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.