 Day Contact Lenses; Visioneering Technologies, Inc., Alpharetta, GA). Follow-up time was 6 to 25 months (mean: 10.94±4.76).
RESULTS: Reductions in the annualized rate of myopic progression from -0.85 D per year ±0.43 D to -0.04 D per year ±0.18 D (P<0.00000) OD, -0.90 D per year ±0.57 D to -0.03 D per year ±0.17 D (P<0.00000) OS were observed. These data represent a reduction of 95.4% OD and 96.25% OS. Approximately 98.4% of the children showed reduction of annualized myopic progression; 91% showed a decrease of 70% or greater. Overall, 81.25% showed complete halting of myopic progression, including 6.25% demonstrating myopic regression.
CONCLUSIONS: This unique extended depth of focus (center distance) daily disposable multifocal contact lens was effective in slowing myopic progression in these children. These findings add to the growing evidence that center distance multifocal soft contact lenses may slow the progression of myopia.

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BACKGROUND: The aim was to report the appearance of a pigmented ring in both eyes of two patients undergoing overnight orthokeratology.
METHODS: Two Caucasian patients, one male and one female, were fitted with orthokeratology lenses to correct myopia between -2.00 and -2.50 DS with Paragon corneal refractive therapy lenses worn overnight. Treatment was successful in both patients achieving uncorrected vision of 6/6 or better monocularly under high (100 per cent) and low (10 per cent) contrast conditions.
RESULTS: At the six-month visit both patients presented with pigmented rings under slitlamp examination in both eyes. The location of the ring was consistent with the corneal area being flattened for myopic correction. Clinical examination was otherwise normal.
CONCLUSIONS: Despite being initially reported in Asian patients from Hong Kong, a pigmented ring related to orthokeratology treatment is also present in Caucasian patients, reducing the potential role of an ethnic link. Further large-scale studies need to be done to estimate the actual incidence of this condition and the potential implications for corneal health.

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OBJECTIVE: A case of asymptomatic corneal foreign body injury during orthokeratology lens wear is reported.
METHODS: An 8-year-old Chinese female myopic child with 21 months of overnight orthokeratology lens wear experienced a corneal foreign body injury without symptoms. The foreign body was removed and the eye treated with prophylactic antibiotic and ocular lubricant. Orthokeratology treatment was resumed 4 weeks after initial detection and management and a small residual corneal scar remained.
CONCLUSIONS: The mechanisms, differential diagnoses, management and role of neural sensitivity in corneal foreign body injury during orthokeratology lens wear are discussed. Clinicians should be aware that subtle corneal insult may be without symptoms during prolonged overnight orthokeratology lens wear.