FDA advisory discussions over Sydnexis data did not produce enough consensus for approval, even as clinicians supported the use case. The advisory panel focus was whether the therapy demonstrates meaningful benefit in pediatric myopia, and its decision leaned toward requiring another trial. The story centers on widespread atropine use among clinicians but concludes that such real-world practice did not sway FDA advisors when evaluating the evidence package for Sydnexis. Panel recommendations effectively extend the development timeline for a pediatric myopia option positioned against or alongside existing clinical approaches. For companies in vision therapeutics and pediatric ophthalmology, the message is clear: clinical uptake and comparator practices alone are unlikely to substitute for trial-defined benefit endpoints required for regulator-level action.