Nearly 128 million Americans of a certain age have trouble seeing or reading up close. It’s called presbyopia. Dr. Karen Saland, an ophthalmologist with Texas Health Presbyterian Hospital Dallas, discussed with KERA's Sam Baker about her concerns over new eye drops that have been FDA-approved for the condition, called Vuity.
INTERVIEW HIGHLIGHTS:
What is Presbyopia
Usually, at approximately the age of 40, we start to lose the natural ability to change the shape of the lens of the eye so that we're able to see the distance that we want to see. It's strictly age-related. What I tell patients is these are things like wrinkles and gray hair. It's just things that happen.
How do the drops (Vuity) work?
It’s a pilocarpinedrop, which actually constricts the pupil. By doing so, it actually expands the depth of focus and uses the natural ability of the eye to just expand its depth to gain a few lines of near vision.
So, it's like an improved formulation of a drop that's been around for a while that ophthalmologists used primarily for glaucoma treatment in the past. It's not something that we use so much anymore.
Is Vuity a more effective option?
It depends on the person. Are they farsighted or nearsighted to begin with? Are they using glasses, contact lenses? It's not like a one size fits all treatment.
This drop is most effective for people who are basically born with 20/20 vision and have perfect vision for distance when they reach the point that their eyes cannot accommodate anymore, which is what we first refer to as presbyopia. They can use this drop and it will be effective for them in giving them extra up-close vision.
Can you adjust your pupil like that every day without some kind of residual side effect?
Pilocarpine in the past has been known to permanently cause pupil constriction. You could say, Well, that's great. Maybe long term, I won't have to use the drops as much because my pupil will be constricted and I'll be able to see better up close.
There are times when we need to have our pupils get larger. For instance, when you are night driving or when you're outside in the dark and you want and need to be able to see more. That's the function of the size of the pupil. That's the natural pupil going to dilation state versus constriction state.
Its peak effect is supposed to last for around six hours. So, if you use it in the morning, you can speculate that maybe by the evening your pupil will be back to normal. But it does actually say in studies done on Vuity that sometimes the pupil can maintain its state for even up to 24 hours. So that's number one.
Number two, long term effects of pilocarpine in the past have been that you can and will probably get pupil issues moving forward, which then makes it harder when you have cataract surgery and you need the eye to be dilated or when you need your eye to be dilated to get a good retinal exam, or if you have to have some other kind of surgery at some points on the eye. It does make it more difficult for the surgeon.
Other eye drops for presbyopia are in the works. Does that bother you?
The fact that presbyopia happens to every human being who lives long enough makes it an obvious thing for the eye industry to look into.
What always worries me would be who will be able to prescribe this? And will it be necessary for someone to get a good eye exam to make sure people who are actually using this have, in fact, 2020 vision who don't have any retinal pathology?
My personal opinion as an ophthalmologist would be if patients are screened properly, at least that will perhaps reduce the incidence of something happening to the eye when using it, because it's definitely not at this time a risk-free approach to treating presbyopia.
What about insurance?
Insurance is not paying for this because it's considered cosmetic. Anything usually that glasses can fix, which a $10 pair of reading glasses could fix, would be no reason for insurance to pay for it.
RESOURCES
The First FDA-Approved Eye Drops to Treat Blurry Vision Are Now Available in The US
New Eye Drops Offer an Alternative to Reading Glasses
Interview highlights were lightly edited for clarity.
Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.
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