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Lievens CW, Hom MM, McLaurin EB, Yuan J, Safyan E, Liu H. Pilocarpine HCl 1.25% for treatment of presbyopia after laser vision correction: pooled analysis of two phase 3 randomized trials (GEMINI 1 and 2). J Cataract Refract Surg 2024; 50:57-63. [PMID: 37702453 DOI: 10.1097/j.jcrs.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To evaluate the efficacy of topical pilocarpine HCl 1.25% (Pilo) in treating presbyopia in individuals with or without a history of laser vision correction (laser-assisted in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]). SETTING Multiple clinical sites. DESIGN Pooled analysis of 2 identically designed prospective, randomized, vehicle-controlled studies (GEMINI 1 and 2). METHODS Adults aged 40 to 55 years with presbyopia received once-daily Pilo or vehicle bilaterally for 30 days. Responder rates for ≥3-line improvement in mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) were determined on day 30. RESULTS Among participants with a history of LASIK/PRK (n = 39 in the Pilo group, n = 41 in the vehicle group), responder rates for ≥3-line improvement in DCNVA on day 30 at hours 0.25, 0.5, 1, 3, 6, 8, and 10, respectively, were 16.7%, 38.9%, 41.7%, 37.8%, 16.2%, 13.9%, and 8.3% with Pilo and 0.0%, 2.6%, 10.5%, 5.1%, 7.7%, 2.6%, and 0.0% with vehicle. Responder rates in the LASIK/PRK subgroup were significantly higher with Pilo than vehicle at hours 0.25 ( P = .0087), 0.5 ( P = .0001), 1 ( P = .0022), and 3 ( P = .0005). In contrast, there were no significant differences in responder rates between Pilo-treated participants with and without LASIK/PRK. Among non-LASIK/PRK participants in the Pilo group (n = 336), responder rates for ≥3-line improvement in DCNVA on day 30 at hours 0.25, 0.5, 1, 3, 6, 8, and 10, respectively, were 16.8%, 32.7%, 39.0%, 28.0%, 17.4%, 12.6%, and 10.5%. CONCLUSIONS Pilo treatment effectively and similarly improved DCNVA in presbyopes with or without a history of laser vision correction.
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Affiliation(s)
- Chris W Lievens
- From the The Eye Center at Southern College of Optometry, Memphis, Tennessee (Lievens); Canyon City Eyecare, Azusa, California (Hom); Total Eye Care, P.A., Memphis, Tennessee (McLaurin); Allergan, an AbbVie company, Irvine, California (Yuan, Safyan, Liu)
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Kannarr S, El-Harazi SM, Moshirfar M, Lievens C, Kim JL, Peace JH, Safyan E, Liu H, Zheng S, Robinson MR. Safety and Efficacy of Twice-Daily Pilocarpine HCl in Presbyopia: The Virgo Phase 3, Randomized, Double-Masked, Controlled Study. Am J Ophthalmol 2023; 253:189-200. [PMID: 37149245 DOI: 10.1016/j.ajo.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To evaluate the safety, efficacy, and pharmacokinetics of pilocarpine hydrochloride 1.25% (Pilo hereafter) compared with vehicle when administered bilaterally, twice daily (6 hours apart) for 14 days in participants with presbyopia. DESIGN Phase 3, randomized (1:1), controlled, double-masked, multicenter study. METHODS Participants (40-55 years of age) had objective and subjective evidence of presbyopia affecting daily activities with mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) of 20/40 to 20/100. The primary/key secondary endpoint was the proportion of participants gaining ≥3 lines in mesopic/photopic, high-contrast, binocular DCNVA on day 14 (last study visit), hour 9 (3 hours after the second dose), with no more than a 5-letter loss in mesopic/photopic corrected distance visual acuity with the same refractive correction. Key safety measures included treatment-emergent adverse events (TEAEs) and some ocular measurements. Pilocarpine plasma levels were assessed in approximately 10% of enrolled participants. RESULTS Overall, 230 participants were randomized to Pilo twice daily (N = 114) and vehicle (N = 116). The proportion of participants achieving the primary and key secondary efficacy endpoints was statistically significantly greater with Pilo twice daily than vehicle, with between-treatment differences of 27.3% (95% CI = 17.3, 37.4) and 26.4% (95% CI = 16.8, 36.0), respectively. The most common TEAE was headache, reported in 10 participants (8.8%, Pilo group) and 4 participants (3.4%, vehicle group). Pilocarpine's accumulation index on day 14 was ≤1.11 after the second dose. CONCLUSIONS Near-vision improvements were statistically greater with Pilo twice daily than with vehicle, without compromising distance acuity. The safety profile of Pilo twice daily was consistent with that of Pilo once daily, and systemic accumulation was minimal, supporting twice daily administration.
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Affiliation(s)
- Shane Kannarr
- From the Kannarr Eye Care (S.K.), Pittsburg, Kansas, USA
| | | | - Majid Moshirfar
- Hoopes Vision (M.M.), HDR Research Center, Draper, Utah, USA; Department of Ophthalmology and Visual Sciences (M.M.), John A. Moran Eye Center, Salt Lake City, Utah, USA; Utah Lions Eye Bank (M.M.), Murray, Utah, USA
| | | | - Jennifer Lee Kim
- Clayton Eye Clinical Research, LLC and Clayton Eye Center (J.L.K.), Morrow, Georgia, USA
| | - James H Peace
- United Medical Research Institute (J.H.P.), Inglewood, California, USA
| | - Eleonora Safyan
- Allergan, an AbbVie company (E.S., H.L., S.Z., M.R.R.), Irvine, California, USA
| | - Haixia Liu
- Allergan, an AbbVie company (E.S., H.L., S.Z., M.R.R.), Irvine, California, USA
| | - Suzanne Zheng
- Allergan, an AbbVie company (E.S., H.L., S.Z., M.R.R.), Irvine, California, USA
| | - Michael R Robinson
- Allergan, an AbbVie company (E.S., H.L., S.Z., M.R.R.), Irvine, California, USA..
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Gao R, Liu J, Zhou X, Huang L, Huang W, Xue Y, Wang F, Gong S, Wu R, Wang Y. Influence of Pilocarpine Eyedrops on the Ocular Biometric Parameters and Intraocular Lens Power Calculation. J Ophthalmol 2023; 2023:7680659. [PMID: 37455794 PMCID: PMC10348856 DOI: 10.1155/2023/7680659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To evaluate the influence of pilocarpine eyedrops on the ocular biometric parameters and whether these parameter changes affect the intraocular lens (IOL) power calculation in patients with primary angle-closure glaucoma (PACG). Methods Twenty-two PACG patients and fifteen normal subjects were enrolled. Ocular biometric parameters including the axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (Km), and white-to-white distance (WTW) were measured by using a Lenstar LS 900 device before and at least 30 minutes after instillation of 2% pilocarpine eyedrops. Lens position (LP) was calculated, and the IOL power prediction based on the ocular biometric parameters was performed using the Barrett Universal II, Haigis, Hoffer Q, Holladay I, or SRK/T formulas before and after pilocarpine application. Results In both PACG and normal groups, pilocarpine eyedrops induced a slight but statistically significant increase in the mean AL (0.01 mm for both groups) and mean LT (0.02 mm and 0.03 mm, respectively) but a significant decrease in the mean ACD (0.03 mm and 0.05 mm, respectively) and mean LP (0.02 mm and 0.04 mm, respectively). No significant changes in the mean Km and WTW were noticed in both groups. In addition, the IOL power calculation revealed insignificant changes before and after the pilocarpine instillation in both groups, regardless of the formula used. Conclusions Pilocarpine eyedrops can induce slight changes in the ocular biometric parameters including the AL, ACD, LT, and LP. However, these parameter changes will not result in a significant difference in IOL power estimation.
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Affiliation(s)
- Ruxin Gao
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Jinkun Liu
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Xiaojie Zhou
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Luping Huang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Weiyi Huang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Yingying Xue
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Fei Wang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Songjian Gong
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Renyi Wu
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Yuhong Wang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
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Ting DSJ, Liu YC, Price ER, Swartz TS, Lwin NC, Hipsley A, Mehta JS. Improvement in Accommodation and Dynamic Range of Focus After Laser Scleral Microporation: A Potential Treatment for Presbyopia. Transl Vis Sci Technol 2022; 11:2. [DOI: 10.1167/tvst.11.12.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Darren S. J. Ting
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Singapore Eye Research Institute, Singapore
| | - Yu-Chi Liu
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Duke–NUS Graduate Medical School, Singapore
| | | | | | | | | | - Jodhbir S. Mehta
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Duke–NUS Graduate Medical School, Singapore
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Croft MA, Nork TM, Heatley G, Mcdonald JP, Katz A, Kaufman PL. Intraocular accommodative movements in monkeys; relationship to presbyopia. Exp Eye Res 2022; 222:109029. [PMID: 35283107 PMCID: PMC9749451 DOI: 10.1016/j.exer.2022.109029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/21/2022] [Accepted: 03/06/2022] [Indexed: 12/16/2022]
Abstract
Our goal was to quantify the age-related changes in the dynamic accommodative movements of the vitreous and aqueous humor in iridic, aniridic, phakic and aphakic primate eyes. Six bilaterally iridic and four bilaterally iridectomized rhesus monkeys, ranging in age from 6 to 25 years, received a stimulating electrode in the midbrain Edinger-Westphal nucleus to induce accommodation, measured by a Hartinger coincidence refractometer. One of the four iridectomized monkeys underwent unilateral extracapsular and another monkey underwent intracapsular lens extraction. Eyes were imaged utilizing specialized techniques and contrast agents to resolve intraocular structures. During accommodation the anterior hyaloid membrane and the posterior lens capsule bowed backward. Central vitreous fluid and structures/strands moved posteriorly toward the optic nerve region as peripheral vitreous, attached to the vitreous zonule, was pulled forward by ciliary muscle contraction. Triamcinolone particles injected intravitreally were also observed in the anterior chamber and moved from the anterior chamber toward the cleft of the anterior hyaloid membrane and then further posteriorly into the vitreous-filled cleft between the vitreous zonule and the ciliary body pars plana. These accommodative movements occurred in all eyes, and declined with age. There are statistically significant accommodative movements of various intravitreal structures. The posterior/anterior fluid flow between the anterior chamber and the vitreous compartments during accommodation/disaccommodation represents fluid displacement to allow/facilitate lens thickening. The posterior accommodative movement of central vitreous fluid may result from centripetal compression of the anterior tips of the cistern-like structure attached to the vitreous zonule, and posterior displacement of the central trunk of the cistern during ciliary muscle contraction and centripetal muscle movement. The findings may have implications for presbyopia.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA.
| | - T Michael Nork
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Gregg Heatley
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Jared P Mcdonald
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Alexander Katz
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA; Wisconsin National Primate Research Center, Madison, WI, 53792, USA; McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53792, USA
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Topical Review: Pilocarpine-induced Miosis as Help for Early Presbyopes? Optom Vis Sci 2022; 99:632-634. [PMID: 35848990 DOI: 10.1097/opx.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE The clinical utility of ophthalmic pilocarpine induced pupil constriction to help overcome image blur of close-up targets in patients with failing accommodation is examined.Pilocarpine in low concentration ophthalmic solution eye drops constricts the pupil to about 2 mm and thus reduces defocus blur. To gain regulatory approval of this drug for the treatment of presbyopia, clinical trials were conducted with 1.25% pilocarpine. Near vision was improved in a modest proportion of early presbyopes: between 12% and 22% more patients reached criterion near visual acuity than with a placebo, depending on conditions. The drug is well tolerated, its effect has onset of just minutes and lasts several hours. Small pupils will cause diminished night vision and may have an impact on distance acuity to which possible minor drug-induced accommodative spasms could contribute. The therapy has a role for patients who want to postpone or briefly pause dioptric supplementation of their failing accommodation. No convincing case has been made for one version of ophthalmic pilocarpine over another.
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Waring GO, Price FW, Wirta D, McCabe C, Moshirfar M, Guo Q, Gore A, Liu H, Safyan E, Robinson MR. Safety and Efficacy of AGN-190584 in Individuals With Presbyopia: The GEMINI 1 Phase 3 Randomized Clinical Trial. JAMA Ophthalmol 2022; 140:363-371. [PMID: 35238902 PMCID: PMC8895317 DOI: 10.1001/jamaophthalmol.2022.0059] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE AGN-190584 (Allergan, an AbbVie company) is an optimized topical formulation of pilocarpine hydrochloride, 1.25%, designed for managing presbyopia and enhanced with a proprietary vehicle. OBJECTIVE To evaluate the efficacy and safety of pilocarpine hydrochloride, 1.25%, in individuals with presbyopia. DESIGN, SETTING, AND PARTICIPANTS This vehicle-controlled, participant- and investigator-masked, randomized, phase 3 clinical study, GEMINI 1, enrolled individuals with presbyopia, aged 40 to 55 years, at 36 sites in the United States from December 21, 2018, to October 31, 2019. Analysis took place between February 2020 and December 2021. INTERVENTIONS AGN-190584 or the AGN-190584 formulation vehicle was administered bilaterally, once daily for 30 days. MAIN OUTCOMES AND MEASURES The proportion of participants with improvement of 3 or more lines in mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) at hours 3 and 6 on day 30 were the primary and key secondary efficacy end points, respectively. Safety measures included adverse events. RESULTS Of 323 participants who were randomized, 235 (72.8%) were female and 292 (90.4%) were White. The mean (SD) age was 49.6 (3.5) years, and the baseline mean (SD) mesopic DCNVA was 29.2 (6.3) letters. A total of 163 individuals were randomized to AGN-190584 and 160 were randomized to vehicle. GEMINI 1 met its primary and key secondary efficacy end points. On day 30, hour 3, the percentage of participants with improvement of 3 or more lines in mesopic DCNVA was 30.7% (50 of 163) in the AGN-190584 group and 8.1% (13 of 160) in the vehicle group (difference, 22.5% [95% CI, 14.3%-30.8%]; adjusted P < .001). At hour 6, those percentages were 18.4% (30 of 163) and 8.8% (14 of 160), respectively (difference, 9.7% [95% CI, 2.3%-17.0%]; adjusted P = .01). At hour 8, the between-group difference in 3 or more lines of mesopic DCNVA gains was not statistically significant, but clinically relevant prespecified outcome measures demonstrated AGN-190584 superiority to vehicle in least-squares mean (SE) mesopic DCNVA change from baseline at hour 8 (5.4 [0.51] vs 3.6 [0.52] letters; P = .009) and photopic distance-corrected intermediate visual acuity at hour 8 (3.9 [0.44] vs 2.4 [0.45] letters; P = .01) and hour 10 (3.5 [0.46] vs 1.7 [0.47] letters; P = .004). No participants with mesopic DCNVA improvement of 3 or more lines at hour 3 had losses of more than 5 letters in mesopic, high-contrast, binocular-corrected distance visual acuity. The onset of effect was at 15 minutes. AGN-190584 demonstrated an acceptable safety and tolerability profile. CONCLUSIONS AND RELEVANCE AGN-190584 demonstrated superiority over vehicle in mesopic DCNVA on day 30, hours 3 and 6, with an acceptable safety profile. AGN-190584 is a safe and efficacious topical therapy for presbyopia through 30 days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03804268.
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Affiliation(s)
| | | | - David Wirta
- Eye Research Foundation, Newport Beach, California
| | | | - Majid Moshirfar
- Hoopes Vision Research Center, Draper, Utah,John A. Moran Eye Center, University of Utah, Salt Lake City
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Ma KK, Rose-Nussbaumer J. Clinical Trial Design-The Best Approach Is Often the Simple One. JAMA Ophthalmol 2022; 140:371-372. [PMID: 35238898 DOI: 10.1001/jamaophthalmol.2022.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kevin K Ma
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Jennifer Rose-Nussbaumer
- Byers Eye Institute, Stanford University, Palo Alto, California.,Francis I. Proctor Foundation, University of California, San Francisco
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Benozzi G, Cortina ME, Gimeno E, Vantesone DL, Solas AE, Lorda GM, Facal S, Leiro J, Orman B. A multicentric study of pharmacological treatment for presbyopia. Graefes Arch Clin Exp Ophthalmol 2021; 259:2441-2450. [PMID: 33704563 DOI: 10.1007/s00417-021-05138-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the safety, efficacy, and patient satisfaction with a pharmacological treatment of presbyopia performed with the Benozzi's method. METHODS A non-randomized multicentric case-series retrospective study was developed. Were included patients from 5 centers of Argentina, from January 2010 to June 2019, aged at baseline between 40 and 60 years old, with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger (J) 2 or worse. The treatment was performed with a patented formulation (pilocarpine and diclofenac preservative-free eye drops). The main outcome was binocular UNVA and UDVA. Differences were evaluated by paired t-test. The presence of side effects and patient's satisfaction were also evaluated. Data was analyzed in separated groups according to their follow-up time, from 2 to 10 years. RESULTS A total of 148 patients were included. At baseline, the UNVA for the different groups were between J3 and J8 which was improved to J1 to J2. The mean baseline UDVA has been ranged between 0.02 and 0.04 logMAR. The mean baseline UDVA has been ranged between 0.02 to 0.04 logMAR, after treatment were between 0.01 to 0.03, without a statisticallysignificant improvement. Side effects were spontaneously resolved, and subjective evaluation shows that patients were satisfied. CONCLUSIONS This first multicentric shows that Benozzi's method for presbyopia treatment was safety and improves the UNVA without affecting the UDVA, maintaining their efficacy even after 10 years, in a population aged between 40 and 60 years old, from different ophthalmic centers in Argentina.
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Affiliation(s)
- Giovanna Benozzi
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina
| | | | | | | | | | | | - Sonia Facal
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Juliana Leiro
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Betina Orman
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina. .,Pharmacology Unit, School of Dentistry, Universidad de Buenos Aires, M. T. de Alvear 2142 - 4to. Piso "B", 1122AAH, Buenos Aires, Argentina.
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Benozzi G, Perez C, Leiro J, Facal S, Orman B. Presbyopia Treatment With Eye Drops: An Eight Year Retrospective Study. Transl Vis Sci Technol 2020; 9:25. [PMID: 32832231 PMCID: PMC7414614 DOI: 10.1167/tvst.9.7.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the safety and efficacy across time, of patients topically treated with Benozzi's method for presbyopia. Methods A nonrandomized case series retrospective study was developed, including patients with emmetropia with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger 2 or worse. The study was set in Buenos Aires, Argentina, from January 2011 to June 2018, with at least 1-year follow-up. Patients were treated with pilocarpine and diclofenac preservative-free eye drops (Benozzi Method; US 8.524.758 B2, EP1.938.839 B1), and the main outcome measured was binocular UNVA at different follow-up times. Other parameters, as the UDVA and presence of side effects, were evaluated. Results A total of 910 patients were included with a mean age at baseline of 48.67 ± 3.72 years old (range, 40–59 years). The baseline UNVA was 4.74 ± 1.53 and at 8 years of follow-up was decreased to 1.36 ± 0.48 (Jaeger scale). The mean binocular UDVA at baseline was 0.00 ± 0.01 logarithm of the minimum angle of resolution (logMAR) and after 8 years of follow-up was 0.03 ± 0.04 logMAR. All side effects reported (decrease of light perception, headaches, symptoms of ocular surface dryness, and dizziness) were spontaneously resolved in patients who continued with the treatment. Conclusions The efficacy of the pharmacological treatment of presbyopia to improve the UNVA without affecting the UDVA is shown. Side effects were well tolerated and resolved before 1 year of treatment. Translational Relevance This is a nonsurgical option for patients with emmetropic presbyopia who do not wish to wear glasses, which is a pharmacological treatment with eye drops.
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Affiliation(s)
- Giovanna Benozzi
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina.,Pharmacology Unit, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Cristian Perez
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Juliana Leiro
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Sonia Facal
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Betina Orman
- Pharmacology Unit, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Tong L, Cui D, Zeng J. Effects of topical pilocarpine on ocular growth and refractive development in rabbits. Eur J Ophthalmol 2020; 31:2107-2115. [PMID: 32524847 DOI: 10.1177/1120672120934962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to investigate whether topical pilocarpine affects ocular growth and refractive development as well as the underlying biochemical processes in early eye development in rabbits. METHODS Twenty three-week-old New Zealand white rabbits were treated with 0.5% pilocarpine in the right eye for 6 weeks. The left eyes served as contralateral controls. The effects of pilocarpine on refractive error, corneal curvature and ocular biometrics were assessed using streak retinoscopy, keratometry, and A-scan ultrasonography, respectively. Eyeballs were enucleated for histological analysis. The ciliary body and sclera were homogenized to determine the mRNA and protein expression levels of five subtypes of muscarinic receptors. RESULTS Compared to control eyes, pilocarpine-treated eyes exhibited approximately -1.63 ± 0.54 D myopia accompanied by a 0.11 ± 0.04 mm increase in axial length (AL) (p < 0.001, respectively). The anterior chamber depth (ACD) was reduced, whereas the lens thickness (LT) and vitreous chamber depth (VCD) increased (p < 0.001, respectively). Corneal curvature decreased over time but was not significantly different between treated and control eyes. The mRNA and protein expression levels of five subtypes of muscarinic receptors were upregulated in the ciliary body and downregulated in the sclera. CONCLUSIONS Based on these results, pilocarpine can induce myopic shift, increase LT, elongate VCD and AL, and reduce muscarinic receptor expression in the sclera early in development. These changes raise the possibility that pilocarpine may promote axial elongation in ocular development and facilitate the emmetropization of hyperopic eyes.
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Affiliation(s)
- Liyang Tong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dongmei Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Koopmans SA, Terwee T, Hanssen A, Martin H, Langner S, Stachs O, van Kooten TG. Prevention of capsule opacification after accommodating lens refilling: pilot study of strategies evaluated in a monkey model. J Cataract Refract Surg 2015; 40:1521-35. [PMID: 25135545 DOI: 10.1016/j.jcrs.2014.02.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 02/20/2014] [Accepted: 02/22/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To test 2 strategies to prevent capsule opacification after accommodating lens refilling in a rhesus monkey model. SETTING Animal laboratory and laboratory of European university medical centers. DESIGN Experimental study. METHODS Six rhesus monkeys had refilling of the lens capsular bag. In the first strategy, before it was filled with a silicone polymer, the capsular bag was treated with noncommercial sodium hyaluronate 1.0% containing cytotoxic substances. In the second strategy, the capsular bag was filled with clinically used sodium hyaluronate 1.0% (Healon) after treatment with actinomycin-D. Slitlamp inspection was performed during a follow-up of 40 to 50 weeks. After enucleation, magnetic resonance images were obtained and confocal fluorescence imaging was performed. RESULTS Using the first strategy, capsule opacification developed in all eyes. Using the second strategy, 1 monkey did not develop capsule opacification after a 9-month follow-up. In a second monkey, the lens capsule remained clear for 3 months, after which the hyaluronate refill material was exchanged with a silicone polymer and capsule opacification developed. Combining these results with those in a previous study, the difference in opacification between silicone and sodium hyaluronate as refilling materials was statistically significant (P<.01). CONCLUSIONS That no capsular bag fibrosis occurred in the presence of hyaluronate suggests that the properties of hyaluronate are the reason that remaining lens epithelial cells do not develop into fibrotic cells. The choice of a suitable lens-refilling material prevents the development of capsule opacification. FINANCIAL DISCLOSURE Mr. Terwee was an employee of Abbott Medical Optics B.V. during the study period. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Steven A Koopmans
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
| | - Thom Terwee
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany
| | - Alex Hanssen
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany
| | - Heiner Martin
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany
| | - Soenke Langner
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany
| | - Oliver Stachs
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany
| | - Theo G van Kooten
- From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany
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13
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Fang F, Huang F, Xie R, Li C, Liu Y, Zhu Y, Qu J, Zhou X. Effects of muscarinic receptor modulators on ocular biometry of guinea pigs. Ophthalmic Physiol Opt 2014; 35:60-9. [PMID: 25376436 DOI: 10.1111/opo.12166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Fang Fang
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Furong Huang
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Ruozhong Xie
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Cheng Li
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Yin Liu
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Ying Zhu
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Jia Qu
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
| | - Xiangtian Zhou
- School of Optometry and Ophthalmology and Eye Hospital; Wenzhou Medical College; Zhejiang China
- State Key Laboratory Cultivation Base and Key Laboratory of Vision Science; Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry; Ministry of Health P.R. China; Zhejiang China
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Pharmacologically and Edinger-Westphal stimulated accommodation in rhesus monkeys does not rely on changes in anterior chamber pressure. Exp Eye Res 2014; 125:244-55. [PMID: 24983145 DOI: 10.1016/j.exer.2014.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 11/21/2022]
Abstract
This study was undertaken to understand the role of anterior chamber pressure (ACP) during pharmacological and Edinger-Westphal (EW) stimulated accommodation in anesthetized monkeys. Experiments were performed on one iridectomized eye each of 7 anesthetized adolescent rhesus monkeys. Accommodation was induced by EW stimulation (n = 2) and intravenous administration of 0.25-4.0 mg/kg pilocarpine (n = 6). Accommodative refractive and biometric changes were measured with continuous 60 Hz infrared photorefraction (n = 6) and 100 Hz A-scan ultrasound biometry (n = 1). An ocular perfusion system was used to measure and manipulate ACP. Pressure was recorded via a 27-gauge needle in the anterior chamber connected to a pressure transducer (n = 7). The needle was also connected to a fluid reservoir to allow ACP to be manipulated and clamped (n = 4) by raising or lowering the fluid reservoir. In all six pharmacologically stimulated monkeys ACP increased during accommodation, from 0.70 to 2.38 mmHg, four of which showed pressure decreases preceding the pressure increases. Two eyes also showed increases in ACP during EW-stimulated accommodation of 2.8 and 7.2 mmHg. ACP increased with increasing EW stimulus amplitudes (n = 2). Clamping or externally manipulating ACP had no effect on resting refraction or on EW and pharmacologically stimulated accommodation in four eyes. The results show that EW stimulated and pharmacologically stimulated accommodation do not rely on ACP in rhesus monkeys.
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15
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Nickla DL, Zhu X, Wallman J. Effects of muscarinic agents on chick choroids in intact eyes and eyecups: evidence for a muscarinic mechanism in choroidal thinning. Ophthalmic Physiol Opt 2013; 33:245-56. [PMID: 23662958 DOI: 10.1111/opo.12054] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 03/06/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE In chicks, ocular growth inhibition is associated with choroidal thickening and growth stimulation with choroidal thinning, suggesting a mechanistic link between the two responses. Because muscarinic antagonists inhibit the development of myopia in animal models by a non-accommodative mechanism, we tested the hypothesis that agonists would stimulate eye growth and thin the choroid. We also hypothesized that the effective growth-inhibiting antagonists would thicken the choroid. METHODS Chicks, age 12-16 days, were used. In vivo: Agonists: Single intravitreal injections (20 μL) of oxotremorine (oxo), pilocarpine (pilo), carbachol (carb), or arecaidine (arec) were given to otherwise untreated eyes. A-scan ultrasonography was done prior to injections, and at 3, 24, 48 and 72 h. Antagonists: -10D lenses were worn on one eye for 4 days. Atropine (atro), pirenzepine (pirz), oxyphenonium (oxy) or dicyclomine (dicy) were injected (20 μL) daily into lens-wearing eyes; saline injections were done as controls. Ultrasonography was done on d1 and on d4; on d4 measurements were done before and 3 h after injections. In vitro: Paired eyecups of retinal pigment epithelium (RPE), choroid and sclera were made from 1-week old chicks. All drugs except atropine were tested on one eyecup, its pair in plain medium. Choroidal thickness was measured at various times over 48 h. RESULTS Agonists: In vivo, oxotremorine caused an increase in the rate of axial elongation (drug vs saline: 24-72 h: 338 μm vs 250 μm; p < 0.001). All except pilocarpine caused choroidal thinning by 24 h (oxo, carb and arec vs saline: -25, -35 and -46 μm vs 3 μm). In vitro, all agonists thinned choroids by 24 h (oxo: -6 vs 111 μm; pilo: 45 vs 212 μm; carb: -58 vs 65 μm; arec: 47 vs 139 μm; p < 0.05). Antagonists: Atropine, pirenzepine and oxyphenonium inhibited the development of myopia in negative lens-wearing eyes, and also caused choroidal thickening (drug vs saline: 42, 80, 88 vs 10 μm per 3 h). In vitro, pirenzepine thickened choroids by 3 h (77 vs 2 μm, p < 0.01). CONCLUSIONS Muscarinic agonists caused choroidal thinning in intact eyes and eyecups, supporting a role for acetylcholine in the choroidal response to hyperopic defocus or form deprivation. Only oxotremorine stimulated eye growth, which is inconsistent with a muscarinic receptor mechanism for antagonist-induced eye growth inhibition. The dissociation between choroidal thinning and ocular growth stimulation for the other agonists in vivo suggest separate pathways for the two.
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Affiliation(s)
- Debora L Nickla
- Department of Biomedical Sciences and Disease, The New England College of Optometry, Boston, MA, USA.
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Comparison between carbachol iontophoresis and intravenous pilocarpine stimulated accommodation in anesthetized rhesus monkeys. Exp Eye Res 2013; 115:123-30. [DOI: 10.1016/j.exer.2013.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 06/13/2013] [Accepted: 06/30/2013] [Indexed: 11/19/2022]
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He L, Wendt M, Glasser A. Long-term reproducibility of Edinger-Westphal stimulated accommodation in rhesus monkeys. Exp Eye Res 2013; 113:80-6. [PMID: 23722076 DOI: 10.1016/j.exer.2013.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/31/2013] [Accepted: 05/18/2013] [Indexed: 11/30/2022]
Abstract
If longitudinal studies of accommodation or accommodation restoration procedures are undertaken in rhesus monkeys, the methods used to induce and measure accommodation must remain reproducible over the study period. Stimulation of the Edinger-Westphal (EW) nucleus in anesthetized rhesus monkeys is a valuable method to understand various aspects of accommodation. A prior study showed reproducibility of EW-stimulated accommodation over 14 months after chronic electrode implantation. However, reproducibility over a period longer than this has not been investigated and therefore remains unknown. To address this, accommodation stimulation experiments in four eyes of two rhesus monkeys (13.7 and 13.8 years old) were evaluated over a period of 68 months. Carbachol iontophoresis stimulated accommodation was first measured with a Hartinger coincidence refractometer (HCR) two weeks before electrode implantation to determine maximum accommodative amplitudes. EW stimulus-response curves were initially measured with the HCR one month after electrode implantation and then repeated at least six times for each eye in the following 60 months. At 64 months, carbachol iontophoresis induced accommodation was measured again. At 68 months, EW stimulus-response curves were measured with an HCR and photorefraction every week over four consecutive weeks to evaluate the short-term reproducibility over one month. In the four eyes studied, long-term EW-stimulated accommodation decreased by 7.00 D, 3.33 D, 4.63 D, and 2.03 D, whereas carbachol stimulated accommodation increased by 0.18 D-0.49 D over the same time period. The short-term reproducibility of maximum EW-stimulated accommodation (standard deviations) over a period of four weeks at 68 months after electrode implantation was 0.48 D, 0.79 D, 0.55 D and 0.39 D in the four eyes. Since the long-term decrease in EW-stimulated accommodation is not matched by similar decreases in carbachol iontophoresis stimulated accommodation, the decline in accommodation cannot be due to the progression of presbyopia but is likely to result from variability in EW electrode position. Therefore, EW-stimulated accommodation in anesthetized monkeys is not appropriate for long-term longitudinal studies of age-related loss of accommodation or accommodation restoration procedures.
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Affiliation(s)
- Lin He
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX 77204, United States
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Wendt M, Glasser A. Reproducibility of carbachol stimulated accommodation in rhesus monkeys. Exp Eye Res 2012; 99:89-97. [PMID: 22504035 DOI: 10.1016/j.exer.2012.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/15/2012] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
Approaches are being explored to restore accommodation to the presbyopic eye. Some of these approaches can be tested in monkeys by stimulating accommodation in various ways including using carbachol iontophoresis. Knowledge of the repeatability of carbachol iontophoresis stimulated accommodation in the monkey phakic eye is necessary to understand the variability of this method of evaluating accommodation. Data from 9 to 10 separate carbachol iontophoresis experiments performed on phakic eyes from 8 monkeys were retrospectively analyzed. For each experiment, carbachol was applied iontophoretically to the eyes of anesthetized monkeys and refraction generally measured every two minutes until accommodation reached a plateau. Repeated experiments were performed in each monkey over periods ranging from 10 to 18 months. Maximum accommodation measured for each monkey ranged from 11.1 D to 18.3 D with standard deviations from 0.8 D to 2.1 D and differences in accommodative amplitude varying from 2.2 D to 7.5 D. Time to reach maximum accommodation ranged from 18 to 64 min in individual experiments. Averaged time-courses indicate that maximum accommodation is generally achieved between 10 and 20 min after carbachol administration. Although carbachol iontophoresis is considered a reliable method to stimulate maximum accommodation in anesthetized monkeys, the amplitude achieved typically varies by more than 2 D. Presbyopia treatments evaluated in this way in phakic monkeys would need to show an increase in accommodation of over 2 D to clearly demonstrate that the treatments work when being tested with carbachol iontophoresis stimulation.
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Affiliation(s)
- Mark Wendt
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX 77204, USA
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He L, Wendt M, Glasser A. Full-field accommodation in rhesus monkeys measured using infrared photorefraction. Invest Ophthalmol Vis Sci 2012; 53:215-23. [PMID: 22125278 DOI: 10.1167/iovs.11-8324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Full-field photorefraction was measured during accommodation in anesthetized monkeys to better understand the monkey as a model of human accommodation and how accommodation affects off-axis refraction. METHODS A photorefraction camera was rotated on a 30-cm-long rod in a horizontal arc, with the eye at the center of curvature of the arc so that the measurement distance remained constant. The resistance of a potentiometer attached to the rotation center of the rod changed proportionally with the rotation angle. Photorefraction and rotation angle were simultaneously measured at 30 Hz. Trial-lens calibrations were performed on-axis and across the full field in each eye. Full-field refraction measurements were compared using on-axis and full-field calibrations. In five iridectomized monkeys (mean age in years ± SD: 12.8 ± 0.9), full-field refraction was measured before and during carbachol iontophoresis stimulated accommodation, a total of seven times (with one repeat each in two monkeys). RESULTS Measurements over approximately 20 seconds had <0.1 D of variance and an angular resolution of 0.1°, from at least -30° to 30°. Photorefraction calibrations performed over the full field had a maximum variation in the calibration slopes within one eye of 90%. Applying full-field calibrations versus on-axis calibrations resulted in a decrease in the maximum SDs of the calculated refractions from 1.99 to 0.89 D for relative peripheral refractive error and from 4.68 to 1.99 D for relative accommodation. CONCLUSIONS By applying full-field calibrations, relative accommodation in pharmacologically stimulated monkeys was found to be similar to that reported with voluntary accommodation in humans.
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Affiliation(s)
- Lin He
- College of Optometry, University of Houston, Houston, Texas 77204, USA
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Benozzi J, Benozzi G, Orman B. Presbyopia: a new potential pharmacological treatment. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2012; 1:3-5. [PMID: 24600609 PMCID: PMC3939740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Presbyopia occurs after 40 years of age in humans with a progressive loss of accommodation. Accommodation depends on the contraction of the ciliary muscle and iris, lens changes and convergence. The parasympathetic system regulates the degree of ciliary muscle and iris contraction necessary to modify the shape and position of the lens and its stimulation is effective through the activation of muscarinic receptors that are present in both structures. The hypothesis proposed here suggests the correction of accommodation in emmetropic presbyopic patients using a pharmacological treatment that includes a cholinergic agent combined with non-steroidal anti-inflammatory drugs (NSAIDs). This drug combination can restore near vision without affecting distance vision. It is important to note that the pharmaceutical form used was devoid of any inflammatory or other collateral effects.
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Affiliation(s)
- Jorge Benozzi
- Fundación Argentina de Glaucoma, Buenos Aires, Argentina
| | | | - Betina Orman
- Pharmacological Unit, Faculty of Dentistry, Buenos Aires University, Argentina
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