Based on the WOS database analysis, 11 172 documents on myopia published between 1900 and 2020 were retrieved. The first article on myopia was published in 1907. Prior to 1990, this field of research had not received much attention. Since 1991, the number of articles published increased gradually from 100 publications to over 400 after 2011 (Figure 1). There were 822 articles published in 2020. In 2021, 429 articles have been published as of June, and the number is likely to increase.

According to the retrieved articles, the articles on myopia originated from 127 countries. Table 1 shows that the United States accounted for the most number of articles published (19.82%), followed by China and Australia. Studies from the United States were cited 105 738 times, ranking first among all countries, followed by Australia and China. The collaboration relationship was analyzed using VOSviewer. As shown in Supplementary Figure 1, the United States (USA), the largest node, is the most active country in this field. The cooperation map showed that the USA intensively collaborated with many countries in myopia fields, such as Germany, France, and Spain.

According to the retrieved results, over 71,292 authors contributed to myopia research. Table 2 lists the 10 most productive authors in the field of myopia research. Among all authors, Saw SM contributed the most publications (175), the most citations (10,448 times). As shown in Supplementary Figure 2, the cooperative relationships among the productive authors are close, except for the group marked in yellow. There are several co-authorship groups, such as the red group with Saw SM as the core, the green group with Smith EL as the core, and the blue group with Mutti DO as the core.

Based on the retrieved results, the articles on myopia research were distributed among 164 journals. The top 10 journals that published articles on this topic are listed in Table 3. According to the citations, Investigative Ophthalmology & Visual Science and Ophthalmology ranked first and second, respectively. The Journal of Cataract and Refractive Surgery published the largest number of myopia articles (834 papers), followed by Investigative Ophthalmology & Visual Science. Among the top 10 journals, eight were from the USA, one was from the United Kingdom, and one from Germany.

As shown in Table 4, the top 10 organizations published 2,161 articles. Citation analysis showed that the National University of Singapore had 14,968 citations and ranked first. According to the publications, National University of Singapore and Sun Yat-sen University ranked first with 285 publications. The University of Melbourne, with 264 articles, ranked third. In the knowledge domain map of collaboration among main research organizations, 45 countries, 6 clusters, and 874 links were displayed and selected. As shown in Supplementary Figure 3, the National University of Singapore has the highest number (35 links) and the strongest link strength (629).

The top 10 cited references are summarized in Table 5. The top 10 papers were co-cited over 6,000 times in total, and the first was co-cited more than 800 times, while the 10th was cited 516 times. Additionally, the fifth paper was the only one published before the year 2000 cited 538 times. The top 10 cited references mainly focused on the prevalence and risk factors of myopia, which is consistent with the latest burst keyword.

The sharp rise in the myopic population increased its socioeconomic burden and posed a public health problem worldwide. Thus, the prevalence of myopia and its risk factors have gained widespread attention (Supplementary Figure 1, Green). Carrying out scientific epidemiological research on myopia is a mainstay for exploring related influencing factors for myopia, which are critical for intervening on its onset and progression. Before 1980, little was known about the distribution of myopia in the worldwide population. East and Southeast Asia showed the highest prevalence, reaching 80–90% at 18 years of age, which was much higher than that of Central Europe and Central Asia (24, 25). A meta-analysis has suggested that by the year 2050, nearly 50% of the world's population will have myopia, and approximately 10% will be high myopic. This is the most cited paper in this myopia area published by Holden et al. in 2016 (2). The first prospective study of the risk factors for myopia, showed that earlier age of onset of myopia was a risk factor for the development of high myopia, which induced non-correctable visual impairment or blindness (3). The genetic pool has changed little over the past few decades, but the changes in the environmental factors may be responsible for the rapid increase in the prevalence of myopia (26). It seems that school myopia is multifactorial, strongly associated with intensive educational pressure and limited outdoor activities (27). In terms of educational level, there was a high prevalence of myopia in boys attending Orthodox schools in Israel compared with their peers attending secular schools (27). The mechanism involved is unclear; however, near-work requires more accommodation which may stimulate eye growth. According to the prevailing view, longer time spent outdoors can prevent myopia (28). The available data revealed that high-intensity outdoor light may act as a protective factor by adding retinal dopamine concentrations and thus preventing myopia (29).

With the development of laser technology in modern ophthalmic surgery, refractive surgery is an important research area to improve the refractive status (30) (Supplementary Figure 5, Blue). Refractive surgery, a safe and effective measure that corrects refractive errors, is generally not recommended until refractive development has stabilized around the age of eighteen. The first case of radial keratotomy surgery was reported by Fyodorov in 1979; however, it has been replaced by cornea laser surgery owing to its lower security and poor efficiency (31). The keratorefractive surgery revolution began with surface ablation techniques. Surface ablation is potentially suitable for high myopia and thin corneas due to the relatively thicker residual stromal thickness (32). Nonetheless, corneal haze and myopic regression may be more common after surface ablation (33). Laser-assisted in situ keratomileusis (LASIK) is a new revolution, which has been the standard refractive surgery used for treating myopia since the 1990's (34). A review of LASIK outcomes was published in 2016 by Sandoval et al. (35). The authors reported that the spherical equivalent refraction (SE) and the uncorrected distance visual acuity of eyes both obtained pretty good correction effects and up to 98.8% of patients were satisfied with their outcome. However, complications associated with this procedure are not rare, such as free cap, buttonhole flap (36, 37). Presently, small-incision lenticule extraction (SMILE) has emerged as a novel surgery for myopia with the introduction of the femtosecond laser platform. The most frequently cited article in this cluster was published in 2011 and written by Sekundo et al. (38). The authors acknowledged that SMILE was a promising new minimally invasive procedure. SMILE has shown a reduced degree of dry eye symptoms and higher-order aberrations relative to LASIK (39, 40). These advantages may stem from small side cut and lower laser energy which retains corneal nerve and reduce inflammatory responses to a large extent (41, 42). Refractive surgery has already achieved excellent visual outcomes; however, the next challenge for clinicians is to choose the best refractive surgery method for each patient. Recently, with the addition of artificial intelligence in preoperative evaluation, data derived from corneal topography, biometry, and aberrometry can optimize customized refractive surgical strategies (43, 44). Based on the keywords, myopia correction remains centered on the corneal refractive operation. Intraocular surgery, which avoids the risk of corneal ectasia, is also developing rapidly (45).

At present, one of the areas that require further studies is the pathogenesis of myopia (Supplementary Figure 6, Violet). The mechanisms underlying axial elongation may provide scientific clues for the prevention and control of this global epidemic. From birth to adolescence, the eye achieves a close match between the power of its optics and its axial length, with images that are focused on the retina without accommodative effort (emmetropia) (46). Interestingly, Rucker FJ discovered that the retina may be using contrast perception to decode the sign of defocus using contrast perception. The chromatic signals of longitudinal chromatic aberration may rely on cone modulation to provide a direction signal for accommodation and eye growth (47, 48). Within the past several decades, it has become clear that alterations in the visual experience can provoke myopia in animal models (19, 49). For instance, form deprivation causes axial myopia through reduced visual stimulation, which is different from defocused-myopia related to the central system (50). The most frequently cited publication is the paper written by Wallman et al.. The authors reported that reading for long periods may disturb the homeostasis in the posterior globe, resulting in scleral remolding (51). The advances in clinical and basic experiments are mainly in the posterior ocular segment (52–54). Recently, Zhou et al. proposed a hypothesis that scleral hypoxia is a target for myopia control in 2018 (54). They speculated that special visual stimulation regulates the choroidal blood, thus initiating scleral hypoxia, leading to the onset and progression of myopia and axial elongation. Therefore, choroidal blood perfusion might be a “rapid predictive index” for myopia management (55). However, despite the progress, the chain of events of choroidal signals and scleral targets are still largely unknown. These clues may direct researchers to improve the understanding of myopia through the expansion of omics and big data analysis. In addition, some studies showed that atropine was found to increase the release of dopamine, strengthen the sclera, and increase the choroidal blood (56, 57).

As for group 4, the frequently cited articles were related to the optical interventions study (Supplementary Figure 7, Yellow). This group was led by the cross-sectional study by Millodot et al., published in 1981, in which the effect was measured between peripheral refraction and ametropia, where peripheral hyperopic defocus accelerated the onset of myopia (58). The first optical intervention was based on the reasoning that there was a relationship between myopia and excessive accommodation. The use of single-vision lenses (SVLs) was the mainstream method to correct myopia; however, SVLs poorly controlled myopia progression. It is not possible to clear the causality between peripheral retinal defocus and central myopia. However, it has been widely recognized that peripheral hyperopia can promote myopia progression (19, 59). Thus, peripheral defocus spectacle lenses (PDSL) and orthokeratology that were precisely designed to reduce peripheral retinal defocus, were effective (60, 61). The most cited publication was the article by Jane Gwiazda et al., which was published in 2003 in Investigative Ophthalmology & Visual Science (62). The authors reported that compared with SVLs, PALs limited the progression of myopia during the 1st year. The evaluation of visual quality in the human eye has always been an important issue in the field of ophthalmology and visual optics, which generally focus on the correlation analysis of visual acuity, wavefront aberrations, and contrast sensitivity (63–65). Previous research has indicated that visual quality was negatively related to the degree of myopia. It decreases gradually and concomitantly as the degree of myopia increases, while contrast sensitivity decreases and higher-order aberrations increase (66, 67).

The connection between myopia and glaucoma clinically has also been a significant research topic in recent years (Supplementary Figure 8, Orange). Glaucoma is the leading cause of irreversible blindness worldwide, and primary open-angle glaucoma (POAG) is the major type of glaucoma. Glaucoma is strongly linked with the onset and progression of myopia, with homogeneity in structural and functional changes (68). The most cited paper was published in 1999 in Ophthalmology by Mitchell et al. and was ranked fifth in the top 10 cited publications (69). The study revealed that myopia, an independent risk, increased the prevalence of glaucoma by 2 or 3-fold. A study from Korea found a positive trend between increased myopic refractive error and POAG prevalence (70). Recently, a meta-analysis by Ahnul Ha et al. corroborated this finding: every diopter in myopia increases the risk of glaucoma by ~20% (71). Thus, high myopia is now regarded as a risk factor for glaucoma (72–74). With increased axial length, high myopia appears to have optic disc morphological changes and optic nerve fiber layer defects, accelerating visual field defects (72, 73). In this group, the newest, most cited citation centers on myopia-related optic disc changes. Saw SM et al. reported that tilted discs and peripapillary atrophy were common in Singaporean adolescent children, which were similar to the pathological changes in glaucoma (75). Retinal degeneration makes it difficult to detect glaucoma with severe myopia, which requires a myopic normative database for analysis (76). Taken together, there is a need for a multimodal approach combining structural images with functional assessments to overcome the clinical diagnostic dilemmas of myopic eyes with glaucoma (77).

Pathological myopia has gained attention because of its sustained axial elongation and irreversible fundus degeneration that leads to severe vision loss (Supplementary Figure 9, Brown). This cluster focuses on myopic maculopathy, especially in myopic choroidal neovascularization (mCNV) (78). The reasons behind the development of myopic maculopathy are not clear, but evidence has shown that excessive axial elongation weakens the retina, choroid, and sclera, which is accompanied by vascular complications and degeneration (79, 80). Curtin and associates first proposed five fundus changes in myopia associated with axial elongation in 1970 (81). This classification did not cover all myopic maculopathy lesions. The development of fundus imaging technology facilitated a clearer visualization of myopic maculopathy. Grossniklaus et al. published an article in 1992 that described the pathological changes in pathological myopia and was the most cited paper in this group (82). A simplified classification system was proposed by Ohno-Matsui et al. (83). In this system, myopic maculopathy lesions were classified into five categories: no myopic retinal lesions (category 0), tessellated fundus only (category 1), diffuse chorioretinal atrophy (category 2), patchy chorioretinal atrophy (category 3), and macular atrophy (category 4), in combination with the three “plus signs” of lacquer crack, myopic choroidal neovascularization, and the Fuchs spot. Choroidal neovascularization may develop in 5–10% of individuals with pathological myopia (84), which is easily diagnosed using optical coherence tomography, optical coherence tomography angiography, and fundus fluorescein angiography. Photodynamic therapy with verteporfin (vPDT) was the first approved treatment for mCNV. Nevertheless, vPDT also resulted in chorioretinal atrophy and influenced the final visual outcome (85, 86). In recent years, intravitreal anti-endothelial growth factor (anti-VEGF) injection has become the first-line treatment for CNV secondary to pathological myopia (87). Anti-VEGF agents, such as ranibizumab and aflibercept, can control neovascularization and reduce macular edema, thereby improving visual acuity (88). However, patients do not acquire significant benefits in long-term vision with this treatment due to the development of mCNV-related macular atrophy (89).