Episode Description In this year-end episode, Chris Wolfe, OD takes a step back from protocols, products, and positioning statements to examine a more fundamental question in clinical care: when does belief help us act, and when does belief get ahead of the data?
Throughout the year, we’ve emphasized that belief during the comprehensive exam is what drives action. If doctors and teams do not truly believe something matters, it does not get prioritized. But belief has a failure mode. When belief outpaces evidence, especially in pediatric care, it can distort expectations, decision-making, and policy.
Using the FDA’s decision on low-dose atropine as a case study, this episode explores how belief forms, how it spreads, and where it may diverge from what the publicly available data actually show. This is not an argument against myopia management or atropine therapy. It is an attempt to slow the conversation down and examine effect size, study design, endpoints, and uncertainty with clarity and humility.
What You’ll Learn in This Episode Why myopia management itself is not the controversy, but certainty often is
How belief influences behavior in the comprehensive exam, for better and for worse
What the FDA actually said in its Complete Response Letter on SYD-101
How professional statements and press releases can amplify belief beyond available data
What the STAR trial poster does and does not show, including effect size and subgroup uncertainty
Why modest effect sizes behave differently in real-world clinical practice
How to think about dose, endpoints, and population selection without oversimplifying
Why belief should motivate action, but evidence should calibrate expectations
Key Sources Referenced in This Episode FDA and Manufacturer Statements Sydnexis Complete Response Letter Press Release Sydnexis Receives Complete Response Letter from FDA for SYD-101 to Slow Pediatric Myopia Progression https://www.sydnexis.com/news/sydnexis-receives-complete-response-letter-from-fda-for-syd-101
Sydnexis Phase III STAR Trial Topline Data Press Release Sydnexis Announces Topline Pivotal Data from Phase 3 STAR Trial https://www.sydnexis.com/news/sydnexis-announces-topline-pivotal-data-from-phase-3-star-trial
UK Approval Announcement (Based on STAR Data) Sydnexis Announces UK Approval of Ryjunea by Partner Santen https://www.sydnexis.com/news/sydnexis-announces-uk-approval-of-ryjunea
Professional Organization Statements AAOMC Public Statement AAOMC Calls for Access to Proven Myopia Therapies as Low-Dose Atropine Gains Global Approvals https://aaomc.org
AAPOS Commentary on Nonapproval of SYD-101 Available via LinkedIn and Healio OSN
Clinical Commentary and Analysis Kyle Klute, OD – Optometry Simplified My Alternative Take on Atropine, Fast Progressors, and Effect Size (NNT Analysis) https://optometrysimplified.com/posts/optometry-simplified-weekly-my-alternative-take-on-atropine-fast-progressors-in-glaucoma-lab-test-ordering-and-more
Strongly recommended for a detailed discussion of effect size and Number Needed to Treat. This episode references Kyle’s framework without reproducing his calculations.
Review of Myopia Management – Ashley Wallace Tucker, OD What Does the FDA Decision on SYD-101 Mean for Eye Care?
Review of Optometry – Paul Karpecki, OD Sydnexis Snubbed
Review of Optometry – Cory Lappin, OD Optometric Physician Commentary on SYD-101
Healio OSN – Ed Wilson, MD and John Hovanesian, MD AAPOS: Nonapproval of SYD-101 Has Important Implications
Why This Episode Matters This episode is not about picking sides. It is about learning to sit in uncertainty without abandoning action. It challenges listeners to examine where belief helps patient care and where belief may unintentionally replace careful analysis.
If you manage myopia, counsel parents, interpret clinical trials, or influence policy, this episode is designed to help you think more clearly, not more loudly.
Connect and Continue the Conversation If this episode resonated with you, or if you found yourself uncomfortable in parts of it, that reaction is worth exploring. Thoughtful medicine requires both conviction and restraint.
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