IMAGINE A 45-YEAR-OLD PROFESSIONAL WOMAN WHO, FOR the first time, finds it difficult to read small print because of presbyopia. She refuses to put on reading glasses at work and suffers headaches and eye strain as a result.

Having had LASIK roughly 12 years ago, the patient has since enjoyed her glasses-free vision. Now, requiring additional accommodative power, the patient uses Vuity (Allergan) when needed.

This patient represents a whole class of patients—in this case, LASIK patients—who have the potential to become first-time Vuity users. Patients who have enjoyed freedom from spectacles and contact lenses for years have a very difficult time going back to glasses.

I was that patient. My story is representative of a number of classes of patients who, for the first time, can use a presbyopia-correcting drop with success. In this article, we’ll review guidance for patient selection with Vuity and the importance of both provider and patient education. First, let’s look at the potential for capturing first-time users.

Trickling in

In my tertiary care referral practice, where we see complex diagnoses, we might expect to see few if any patients who would be interested in Vuity. Yet we do have patients ask about Vuity. There is high curiosity from patients when they hear about a drop that can potentially improve their near vision without their needing glasses. Everyone who hears about it is interested! It’s easy to assume that general care practices have even more patients asking about the medication.

As word gets out through advertising and word of mouth, we are seeing a trickle of patients asking about Vuity. That’s likely to increase.

There are at least 3 keys to success for capturing first-time patients with Vuity and, by extrapolation, with other anticipated presbyopia-correcting drops. These keys include appropriate patient selection, solid provider education, and thorough patient education.

Patient Selection

Like any medication or technology, Vuity does not meet the needs of all patients. Putting unsuitable patients on Vuity will only lead to disappointment. One size does not fit all.

In one case, I put a patient on Vuity and warned her about the potential for headache, which unfortunately she experienced. As a result, she discontinued the drug.

As more presbyopia-correcting therapeutics come to the market, such adverse reactions may occur less, especially with lower concentrations. Moreover, preservative-free versions may reduce or eliminate the burning or irritation that some patients experience with Vuity.

With broad labeling, it’s reasonable for physicians to use Vuity in a wide range of patients. But the patients who perhaps are the most suitable are those who don’t have a huge refractive error to begin with, such as mild hyperopes or emmetropes and those who are in their 40s and early 50s. Patients with higher refractive errors who are older than 50 who don’t have much residual accommodative amplitude might not experience as much success.

When older presbyopes visit an eyecare professional to ask about Vuity, it presents a chance to discover early cataract or to at least educate the patient about lens changes. It can open the door to those patients who could benefit from intraocular lens-correcting presbyopia treatments.

I’ve had several patients who we’ve been able to move toward a surgical approach to correct their presbyopia since pharmacologic treatments would not have been ideal. The direct-to-consumer advertising got them in the door, so we could examine their eyes and find this pathology. These patients wouldn’t have otherwise presented.

Provider Education

One key for physicians in capturing first-time patients with Vuity involves understanding that Vuity is not generic pilocarpine. Vuity uses Allergan’s proprietary pHast technology, which allows the drop to quickly adjust to the physiologic pH of the tear film. Vuity is far better tolerated than generic pilocarpine.

At the same time, providers must realize that Vuity may cause adverse effects for some patients, such as browache, headache, or ocular irritation. These potential adverse effects must be understood and expected in a subset of patients. Most of these side effects are mild and resolve with continued use.

Eyecare professionals also need to understand that Vuity will not replace spectacle need completely. Given its duration-of-effect of 4-6 hours, patients will still require reading glasses at times. Vuity is not a therapy that will cannibalize the eyeglasses market or optometric practices. In fact, Vuity will draw more patients into practices, where full eye exams will be done, and otherwise unknown ocular pathologies may be discovered. Patients who come to the office and leave with a Vuity prescription will also leave with a pair of glasses to use when they are not on the drop. With correct education, both patients and eyecare practices will benefit.

Patient Education

For success, make sure to educate patients that adverse effects, such as a mild browache, are an expectation, not a complication. Also make sure they understand that such effects are likely to improve over time.

Furthermore, patients need to understand that, if they instill Vuity in the morning, the effect will not last all day. The current labeling is for once-daily use. They’ll have to instill the drop when they most need it for near tasks, and the need for glasses at certain times will not be eliminated completely.

Patients also must be aware that their gains in reading vision may vary. Some patients, depending on age and refractive error, may gain 1 line; others may gain as many as 4 lines.

Cost is Not an Obstacle

In my practice, the cost of Vuity has not presented an obstacle. Allergan offers a points program through which eligible patients pay an out-of-pocket price of $79 per bottle and earn points toward rewards.

Success Story

Recently, a 52-year-old woman with minimal hyperopia of +0.50 OU came to see me for a LASIK evaluation. She had been used to having excellent vision for most of her life and was very frustrated at having to rely on her reading glasses to look down at her phone.

After a thorough discussion of presbyopia and the lens changes that occur, she understood that LASIK would not be the ideal solution for her. Instead, we started her on Vuity to use during the day at her busiest time when she required strong intermediate-near vision. We discussed realistic expectations and the potential for mild side effects. She called me back 2 weeks later to rave about how this therapy had changed her life. She was more productive as a result and very happy.

Conclusion

It is such an exciting time in eye care to be able to finally offer a pharmacologic treatment for presbyopia. With continued physician and patient education, we can appropriately treat a large segment of the population that suffers from presbyopia and offer something more than glasses.

As we continue to open this market, we will continue to see exciting improvements and diversity with this class of therapeutics, including preservative-free vehicles, novel delivery methods, twice-daily dosing, and longer acting drugs. We need to get better at learning about this market and how to help this group of patients. ■

Dr. Farid is clinical professor of ophthalmology; director of cornea, cataract, and refractive surgery; and director of the ocular surface disease program at the Gavin Herbert Eye Institute at the University of California, Irvine.

Disclosures
Dr. Farid serves as consultant/advisor to Alderya Therapeutics, Inc.; Allergan; Bausch + Lomb; Bio-Tissue, Inc.; CorneaGen; Dompe; Johnson & Johnson Vision; Kala Pharmaceuticals, Inc.; Novartis; Alcon Pharmaceuticals; Orasis Pharmaceuticals; Sun Ophthalmics; Tarsus; and Zeiss.