ESCRS - FP31.10 - Low-Dose Pilocarpine Effects On Near Vision In Early Presbyopic Subjects, And Correlation With Anterior Segment Changes Using Custom-Made Extended-Depth Oct.

Low-Dose Pilocarpine Effects On Near Vision In Early Presbyopic Subjects, And Correlation With Anterior Segment Changes Using Custom-Made Extended-Depth Oct.

Published 2023 - 41st Congress of the ESCRS

Reference: FP31.10 | Type: Free paper | DOI: 10.82333/pfmr-x964

Authors: Francesco Pozzo Giuffrida* 1 , Elaine Zhou 1 , Bianca Heilman 2 , Marco Ruggeri 2 , Leana Rohman 2 , Fabrice Manns 2 , Florence Cabot 1

1Department of Ophthalmology,Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine,Miami,United States, 2Department of Biomedical Engineering,Ophthalmic Biophysics Center, Bascom Palmer Eye Institute,Miami,United States

Purpose

To assess the visual acuity and the accommodative effort in eyes of subjects with early presbyopia symptoms using a custom-made extended-depth OCT, before and after the administration of low-dose pilocarpine (1% and 1.25%).

Setting

This study was conducted at the Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.

Methods

This prospective study included five eyes from five patients in the presbyopic age range (40, 44, 46, 47, and 51 years). Subjects were measured under photopic conditions for best-corrected distance visual acuity (BCDVA) and best-corrected near visual acuity (BCNVA) at 40 cm and 66 cm. Imaging of the anterior segment using a custom-built extended-depth optical coherence tomography (OCT) system was performed at baseline and 1 hour after administration of 1% and 1.25% pilocarpine. Each patient was tested with accommodation targets simulating distant (0D), intermediate (66cm/1.5D), and near vision (40cm/2.5D). Dynamic anatomical changes in pupil diameter and lens thickness were captured by OCT.

Results

Mean BCVA were logMAR -0.06, 0.21 and 0.29 at distance, 66 cm and 40 cm respectively at baseline. Near visual acuity (BCNVA) at 40 cm improved by 1 line on average in both groups (0.16 and 0.19 for 1% and 1.25% respectively). Distant visual acuity (BCDVA) decreased on average by 2 letters (-0.02 logMAR) with 1% and 4 letters (0.02 logMAR) with 1.25% pilocarpine. In all subjects, pupillary diameter decreased after pilocarpine, independently of the dosage and the accommodative stimuli. In the pre-presbyopic subject (40 y/o), an increase in lens thickness after 1% (+0.08mm) and 1.25% pilocarpine (+0.25 mm) administrations were observed, while no significant changes were detected in the four other presbyopic eyes.

Conclusions

Preliminary data suggest similar visual effects and structural changes in presbyopic eyes treated with 1% and 1.25% pilocarpine. The mechanism that increases near visual acuity induced by pilocarpine in these subjects may lie in the increased depth of focus secondary to the reduced pupil size (pinhole effect). The accommodative effect was dual in the pre-presbyopic subject, where both pupil constriction and a change in lens thickness were present after pilocarpine administration.