Consider pros, cons of presbyopia eye drops
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BOSTON — Eye drops are an “exciting” technology for presbyopia in the right candidates, but ophthalmologists must educate patients on their drawbacks, according to a speaker here.
Presbyopia drops increase depth of field through the pinhole effect, while avoiding a myopic shift that affects vision. The ideal eye drop needs to have a rapid onset and good duration, as well as efficacy, safety and convenience with no side effects, Kathryn M. Hatch, MD, said at Refractive Day at the American Society of Cataract and Refractive Surgery meeting.
The ideal target for eye drops is a person with mild to moderate presbyopia.
“So, the 40- to 55-year-old who has some accommodation but is really starting to need readers,” Hatch said.
Good candidates include emmetropes, post-refractive emmetropes, mild hyperopes and pseudophakes, while contraindications include long axial length and a history of retinal tears or other retinal pathology.
Eye drop options for presbyopia include Vuity (pilocarpine hydrochloride ophthalmic solution 1.25%, Allergan) and Qlosi (pilocarpine hydrochloride ophthalmic solution 0.4%, Orasis Pharmaceuticals), both of which are FDA approved, with several other candidates in the pipeline.
Advantages of a presbyopia drop include that it is a temporary, reversible solution that lets patients “try out” vision, which may help with future surgical planning, but there are potential drawbacks.
“It’s temporary, so pro and con. ... The results are varied, depending on the patient’s age and their refractive error,” Hatch said. “And also [there is the] risk of potential side effects,” including dim vision and headache.
Drops can be a bridge for patients who are not ready for surgery, but “we do need to be aware of potential side effects and talk to patients about that as well,” she said.
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Hatch KM. Presbyopia eye drops. Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
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