Getting the Drop On Presbyopia

Have you ever seen someone at a restaurant having to hold their menu at arm’s length or turn on their cell phone’s light to see better?  Then you have seen Presbyopia. In fact, there are around 129 million presbyopes or emerging presbyopes in the US today.

Presbyopia is the gradual loss of your eyes’ ability to focus on nearby objects. It is a natural, often annoying part of aging. Presbyopia usually becomes noticeable in your early to mid-40s and continues to worsen until around age 65. You may start having symptoms like eye strain, headaches and twitching before you notice the vision changes. A basic eye exam can confirm presbyopia. 

So, how do we “get the drop” on presbyopia? Until now, the only options available to help presbyopes have been wearing corrective lenses like bifocal, contact lenses and readers, or, undergoing elective surgical procedures such as multifocal IOL implantation, Corneal Inlays, or femto laser intrastromal correction.  All these options have imperfect results.

Today, there are numerous companies nearing regulatory approvals for presbyopia-correcting eye drops.  There are two main categories: miotic-based eye drops (Pharmaco-refractive) and lens restoration drops (Pharmaco-treatment). 

Miotic based eye drops (Pharmaco-refractive)

These drops function by constricting the pupil and creating a pinhole like optical effect.  These drops enhance near vision by creating a greater depth of focus with pupil constriction.  Similar drops have been on the market for other therapies but have had a lot of side effects.  Companies such as Allergan, Presbyopia therapies, Orasis Pharmaceuticals, OSRX Pharmaceuticals are deep into clinical studies and are close to FDA approval on their proprietary drop cocktail of miotic drops.  The differences between these drops are the other active ingredients that help make the miotic drops more tolerable by decreasing inflammation and the other side effects such as headaches and muscle spasms.  In initial studies, most have shown a 3–4-line improvement of near acuity. Look for Allergan to be first to market.

Lens restoration drops (Pharmaco-treatment)

The second category of drops is the restoration drops.  These work by breaking apart the disulfide bonds that form in the crystalline lens fiber cells which increases lens flexibility and restores some elasticity.  The active ingredients in this eye drop are lipoic acid choline ester.  It has shown good penetration into the eye and has shown to restore natural accommodation.  Novartis is the company working with this pharmaceutical agent and has seen good results to this point of their clinical studies.  82% by day 91 had seen 20/40 or better at near.  The expected dosing on this is 2x per day for 90 days and the effects have been seen to last 7 months out with this 90- day regimen.  

While the market for these products is just beginning, the opportunities for this treatment will grow.  It can be used as a stand-alone treatment for those who have great distance vision or in combination with contact lenses, LASIK and other refractive surgeries, and glasses.  We hope it can remove some presbyopic frustrations such as reading a menu in a dim lit restaurant.

Torrey J. Carlson, O.D.

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