New Eye Drops Improve Aging Vision Without Glasses. Here s How They Work

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Can Eye Drops Replace Your Reading Glasses?

Medication now available to treat age-related vision loss

by Beth Levine, AARP, December 17, 2021

Toni Wright, 54, a beauty industry professional from Pittsburgh, Pennsylvania, was forever squinting at her computer screen and cellphone. In restaurants, especially those with low lights, she was the one holding the menu as far away as her arm could reach. Diagnosed with presbyopia — age-related blurred near vision — when she was 50, Wright says, “I needed to have reading glasses with me at all times and almost panicked if I didn’t.”

Presbyopia is estimated to affect 2 billion people globally, according to the American Academy of Ophthalmology (AAO). But there is good news for all the squinters among us: In October, the U.S. Food and Drug Administration (FDA) approved the first (and so far, only) eye drops that treat presbyopia. The eye drops, called Vuity, contain pilocarpine, which has been used for around 120 years to treat glaucoma. This is the first formulation to target presbyopia specifically.

Allergan, a subsidiary of AbbVie, rolled out Vuity on Dec. 9. Available by prescription only, Vuity works very simply. Itslightly reduces pupil size by constricting certain muscles, explains AbbVie advisory board consultant Marguerite McDonald, M.D., a clinical professor of ophthalmology at both New York University and Tulane University. The constriction allows for improved up-close vision. Approved for use once daily, it works for up to six hours. It costs about $86 for a 2.5 milliliter bottle (about a 30-day supply), depending on the pharmacy you visit. 

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Wright, who participated in the clinical trial for Vuity, would put the drops in her eyes in the morning, and she found that the effect kicked in by the time she got to work. McDonald says, on average, it should start working within 15 minutes. “I could see on my computer without struggling or needing glasses, and it lasted throughout the workday,” Wright reports. She says she felt no negative side effects. ​Vuity reports that users may experience temporary problems when changing focus between near and far objects.​

In its development of the drops, the company found that participants achieved a “three-line gain or more reading a near-vision eye chart without losing more than one line in a distance vision eye chart at Day 30, three hours after dosing.” ​

“We know a great deal about the active compound pilocarpine. It was used in higher concentrations and it’s very safe,” McDonald says. She adds that the drops can be used with contact lenses, but as with all eye medications, users should wait 15 minutes after application before inserting lenses. If using other eye drops, wait five minutes between different applications.

Steven Plotycia, M.D., an ophthalmologist affiliated with Mount Sinai Medical Center in New York, warns that the drops may not work for everyone with presbyopia. “The ideal patient for these drops are people in their 40s to 50s who don’t want to wear reading glasses. The age group is old enough to have developed presbyopia but young enough that they would not have started developing cataracts,” he explains. Cataracts are lenses that have started to yellow, restricting the amount of light that gets in, making vision appear darker. Since Vuity acts by constricting the iris, limiting the amount of light that hits the lens, cataract patients will find that the drops make their vision appear even darker. They would have a lot of trouble driving at night or in other situations where light is low.

“The significance of this FDA approval is massive. Glasses, contact lenses, and surgery are traditional treatments, but, for various reasons, do not work well for every patient. Having a novel treatment option in the form of a presbyopia eye drop is a welcome addition to our armamentarium against this universal age-related near vision condition that effects essentially everyone over the age of 40,” says Christopher Starr, M.D., clinical spokesperson for the AAO.

Nine similar eye drops for presbyopia are in development and may be available in the future.

Beth Levine is a health writer whose work has appeared in O: The Oprah Magazine, Woman’s Day, Good Housekeeping, Reader’s Digest and many more.

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New Eye Drops Improve Aging Vision Without Glasses. Here’s How They Work

When people get into their 40s and beyond, their close-up vision starts to worsen. For many people, cranking up the font size on a phone or maxing out the brightness on a computer is the only way to be able to read some text.

This condition is known as presbyopia, and it affects around 128 million people in the US and more than a billion people worldwide.

In late 2021, the US Food and Drug Administration approved a new eye drop medication to treat presbyopia. As an optometrist, I was initially skeptical.

Prior to the release of these eye drops – called Vuity – people would either need glasses, contacts or eye surgery to alleviate presbyopia. But after learning how these eye drops work, I recognized that for many people, they could offer an easier and safer way to see clearly again.

Pupil and lens are important parts of the eye involved in focusing on objects. (ttsz/iStock/Getty Images)

How eyes focus

Many parts of the human eye interact with incoming light to produce a clear image.

The first thing light hits is the cornea, the clear outer layer that initially bends the light. Then light passes through the iris and pupil, which can shrink or grow to let more or less light into the inside of the eye. It then travels through the lens, which further bends the light and precisely focuses it onto the center of the retina. Finally, the light signal is transferred to the optic nerve at the back of the eye, for the brain to interpret as an image.

To produce a clear image, your eyes need to adjust to how far away an object is. Your eyes take three major steps to focus on objects close to your face: your eyes point toward the object you want to look at, your lenses change shape and your pupils constrict.

Once you point your gaze at what you’re interested in, a small muscle in the eye contracts, which changes the shape of the lens to make it thicker. The thicker the lens is, the more the light bends as it passes through. At the same time, your pupils constrict to block some of the incoming light from other objects in the distance.

When light bounces off an object and enters your eye, the rays of light at the center are what provide a clear image. Blocking the scattering light by constricting the pupil helps to sharpen the image of close objects.

You can simulate this process using a camera on your cellphone. First, point the camera at something in the distance. Then, move your thumb into the image, holding it about 6 inches away. Your thumb will start off blurry, but as the camera’s lens changes shape, your thumb will come into focus.

IMAGE: Presbyopia stiffens the lens in the eye, and when a person can’t bend their lens as easily, they are unable to focus incoming light on the correct part of the retina and images appear blurry.

What is presbyopia?

Presbyopia is the inability of the eyes to focus on close objects, which results in blurry images. It begins when people are in their 40s and progresses until it plateaus around the age of 60.

Researchers know that age is the main driver of presbyopia, but there is an ongoing debate over the mechanical causes at its root.

One theory suggests that as lenses age, they get heavier and can’t change shape as easily. Another theory suggests that the muscle that pull on the lens become weaker with age. I suspect presbyopia likely occurs due to a combination of both.

Regardless of the cause, the result is that when looking at close objects, people’s eyes are no longer able to bend incoming light enough to direct it at the center of the retina. Instead, the light is focused at a place behind the retina, resulting in blurry vision.

How the eye drops work

Remember, there are two major things an eye does to focus on close objects: the lens changes shape and the pupil gets smaller. Since presbyopia limits the ability of the lens to change shape, these eye drops compensate by causing the pupil to get smaller.

Constricting the pupil reduces the amount of light scatter. This makes it so that the light entering the eye is better concentrated onto the retina, thus creating a wider range of distances where objects are in focus and allowing people to see both close and far objects clearly.

Once you put the drops in your eyes, it takes about 15 minutes for the active ingredient, pilocarpine, to begin working. Pilocarpine is a medication that was first discovered in the late 1800s, and can treat conditions such as glaucoma and ocular hypertension. The effect on pupils lasts for about six hours.

Smaller pupils mean that less light gets into the eye. While this isn’t a problem during the day when there is a lot of sun, it can cause difficulty seeing in low-lighting conditions. Aside from these downsides, the most common side effects of the drops are headache and red eyes.

IMAGE: Making the pupil smaller and allowing less light into the eye increases depth of field, making closer objects appear in focus – as seen in diagram a above – compared to a larger pupil and narrower depth of field as seen in diagram b.

Presbyopia in the future

Vuity is currently approved for once-daily use in each eye. A bottle will cost around US$80, requires a prescription and will last for nearly a month if used daily. For some people, it could be a great alternative or adjunct to glasses or surgery.

While Vuity may be the first FDA-approved eye drops to treat presbyopia, researchers are studying a number of other approaches. Some are developing eye drops that include non-steroidal anti-inflammatory drugs to help constrict the pupil – similarly to Vuity.

Other teams are studying drops that soften and reduce the weight of the lens to promote easier focusing. Finally, some early research has shown that pulsed electrostimulation of eye muscles can help strengthen them and improve people’s ability to bend their lenses.

The future of presbyopia treatment is exciting as researchers work on many potential ways to overcome this universal condition of old age. For now, Vuity – while not a magic cure for everyone with presbyopia – is an innovative option and may be worth asking your eye doctor about.

This article is republished from The Conversation under a Creative Commons license. Read the original article.