Customized solutions enhance the management of presbyopia

Customized solutions enhance the management of presbyopia

A pharmaceutical approach (pilocarpine hydrochloride ophthalmic solution 1.25%) can be used to improve near vision in combination with other techniques, benefiting a wide range of patients.

When it comes to discussing presbyopia with patients, the devil – as they say – is in the details. It is important that we meet our conversations with the patient in our chair and the visual needs of that individual.

Through these conversations, we need to learn how our patients use their vision and design our solutions to fit their lifestyle.

In general, I start my consultant by telling patients that they suffer from presbyopia, which basically means not being able to focus on things up close. I say that with age, the lens becomes less flexible, and I tell them everyone eventually develops presbyopia.

Related: Is presbyopia the latest subspecialty?

The good news is that the condition is normal and expected. The challenge is how best to treat it to improve functional near vision. Inform them that the first option is glasses, the second is contact lenses, and the third is a newly available, FDA-approved eye drop that improves near vision (pilocarpine hydrochloride eye solution 1.25%). [Vuity; Allergan]).

Dive into the details

The tools we use to help patients see better up close depend on the details: age, lifestyle, desires or visual goals. Here are some examples.

Emmetrope has near vision problems

A shrunken woman, aged 50, began to experience near vision. I discuss the three options, followed by a conversation about each. At this point, if a patient is interested in trying pilocarpine hydrochloride 1.25% ophthalmic solution, we instill the drops in the office. We wait 15 minutes and measure the visual response. We do not measure vision on an eye chart. Instead, we have patients who pull out their cell phones and read their text messages. Almost everyone will be able to see their phone better.

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Conversational anticipation is crucial. I always tell patients that presbyopia correction drops will make your near vision better, but we don’t know how much better.

I say, “Over the next several minutes, we will see how the drop affects your near vision. Then you can make a decision whether you want to follow the drops.”

We also set an expectation that over the next week of use, visibility will likely improve as well.

Contact lenses did not help

A 52-year-old woman who adds +2.25 has tried many brands of contact lenses. Although she was very stimulated, contact lenses did not work well with her, and she resorted to wearing glasses. She was eager to try the drops, so we planted them in the office.

When she looked at her phone, she said it was a little better. I knew it wouldn’t be drastically better because of how presbyopy she was. I told her the real test would be how she works in her office, where she works on a desktop computer.

I said, “I hope it provides more independence from glasses.”

Related: Addressing the problem of contact lens leakage from presbyopia

She returned to her office, and instructed my staff to follow up with her as soon as she returned to her desk at her desk.

She stated that she was so glad she could see her computer screen better, and she chose to go ahead with her prescription.

Often, it is not what patients can see in the examination room that is important to them – it is how they function in their daily lives.

We may have thought that an individual with advanced presbyopia was not an ideal candidate for pharmaceutical treatments for presbyopia.

However, when their scientist sits in front of a computer that is 18 to 22 inches away from them and they rely on glasses, this drop can give them some independence.

irregular corneas

Patients with corneal irregularities can succeed in this reduction. Patients who have had radial keratotomy often wear special lenses and are highly motivated to get out of their glasses.

In my experience, these are individuals who are very happy with the escape option. A patient with mild epithelial basement membrane atrophy uses eyedrops 15 minutes prior to putting in their contact lenses.

Awareness of Presbyopia: A Deep Dive with Brieann Adair, OD

I recently saw a patient with keratoconus, 48 ​​years old, with a penetrating keratoplasty. He had now developed presbyopia and panicked because he thought his inability to see up close meant the graft was being rejected.

This is another patient using presbyopia eye drops with his contact lenses and is very happy with his near vision.

Medications for presbyopia can be an option for many different types of patients, including patients with interchangeable refractive lenses, patients with cataract surgery who want to see closer to the eye, and contact lens wearers.

The dip can be used in conjunction with other techniques to enhance overall near vision.

Other considerations

In my opinion, there are three main categories of users: those who use drops every day, those who use part-time, and those who use drops infrequently. This is similar to what we find with wearers of disposable contact lenses.

Patients need to be advised about possible adverse effects. A small number of patients may experience symptoms such as eyebrow soreness, blurring of vision, and temporary hyperemia.

Most of these issues are resolved over time. I’ve seen great diversity in patients’ responses to the instillation process. Some enjoy some sort of oily feel and some have some initial awareness of the drop. There is also a wide range in terms of how long the effect of the decline lasts.

Related: Postoperative problem solving: Presbyopia correction drops

Some patients work for up to 12 hours while others may only take 3 to 4 hours. The bulk of my patients work 4 to 10 hours.

Be sure to perform an extended retinal examination on patients who will be prescribed narrow drops for presbyopia in order to rule out any retinal disease before prescribing the drops, and I always advise patients that this drop is for geriatric patients without any retinas. Circumstances.


We have had an interesting journey so far with the pharmaceutical treatment of presbyopia and are learning that there are many different types of aging for which regression can be an appropriate option.

Future products may be modified to last longer or formulated for twice a day doses – I have no doubts that Presbyopia Correction Drops will continue to improve. It was great to witness firsthand the dramatic effect of iris modulation on increasing depth of focus and enhancing near vision.

2022-06-03 04:05:29

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