Myopia is a global problem, with 80% of the population in China, Taiwan and Hong Kong suffering from myopia, and as many as 93% of 18-year-old girls in Taiwan suffering from myopia. Recent studies have shown that genetic influences are only a small part of the problem, and environmental factors are the main cause, which is a complete change of concept from the past. From this philosophy, we believe that keratoplasty occupies a new and important place. It is clearly effective, but the question is how best it can be achieved and how widespread it can be. We take big steps across histology and physiology to affect optical changes. Keratoplasty has great importance in the future, especially in children, where we can use optical manipulation to influence the environment in which children’s eyes grow.