"Wow, Everyone Else Can See Like This”

Why the Comments on the FDA Atropine Decision Matter More Than the Article

I still remember getting my first pair of glasses. I must have been around eleven. I walked outside, looked up and down the street and was just blown away, “Wow. Everyone else can see like this?”

I recently came across Dr David Hunter’s LinkedIn post about about his Washington Post piece on the FDA’s October 2025 decision to reject SYD-101, a low-dose atropine treatment for progressive childhood myopia. The article focused on the confusing regulatory reasoning — behind the decision not to license SYD-101 in the US. On face value, it is confusing! I am no expert of course, but the arguments made in the article appear well formed. Whether the FDAs reason was valid, or whether there was a failure in the process, I am not judging. All I thought was - it's a shame, that a potential treatment was not given approval.

Because, if I’m honest, whilst the decision seems confusing, it wasn’t the article that struck me most. It was the comments beneath it.

Scrolling through them was, in many ways, more illuminating than the piece itself. Dozens of older adults described remarkably similar journeys: early myopia, steadily increasing prescriptions, and then later-life complications — retinal detachments, myopic macular degeneration, glaucoma, early cataracts, injections, surgeries, the loss of night driving decades earlier than expected. The pattern repeated again and again. Early elongation, unmanaged progression, then structural disease.

I have suffered from myopia all my life and now have myopic macular degeneration. I don't wish this on anyone. Having extreme myopia impacted my life in so many ways. Imagine how great it would be to have treatments like the one discussed in this article. To deny this is sentencing myopic people to a lifetime of issues.

Islandfox

One line in particular stayed with me: “I wish this had been available when I was young.” That sentiment appeared in different forms throughout the thread. It’s easy to debate endpoints and p-values, and whether a percentage reduction in progression meets a regulatory threshold. It’s harder to ignore lived experience from people describing the cumulative consequences of axial elongation over 40 or 50 years.

For decades, myopia has been treated primarily as a refractive inconvenience. If a child still needs glasses, some ask, what is the point of intervention? But axial elongation is not cosmetic. The eye physically lengthens. The retina stretches. Lifetime risk increases. Every additional millimetre matters. The goal of atropine — and of myopia management more broadly — is not to eliminate spectacles; it is to reduce long-term risk.

Low-dose atropine itself is not new. It has been studied for years, used widely in parts of East Asia, authorised in the European Union and now licensed in the UK. In the United States, however, clinicians largely rely on compounded preparations following the FDA’s Complete Response Letter. It will be important to understand in more detail why the agency determined that the degree of benefit did not justify approval under its framework. Regulatory rigour is essential in paediatric medicine. At the same time, the wider context cannot be ignored: global myopia prevalence is rising, and childhood remains the only meaningful window in which to influence axial growth.

Reading those comments was uncomfortable, not because of politics or policy disagreements, but because of how familiar the stories felt. Many of us in eye care remember the moment the world snapped into focus for the first time. What we don’t want is for today’s children — who already have access to better understanding and earlier intervention — to be the next generation writing about retinal tears and macular degeneration in middle age.

Myopia management is not about avoiding glasses. It is preventative medicine. And that is why this conversation matters.