The prospective observational study enrolled treatment-naive adults aged 20 years and older who were newly diagnosed with POAG between February and December 2022. All participants were started on OMDI 0.002% eye drops at baseline. Comprehensive ophthalmic evaluations were conducted at the start of treatment and again after one month. These assessments included measurements of refractive error, corneal curvature, central corneal thickness, anterior chamber depth, axial length, lens thickness, visual acuity, and intraocular pressure.
The following findings were reported:
- The study analyzed 44 eyes from 44 patients with primary open-angle glaucoma.
- At one month after starting omidenepag isopropyl therapy, 13.6% of patients experienced a clinically significant myopic shift of 0.75 diopters or more.
- A modest but measurable increase in overall nearsightedness was observed across the study population.
- Structural ocular changes accompanying the refractive shift included increased corneal curvature, central corneal thickness, and lens thickness.
- A decrease in anterior chamber depth was also noted after OMDI administration.
- Changes in corneal curvature were correlated with the magnitude of the myopic shift.
- Multiple linear regression analysis showed that alterations in corneal curvature and visual acuity were significantly associated with refractive error changes following OMDI use.
- No specific demographic factors or baseline ocular characteristics were identified as definitive risk factors for developing a myopic shift.
The authors suggest that ciliary muscle spasm may play a key role in the observed refractive changes. Activation of EP2 receptors by omidenepag may influence ciliary muscle tone, leading to lens thickening and forward movement, which in turn could contribute to a myopic shift. The concurrent decrease in anterior chamber depth supports this proposed mechanism.
Although the study was limited by its small sample size and short follow-up period, the findings highlight an important potential adverse effect of OMDI therapy. The authors emphasize that clinicians should be aware of possible refractive changes when prescribing omidenepag isopropyl, particularly in patients who report new-onset visual discomfort or vision changes. Monitoring refractive status during early treatment may help optimize patient care and counseling in glaucoma management.
Reference:
Lee, Yun Jeong MD, PhD*,†; Choe, Sooyeon MD, PhD‡; Kim, Jin-Soo MD§,∥. Myopic Shift Induced By Omidenepag Isopropyl 0.002% in Patients With Primary Open Angle Glaucoma. Journal of Glaucoma 35(1):p 1-6, January 2026. | DOI: 10.1097/IJG.0000000000002643
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