BLOG: Experience with Vuity: What have we learned?
Click Here to Manage Email Alerts
We now have more than a year’s worth of experience with Vuity, the first pharmaceutical FDA approved for the treatment of age-related blurry vision or presbyopia.
Our surgical practice centers around providing patients vision for a lifetime with multiple surgical offerings for each stage of ocular maturity. Plano presbyopic patients who present with the very earliest stages of dysfunctional lens syndrome feel like they are rapidly falling off the vision cliff, and these are patients for whom we have limited surgical options.
We begin by educating these patients about what the future may hold, letting them know that their near vision will continue to decline. We share that we have a wonderful alternative: the Vuity eye drop (pilocarpine hydrochloride ophthalmic solution 1.25%, Allergan). We outline the appropriate expectations, recommendations for dosing and potential side effects and, importantly, have a carefully documented risk and benefit discussion.
The data suggest that results improve with continued use. Side effects are generally mild and self-limiting and seem to diminish after about 2 weeks of regular use. With proper counseling and education, we have had very little discontinuation due to side effects. Duration is about 6 hours, and with experience, we have become comfortable offering a second dose.
Advanced vision analysis
As a surgical practice, we have a standard approach to each stage of ocular maturity, with the mainstay of presbyopia treatment being custom lens replacement, followed by blended vision with LASIK. We perform an advanced vision analysis and obtain key diagnostic information to determine their candidacy — whether for custom lens replacement or a pharmacological drop. This includes a macular exam and OCT, a peripheral retinal exam with imaging and, importantly, axial length.
I was the lead investigator for the FDA trial, which was limited to patients with less than –4 D of myopia and showed an excellent safety profile. It did not formally study axial length. The published literature suggests that patients with longer axial length may have an increased risk for retinal detachment; therefore, we do not recommend the drop to patients with any additional risk factors for retinal detachment. The rare retinal issues observed since approval have typically been associated with patients who have a refractive status outside of the trial parameters. We essentially follow similar recommendations for custom lens replacement, and of course every case is an individual decision-making process.
The pharmacologic option is not only an additional tool in our toolbox for presbyopia correction, but its availability has also increased the public’s awareness of presbyopia as a treatable condition. Vuity has become our go-to solution for the truly incipient presbyopes seeking an alternative to glasses or contact lenses.
The drop can be useful for pseudophakes looking to enhance their reading vision and, anecdotally, off label as a tool to potentially improve dysphotopsias. We are always very careful to discuss and evaluate postoperative status in general, as well as axial length in any patient who has had surgery, whether previous LASIK or cataract surgery, as refractive status masks axial length.
Collapse