Eyeworld

SPRING 2025 | EYEWORLD | 75 R Contact Repka: mrepka@jhmi.edu References (continued) 7. Yam JC, et al. Low-Concen- tration Atropine for Myopia Progression (LAMP) study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology. 2019;126:113–124. 8. Repka MX, et al. Low-dose 0.01% atropine eye drops vs. placebo for myopia control: a randomized clinical trial. JAMA Ophthalmol. 2023;141:756–765. 9. Walline JJ, et al. Effect of high add power, medium add power, or single-vision contact lenses on myopia progression in children: The BLINK randomized clinical trial. JAMA. 2020;324:571–580. Relevant disclosures Repka: None but they may cause more symptoms; 0.01% is fairly innocuous," he said. Dr. Repka said that there are some reports of minor statistically significant effects being detected with 0.01%, though it was not clinical- ly meaningful, in his opinion. "Maybe this is a signal that there is something here, and we just have to find the right dose," he said. In addition to studying higher doses of atropine in a Western population, he said other methods to stem or slow myopia progression are needed. He discussed the only FDA-approved product for myopia control, MiSight (Cooper- Vision), which are contact lenses approved for patients as young as 8 years old. This lens was successfully able to slow progression compared to the control, single-vision contact lens. He mentioned the BLINK study, which found that "off-label treatment with high-add power mul- tifocal contact lenses significantly reduced the rate of myopia progression over 3 years com- pared with medium-add power multifocal and single-vision contact lenses" in pediatric patients with myopia. 9 The study noted the need for fur- ther research to better understand "the clinical importance of the observed differences." As Dr. Repka put it, "there is some evidence in our population that you can slow progression, in this case with two different forms of contact lenses (one that's FDA approved and one that would be off-label use of an FDA-approved product). That remains exciting. The effects are modest, and we should not oversell these effects. Having an effect is good, having a stron- ger effect would be better; we are in the early days of treatment development." Dr. Repka also brought up research being conducted with spectacles to slow myopia pro- gression. "A number of large eyeglass manu- facturers are looking at lenses that are in some cases designed to do something similar to what the contact lens model did to achieve slowing of myopia progression. The advantage of these lenses is you can treat younger children, and it's better to treat younger based on what we know because the younger you are at onset, the more severe the myopia typically is at the end of the teenage years," he said. Takeaway message From the increasing prevalence standpoint, Dr. Repka said "the story is not clear" in the West, but he emphasized that even if it's not an epidemic, there is "a sizable percentage of our population" who are myopic. "There are still a lot of people wearing glasses who maybe don't have to be wearing glasses as strong, and there is a large number of people who might be at risk for the retinal complications of myopia 50 years down the road," he said, adding that myopia progression remains an important area of research globally. As treatments to slow myopia progression become available, Dr. Repka said he's interest- ed to see how the healthcare market sorts out coverage. He said he thinks these treatments should be considered medical eyecare, rather than vision care, which currently covers glasses and contact lenses. "I think the biggest change has been myopia has gone from the, 'You just change the glasses' statement of a decade ago to, 'There are things we can do.' We're learning more about it every day, but there are things we could consider do- ing. That's a big change," Dr. Repka said. First FDA-approved pharmaceutical for myopia on the horizon? In March 2025, Sydnexis announced that the FDA had accepted its New Drug Applica- tion for SYD-101, setting a Prescription Drug User Fee Act (PDUFA) target action date for October 23. If approved, the company re- ported that this would be the first and only currently available pharmaceutical for the treatment of progressive pediatric myopia in the U.S. In the company's press release at the time, Sydnexis described SYD-101 as having a propriety formulation of low-dose atropine.

• Cover