Looking to the future of myopia management: Taking a multifaceted approach

The landscape of myopia management is evolving rapidly, with growing global awareness and an increasing arsenal of treatment options. In a recent discussion on the FDA's acceptance of Sydnexis's NDA submission for SYD-101, a non-compounded atropine drop indicated for myopia, Paul Karpecki, OD, FAAO, emphasized how the perception of myopia has shifted—from a benign refractive error to a serious medical condition with long-term ocular health implications.

This transformation has been fueled by a wealth of research and advocacy. In 2024 alone, key institutions such as the American Academy of Ophthalmology, the American Optometric Association, UC Berkeley, the National Eye Institute, and Prevent Blindness released consensus reports reinforcing the significance of myopia as a public health concern. Over 1,000 studies support these findings, particularly regarding the risks associated with axial length elongation.

Epidemiological trends underscore the urgency: one in three children worldwide is now myopic, a figure that aligns with Brien Holden’s now-validated projections for 2050. Myopia’s associated risks are stark. Individuals with -6.00 D of myopia are 41 times more likely to develop myopic maculopathy, 22 times more likely to suffer a retinal detachment, and 14 times more likely to develop glaucoma. Even low myopes (-2.00 D and above) face a 10-fold increased risk of maculopathy.

The speaker highlighted the critical need for early detection and intervention, noting that myopia can often be predicted by age four. A cycloplegic refraction showing +0.50 D at that age may indicate a trajectory toward high myopia, while +1.00 to +2.00 D is considered safer.

Looking ahead, successful myopia management will depend on having a broad toolkit. This includes pharmaceutical options like the Sydnexis low-dose atropine formulation, which offers a practical, non-invasive treatment ideal for younger children. The convenience of nighttime instillation enhances compliance, particularly for families with young, pre-verbal children.

Other modalities—orthokeratology, myopia-control spectacles, and combination therapies—will continue to play essential roles. Treatment plans should be tailored based on the child's age, degree of progression, and family motivation. If a single intervention fails to sufficiently slow progression, a multi-pronged strategy may be required.

Ultimately, the future of myopia management lies in personalized care supported by ongoing research, parental engagement, and a growing array of therapeutic options.