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BLOG: Three predictions about presbyopia-correcting eye drops
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Ask any presbyope, and they’ll tell you that restoring natural accommodation would not just serve their vanity. It would be a miracle. We still do not have a widely accepted, highly successful, spectacle-free treatment for the plano presbyope. Besides the Kamra inlay from CorneaGen, we have mostly had to choose between monovision and compromised (multifocal) optics. The latter are reasonable choices for cataract patients, but not for the majority of young emmetropic presbyopes.
The advent of eye drops that reverse the symptoms of presbyopia, even temporarily, will likely bring about three outcomes:
1. Presbyopia correction will become a thing. Phase 1 and 2 studies of presbyopia-correcting drops suggest they will have at least modest success. Once approved, nearly 100 million patients in the U.S. will instantly become candidates. Certainly millions will want to try them. Responding to this demand, savvy refractive practices will market to their existing patients and the outside world the availability of safe, effective presbyopia reversal without surgery. This will lead to the second effect.
2. They will drive other refractive procedures. The cost and repeat dosing needed with these topical treatments will certainly drive some patients to choose more definitive refractive procedures, which will certainly drive interest in monovision LASIK, multifocal ablations and corneal inlays. Patients’ first contact may be for nonsurgical treatment, but their comfort with a surgical approach may only grow as many realize it is a simpler, more permanent solution.
3. Refractive cataract surgery will increase. For decades, some of our colleagues have used the term “dysfunctional lens syndrome” to describe presbyopia and the precursor condition to cataract. This concept will certainly gain credibility, especially for patients whose pupils, constricted with drops, are forced to focus through the most aberrated part of their crystalline lens. Ever-improving lens implants will also make us more comfortable recommending lens-based procedures for emmetropic presbyopes at an earlier stage. Meanwhile, as cataract surgery moves out of the operating room and into the office environment — a trend that is likely to occur — the patient cost for lens-based refractive procedures (without facility or anesthesia fees) will become more affordable, further driving this trend.
Presbyopia-reversing eye drops, which seem like a curious innovation now, may soon cause (or at least accompany) some remarkable trends in eye care. In our practice, where we were early adopters of presbyopia-correcting lens implants, we certainly plan to embrace presbyopia reversal as a niche offering where we would like to be perceived as a community leader. This enticing offering for young, healthy presbyopes seems a perfect way to position ourselves as the patient’s partner in achieving better vision for life.
Disclosure: Hovanesian reports he is an investor in Orasis and a consultant to Alcon.