Pharmaceutical options for presbyopia on the horizon
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SAN FRANCISCO —Medical treatments for addressing presbyopia are on the horizon, with two approaches currently being studied, according to a speaker here.
“Presbyopia, literally meaning ‘old-eye,’ results in a gradual decrease in lens accommodation, leading to a significant lack of functional near vision. It affects the majority of people over the age of 40, with a target population of 30 to 40 million in the United States, and we have no approved pharmacologic treatment,” Sheri L. Rowen, MD, said at Refractive Subspecialty Day at the American Academy of Ophthalmology annual meeting.
Reading glasses, contact lenses and surgical procedures that can be invasive and difficult to reverse are currently the only ways to treat presbyopia, but there are new agents using two different mechanisms of action under study, she said.
Novartis’ UNR844 (lipoic acid choline ester chloride) works directly on the accommodative aspect of the lens.
Allergan, Presbyopia Therapies and Orasis Pharmaceuticals all have miotic drop products in development that create a pinhole effect. All three claim their drops address unmet needs and enable significant near vision gains, Rowen said.
Allergan’s topical once-daily drop AGN-1883 is currently in phase 3 trials. Presbyopia Therapies’ LiquidVision eye drops have produced positive phase 2b results, while Orasis’ phase 2b study of CSF-1 has recently been completed, Rowen said.
The mechanism of action of UNR844 works by allowing the lens to change shape.
“In a young eye, we have normal disulfide bonds allowing cytosol displacement centrally and allowing the lens to change shape,” Rowen said.” In the aging eye oxidation-induced disulfide bonds form between the crystalline proteins and causes lens stiffening, not allowing cytosol to move through the lens and not allowing the lens to change shape.”
UNR844 goes into the cornea to create a free flow of cytosol, she said.
“The landscape is changing for the medical treatment of presbyopia,” Rowen said. “Pupillary miotics will be the first to market. They appear safe, effective and easy to use in early studies...The lens softening drops are hopefully now approaching phase 2 studies as we speak.” – by Rebecca L. Forand
Reference: Rowen S. Medical treatment of presbyopia. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: Rowen reports she has financial relationships with Allergan, Alcon, Bausch + Lomb, Johnson & Johnson, Orasis Pharmaceuticals, Novartis and Shire.