Utility of Vuity may extend beyond presbyopia
The FDA approved the first pharmacological drug for the treatment of presbyopia in October 2021. Vuity from Allergan is a once-daily 1.25% pilocarpine HCL ophthalmic solution with pHast technology.
The GEMINI 1 and GEMINI 2 phase 3 clinical studies showed a three line or more gain in mesopic, high-contrast, binocular distance corrected near visual acuity at day 30, hour 3 without losing more than five letters in corrected distance visual acuity with the same refractive correction. GEMINI 1 even made statistical significance at hour 6, day 30. Both studies had headaches as a solicited adverse event of interest in 14.9% of the active arm vs. 7% of the vehicle group, with 99% of headaches being mild and transient.
The good news is premium surgeons finally have an option for treating presbyopia before cataract surgery is necessary. Even better news is the discovery of other off-label uses of Vuity from personal experience and those of colleagues since FDA approval. Irregular astigmatism, glare and halo in multifocal IOL technology, monocular diplopia, and even low-powered regular astigmatism from my personal experience have been temporarily eliminated with the use of Vuity.
Case examples
1. Irregular astigmatism: The pinhole effect of Vuity, even if temporary, has significantly helped many of my post-refractive surgery patients (especially post-RK patients), no different than the more permanent IC-8 IOL (AcuFocus) that may soon be accessible to premium surgeons in the U.S.
2. Visual disturbances in multifocal IOL technologies: During the postoperative period of neuroadaptation or neuroresignation in patients who received a multifocal IOL, glare and halo symptomatology can become visually debilitating. My experience has been if patients are unhappy from day 1, they typically will not gain improvement from a YAG capsulotomy or a pair of temporary prescription glasses, but I have found Vuity to be the most significant option to help in the neuroadaptation process.
3. Monocular diplopia: In patients with monocular diplopia from a variety of causes (not necessarily after surgery), I have found Vuity to be a good first option to help alleviate this symptomatology before any surgical option.
4. Regular astigmatism, even as low as 0.5 D: One of my recent monofocal toric IOL patients had as low as 0.5 D of regular residual astigmatism postoperatively in their dominant eye and unbelievably was quite symptomatic. A trial of once-daily Vuity fixed the problem, and the patient was happy.
5. Unknown other potential benefits of Vuity: More examples of the pinhole effect of Vuity are still being discovered daily, so stay tuned.
Other companies, including Visus, Orasis and Ocuphire, are looking to come out with a presbyopia treatment that has a pinhole effect; these will most likely have the same benefits as Vuity on label and off label. Some of these off-label modifications may enhance duration of effect. Nevertheless, Vuity is the leader paving the way for presbyopia and other complex off-label symptomatology treatments thus far. This is just the beginning of the presbyopia pharmacological revolution
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
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