With new options for presbyopia-correcting drops on the horizon, the time to start educating our patients is now. As exciting as these pharmaceutical advancements are, it’s essential for eye doctors to understand the value of beating the commercials to the punch by educating patients now, before they start to see new innovative options on television ahead of their next annual exam.
Traditionally, presbyopia has been managed through reading glasses, contact lenses, or surgery; however, presbyopia-correcting eye drops could provide a convenient, flexible alternative that fits seamlessly into daily routines, decreasing dependency on corrective eyewear at near distances. New possibilities for managing age-related near-vision loss are emerging, with the development of the following presbyopia-correcting drops.
• Vuity (AbbVie): The first FDA-approved presbyopia drop, Vuity (pilocarpine HCl ophthalmic solution 1.25%) works by temporarily constricting the pupil, which increases depth of focus and improves near vision for up to 6 hours.1,2
• Qlosi (Orasis): Second to be FDA approved and next up to bat, Qlosi (pilocarpine HCl ophthalmic solution 0.4%) aims to offer twice-daily dosing with fewer side effects, using a lower concentration of pilocarpine and a preservative-free formulation to assist in comfortable vision correction.1,3
• LNZ100 (Lenz Therapeutics): The FDA has recently accepted a New Drug Application from Lenz for LNZ100 for the treatment of presbyopia, with a PDUFA date of August 8, 2025.6 This aceclidine-based ophthalmic solution has a unique mechanism of action. Aceclidine is the only pupil-selective miotic.1,7
• Nyxol + LPD (Ocuphire): Unlike pilocarpine-based drops, Nyxol (phentolamine ophthalmic solution 0.75% and low-dose 0.4% pilocarpine [LDP]) works by reducing pupil size through alpha-adrenergic antagonism, without stimulating the muscles that constrict the pupil. With phase 3 trials ongoing, this mechanism is thought to offer a more gradual change in pupil dynamics, which may reduce the likelihood of side effects, such as headaches or low-light vision problems.1,4,5
• MicroLine (Eyenovia): Taking a different approach, Eyenovia uses a microdosing platform to deliver more precise amounts of pilocarpine via a spray technology.1,8,9 With phase 3 studies completed regarding the delivery of pilocarpine 1% and 2%, more studies may still be needed before MicroLine is brought to market.1,8,9
Each of these options represents significant progress in nonsurgical treatment for presbyopia, offering patients more choice and flexibility in how they manage their vision. These innovative presbyopia-correcting eye drops offer a convenient, noninvasive solution to reduce reliance on near correction. Although these pharmaceutical options bring exciting advancements, the commercials and advertisements that come along with a new product will inevitably gain the attention of patients.
Educating Our Patients: Why Wait?
Presbyopia-correcting eye drops and sprays are some of the most promising new treatment options for age-related vision decline, and they are likely to gain traction with patients. Pharmaceutical companies are likely to promote these products directly to consumers, but optometrists have the critical role of providing context. Our patients look to us for guidance that considers their unique vision needs and health status. Although eye drops for presbyopia offer a promising alternative to reading glasses, not every patient will be an ideal candidate for every product. We must be prepared to discuss potential side effects, realistic outcomes, and alternative treatments, such as multifocal lenses or surgical options.
In addition, these drops represent temporary solutions. Presbyopia is progressive. Our role extends beyond the initial prescription—we must provide ongoing care and ensure our patients’ treatment plans evolve as their vision changes. Having this conversation now and encouraging a comprehensive dilated exam can help optometrists weigh all the options of future pharmacologic interventions. In addition to determining whether someone is even a good candidate, now is the perfect time for patients to understand how these drops compare to other treatments, such as multifocal lenses or progressive eyeglasses.
As with any new medical treatment available, the best outcomes come from understanding both the benefits and the potential limitations. Consulting with patients now ensures they receive personalized advice that considers their current and future overall eye health, lifestyle, and vision needs. Some patients might prefer using drops only during specific activities such as reading or working on a computer, whereas others might prefer to use them as an added benefit to their current lenses, and others may desire a more permanent solution such as surgery.
Patient Education Is Key
The rise of presbyopia-correcting drops is an exciting advancement in our field, but as with any new treatment, patient education is key. As optometrists, we have the responsibility to ensure our patients make informed decisions based on their specific needs and the best available clinical evidence. By staying well informed about these products, we can offer tailored recommendations and deliver the highest standard of care.
References
1. FDA adverse event reporting system (FAERS) public dashboard. US Food and Drug Administration website. Accessed October 7, 2024. https://fis.fda.gov/sense/app/95239e26-e0be-42d9-a960-9a5f7f1c25ee/sheet/45beeb74-30ab-46be-8267-5756582633b4/state/analysis
2. Allergan, an AbbVie company, announces positive topline phase 3 results evaluating investigational twice-daily administration of VUITY™ (pilocarpine HCl ophthalmic solution) 1.25% in adults with age-related blurry rear vision (presbyopia) [press release]. Abbvie website. Published April 5, 2022. Accessed October 7, 2024. https://news.abbvie.com/2022-04-05-Allergan,-an-AbbVie-Company,-Announces-Positive-Topline-Phase-3-Results-Evaluating-Investigational-Twice-Daily-Administration-of-VUITY-TM-pilocarpine-HCI-ophthalmic-solution-1-25-in-Adults-with-Age-Related-Blurry-Near-Vision-Presbyopia
3. Orasis Pharmaceuticals website. Accessed October 7, 2024. https://www.orasis-pharma.com/
4. VEGA-1: Presbyopia phase 2 clinical trial for Nyxol with low-dose pilocarpine. Ocuphire Pharma website. Accessed October 7, 2024. https://www.ocuphire.com/clinical-trials/vega-1-presbyopia-phase-2-clinical-trial-for-nyxol-with-low-dose-pilocarpine
5. Ocuphire’s VEGA-1 phase 2 trial in presbyopia meets primary and secondary endpoints [press release]. Ocuphire Pharma website. Published June 30, 2021. Accessed October 7, 2024. https://www.ocuphire.com/news-media/press-releases/detail/344/ocuphires-vega-1-phase-2-trial-in-presbyopia-meets
6. LENZ Therapeutics announces FDA acceptance of New Drug Application for LNZ100 for the treatment of presbyopia [press release]. Lenz Therapeutics website. Published October 21, 2024. Accessed October 21, 2024. https://ir.lenz-tx.com/news-events/press-releases/detail/22/lenz-therapeutics-announces-fda-acceptance-of-new-drug-application-for-lnz100-for-the-treatment-of-presbyopia
7. Lenz presbyopia drop meets endpoints in near vision improvement in phase 3 trials. Ocular Surgery News website. Published April 4, 2024. Accessed October 7, 2024. https://www.healio.com/news/ophthalmology/20240403/lenz-presbyopia-drop-meets-endpoints-in-near-vision-improvement-in-phase-3-trials
8. Eyenovia announces positive topline results from VISION-1 phase 3 clinical study of MicroLine for the treatment of presbyopia [press release]. Eyenovia website. Published May 25, 2021. Accessed October 7, 2024. https://eyenovia.com/eyenovia-announces-positive-topline-results-from-vision-1-phase-3-clinical-study-of-microline-for-the-treatment-of-presbyopia/
9. Eyenovia announces positive results from VISION-2 Phase 3 study of MicroLine as a potential on-demand treatment for presbyopia. Eyenovia website. Published October 20, 2022. Accessed October 7, 2024. https://eyenovia.com/eyenovia-announces-positive-results-from-vision-2-phase-3-study-of-microline-as-a-potential-on-demand-treatment-for-presbyopia/
Disclosures
Dr. Coats has financial relationships with, AbbVie, Alcon, Bausch & Lomb, Dompe, Harrow, Novaliq, Orasis, Sun, Tarsus, and Thea.
