Myopic Shift Induced By Omidenepag Isopropyl 0.002% in Patients With Primary Open Angle Glaucoma

Précis: – Among POAG patients, 13.6% experienced a myopic shift of 0.75 D or more at 1 month following OMDI administration. Ciliary spasm may be the underlying mechanism. Purpose: – To evaluate the incidence, pathophysiology and risk factors for myopic shift following omidenepag isopropyl (OMDI) 0.002% administration in patients with primary open angle glaucoma (POAG). Methods: – This prospective, observational study included adult patients aged 20 years or older who visited the clinic between February and December 2022 and were diagnosed with POAG (treatment-naive). Participants were prescribed OMDI 0.002% eyedrops at the baseline visit. Comprehensive ophthalmic examinations, including measurements of refractive error (RE), keratometry, corneal topography, optical biometry, visual acuity (VA), and intraocular pressure (IOP) were performed at the baseline and 1 month after OMDI instillation. Main outcome measures were changes in ocular parameters, including RE, corneal curvature (CC), central corneal thickness (CCT), anterior chamber depth (ACD), axial length, lens thickness (LT), white-to-white, VA and IOP. Results: – A total of 44 eyes of 44 subjects were included. 13.6% of patients experienced a myopic shift of 0.75 D or more 1 month after OMDI instillation. Other ocular parameter changes included increased CC, CCT, and LT, along with decreased ACD. In the correlation analysis, CC change was associated with the myopic shift. Multiple linear regression analysis further revealed that changes in both CC and VA were significantly associated with the myopic shift, though no specific risk factor was identified. Conclusions: – OMDI 0.002% eyedrops were associated with a notable incidence of myopic shift in patients with POAG. Ciliary muscle spasm is a possible underlying mechanism of myopic shift.