Real-world assessment of topical pilocarpine for presbyopia: patient education on retinal detachment
Abdelrahman Elhusseiny, MD, of the University of Arkansas, discussed outcomes of a study presented at the American Society of Cataract and Refractive Surgery Annual Meeting that highlighted the important need for retinal assessment in patients receiving treatment for presbyopia.
Abdelrahman Elhusseiny, MD:
I’m glad to be here today to present our study about the association between the topical low-dose pilocarpine and the risk of rhegmatogenous retinal detachment.
A bit of background about our study is in 2021, the FDA approved the use of low-dose pilocarpine for management of presbyopia. Since that time, there has been growing interest in using this treatment option for our patients. In the original trials, there were no reported cases of retinal detachment after initiation of the therapy. However, later in 2022, there were some case reports that showing possible association of rhegmatogenous retinal detachment after the start of topical pilocarpine therapy. That was the main goal of our study, is to use a large database called TriNetX to evaluate this association of retinal detachment in presbyopic patients who just started on pilocarpine.
Our study, our primary group, was presbyopic patients above the age of 40 who started on pilocarpine medication 1.25%. Then we compared them to a control cohort of patients with similar baseline characteristics who have started on artificial tears. Then we evaluated the risk of rhegmatogenous retinal detachment within the first year, at 3 months, 6 months, and 1 year after initiation of the therapy.
We found that patients who started on low-dose pilocarpine has significantly increased risk of retinal detachment at all time points, and the risk differs between 2- to 3-fold depending on the time point. We did Cox proportional hazards model to adjust for confounding factors, and this association was still significant. We found also that patients who are myopic who had lattice degeneration were at increased risk of retinal detachment.
The importance of this study is that it informed the practitioners who prescribed the pilocarpine for proper patient selection. Before prescribing topical pilocarpine, you need to have a detailed eye exam to evaluate for risk factors that patients have, including myopia, lattice degeneration, previous history of retinal detachment, before prescribing that.
The second most important point is patient education, that you have to inform patients about warning signs such as loss of vision, sudden loss of vision, blood curtain, flashes of light after initiation of the therapy, so that they can go to their eye doctor, inform them about it for any detection of retinal tears and retinal detachment.
