ICON-PM: International consensus on nomenclature for adult pathologic myopia

To develop an international consensus on terminology for adult pathologic myopia based on contemporary imaging, with emphasis on optical coherence tomography (OCT).

An international panel of 32 experts in myopia and retinal disease from 13 countries was assembled. The writing group reviewed existing classification systems and the published literature and developed candidate statements organized into six domains: atrophic, mechanical expansion, tractional, neovascular, optic nerve, and retinal detachment. A Delphi process with anonymous voting was used. Consensus was defined a priori as ≥75% agreement (Agree or Strongly Agree). Statements not reaching consensus were revised based on structured feedback and re-voted.

Forty-four consensus statements were developed that met the predefined threshold for agreement after iterative revision. The mean agreement was 90.6% (median 92.5%). The framework emphasizes structural definitions derived from OCT and multimodal imaging rather than fundus appearance. The nomenclature system organizes manifestations of pathologic myopia into six domains reflecting distinct but often overlapping anatomical and biomechanical processes. Key elements include the central role of choroidal thinning in visual function, recognition of focal chorioretinal loss as a structural endpoint across multiple pathways, and integration of mechanical, tractional, and vascular mechanisms in disease expression.

This consensus establishes a unified, imaging-based lexicon for adult pathologic myopia grounded in structural anatomy and contemporary imaging. By organizing disease features into six domains and defining entities using OCT, the framework reduces ambiguity, improves reproducibility, and provides a foundation for future classification systems, clinical studies, and therapeutic trials.