FDA advisors reportedly did not shift their position on data from Sydnexis despite widespread atropine use, with the panel backing another trial to establish meaningful benefit in pediatric myopia. The decision comes amid clinician support for approval and highlights how real-world prescribing patterns may not translate into the evidentiary threshold regulators and advisors use. The dispute centers on whether the dataset demonstrates benefit sufficiently for a pediatric indication, rather than on whether atropine is broadly used in practice. For developers, the outcome signals the bar for trial design and endpoints remains the central focus. The update may affect timelines for any label expansion efforts and underscores the difficulty of closing evidentiary gaps for myopia therapeutics using indirect utilization arguments.