Pharmacological treatment of presbyopia

Rosenfield, Mark

doi:10.1111/opo.12995

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…In addition, pilocarpine can lead to contraction of the ciliary muscle, which may on the one hand improve accommodation and in turn near vision, but on the other hand can impact visual acuity [ 85 ]. In rare cases, pilocarpine could result in an accommodative spasm [ 46 ]. Nevertheless, safety studies have shown that pilocarpine in concentrations up to 1.5% has an acceptable safety and tolerability profile [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly used drug for inducing pupil constriction is pilocarpine, a cholinergic muscarinic receptor agonist that acts through the M3 muscarinic receptors. Pilocarpine binds and activates muscarinic M3 receptors located on the iris sphincter [ 45 ] and on the ciliary body, inducing both pupillary miosis and, potentially, accommodative spasm [ 46 ]. Moreover, pilocarpine stimulates the contraction of the longitudinal ciliary muscle fibers, which pull on tendons terminating in the trabecular meshwork and the inner wall of Schlemm’s canal.…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, Vuity’s prescribing information states ‘Patients should be advised to exercise caution in night driving and other hazardous occupations in poor illumination’ [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Miosis on the Visual Acuity Space under Varying Conditions of Contrast and Ambient Luminance in Presbyopia

Onyszkiewicz,

Hilmers,

Rejdak

et al. 2024

JCM

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Background: Presbyopia is an age-related ocular condition, typically affecting individuals aged over 40 years, characterized by a gradual and irreversible decline in the eye’s ability to focus on nearby objects. Correction methods for presbyopia encompass the use of corrective lenses, surgical interventions (corneal or lens based), and, more recently, the FDA-approved topical administration of 1.25% pilocarpine. While prior research has demonstrated the efficacy of daily pilocarpine eye drop application in enhancing near visual acuity by increasing the depth of focus leveraging the pinhole effect, limited knowledge exists regarding its influence on visual acuity under varying conditions of contrast and ambient luminance. Methods: This study aims to investigate the impact of these variables on visual acuity, employing the VA-CAL test, among 11 emmetropic and 11 presbyopic volunteers who reported subjective difficulties with near vision. This study includes evaluations under natural conditions with a pinhole occluder (diameter of 2 mm), and subsequent administration of 1% pilocarpine (Pilomann, Bausch + Lomb, Laval, Canada). Results: The VA-CAL results demonstrate the expected, statistically significant effects of contrast and ambient luminance on visual acuity in both emmetropic and presbyopic volunteers. Furthermore, in emmetropic individuals, the application of pilocarpine resulted in a statistically significant reduction in visual acuity. In contrast, presbyopes did not exhibit statistically significant differences in the visual acuity space under either the pinhole or pilocarpine conditions when compared to natural conditions. Conclusions: The pharmacological treatment of presbyopia with pilocarpine eye drops, intended to enhance near vision, does not adversely affect visual acuity in presbyopes. This suggests that pilocarpine may offer a viable alternative for individuals averse to wearing corrective eyewear.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Miosis on the Visual Acuity Space under Varying Conditions of Contrast and Ambient Luminance in Presbyopia

Onyszkiewicz,

Hilmers,

Rejdak

et al. 2024

JCM

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“…However, large pupils are most effective at expanding the depth of focus under mesopic light levels [35]. Interestingly, an increase in depth of focus may not be related with the near vision improvement as only pupils \ 2 mm can increase the depth of focus of the human eye [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Non-Miotic Improvement in Binocular Near Vision with a Topical Compound Formula for Presbyopia Correction

Vejarano

Alió

Iribarren³

et al. 2023

Ophthalmol Ther

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Introduction:The aim of this case series was to examine the association between unaided binocular visual acuity for near vision and pupil change after the instillation of a special topical formulation for presbyopia treatment. Methods: This was a case series consisting of consecutive participants with presbyopia aged 40-70 years who were tested for visual acuity and pupil diameter before and 2 h after instillation of a formulation of pilocarpine and phenylephrine drops (FOV Tears) for presbyopia. Participants underwent subjective refraction, photopic and scotopic pupil diameter measurement and unaided monocular and binocular visual acuity testing by logMAR for distance and near vision both pre-and post-instillation of eye drops.Results: The study enrolled 363 subjects (n = 176 women, 48%) with a mean (± standard deviation) age of 50.4 ± 5.8 years. Mean spherical equivalent (SE) changed significantly (-0.17 Diopters) after instillation of the FOV Tears formulation (p \ 0.001). Post-instillation of eye drops, the scotopic pupil diameter decreased by 0.97 ± 0.98 mm, and the near visual acuity by logMAR improved significantly by nearly two lines (p \ 0.01). In the linear regression analyses, age (p \ 0.001) and SE predrop instillation (p \ 0.001) were associated with unaided binocular visual acuity. The changes in photopic pupil diameter and the scotopic pupil diameter were not associated with unaided binocular visual acuity.Conclusions: The use of the pilocarpine and phenylephrine formulation (FOV Tears) improved binocular visual acuity for near vision in presbyopic patients, and the effect was independent of pupil change.

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