Italian consensus on pediatric myopia: findings from a three-round modified delphi study

BACKGROUND: Pediatric myopia is a growing public health concern, influenced by genetic and environmental factors such as limited outdoor time and excessive near work. It entails long-term risks beyond refractive correction. Despite expanding evidence on pharmacologic and optical interventions, clinical practice remains variable and several operational issues persist. OBJECTIVES: To develop evidence-informed consensus statements on pediatric myopia management in Italy, covering epidemiology, risk factors, prevention, monitoring, policy, and economic aspects. METHODS: Surveys were administered through REDCap between November 2024 and August 2025. Pediatric ophthalmologists rated domain-specific items using Likert scales and optional comments. After each round, anonymized summaries were shared. Items reaching consensus were removed; others were revised when appropriate. RESULTS: All 37 ophthalmologists completed every round. Fifty-three statements reached consensus. Key recommendations included early screening at age three, specialized clinics, awareness campaigns, financial support, prioritizing outdoor activity, not recommending red-light therapy, endorsing simultaneous competitive defocus spectacle lenses, and monitoring via cycloplegic refraction and axial length every 6 months. CONCLUSIONS: This consensus offers a structured framework for Italian practice and policy, while highlighting priorities for future research.