New pharmaceutical treatments are an exciting advancement for presbyopia

Nathan Lighthizer, OD, an optometrist and faculty member at the NSU Oklahoma College of Optometry in Tahlequah, shares his take on exciting new therapeutics available for the management of presbyopia.

Question:

What are the signs and symptoms of presbyopia? How do you talk to your patients to educate them on this condition?

Nathan Lighthizer, OD:

Yeah. I mean, presbyopia is something that affects so many patients. I mean, if you live long enough, you’re going to be affected by presbyopia, which is a loss of the focusing ability of the natural lens. You lose the ability to what we call accommodate is the medical term or be able to see up close.

Patients, most often, their main symptom or initial presenting symptom is, “Doc, my arms aren’t long enough.” We’re used to, when we’re reading up close here, our lens flexes. Our lens focuses and allows us to see up close. Well, as we lose that power, as we lose that ability to accommodate or focus, we have to start stretching things further away.

That’s often the initial presenting symptom is, “Doc, my arms aren’t long enough. I’m struggling up close to see things as well as I could in the past. Or maybe I need better lighting, better contrast to be able to see that fine print.” That’s the initial symptom that patients often have.

Question:

What are the treatment options or ways to manage presbyopia?

Nathan Lighthizer, OD:

Yeah, there’s a variety of different things that we have to manage this. Again, it’s a patient that’s the right age. This usually hits somewhere between the ages of 40 and 50 for most patients, depending on what their prescription is, how well they tolerate blur, things like that. Usually between the ages of 43 and 47, somewhere in that mid-40s.

Fortunately, we have a lot of treatment options. I mean, traditionally eyeglasses, having a bifocal or a progressive addition lens, which is a no-line bifocal. If you had no prescription before, I mean, people go buy over-the-counter readers. You can get by with the plus ones or plus 150s or plus twos. But that obviously depends on what the prescription is, so see your doctor to make sure you have the best possible optics in place.

But it’s been glasses, we have a variety of contact lenses now, multifocal contact lenses that suit a variety of needs. Glasses, contact lenses.

Pharmaceutical options we now have. We have eye drops in the presbyopia space to help with early mild to moderate presbyopia. They help give patients… A drop called Vuity was the first one on the market. Now second drop called Qlosi is now on the market to both work on pupil size to be able to kind of shrink the pupil, which improves, increases depth of focus, the ability to see things at different distances.

We now have pharmaceutical options for patients that are in mild to moderate presbyopia, early to mid-presbyopia, where maybe they’re not used to glasses or maybe they’re not used to contact lenses and they say, “Glasses don’t work for me,” for whatever reason or “Contact lenses don’t work for me,” we now have pharmaceutical options.

There are surgical options as well. If you wanted to go to the extreme end, if somebody had an early cataract, obviously their natural lens would come out and there are accommodating IOLs or multifocal IOLs that can be put in. Usually that’s reserved for patients as they get into their 60s and 70s and more cataract age, but surgical options are available as well.

You’ve got glasses, we’ve got contact lenses, we’ve got pharmaceutical options now and surgical options as well.

Question:

What areas of innovation are most exciting for you, and what are you keeping an eye on in the presbyopia field?

Nathan Lighthizer, OD:

Well, I think it’s the pharmaceutical treatment options that is very interesting and very intriguing because it’s brand new. We’ve never had this before a couple of years ago, and it’s been glasses or contact lenses and surgeries not usually available, and not usually needed yet for a few decades.

The pharmaceutical options, and we started with Vuity, it’s pilocarpine and working on pupil size, but there’s a variety of other molecules and drugs that are being studied. Again, currently there are 2 that are FDA approved, but there’s a number of them that are going through the FDA approval process by different companies right now.

I think we’re going to keep our eye on where do these different options fit, whether it’s working on pupil size or it’s working on the structural integrity of the lens or things like that. It’s where are these pharmaceutical options going.

Then it’s getting clinical experience. Because you can have the best data in the world, but at the end of the day, we got to make it work in the clinical trenches when we’re seeing patients and does it meet the needs that they are looking for. I’m excited about looking at the different pharmaceutical options that are coming down the pike for the treatment of presbyopia.