Traditional measures of ametropia focus on the visual axis, yet ocular growth and refractive development occur in three dimensions. Two individuals may share identical on-axis refractions but differ markedly in off-axis morphology and retinal appearance. These differences may influence their risk of myopia-related pathology. This lecture introduces a ‘fundus-centric’ approach that integrates fundus appearance into the assessment of myopia, highlighting its potential to refine risk evaluation, personalise care, and shape future directions in clinical research.

Learning outcomes:

• Practitioners will recognise how variations in fundus appearance and ocular shape can influence the clinical assessment and management of myopia