Q&A: Patients with early presbyopia are best candidates for Vuity
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Since the FDA approval and release of Vuity in late 2021, physicians and patients now have a new option for presbyopia treatment.
Vuity (Allergan) delivers a proprietary formulation of pilocarpine 1.25% to the eye to induce a pinhole effect, thus improving near vision.
Healio/OSN spoke with Nandini Venkateswaran, MD, about finding the right patients for Vuity and what other options she uses in patients with presbyopia.
Healio/OSN: Which patients are ideal candidates for Vuity?
Venkateswaran: In my practice, I am finding that the ideal patients for Vuity are probably early to moderate presbyopes, usually ranging in age from 40 to 50 years. They are just starting to have symptoms of presbyopia and are wearing low-power readers, about a +1 D up to +2 D. They still have accommodative capacity of their natural lens but need something else to help them get over that hump of focusing well up close. It is more challenging for patients who are older than 55 years with more advanced presbyopia and less accommodative capacity of their crystalline lens to appreciate the full effects of Vuity.
Healio/OSN: Which patients are not good candidates for Vuity? What other options do you have?
Venkateswaran: When patients wear readers that are above +2.5 D, they do not have much of their natural accommodation left. I have tried Vuity in these patients, but much of the feedback is, “It’s helping me a little bit, but I still need to wear readers,” or “I still need to enlarge my print when trying to see small fonts.” At that point, they could use Vuity and augment with lower-power readers or start to consider some other options. You can consider monovision or multifocality with contact lenses, monovision with LASIK, PRK or SMILE, or a clear lens exchange in which their natural lens is replaced with a premium lens, such as a trifocal lens, Light Adjustable Lens (RxSight) or an extended depth of focus lens. All these options are going to give them more range than what their natural lens is able to provide at this juncture of presbyopia.
Healio/OSN: How do you match a patient with the best treatment?
Venkateswaran: I have started to proactively have conversations about presbyopia with patients because now I have a tangible treatment modality to offer them. Vuity has changed the way I target my audience and how I frame the conversation. When patients are coming in for a comprehensive eye exam and they are 45 years old but their only complaint is reading vision, I say, “Now there’s a drop that’s FDA approved to help with your reading vision difficulties. It creates what we call a pinhole effect and works to bring your up-close vision into better focus. It’ll probably work well for you, given that you’re younger with a more elastic lens but it’s not going to take away reading glasses altogether. The drop lasts for about 4 to 6 hours, takes effect in about 15 minutes, and should be used during times of the day or during outings when you don’t want to always depend on your readers.” Most patients are receptive to that description and willing to try it.
I always perform a dilated fundoscopic exam before dispensing Vuity and will avoid the drop in patients with any retinal pathology (ie, retinal thinning, history or retinal detachment). I also advise patients about some side effects associated with drop use, including mild dimming of vision, headache, or minor eye redness or pain.
I emphasize that patients need to try the drop for at least a week and can try using it in one or both eyes.
Patients might also come in to see me about getting laser vision correction such as LASIK, PRK or SMILE, but a subset of these patients are hoping these surgeries will solve their near vision issues. In these scenarios, I set expectations with patients that modern-day laser vision correction surgeries cannot fully correct both distance and near vision. They may be better candidates for monovision or multifocal contact lenses, monovision LASIK, PRK or SMILE, or a clear lensectomy with a premium lens implant.
Healio/OSN: Are there other patients you can consider for Vuity?
Venkateswaran: I have been using Vuity for the pseudophakic population. Some patients who have had premium lens technologies, such as an extended depth of focus lens, may not get as much reading vision as they had wanted. Inducing the pinhole effect with Vuity can sometimes augment that near vision and give them more range. It has also been helpful in patients with corneal scars, keratoconus or irregular corneal architecture. The drop helps focus the light rays better, prevents light scatter and can help patients have a increased quality of vision, including some improvement in visual acuity. The drop is in ways a precursor to using the IC-8 Apthera IOL (AcuFocus) that was recently approved by the FDA in July. This is an exciting small aperture IOL that creates a permanent pinhole, which is helpful for patients with irregular corneas.
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