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Pharmacological correction of presbyopia

Poster Details

First Author: S.Patel UK

Co Author(s):    F. Salamun   K. Matovic           

Abstract Details



Purpose:

Presbyopia cannot be cured, but individuals can compensate for it by wearing reading, bifocal, trifocal or multifocal eyeglasses or contact lenses and multifocal or trifocal intra-ocular lenses or corneal inlays. Presbyeyedrops© is a medical treatment to correct presbyopia by means of ophthalmic drops. It is a pharmacological treatment for presbyopia that avoids the use of eye glasses, contacts or invasive surgery. It consists of an ophthalmic drop which contains a combination of two drugs: a parasympathomimetic and a non-steroid anti-inflammatory agent. Causes of presbyopia could be related to the progressive decrease in the production of the neurotransmitter responsible for the stimulation of the ciliary muscle in the human eye. By means of this drop, the eye is kick-started, provided with that neurotransmitter that the system stopped producing and in the necessary amount; thereby compensating this deficiency and recovering the compromised near vision. Thus, a small study has been undertaken in order to justify further research of the actions of this eye-drop and if it really helps in overcoming the problems of intermediate and near vision.

Setting:

Medicinski Center, Vid, Slovenia and Vision4You, Lund, Sweden

Methods:

The pharmacological treatment has 2 purposes namely a stimulation of the parasympathetic innervation (accommodation) and prolonging the effect of the parasympathomimetic action (NSAID). The drop action results in the following: 1. Stimulation of the muscarinic receiver of the ciliary muscle and the iris 2. Inhibition of prostaglandin production by the anterior uvea 3. Produce contraction of circular and transverse fibers of the ciliary muscle (depending of quality and quantity of muscarinic receivers). 4. Rehabilitation of the muscle function, producing a change in shape and position of the crystalline lens, and thus accommodation is possible again. Indications of usage of the drops are that the patient has to be between 40 and 80 years of age without any ocular pathology except phorias and glaucoma and lens opacities and intra-ocular lenses. The distance refraction should be between +0.75D to -0.75D sphere and astigmatism no higher than -2,00. The dosage and periodicity is decided individually. The contra-indications are myopa of more than -1,00, hyperopia of more than +1,00 or astigmatism of more than -2,00. Further corneal or vitreous opacities and retinal pathologies and general chronic pathologies. Number of eyes participating in this pilot study was 15.

Results:

As expected the pupil reacted to the drop. The mean pupil diameter before instillation was 4,1mm and after instillation 2,7mm with a standard deviation of 1,110 and p-value of <0,001. The mean UCVA for distance was before instillation 0,8 and after instillation 1,0 with a standard deviation of 0,1907 and a p-value of <0,001. The mean UCVA for near was before instillation 0,54 and after instillation 0,8 with a standard deviation of 0,1907 and a p-value of 0<0,001. The depth of focus was before instillation 1,6D and after 2,8D, the standard deviation was 0,8288 and the p-value <0,001. The statistical analyses are clinically significant and show an improvement of the patientÂ’s ability to perform intermediate and near work without spectacles. The safety of the drops is excellent, all eyes improved both for distance and near. The adverse reactions to the drops were that 1 patient reported nausea just after instillation but was quickly relieved, 1 patient reported dryness that gradually disappeared and 1 patient had a burning feeling that gradually disappeared.

Conclusions:

It has been shown that a topical treatment to correct presbyopia is a safe and easy way to eliminate the use of glasses in presbyopic patients. It is completely reversible, if the patient does not want to use the drops one day or more then they will not be able to read without some form of correction. A complete and careful examination of each patient is neccessary and you have to know that it is not suitable for all presbyopic patients. A larger patient material is needed to be absolutely sure that the drops are completely harmless, further studies will be undertaken.In this small cohort of subjects, both near and distance UCVA improved after drop instillation. On average a 1mm reduction of pupil size was associated with a 0,9D increase in depth of focus. The authors have a financial interest in the product presented.

Financial Disclosure:

... gains financially from product or procedure presented

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