Between 4 and 7 September 2022, the very successful 18th International Myopia Conference (IMC) was held in Rotterdam, the Netherlands. It was a fruitful meeting which brought together over 800 researchers, clinicians, delegates, patients, industries and representatives. The Rotterdam myopia research group was delighted to host this meeting and to welcome participants from over 44 countries. The meeting had been delayed for a year due to COVID-19. It was even doubtful if the meeting would be held. COVID-19 restrictions were still in place in the Netherlands in February 2022, just 7 months before the conference. Fortunately, the meeting went ahead with inspiring discussions between participants alternating with lectures and social activities in the warm and friendly harbour city of Rotterdam. The meeting started with an overview session of ‘myopia around the world’ in which experts explored the prevalence and development of this refractive error in different parts of the world (Figure 1). Other sessions included experimental models, myopia management with optical or pharmaceutical interventions, animal models, imaging and biometry, risk factors and genetics. In one session covering complications and public health, a representative of the Dutch Myopia Patient society gave a fascinating presentation from the patient's perspective, and urged the scientific community to develop personalised treatment and unify the fragmented care for highly myopic patients. The opening day included the Zeiss ‘Josh Wallman Memorial Lecture’ presented by Jason C.S. Yam (Figure 2). The Josh Wallman award is given to a promising young investigator in myopia research and is named for a famous researcher who was known for stimulating junior researchers to produce high-quality work. Dr Yam gave an insightful presentation about the Low-concentration Atropine for Myopia Progression study and highlighted the inhibiting effect of atropine on axial length and myopia progression. The highlights of his talk are presented in his paper found in this special issue of OPO. On the second day, the senior ‘Sek-Jin Chew Award’ was given by Professor Joan Bailey Wilson (Figure 3). This award is named after another famous and influential myopia researcher from Singapore who, just like Dr Wallman, was taken from us far too soon. Professor Wilson won this award for her extensive research into the genetic background of myopia. Her presentation led the audience through many years of unravelling the genetic factors leading to myopia, including many significant breakthroughs. It must be noted that the conference programme also included diverse social events. The meeting began with an opening reception of drinks and oysters. On Sunday morning, a sportive group of delegates ran across the riverbanks and the Rotterdam bridges enjoying the sunrise. Additionally, a social tour was organised to the historic city of Delft. A major highlight was a conference dinner on the former cruise ship, SS Rotterdam, one of the former steamships of the Holland America Line. In this beautiful atmosphere, the evening ended with live music that brought the myopia community onto the dance floor. The IMC is growing in size with more participants, sponsors, abstracts and representatives. Indeed, the 18th edition attracted a record number of visitors, despite COVID-19-related travel restrictions still being present, especially in China. We feel it is important that future meetings maintain the informal atmosphere and the varied programme with all aspects of research from basic to translational and clinical research, with equal opportunity to present to a broad audience. The time has come to establish an overarching formal organisation looking at continuity and independency. This is essential to facilitate basic science, promote independent clinical advice and to support relatively small groups to organise future IMCs and host a large group of people. Given the increasing size of the meeting and ever-increasing myopia treatment options, commercial interest continues to grow as sales in treatment options increase. The last five conferences have seen a significant increase in presentations by individuals affiliated with commercial companies or parties with commercial interest. While the earnings model for myopia is treatment and monitoring options, basic science investigations to avoid myopia (onset and progression) are essential and represent important pillars of the IMC. Whereas commercial parties in general have more resources to run larger research studies, on occasion they may have less interest in publishing negative results, or to investigate factors lacking a clear revenue model. Nevertheless, public health studies are important for advocacy. Without clear guidelines and a formal structure so that all groups feel represented, it may become difficult to balance varying interests for best practice and ensure a prominent position for different research fields within myopia. Furthermore, the IMC is a conference that rotates across the continents of the world and the last seven conferences were held in Europe (thrice), Asia (twice), North America (once) and Australia (once). The voting system of the IMC is performed during an open business meeting where the audience present can vote for bidding parties. The business meeting has evolved from 10 people without screens to over 100 people viewing promotional movies about tourist attractions in the various locations. All persons present have one vote and can choose between bidding parties. This might lead to a biased election as the larger groups could gain an advantage over smaller parties. Developing a formal structure for the IMC can create better guidelines and allow an overview of bids with sufficient time for voters to consider the different options. This will assure a spread over the different continents. A structured organisation may also help smaller groups to bid as well as allow a 4-year planning interval, although a larger conference may also increase both the financial risk and responsibilities. The planning horizon for the IMC has been extended to 4 years to allow greater preparation time as the marked increase in the number of participants has made organising the meeting more complicated. The business meeting confirmed that the 19th IMC in 2024 will be held in Hainan, China, led by the Aier Eye Hospital Group. Additionally, the meeting voted to hold the 20th IMC in 2026 in Houston, Texas, USA. Of course, the successful meeting could not have been possible without the support of our sponsors. We acknowledge the Diamond sponsors CooperVision, EssilorLuxottica, Hoya, Menicon and Zeiss; Platinum sponsors were Johnson & Johnson and Topcon; Gold sponsors were Oculus, Sightglass and Tsuboto Lab. The Silver sponsor was Medical Workshop and the remaining sponsors were Bayer, Novartis, Stria Tech, Vyluma and Zero Residual-SJJ solutions. As an organising committee, we were honoured to have held the post-COVID-19 18th IMC in Rotterdam. It was a warm and informal meeting, which served as fertile ground for new connections and hopefully the start of new collaborations. As all good things must come to an end, we now hand over the baton to the Hainan group. We are confident that the next IMC in China will be as enjoyable as the previous conferences, and future meetings will encompass the independent mix of all disciplines involved in myopia research that the IMC community stands for. J. Willem L. Tideman graduated in 2012 as a medical doctor from the University of Groningen. He defended his thesis ‘The Causes and Consequences of Childhood Myopia’ in February 2019 at the Department of Ophthalmology and Epidemiology at the Erasmus Medical Center under the supervision of Professor C.C.W. Klaver. During his PhD, he also completed a Master of Science in Genetic Epidemiology at the Netherlands Institute of Health Science. He looked at environmental and genetic risk factors for myopia, axial length and axial length growth and developed growth curves to monitor myopia progression in children. Since 2017, after completing his PhD, Dr Tideman worked as an ophthalmology resident at the Erasmus Medical Center, where he is also involved in the myopia clinic. He is currently working at Martini Hospital in Groningen as an ophthalmologist and holds a postdoctoral appointment in the Erasmus Medical Center.