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Fernández Jiménez-Ortiz H, Toledano Fernández N. Pharmacological treatments for the correction of presbyopia. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:331-339. [PMID: 38663714 DOI: 10.1016/j.oftale.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/10/2024] [Indexed: 04/29/2024]
Abstract
Presbyopia affects between 1.7 and 2 billion people worldwide. Presbyopia significantly impacts productivity and quality of life in both developed and developing countries. During accommodation, the human eye changes its dioptric power by altering the shape of the lens, but the exact nature of this change has not been fully explained. Recently, topical treatments have been marketed for the treatment of presbyopia and others are under investigation. In order to prepare a review of these novel therapies, we searched the major biomedical search engines. We found 15 randomized clinical trials and 12 reviews that met our review criteria. There are two different strategies for this purpose, the pinhole effect that increases depth of focus and "crystalline lens relaxation" for which parasympathetic mimetics and lens oxidation intermediates have been used. The results are generally favorable in terms of improvement of near visual acuity, although the follow-up period of the studies is short. These are novel strategies in the early stages of research that could be useful in the treatment of presbyopia.
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Affiliation(s)
| | - N Toledano Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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2
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Alsaqr AM, Alasmi AM, Fagehi R, Ali A. Perception and awareness of the public about presbyopia and its corrective approaches in Saudi Arabia: a population-based survey. BMC Public Health 2024; 24:1950. [PMID: 39033287 PMCID: PMC11265060 DOI: 10.1186/s12889-024-19508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND This study investigated patients' awareness of presbyopia and its management approaches and their preferred methods for near vision correction. METHODS In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online, consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It was designed to record participants' awareness of and preferences for presbyopia and its refractive corrections. Nonparametric tests and descriptive analyses were conducted to analyse participants' responses. RESULT Approximately half of the participants had difficulty with near vision activities, such as reading newspapers or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncorrected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of presbyopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants). When asked if they were aware of management approaches other than spectacles, 72% responded with not at all. Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia correction (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyopia other than spectacles were noted. Finally, participants' age, sex, region, education, and income had a statistically significant impact on essential parts of their responses (p < 0.05). CONCLUSION Presbyopia is a highly prevalent age-related ocular disorder, and a significant percentage of cases are uncorrected due to a lack of awareness or reluctance to wear spectacles. More efficient health education about presbyopia and its corrective alternatives is urgently needed.
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Affiliation(s)
- Ali M Alsaqr
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulrahman M Alasmi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abusharha Ali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Onyszkiewicz M, Hilmers J, Rejdak R, Zrenner E, Straßer T. Effects of Miosis on the Visual Acuity Space under Varying Conditions of Contrast and Ambient Luminance in Presbyopia. J Clin Med 2024; 13:1209. [PMID: 38592033 PMCID: PMC10931829 DOI: 10.3390/jcm13051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
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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Affiliation(s)
- Maksymilian Onyszkiewicz
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Julian Hilmers
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- STZ Eyetrial, University Eye Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Robert Rejdak
- STZ Eyetrial, University Eye Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- University Eye Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Torsten Straßer
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland
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Orman B, Benozzi G. Pharmacological Treatments for Presbyopia. Drugs Aging 2023; 40:105-116. [PMID: 36670320 DOI: 10.1007/s40266-022-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/22/2023]
Abstract
Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40-50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field.
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Affiliation(s)
- Betina Orman
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina.
| | - Giovanna Benozzi
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
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Vejarano F, Alió J, Iribarren R. Review of Pharmacological Treatments for Presbyopia. CURRENT OPHTHALMOLOGY REPORTS 2023. [DOI: 10.1007/s40135-023-00307-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Haghpanah N, Alany R. Pharmacological treatment of presbyopia: A systematic review. Eur J Transl Myol 2022; 32. [PMID: 36121117 PMCID: PMC9580536 DOI: 10.4081/ejtm.2022.10781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to identify the efficacy of drug agents for pharmacological Treatment of Presbyopia. Published research papers were reviewed using the relevant terms in PubMed, Science direct, Google scholar, Medline, Google patent, Ovid, Cochrane Database of Systematic Reviews, Scopus. In the initial search, 2270 records were obtained. By removing duplicate articles and all articles that did not meet the inclusion criteria or were inappropriate due to indirect relevance to the subject, 44 studies were selected. It should be noted that all studies had inclusion criteria. There are a number of topical pharmacological agents available for treating presbyopia such as FOV Tears and PresbiDrop. They consist of parasympathetic agent and non-steroidal anti-inflammatory drugs (NSAIDs), to contract the ciliary and pupil muscle and restore the accommodation. Another example of topical pharmacological agent is EV06. It is a lens-softening eye drop which can affect the rigid lens in presbyopia. Currently there is no pharmacological agent available to treat presbyopia. Although there are limited number of peer-reviewed articles available, the outcome for future agents under investigation are promising.
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Affiliation(s)
- Negin Haghpanah
- Undergraduate Master of Pharmacy, Faculty of Science Engineering and Computing, School of Life Sciences, Pharmacy and Chemistry, Department of Pharmacy, Kingston University, London.
| | - Raid Alany
- Faculty of Science, Engineering and Computing, School of Life Sciences, Pharmacy and Chemistry, Department of Pharmacy, Kingston University , London.
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Zhu Y, Zhong Y, Fu Y. The effects of premium intraocular lenses on presbyopia treatments. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100042. [PMID: 37846220 PMCID: PMC10577869 DOI: 10.1016/j.aopr.2022.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/28/2022] [Accepted: 02/20/2022] [Indexed: 10/18/2023]
Abstract
Background Presbyopia has become a global disease affecting the world's aging population. Among various treatments, cataract extraction and intraocular lens (IOL) implantation have become the most popular and common methods of presbyopia correction. During the twentieth century, IOLs have underwent significant innovation and advancements to meet the patients' high demands for functional vision at all distances. Main Text To meet the increasing needs for excellent near and intermediate vision for daily activities, some premium IOLs with more than one focus have been developed, for example, the refractive MfIOLs, diffractive MfIOLs, extended depth of field (EDOF) IOLs, and accommodating IOLs (AIOLs) were introduced to meet this need. In addition, the add-on MfIOLs have been explored as promising supplementary IOLs for pseudophakic presbyopia. When selecting the MfIOLs, the IOLs' features, patients' characteristics, preoperative eye conditions, and treatment expectations should be considered. Conclusions In this review, we focus on the multifocal IOLs (MfIOLs) commonly used for presbyopia correction and systematically summarized their optical designs and clinical outcomes. More evidence-based studies are required to provide guidelines for MfIOL selection, provide maximum visual benefits, and develop personalized visual solutions in the future.
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Affiliation(s)
- Yanan Zhu
- Corresponding author. Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
| | | | - Yanyan Fu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
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Pharmacological Treatment in Presbyopia. J Clin Med 2022; 11:jcm11051385. [PMID: 35268476 PMCID: PMC8910925 DOI: 10.3390/jcm11051385] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/04/2022] Open
Abstract
Pharmacological treatment of presbyopia may be an alternative for those who want a spectacle-free scenario and an easy-to-use method with lower risk of irreversible ocular adverse events. There are two main agents, miotics and lens softeners, investigated as agents for the pharmacological treatment. Miotic agents treat presbyopia by creating a pinhole effect which may increase the depth of focus at all working distances. The miotic agents have been studied for application to only one eye for monovision or both eyes. Their effect is temporary with common adverse events, such as headache and dim vision at nighttime, with no known long-term safety and efficacy. There have been studies on the miotic agents in combination with other agents for additive treatment effects or lessening adverse events, however, these combination effects are not clear. Lens softeners increase the elasticity of the lens, which is targeted at one of the etiologic mechanisms of presbyopia. There is only one lens softener being investigated in only a few trials. The results were inconclusive. The recent approval of 1.25% pilocarpine for treatment of presbyopia by the US FDA may be an important milestone for investigation of real-world data of pharmacological treatment of presbyopia.
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Price FW, Hom M, Moshirfar M, Evans D, Liu H, Penzner J, Robinson MR, Lee S, Wirta DL. Combinations of Pilocarpine and Oxymetazoline for the Pharmacological Treatment of Presbyopia. OPHTHALMOLOGY SCIENCE 2021; 1:100065. [PMID: 36246939 PMCID: PMC9562347 DOI: 10.1016/j.xops.2021.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/04/2022]
Abstract
Purpose To determine the safety, efficacy, and tolerability of combinations of pilocarpine (Pilo) and oxymetazoline (Oxy) ocular drops dosed once daily and identify the optimal concentration of each for the pharmacologic treatment of presbyopia. Design Two concurrent Phase 2, multicenter, double-masked, randomized, vehicle-controlled studies, 1 short-term and 1 extended study. Participants Emmetropic individuals affected by presbyopia and in good general health. Methods Uncorrected near visual acuity (UNVA) was measured throughout both studies with various concentrations and combinations of Pilo (0%, 0.5% 1.0%, and 1.5%) and Oxy (0%, 0.0125%, 0.05%, and 0.125%). For safety, uncorrected distance visual acuity (UDVA) was measured, treatment-emergent adverse events (TEAEs) were recorded, and a temporal/supraorbital headache assessment was completed. Main Outcome Measures The primary efficacy end point was mean change from baseline in UNVA. Results In the short-term study, Pilo was shown to produce a significant dose response in the average increase of letters (P < 0.001), whereas Oxy did not have a significant impact (P = 0.4797). The addition or increase in concentration of Oxy did not reduce incidence or severity of headaches when compared with Pilo alone. Efficacy results from the extended study supported the results from the short-term study. As early as 15 minutes postadministration, a dose response could be seen, with peak effect at 1 hour. Peak improvement increased from day 1 to day 14 and was maintained up to day 28. The most common TEAE was headache. There was no clinically significant reduction in UDVA. A polynomial regression model was developed and determined that the optimal concentration range of Pilo is between 1.16% and 1.32%. Conclusions On the basis of the results of the 2 Phase 2 studies, AGN-190584, a reading drop containing an optimized concentration of pilocarpine HCl (1.25%) delivered using a proprietary formulation, was developed and is currently under investigation in Phase 3 studies.
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Tsuneyoshi Y, Negishi K, Tsubota K. Multifaceted Assessment of the Effects of an Eye Exercise for Presbyopia. Rejuvenation Res 2021; 24:417-423. [PMID: 34841886 DOI: 10.1089/rej.2021.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Exercise for presbyopia is theoretically ineffective. However, some studies have reported favorable subject responses, although the reasons were not detected. We investigated one such presbyopic exercise. Twenty-three volunteers (48.5 ± 5.0 years) viewed near (30-40 cm) and far (>5 m) points back and forth 20 times in one set and repeated this four times daily. After 2 months, the accommodation or near visual acuity did not improve. The pupillary size under accommodative stimulation decreased significantly (p = 0.04) from 4.03 ± 0.84 to 3.75 ± 0.98 mm, and the convergence amounts increased significantly (p = 0.03) from 0.71 ± 0.25 to 0.98 ± 0.46 mm. The overall satisfaction with the near vision improved significantly (p = 0.02). The changes in the pupillary sizes and convergence amounts did not differ between subjects with improved satisfaction (positive group) and those without improvement (negative group) (p = 0.50 and p = 0.94, respectively). The pupillary size after exercise was significantly (p = 0.04) smaller in the positive group (3.19 ± 0.82) than in the negative group (4.08 ± 0.94). In conclusion, the exercise for presbyopia was fundamentally ineffective to improve accommodation, however, it strengthened miosis while viewing near and might improve satisfaction for near vision. (Clinical Trial Registration number: UMIN000023561).
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Affiliation(s)
- Yukari Tsuneyoshi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Tsubota Laboratory, Inc., Tokyo, Japan
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Chang DH, Waring GO, Hom M, Barnett M. Presbyopia Treatments by Mechanism of Action: A New Classification System Based on a Review of the Literature. Clin Ophthalmol 2021; 15:3733-3745. [PMID: 34522079 PMCID: PMC8432361 DOI: 10.2147/opth.s318065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/08/2021] [Indexed: 01/07/2023] Open
Abstract
Presbyopia, a loss of accommodative ability associated with aging, is a significant cause of vision impairment globally. At the clinical level, it is a frustrating and difficult issue that negatively impacts patients’ quality of life. Less appreciated is the fact that loss of accommodative ability and its current treatments methods may present safety concerns, for example, increasing the risk of falls. Therefore, a more complete understanding of treatment options with respect to how they relate to the natural ability of the eye is needed to improve decision making and to aid clinicians in individualizing treatment options. This article reviews the options for expanding functional through focus—a term coined to describe the ability of the eye to see at all distances with minimal latency—by how they vary the refractive power over time, across the visual field, between eyes, or across a range of distances. ![]()
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Affiliation(s)
| | | | | | - Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, USA
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McDonald MB, Mychajlyszyn A, Mychajlyszyn D, Klyce SD. Advances in Corneal Surgical and Pharmacological Approaches to the Treatment of Presbyopia. J Refract Surg 2021; 37:S20-S27. [PMID: 34170764 DOI: 10.3928/1081597x-20210408-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this article is to review the current status of presbyopia amelioration with surgical and pharmacologic procedures that partially compensate for loss of accommodation in advance of cataract surgery and lens replacement. Over the last few years, several corneal surgical and topical pharmacological approaches for the treatment of presbyopia have been introduced to the marketplace or are in the developmental pipeline. The approaches vary in invasiveness, duration of effect, reversibility, risk/benefit ratio, and clinical results. The advantages and disadvantages for each are discussed. Corneal surgical interventions aim to provide improved near and intermediate vision in patients with presbyopia through refractive means that extend ocular depth of focus through shape modification. The use of miotic drops or corneal lamellar implants extend depth of focus with the "pinhole" aperture size reduction effect. Unlike in adults younger than 40 years, the refractive status of the patient with presbyopia is not stable. Hence, procedures that provide a permanent refractive change may not provide long-term full correction; eye drops or other treatments that are self-reversing in time or are easily reversible may be used as needed. On the horizon, procedures are being explored that may add years of functional lens accommodation by preserving the deformable gel properties of the lens. [J Refract Surg. 2021;37(6 Suppl):S20-S27.].
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Katz JA, Karpecki PM, Dorca A, Chiva-Razavi S, Floyd H, Barnes E, Wuttke M, Donnenfeld E. Presbyopia - A Review of Current Treatment Options and Emerging Therapies. Clin Ophthalmol 2021; 15:2167-2178. [PMID: 34079215 PMCID: PMC8163965 DOI: 10.2147/opth.s259011] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/11/2021] [Indexed: 01/07/2023] Open
Abstract
Presbyopia is a common age-related vision disorder characterized by a progressive inability to focus on near objects. If uncorrected or under-corrected, presbyopia can significantly impact patients' quality of life. Presbyopia represents an area of considerable unmet need due to its rising prevalence worldwide as the population ages, the high proportion of under-treated individuals in some parts of the world, and the limitations of currently available corrective methods. Progressive or bifocal spectacles are associated with peripheral blur, a restricted visual field and impaired depth perception, which have been linked to an increased risk of falls in the elderly. Contact lens options can be difficult to maintain due to the development of age-related dry eye symptoms and reduced manual dexterity. Other corrective methods involve surgical interventions that modify the optics of the cornea, replace the crystalline lens, or attempt to restore active accommodation. While patients undergoing surgery report satisfactory outcomes post-operatively, many of them eventually require reading glasses. Non-invasive therapies with novel mechanisms of action are currently being investigated; these include miotic agents and UNR844, a lipoic acid choline ester. In this narrative review, available evidence on presbyopia prevalence, quality of life impact and risk factors are described, with a focus on observational studies in non-clinical settings. The diagnosis pathway and patient journey in presbyopia are outlined, and various treatment options are analyzed. The data reviewed herein reveals significant gaps in the provision of vision correction for this common condition, with a paucity of effective, non-invasive treatment options broadly accessible to presbyopic individuals.
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Affiliation(s)
- James A Katz
- The Midwest Center for Sight, Des Plaines, IL, USA
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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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Xu R, Gil D, Dibas M, Rickert M, Meyer D, Perron L, Kollbaum P, Bradley A. Time-course of the visual Impact on presbyopes of a low dose miotic. Ophthalmic Physiol Opt 2020; 41:73-83. [PMID: 33150654 DOI: 10.1111/opo.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the pupil and visual impact of a single early morning drop of a low concentration miotic. METHODS Pupil size, refraction, visual acuity (VA), near reading performance and intraocular pressure were monitored for 8 h at a wide range of light levels following bilateral instillation of single drops of 0.1% brimonidine tartate in 19 early presbyopes (40-50 years) and 11 mature presbyopes (>50 years). RESULTS Pupil miosis did not alter distance VA or refraction. Significant pupil miosis peaked at 1-2 h after dosing, which expanded the depth of focus of mature presbyopes with the mean improvement in near logMAR VA of -0.15, -0.07 and -0.03, at 20, 200 and 2000 lux, respectively. One hour after instillation, near reading speed improved by 21, 24 and 5 words per min for text size commonly seen in US newspaper and cellphone text messages, 18, 21 and 19 words per min for text size of grocery labels and 12, 13 and 30 words per min for text size of over-the-counter medications at light levels of 20, 200 and 2000 lux, respectively. No such improvements in near VA and near reading speed were observed in the young presbyopes having some residual accommodation. Most of the pupil miosis remained 8 h after instillation, whereas near VA improvements disappeared after 4 h. CONCLUSION Low dose miotics can enhance near vision in presbyopic subjects while retaining high quality distance vision over a wide range of light levels. Significant improvements in near vision were observed only during the 1-2 h period after dosing when miosis peaked.
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Affiliation(s)
- Renfeng Xu
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, USA
| | | | | | - Martin Rickert
- School of Optometry, Indiana University, Bloomington, USA
| | - Dawn Meyer
- School of Optometry, Indiana University, Bloomington, USA
| | - Laura Perron
- School of Optometry, Indiana University, Bloomington, USA
| | - Pete Kollbaum
- School of Optometry, Indiana University, Bloomington, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, USA
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16
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Vargas V, Vejarano F, Alió J. Pharmacological Therapy for Presbyopia in Patients with Previous Corneal Refractive Surgery: A Pilot Study. Ophthalmol Ther 2020; 9:1003-1010. [PMID: 32965637 PMCID: PMC7708543 DOI: 10.1007/s40123-020-00301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To perform a pilot evaluation of a novel pharmacological therapy for presbyopia in patients with previous corneal refractive surgery. Methods This interventional study included 130 presbyopic patients. The patients were divided into three groups: (1) LASIK group, which included patients with previous LASIK for myopia or hyperopia; (2) previous presbyopia surgery group, including patients with previous monovision or PresbyLASIK (PresbyMAX, SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany); and (3) control group, which included presbyopes without any corneal refractive procedure. The main reason for dividing them into groups is that we hypothesized that the previous presbyopia surgery group may have better outcomes as the patients already have an increased depth of field. The uncorrected near and distance visual acuity was measured before and 2 hours after the binocular instillation of the eye drop (FOV tears), as well as the objective scatter index (OSI), and pupil diameter in photopic and scotopic conditions. Side effects were reported as well. Results There was a statistically significant improvement in the uncorrected near vision in all groups (p = 0.001). Ninety-one percent of the patients included in this study gained at least one line in near vision. All patients in the previous presbyopia surgery group gained at least one line in near vision. Six patients (13.9%) in the LASIK group and five (7.6%) in the control group did not gain any lines of near vision. There was no significant difference in the OSI, there was a significant change in pupil size in scotopic conditions in all groups (p = 0.001), and 5.3% of the patients reported having a headache as a side effect of the therapy. Conclusions Topical treatment with this pharmacological therapy offers a potential for near vision improvement in patients with previous corneal refractive surgery, especially in those with previous presbyopia surgery.
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Affiliation(s)
- Veronica Vargas
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research, Investigation & Development Department, VISSUM, Alicante, Spain
| | | | - Jorge Alió
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain. .,Research, Investigation & Development Department, VISSUM, Alicante, Spain. .,Department of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain.
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17
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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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18
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Grzybowski A, Markeviciute A, Zemaitiene R. A Review of Pharmacological Presbyopia Treatment. Asia Pac J Ophthalmol (Phila) 2020; 9:226-233. [PMID: 32511122 PMCID: PMC7299227 DOI: 10.1097/apo.0000000000000297] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/02/2020] [Indexed: 11/25/2022] Open
Abstract
Presbyopia reduces an individual's ability to perform visual tasks at near distances. It is a global problem, affecting over a billion people worldwide. Contact lenses, glasses, refractive surgery, and intraocular lens surgery are the main modalities in presbyopia treatment, although they all have some disadvantages. Thus, there is an increasing need for effective, easy-to-use, and noninvasive approaches for treating presbyopia while not limiting patients' daily activities. Pharmacological presbyopia treatment as an alternative method has been under investigation in recent years. We reviewed all relevant articles using the keywords "presbyopia," "presbyopia treatment," "pharmacological presbyopia treatment," and "presbyopic corrections" from 2010 to February 9, 2020, and summarized the main results of clinical trials, investigating the drops used for presbyopia treatment.
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Affiliation(s)
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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19
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Montés-Micó R, Charman WN. Pharmacological Strategies for Presbyopia Correction. J Refract Surg 2019; 35:803-814. [DOI: 10.3928/1081597x-20191010-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
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20
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Kollbaum PS, Bradley A. Correction of presbyopia: old problems with old (and new) solutions. Clin Exp Optom 2019; 103:21-30. [PMID: 31734940 DOI: 10.1111/cxo.12987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022] Open
Abstract
We live in a three-dimensional world and the human eye can focus images from a wide range of distances by adjusting the power of the eye's lens (accommodation). Progressive senescent changes in the lens ultimately lead to a complete loss of this ability by about age 50, which then requires alternative strategies to generate high-quality retinal images for far and close viewing distances. This review paper highlights the biomimetic properties and underlying optical mechanisms of induced anisometropia, small apertures, dynamic lenses, and multi-optic lenses in ameliorating the visual consequences of presbyopia. Specifically, the advantages and consequences of non-liner neural summation leveraged in monovision treatments are reviewed. Additionally, the value of a small pupil is quantified, and the impact of pinhole pupil location and their effects on neural sensitivity are examined. Different strategies of generating multifocal optics are also examined, and specifically the interaction between ocular and contact or intraocular lens aberrations and their effect on resulting image quality are simulated. Interestingly, most of the novel strategies for aiding presbyopic and pseudophakic eyes (for example, monovision, multifocality, pinhole pupils) have emerged naturally via evolution in a range of species.
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Affiliation(s)
- Pete S Kollbaum
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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21
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Near reading speed changes after panretinal photocoagulation in diabetic retinopathy patients: a prospective study using an iPad application for the measurement of reading speed. Graefes Arch Clin Exp Ophthalmol 2019; 257:2631-2638. [PMID: 31654187 DOI: 10.1007/s00417-019-04494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate the changes in the near reading speed after panretinal photocoagulation (PRP) in diabetic retinopathy patients. METHODS This non-randomized, prospective, clinical study enrolled diabetic retinopathy patients who underwent PRP from January 2016 to June 2017. The near reading speed was measured before and 1 week, 1 month, and 4 months after PRP by using an iPad application for the assessment of reading speed; near best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT) were also analyzed. The reading speed of age-matched healthy individuals was compared with that of diabetic retinopathy patients. RESULTS Forty-seven patients were enrolled in this study. The baseline near reading speed of diabetic retinopathy patients was significantly slower than that of age-matched healthy controls. The near reading speed was reduced at 1 week after PRP, but recovered at 1 and 4 months after PRP. Near BCVA showed a similar pattern after PRP. SFCT increased at 1 week after PRP and significantly decreased at both 1 and 4 months after PRP. CONCLUSION The near reading speed of diabetic patients was significantly slower than that of age-matched healthy controls. The speed was temporarily reduced at 1 week after PRP, potentially due to short-term impairment of parasympathetic nerve innervation.
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22
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Small-pupil versus multifocal strategies for expanding depth of focus of presbyopic eyes. J Cataract Refract Surg 2019; 45:647-655. [DOI: 10.1016/j.jcrs.2019.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 11/23/2022]
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23
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Affiliation(s)
- W Neil Charman
- Biology, Medicine and Health, University of Manchester, Manchester, UK
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24
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Shah M, Cabrera-Ghayouri S, Christie LA, Held KS, Viswanath V. Translational Preclinical Pharmacologic Disease Models for Ophthalmic Drug Development. Pharm Res 2019; 36:58. [PMID: 30805711 PMCID: PMC6394514 DOI: 10.1007/s11095-019-2588-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
Preclinical models of human diseases are critical to our understanding of disease etiology, pathology, and progression and enable the development of effective treatments. An ideal model of human disease should capture anatomical features and pathophysiological mechanisms, mimic the progression pattern, and should be amenable to evaluating translational endpoints and treatment approaches. Preclinical animal models have been developed for a variety of human ophthalmological diseases to mirror disease mechanisms, location of the affected region in the eye and severity. These models offer clues to aid in our fundamental understanding of disease pathogenesis and enable progression of new therapies to clinical development by providing an opportunity to gain proof of concept (POC). Here, we review preclinical animal models associated with development of new therapies for diseases of the ocular surface, glaucoma, presbyopia, and retinal diseases, including diabetic retinopathy and age-related macular degeneration (AMD). We have focused on summarizing the models critical to new drug development and described the translational features of the models that contributed to our understanding of disease pathogenesis and establishment of preclinical POC.
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Affiliation(s)
- Mihir Shah
- Biological Research, Allergan plc, 2525 Dupont Drive, Irvine, California, 92612, USA
| | - Sara Cabrera-Ghayouri
- Biological Research, Allergan plc, 2525 Dupont Drive, Irvine, California, 92612, USA
| | - Lori-Ann Christie
- Biological Research, Allergan plc, 2525 Dupont Drive, Irvine, California, 92612, USA
| | - Katherine S Held
- Biological Research, Allergan plc, 2525 Dupont Drive, Irvine, California, 92612, USA
| | - Veena Viswanath
- Biological Research, Allergan plc, 2525 Dupont Drive, Irvine, California, 92612, USA.
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25
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Ayaki M, Tsuneyoshi Y, Yuki K, Tsubota K, Negishi K. Latanoprost could exacerbate the progression of presbyopia. PLoS One 2019; 14:e0211631. [PMID: 30703139 PMCID: PMC6355011 DOI: 10.1371/journal.pone.0211631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/17/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose Prostaglandin analogues (PG) reduce intra-ocular pressure by enhancing uveoscleral flow at the ciliary body, which controls accommodation via the ciliary muscle. We investigated the effect of PG on accommodation and presbyopia progression in glaucoma patients. Methods We conducted a clinic-based, retrospective, cross-sectional study. Inclusion criteria were bilateral phakic patients aged 40–69 years with best corrected visual acuity better than 20/30. Exclusion criteria were any disease affecting vision other than glaucoma and history of ocular surgery. Subjects with no prescription or vision-affecting disease served as controls (n = 260). The glaucoma patients were prescribed eye drops containing 0.005% latanoprost for more than six months (n = 23). We measured the binocular near add power at a distance of 30 cm in both groups and compared the results using Kaplan-Meier analysis. Results The mean age (± SD) of the control subjects was 51.5 ± 5.2 years and 39% were male. Similarly, the glaucoma patients had a mean age of 51.0 ± 7.2 years and 39% were male. There were no significant differences in age, gender, intra-ocular pressure, spherical equivalent, astigmatism, or anisometropia between groups. Survival analysis indicated that the glaucoma patients in this study reached the endpoint (near add power of +3.00 D) significantly earlier than control patients (P = 0.0001; generalized Wilcoxon test). Conclusions Exacerbation of presbyopia progression in glaucoma patients is a potential side effect of latanoprost eyedrops.
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Affiliation(s)
- Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Otake Clinic Moon View Eye Center, Yamato, Japan
- * E-mail: (MA); (KN)
| | - Yukari Tsuneyoshi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- * E-mail: (MA); (KN)
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26
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Affiliation(s)
- Kyung-Sun Na
- Department of Ophthalmology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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27
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Vargas V, Vejarano F, Alió JL. Near Vision Improvement with the Use of a New Topical Compound for Presbyopia Correction: A Prospective, Consecutive Interventional Non-Comparative Clinical Study. Ophthalmol Ther 2018; 8:31-39. [PMID: 30465236 PMCID: PMC6393255 DOI: 10.1007/s40123-018-0154-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction To report the outcomes in near vision, optical quality and pupil diameter of a new pharmacological therapy (FOV tears) for presbyopia. Methods This was a prospective, consecutive, interventional, non-comparative clinical study in which 117 presbyopic patients were given one drop of the novel therapy (FOV tears) in each eye, followed 2 h after the instillation of the eye drop by an evaluation of the binocular uncorrected near visual acuity (UNVA) and uncorrected distance visual acuity. The objective scatter index and pupil diameter under photopic and scotopic conditions before and after instillation were also assessed. The patients were divided into two groups according to their age, with group 1 patients being 41 and 50 years old and group 2 patients, between 51 and 65 years old. Results The mean age of the patients was 50.2 years. The mean UNVA before the use of the eye drop was 0.35 LogMAR, which improved to 0.16 LogMAR at 2 h after the use of the eye drop (p = 0.000). Nine patients did not show an improvement in UNVA, but no patient showed a loss of lines. Fourteen patients (11.9%) reported headaches as a side effect of the therapy. Conclusion This pharmacological therapy improved near vision by one or more lines (mean improvement 0.18 lines) in 92.3% of the patients at 2 h following the instillation of the eye drops. The group with the youngest patients gained more lines than the group with the oldest patients.
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Affiliation(s)
| | | | - Jorge L Alió
- Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. .,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
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28
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Wolffsohn JS, Davies LN. Presbyopia: Effectiveness of correction strategies. Prog Retin Eye Res 2018; 68:124-143. [PMID: 30244049 DOI: 10.1016/j.preteyeres.2018.09.004] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 01/04/2023]
Abstract
Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in developing world populations, due to a lack of awareness and accessibility to affordable treatment, and is even as high as 34% in developed countries. Definitions of presbyopia are inconsistent and varied, so we propose a redefinition that states "presbyopia occurs when the physiologically normal age-related reduction in the eye's focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual's requirements". Strategies for correcting presbyopia include separate optical devices located in front of the visual system (reading glasses) or a change in the direction of gaze to view through optical zones of different optical powers (bifocal, trifocal or progressive addition spectacle lenses), monovision (with contact lenses, intraocular lenses, laser refractive surgery and corneal collagen shrinkage), simultaneous images (with contact lenses, intraocular lenses and corneal inlays), pinhole depth of focus expansion (with intraocular lenses, corneal inlays and pharmaceuticals), crystalline lens softening (with lasers or pharmaceuticals) or restored dynamics (with 'accommodating' intraocular lenses, scleral expansion techniques and ciliary muscle electrostimulation); these strategies may be applied differently to the two eyes to optimise the range of clear focus for an individual's task requirements and minimise adverse visual effects. However, none fully overcome presbyopia in all patients. While the restoration of natural accommodation or an equivalent remains elusive, guidance is given on presbyopic correction evaluation techniques.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Leon N Davies
- Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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29
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Charman WN. Non-surgical treatment options for presbyopia. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1506330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- W. Neil Charman
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, Manchester, UK
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30
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Gualdi L, Gualdi F, Rusciano D, Ambrósio R, Salomão MQ, Lopes B, Cappello V, Fintina T, Gualdi M. Ciliary Muscle Electrostimulation to Restore Accommodation in Patients With Early Presbyopia: Preliminary Results. J Refract Surg 2018; 33:578-583. [PMID: 28880331 DOI: 10.3928/1081597x-20170621-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/26/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report short-term results of pulsed ciliary muscle electrostimulation to improve near vision, likely through restoring accommodation in patients with emmetropic presbyopia. METHODS In a prospective non-randomized trial, 27 patients from 40 to 51 years old were treated and 13 age- and refraction-matched individuals served as untreated controls. All patients had emmetropia and needed near sphere add between +0.75 and +1.50 diopters. The protocol included four sessions (one every 2 weeks within a 2-month period) of bilateral pulsed (2 sec on; 6 sec off) micro-electrostimulation with 26 mA for 8 minutes, using a commercially available medical device. The uncorrected distance visual acuity (UDVA) (logMAR) for each eye, uncorrected near (40 cm) visual acuity in each eye (UNVA) and with both eyes (UNVA OU) (logMAR), and reading speed (number of words read per minute at 40 cm) were measured preoperatively and 2 weeks after each session. Overall satisfaction (0 to 4 scale) was assessed 2 weeks after the last session. RESULTS UDVA did not change and no adverse events were noted in either group. Bilateral and monocular UNVA and reading speed were stable in the control group, whereas they continuously improved in the treated group (Friedman, P < .00001). Post-hoc significant differences were found for monocular and binocular UNVA after the second treatment and after the first treatment considering words read per minute (P < .001). One patient (3.7%) was not satisfied and 18 patients (66.7%) were very satisfied (score of 4). Average satisfaction score was 3 (satisfied). CONCLUSIONS Ciliary muscle contraction to restore accommodation was safe and improved the short-term accommodative ability of patients with early emmetropic presbyopia. [J Refract Surg. 2017;33(9):578-583.].
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Renna A, Alió JL, Vejarano LF. Pharmacological treatments of presbyopia: a review of modern perspectives. EYE AND VISION 2017; 4:3. [PMID: 28191476 PMCID: PMC5294898 DOI: 10.1186/s40662-017-0068-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/16/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Presbyopia affects people from the 4th decade of life and is characterized by accommodative loss that leads to negative effects on vision-targeted health-related quality of life. A non-invasive pharmacological treatment providing near-lenses independence would be a truly groundbreaking approach in the treatment of presbyopia. The purpose of this review is to analyze the emerging pharmacological solutions proposed to address presbyopia. RESULTS Several ophthalmic eye drops compounds solutions have been described in peer-reviewed papers or presented in ophthalmological tabloids and congresses. Each topical treatment deals with drug combinations aimed to modify one or more factors involved in the accommodative process and have been proposed to be instilled either monocularly or binocularly. It remains unclear how much each drug in the final combined form is involved in the achievement of the outcome and contributes to it. CONCLUSION Despite the lack of a completely well understood mechanism, pharmacological control of presbyopia seems to be a possible and very attractive alternative for presbyopic patients. The studies mentioned in this review are to be considered pilot investigations as they involve either a small number of subjects or are single case series. Complete studies are needed to confirm which will be the more effective pharmacological compound for the treatment of presbyopia.
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Affiliation(s)
- Antonio Renna
- Vissum Alicante, Alicante, Spain.,Studi Medici Renna, Melendugno Lecce, Italy
| | - Jorge Luciano Alió
- Universidad Miguel Hernandez, Calle Cabañal 1, 03016 Alicante, Spain.,Vissum Instituto Oftalmologico de Alicante, Alicante, Spain
| | - Luis Felipe Vejarano
- Fundación Oftalmológica Vejarano, Popayan, Colombia.,Universidad del Cauca, Popayan, Colombia
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32
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Abdelkader A, Kaufman HE. Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia. EYE AND VISION 2016; 3:31. [PMID: 27981057 PMCID: PMC5139101 DOI: 10.1186/s40662-016-0065-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022]
Abstract
Background To test and compare in a masked fashion the efficacy of using a parasympathomimetic drug (3% carbachol) and an alpha-2 agonist (0.2% brimonidine) in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia. Methods A prospective, double-masked, randomized, controlled clinical trial was conducted. Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. All subjects received 3% carbachol and 0.2% brimonidine in both combined and separate forms, 3% carbachol alone and 0.2% brimonidine (control) alone in their non-dominant eye in a crossover manner with one week washout between tests. The subjects’ pupil sizes and both near and distance visual acuities will be evaluated pre- and post-treatment at 1, 2, 4, and 8 h, by a masked examiner at the same room illumination. Results Statistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received combined 3% carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone (P < 0.0001). Conclusion Based on the data, the combined solution demonstrated greater efficacy than the other solutions that were tested. Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity, with no change in binocular distance vision. Trial registration ACTRN12616001565437. Registered 11 November 2016.
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Affiliation(s)
- Almamoun Abdelkader
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Herbert E Kaufman
- Department of Ophthalmology, Louisiana State University Eye Center, LSU Medical School, New Orleans, LA USA
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Renna A, Vejarano LF, De la Cruz E, Alió JL. Pharmacological Treatment of Presbyopia by Novel Binocularly Instilled Eye Drops: A Pilot Study. Ophthalmol Ther 2016; 5:63-73. [PMID: 27168149 PMCID: PMC4909677 DOI: 10.1007/s40123-016-0050-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The feasibility, in terms of safety and potential efficacy, of a new drug combination for binocular use as a noninvasive pharmacological solution for treating presbyopia was examined. METHODS Fourteen emmetropic presbyopic subjects (28 eyes) were given one drop of the preparation under study in each eye. For each patient, the uncorrected distance visual acuity, uncorrected near visual acuity, near and far refraction, best corrected visual acuity, best corrected far-near visual acuity, photopic and scotopic pupil size, Schirmer's test, endothelial cell count, intraocular pressure, keratometry, pachymetry, and anterior chamber depth were all performed or assessed prior to the administration of the eye drops and then 0.5, 1, 2, 3, 4, and 5 h, 1 week, and 1 month post-administration prospectively in each eye and binocularly. RESULTS The results showed that near uncorrected visual acuity improved by about 2-3 lines from baseline in each eye and binocularly. There was no degradation in uncorrected far vision in each eye and binocularly in any patient. Refractive measurements performed in this study showed there was a maximum myopic shift of just 0.5 D that progressively reduced and disappeared at 4 h. CONCLUSION The new topical drug treatment analyzed herein significantly improved near vision without affecting far vision. This binocular pharmacologic treatment of presbyopia has the potential to ameliorate the reading vision of presbyopes and possesses the advantages of a nonmonovision therapy. A randomized, controlled, double-masked clinical trial with a twice-a-day treatment schedule is ongoing at our institution. FUNDING This study was supported in part by the Spanish Ministry of Health, Instituto Carlos III, Red Temática de Investigación Oftalmológica (OFTALRED), and Fundación Oftalmológica Vejarano (Popayán, Colombia).
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Affiliation(s)
- Antonio Renna
- Vissum Alicante, Calle Cabañal, 1, Edificio Vissum, 03016, Alicante, Spain.,Department of Medical and Biological Sciences-Ophthalmology, University of Udine, Udine, Italy
| | - L Felipe Vejarano
- Fundación Oftalmológica Vejarano, Popayan, Colombia.,Universidad del Cauca, Popayan, Colombia
| | - Ernesto De la Cruz
- Department of Physical Activity and Sport, University of Murcia, Murcia, Spain
| | - Jorge L Alió
- Vissum Alicante, Calle Cabañal, 1, Edificio Vissum, 03016, Alicante, Spain. .,Ophthalmology, Universidad Miguel Hernandez, Alicante, Spain.
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