BLOG: How to get started with presbyopia-correcting drops
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With a new pharmaceutical treatment option, my conversations with presbyopic patients have gotten a lot more exciting.
When patients appear to be good candidates for Vuity (pilocarpine HCl ophthalmic solution 1.25%; Allergan, an AbbVie company), I tell them about this new treatment category, and about nine out of 10 are eager to try it.
The pharmaceutical solution can be appropriate for a wide variety of patient types, including emmetropes, low hyperopes and low myopes with presbyopia.
I have prescribed Vuity for post-LASIK patients in their early 40s who desire enhanced near and intermediate vision. Pseudophakes of any age may benefit from the drop, but for those with their natural lens, the sweet spot appears to range from early 40s to the 60s. Patients are highly motivated to try new technology to help them see up close, and they are very happy with the results.
I consider this a lifestyle drop. Most of my patients are using it 3 or 4 days a week – often on weekends, when they are going out at night. For them, one bottle may last a few months, which is a good value.
Vuity takes about 15 minutes to work. In light eyes the effect is quicker, but does not last as long, and the opposite is true for darker eyes. The difference, however, is quite subtle.
The refill rates have been high, which tells me these patients are doing well and are satisfied.
I am candid with patients about what to expect and let them know the effect will wane over time. Despite some early concern from eye care providers about headaches, that has not been an issue in my experience. There is a period of neuro-adaptation, and there may be initial stinging, dim vision due to the small pupil and redness that resolves with use. We are seeing that younger patients who still have some accommodating ability may experience altered distance vision.
I recommend that patients use the drop for at least 7 days, and any side effects should abate during that time. Tolerability has been high.
Our practice has come up with a "cheat sheet" for patients that includes suggestions for experimenting with the drops as well as some tips and tricks.
For example, I tell patients they can use it off label twice a day or in just one eye. The sheet also covers adaptation and other information to help them have a successful experience.
This presbyopia-correcting drop is not for everyone, however. Although about 90% of patients are excited to try it and do well; those with extremely large or very small pupils might not have as much success.
Vuity opens up a door of opportunity for us to see individuals who wear reading glasses and have never had an eye exam, which is a large proportion of presbyopes. We have a chance to help these patients by providing comprehensive eye exams and identifying other pathologies.
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