THANKS TO WIDESPREAD MEDIA COVERAGE, OUR OFFICES started getting calls a few months ago from people who had heard about the presbyopia-correcting drop Vuity (pilocarpine hydrochloride ophthalmic solution 1.25%; Allergan/AbbVie) and were looking to find out more about it. I knew the novel drug was coming, but I hadn’t yet trained my staff on how to respond to these queries. That was a mistake, and it resulted in lost opportunities.

According to the Vision Council, about 32.6 million Americans wear over-the-counter reading glasses.¹ Every single one of them represents an opportunity for a comprehensive eye exam and a discussion about their presbyopia-correcting options. Now, because it all starts with the front desk, we have implemented a protocol so that my staff is prepared to address callers’ questions.

Pretest Queries

As part of our pre-test once patients are in the office, we now include questions such as: Do you wear reading glasses, and do have any frustration with them? Are your multifocal contacts adequate for reading up close? Do you experience any trouble with near vision, such as seeing your cell phone and computer? The goal is to identify those patients who are struggling with or frustrated by presbyopia.

Over time and with experience prescribing Vuity, my own expectations have shifted, and how I talk to patients has changed. We are finding that the drop is not just a solution for certain types of presbyopes; rather, virtually all presbyopes can be considered potential candidates. The drop does work differently for each patient, however, so it is our responsibility to accurately set their expectations. In my practice, we let patients know that a new FDA-approved eyedrop may potentially help them better see their cell phone and computer. We have learned the importance of not overstating the benefits and informing them that not everyone will achieve the same level of near vision.

For patients who want to try the drop, we have them use it for at least 7 days to fully gauge their results. We have found that the common side effects we have observed, such as eye redness and dimming of vision, improve with time. When we prepare patients properly, there are no surprises. By setting patients up accurately, our practice has been more successful prescribing Vuity.

Many Different Types Of Candidates

Vuity will not be right for everyone, and sometimes we do not know until we try it. We make sure to explain this point to patients. Still, we consider essentially all presbyopes as potential candidates. They will vary in terms of their daily activities and what they would like to do with more freedom from their glasses. For example, a 60-year-old patient might not be able to eliminate reading glasses completely, but he or she may be able to better see his or her computer. Similar patients have been thrilled with their results. Again, setting the proper expectations is key.

Irregular cornea patients can be great candidates for Vuity, and many of our keratoconus patients who wear scleral lenses have had success with the drop. Particularly in those with irregular corneas, scleral multifocals do not provide great near vision, making it necessary for these patients to also wear prescription reading glasses. Two of our patients in particular, an accountant and an engineer in this category, are extremely happy with the near vision that they achieved with the drop. We have also found that patients who have had previous refractive surgery and are now becoming presbyopic are very unhappy about the need to wear glasses. These patients have been successful with Vuity, as well as those who experience glare and halos driving at night or who have larger pupils and struggle to see well up close.

Another patient type that makes a good candidate for the drop is one who has dropped out of multifocal contact lens wear. Often these folks do not want to compromise their distance vision and end up going back to their distance-only contacts. We’re finding that Vuity has really helped multifocal dropout patients to achieve the near vision they are looking for. We use our electronic medical records system to identify patients of presbyopia age who were not able to adapt to progressive lenses so that we can inform them of this option.

Patients with very high myopia may not be good candidates for presbyopia-correcting drops. We also closely monitor those with any lattice degeneration to make sure that we’re not creating any longstanding issues. In the GEMINI 1 and 2 FDA clinical trials of the drop, there were no retinal side effects reported.² Still, if patients are more nearsighted, we let them know that, although there were no adverse events in the clinical trials, there are theoretical risks of which we must inform them.

Comprehensive Eye Exams a Must

Patients who are interested in Vuity must first have a comprehensive eye exam. If we have seen them within the past year, we will schedule them for a presbyopia cash-pay consultation. We explain to them on the phone that presbyopia is not a medical diagnosis so that they understand there will be an out-of-pocket charge. They can discuss their situation with an eyecare provider and be sure they have all of their questions answered. We will check their vision, perform optical coherence tomography of the macula, and try the drop in office. We then send a prescription to the pharmacy and educate the patient to use it for a solid 7 days. If they have not had an annual eye exam, we set that up right away.

The patient discussion and education can be provided during their annual eye exam; however, some patients will have numerous questions. We simply let them know that presbyopia is causing their difficulty with focusing up close. We explain their options and tell them about Vuity. We let them know we want them to try it for 7 days, saying that the office will text them to follow up and ask about their experience.

For patients who have many questions and need more time, we can schedule a follow-up. We let them know that we want to give them ample time to answer their questions, so we are going to bring them back for a more detailed discussion. We say, “Just like your time is precious, we have other patients waiting. We want to be polite, but we do not want our doctors to get behind.” I learned in the beginning I was spending too much time on education. There is nothing wrong with scheduling a follow-up/consultation to make sure patients have all of their questions answered and feel comfortable.

Conclusion

Vuity is synergistic with other services and products that we offer. For example, we also do aesthetic consultations in our office and prescribe products such as Upneeq (oxymetazoline hydrochloride 0.1%; RVL Pharmaceuticals, Inc.), the first FDA-approved pharmaceutical for treating blepharoptosis. These types of discussions allow us to uncover more concerns patients may have, opening the door to other opportunities. This is why it is so valuable to spend time with patients, educating them on all of their treatment options.

The new presbyopia-correcting drop is driving more patients to practices for comprehensive eye exams, some for the first time. It also means that eyecare providers have even more chances to offer additional services and further build their practices. ■

References

1. Organizational overview. The Vision Council website. Accessed April 19, 2022. https://thevisioncouncil.org/sites/default/files/TVC_OrgOverview_sheet_0419.pdf .
2. VUITY™ (pilocarpine HCI ophthalmic solution) 1.25%, the first and only FDA-approved eye drop to treat age-related blurry near vision (presbyopia), is now available. Abbvie website. December 9, 2021. Accessed April 19, 2022. https://news.abbvie.com/news/press-releases/vuity-pilocarpine-hci-ophthalmic-solution-125-first-and-only-fda-approved-eye-drop-to-treat-age-related-blurry-near-vision-presbyopia-is-now-available.htm .

Dr. Wruble is optometrist and owner of Belmont Eye, Belmont, NC, and Northlake Eye, Charlotte, NC. She is a private and corporate practice consultant for revamping practices.

Disclosure
Dr. Wruble is a consultant to Allergan.