Understanding Presbyopia: Treatment Options, FDA-Approved Eye Drops, and LASIK Solutions


Hello, everyone! I'm Dr. Audrey Tai, a board-certified and fellowship-trained refractive and cataract surgeon, ophthalmologist, and cornea specialist. Welcome back to my channel, Eye Surgery Insights.

In today's video, I will review the treatment options for presbyopia, also known as the need for reading glasses, which often begins in the early 40s. We’ll explore the causes of presbyopia, discuss the latest FDA-approved eye drops, and review surgical treatment options available in the U.S.

If you don't have time for a full 10-minute video, follow me on Instagram @DrAudreyTai for short, engaging clips that offer eye care tips.

What is Presbyopia?

Presbyopia is the gradual decline in the ability to read close-up as we age. You may find reading small or fine print increasingly difficult over time, and you might catch yourself holding reading material further away to see it clearly. Eventually, you may need over-the-counter reading glasses, prescription bifocals, or multifocal contact lenses.

You're Not Alone

Presbyopia affects 128 million Americans, and this number is growing.

What Causes Presbyopia?

The lens in our eye is flexible and changes shape to focus on objects at different distances. This flexibility is enabled by muscles called the ciliary body. As the lens curves, it helps us see close objects more clearly, while a flatter shape allows us to see distant objects. However, as we age, the lens loses its elasticity, and it no longer adjusts effectively when the eye muscles contract, leading to presbyopia.

Current Treatments

While we can't restore the lens's natural elasticity, effective treatments are available to manage presbyopia. Please note, I have no financial interest in any of the treatments mentioned. These insights are based on my clinical experience and research.

VUITY Eye Drops

Recently, many patients have inquired about VUITY, an FDA-approved eye drop made by Allergan. VUITY contains 1.25% pilocarpine, which temporarily improves near vision through two mechanisms:

  1. Stimulating Lens Flexibility: Pilocarpine can stimulate the ciliary body muscle to enhance any residual elasticity in the lens, temporarily improving near vision.

  2. Creating a Pinhole Effect: By constricting the pupil, pilocarpine creates a pinhole effect that improves vision. This phenomenon is akin to looking through a small hole, which enhances clarity.

FDA Approval and Usage

Pilocarpine was initially approved by the FDA in 1974 to treat glaucoma and for eye exams or surgeries requiring pupil constriction. VUITY was approved in October 2021 specifically for presbyopia treatment. The recommended dosage is one drop in each eye once daily.

Effectiveness and Side Effects

According to clinical trials (GEMINI 1 and 2 studies), VUITY can improve near vision as soon as 15 minutes after application, with effects lasting 6 to 10 hours. However, some potential side effects include eye redness and headaches. VUITY may also reduce night vision by limiting light intake through a constricted pupil. In rare cases, pilocarpine can cause retinal detachment, so consult your eye doctor before use.

Cost and Availability

Currently, VUITY is not covered by most insurance plans and costs about $75 for a 2.5 mL bottle. As it becomes more widely available, we will continue to learn about this medication.

LASIK Surgery

LASIK, commonly known for correcting nearsightedness, can also treat presbyopia. For presbyopia patients, I customize treatments for each eye, creating a monovision effect. This technique allows one eye to focus better on close objects while the other focuses on distant objects, enhancing overall vision.

Monovision Technique

Monovision involves correcting each eye differently, similar to wearing contact lenses with distinct prescriptions. LASIK achieves this permanent correction using two lasers:

  1. Femtosecond Laser: Creates a thin flap on the cornea.
  2. Excimer Laser: Reshapes the cornea to achieve the desired prescription.

Considerations

Monovision might slightly decrease depth perception, so finding the right balance is crucial. I recommend trying monovision contact lenses to simulate this effect before opting for surgery.

Refractive Lens Exchange

For a permanent solution, consider refractive lens exchange, akin to cataract surgery. This procedure removes the natural lens and replaces it with a multifocal or extended-depth-of-focus intraocular lens (IOL). These advanced lenses enable clear vision at various distances, reducing the need for glasses.

Surgical Process

I perform femtosecond laser-assisted refractive lens exchange for presbyopic patients. This method offers precision and better outcomes.

Potential Risks

As with any surgery, there are risks. An individualized eye exam and consultation with your eye surgeon are essential to determine the best treatment for you.

International Treatments

Other treatments, such as various corneal laser surgeries, are available internationally. Consult with your eye specialist for options best suited to your needs.

Connect With Me

I hope you find this video informative. If you learned something new, please hit the like button and subscribe to my channel for more eye health insights. You can also follow me on Facebook, Instagram, and LinkedIn @DrAudreyTai to learn more about my practice.

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