In part 4 of a video series, a panel of ophthalmologists and optometrists discusses the newest FDA-approved presbyopia-correcting drop, Yuvezzi, a convenient, preservative-free combination therapy that can provide approximately 8 to 10 hours of near-vision improvement with a single daily drop. They highlight its dual-agent mechanism, favorable tolerability, and potential to reduce ocular redness.
Nathan Lighthizer, OD, FAAO:
Dr. Brujic, let’s focus on the newest FDA-approved one, again, our first combination agent, carbachol and brimonidine. It is preservative-free like Qlosi and Vizz are. I know you’ve got extensive experience with Yuvezzi. Tell us your thoughts, daily drop, it’s got a little bit different mechanism, clinical trial data. Give us your thoughts on Yuvezzi.
Mile Brujic, OD:
Yeah, I think Dr. Mah and Dr. McDonald really hit on some important points. This is a lifestyle medication, and presbyopia is a lifestyle strategy to help our patients with. With that said, we want to mitigate things that are going to happen with any of the treatments that we’re actually utilizing for patients for this.
Now, there are several interesting things with it. First and foremost, the thing that I like about Yuvezzi is there’s not a lot of extra rules. It doesn’t have to be refrigerated. There’s not a lot of like other things. You just use the drop when you want the efficacy, and you can expect 8 to 10 hours of efficacy from that single drop. I like that there’s 30 vials in the container. It just makes it logical and easy to prescribe as well, too.
One of the things that sometimes doesn’t get brought to the attention of the clinicians that are prescribing is the fact that there are 2 agents, 2 active molecules in this combination. That is a difficult barometer to hit in the eyes of the FDA because you have to actually demonstrate contribution of elements. What that means is the combination has to perform better than either agent by itself. Although it sounds pretty logical and although, if you don’t look a lot at clinical trials, you’d think, “Well, of course, that has to be the case.” It is a very, very difficult endpoint to hit. It is a testament to how well they actually perform their clinical trials.
When you look at the data from Yuvezzi, you see that the control arm didn’t respond. There was almost zero response. I’ve never seen trials on presbyopia drops that showed such low placebo-responder rates. All of this to share that it is a drop that’s convenient. It is a drop that, again, you have a contribution of elements, that met the FDA criteria and that it did work better than each individual component separately. They do act additively. Because brimonidine is in the system, it is a nice lifestyle medication because people that use it don’t have to be concerned about, sometimes, the redness that can happen with those cholinergic agonists. As a category, they tend to do that. But, again, brimonidine helps mitigate some of those effects.
Nathan Lighthizer, OD, FAAO:
Let’s talk on Yuvezzi just for another minute or 2. In 30 seconds, from each of you, who is the optimal patient for this on Yuvezzi? Dr. McDonald, optimal patient for you?
Marguerite McDonald, MD, FACS:
Well, the low-hanging fruit, certainly the young person in their early to mid-40s who is upset about using reading glasses. That’s easy. But I mentioned a few other patient types that are also, at least in our practice, very common, like the LASIK patient who’s now 45. They had LASIK at 23. They’re upset now that they’re back in glasses. I mentioned the premium IOL patient who doesn’t get quite enough near vision after paying the surgeon extra for the privilege of getting near vision. People who had cataract surgery years ago and picked a monofocal IOL, perhaps before there was even a premium IOL available, they’re still youthful and vital, and they want to enjoy a glasses-free existence like all their friends, so there are quite a few patient groups.
Nathan Lighthizer, OD, FAAO:
Dr. Mah, anything to add to that? Any optimal patient that you are seeing for Yuvezzi? What have you found?
Francis Mah, MD:
Yeah, I mean, I agree with Marguerite. The low-hanging fruit is the person who’s kind of the young presbyope. I will highlight, I’ve got a couple patients, one, she actually had an ICL. She developed a cataract. She was young. She didn’t have anything in the other eye. She didn’t want surgery in the other eye. She actually liked the ICL. She was seeing very well, so I had to take the cataract out, took the ICL out, and she was kind of unhappy. Right? She’s 40, young 40s. She was unhappy that I had to take the ICL out and her lens out.
I didn’t really want to put a diffractive multifocal because, a lot of times, those people are unhappy when they’ve got a diffractive multifocal in one eye and they’ve got absolutely no cataract in their other eye. I actually did put in a standard toric monofocal lens, and she was a little unhappy. I then prescribed a topical agent like Yuvezzi, and she was ecstatic. She puts it in both eyes. She’s now in her late 40s. She’s fully presbyopic. Now, she’s ecstatic. She doesn’t have cataract surgery in the 1 eye. She’s got a toric monofocal in the other. She can read.
The other one is, I just did a 60-year-old who had cataract surgery initially in 1 eye about 5 years ago, again, standard monofocal lens. The first question after her cataract surgery in the second eye, because I just put a monofocal to match, was, “When can I restart my topical drop, my Yuvezzi? When can I start that again?” I was stunned because she didn’t tell me that before. I said, “Well, I guess, in a week, you can start that back up.” These are patients that are using it that are very happy with the eye drops. They can reduce their need for reading glasses and, again, kind of improve that lifestyle, feel young again.
Nathan Lighthizer, OD, FAAO:
I’m hearing multiple different types of patients. It’s another tool in our toolbox to meet the variety of needs that we are seeing on a day-in-and-day-out basis. I love the fact that you guys kept saying the ideal patient, or one of them, is the young patient in their early to mid-40s. It’s me then, huh? It’s that young patient that’s never worn glasses and never worn contact lenses.
I will tell you that I’m a Yuvezzi prescriber, but also a Yuvezzi patient as well. Again, I still have a decent amount of near, but, when I have that critical, high, intense near demand, it’s been very helpful for me.
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