A new study reveals that daily use of eye drops, which combine pilocarpine and diclofenac, can significantly enhance near vision for presbyopia patients
A recent study presented at the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) reveals that daily eye drops combining pilocarpine and diclofenac can significantly improve near vision in individuals with presbyopia. The research demonstrated that patients could read multiple additional lines on vision charts, with effects lasting up to two years. This non-surgical treatment offers a promising alternative to reading glasses, providing a convenient and effective solution for those seeking improved near vision.
Revolutionary eye drops offer non-invasive, long-lasting relief for presbyopia
Presbyopia, a condition that affects everyone as they age, can cause difficulty focusing on near objects and reading text, often necessitating the use of reading glasses. However, the development of these special eye drops, to be used two or three times a day, offers a convenient and hassle-free solution.
A retrospective study of 766 patients found that the majority could read an extra two, three, or more lines on the eye chart used for testing near visual acuity (the Jaeger chart) after using specially formulated eye drops. The study was conducted over two years, with patients being assessed at regular intervals. This improvement was sustained for up to two years.
Dr Giovanna Benozzi, director of the Center for Advanced Research for Presbyopia, in Buenos Aires, Argentina, said: “We conducted this research due to the significant unmet medical need in presbyopia management. Current solutions, such as reading glasses or surgical interventions, have limitations, including inconvenience, social discomfort, and potential risks or complications. There is a group of presbyopia patients who have limited options besides spectacles, and who are not candidates for surgery; these are our primary focus of interest. We sought to provide robust clinical evidence supporting an innovative pharmacological solution to offer patients a non-invasive, convenient and effective alternative.”
Eye drops improve near vision with minimal side effects
The eyedrops contain two active agents: pilocarpine, a drug that constricts the pupils and contracts the ciliary muscle, which is a muscle controlling the eye’s accommodation for seeing objects at varying distances, and diclofenac, a non-steroidal anti-inflammatory drug (NSAID) that reduces inflammation and the discomfort that pilocarpine often causes. Pilocarpine works by stimulating the ciliary muscle, which in turn alters the shape of the lens, enabling better near vision. Diclofenac, on the other hand, helps to reduce any discomfort or inflammation that the action of pilocarpine may cause.
Administering the eye drops was straightforward. Patients were instructed to use the drops twice a day, once upon waking and again six hours later, with the option for a third dose if symptoms persisted. The study group, consisting of 373 women and 393 men with an average age of 55, was divided into three groups, each receiving a different eye drop formulation. Each formulation contained a fixed dose of diclofenac, but the concentrations of pilocarpine were 1%, 2%, and 3%.
The researchers assessed the improvement using the Jaeger chart without reading glasses, one hour after the first dose, and followed up with the patients over a two-year period.
Dr Benozzi told the Congress: “Our most significant result showed rapid and sustained improvements in near vision for all three concentrations. One hour after having the first drops, patients had an average improvement of 3.45 Jaeger lines. The treatment also improved focus at all distances.
“Impressively, 99% of 148 patients in the 1% pilocarpine group reached optimal near vision and were able to read two or more extra lines. Approximately 83% of all patients maintained good functional near vision at 12 months. Importantly, no significant adverse events like increased intraocular pressure or retinal detachment were observed.”
In the 2% group, 69% of 248 patients were able to read three or more extra lines on the Jaeger chart, and in the 3% group, 84% of 370 patients could read three or more extra lines.
The improvement in the patient’s vision was sustained by up to two years, with a median duration of 434 days. Side effects were mild, and the most common was dim vision, which occurred in 32% of the cases.
Dr Benozzi continued:
“Nearly all patients experienced positive improvements in near visual acuity, although the magnitude of the improvement depended on the status of their vision before treatment at baseline”
“Our study revealed that optimal pilocarpine concentrations can be individualised based on the baseline severity of presbyopia, as assessed by the initial Jaeger scores.
“Patients with less severe presbyopia responded best to 1% concentrations, while those with more advanced presbyopia required higher 2% or 3% concentrations to achieve significant visual improvement.”
She concluded: “These results suggest this combination therapy offers a safe, effective, and well-tolerated alternative to traditional presbyopia management. It significantly reduces dependence on reading glasses, providing a convenient, non-invasive option for patients, although these eye drops may not eliminate the need for glasses in all individuals.
Importantly, this treatment is not intended to replace surgical interventions, but rather to serve as a valuable solution for patients who need safe, effective, and personalised alternatives and seek freedom from the inconvenience of eyewear. Eye care professionals now have an evidence-based pharmacological option that expands the spectrum of presbyopia care beyond glasses and surgery.”
