A Renewed Appreciation for Refractions

Hot Topic

Progress on the Presbyopia Front

Ocuphire Pharma announced the initiation of its VEGA-2 phase 3 pivotal trial with the first patient enrolled in late December. The trial is evaluating the efficacy and safety of two of its labels: Nyxol by itself and Nyxol with adjunctive low-dose pilocarpine therapy for presbyopia.

The Details

Nyxol is a preservative-free ophthalmic solution containing 0.75% phentolamine (or 1% phentolamine mesylate), a nonselective alpha-adrenergic antagonist that inhibits the contraction of the smooth muscle of the iris. In phase 2 and phase 3 trials, Nyxol was shown to reduce pupil diameter, resulting in better contrast sensitivity and visual acuity. Nyxol is being developed for the reversal of pharmacologically induced mydriasis, presbyopia, and night (or dim light) vision disturbances.

My Two Cents

This is pretty neat. I've personally had quite a bit of luck clinically with pilocarpine HCl ophthalmic solution 1.25% (Vuity, Allergan/AbbVie) in my patients with mild to moderate presbyopia and those for whom a constricted pupil may aid their acuity (ie, patients who are unhappy with their premium IOLs, post RK patients, etc). Having more than one presbyopia drop in our armamentarium can only be viewed as a positive. Quite interestingly, Nyxol is also being developed to reverse in-office dilation, something our patients have been begging us about for years, as well as assistance in low light environments.

Kudos to Ocuphire for addressing two of the most common things we hear in the clinic:

"Can't you use a drop to reverse my dilation?" and "Isn't there anything else to help me drive better at night?"

Can You Relate

Over the holiday break, my 4-year-old son Brooks was off from school (glorified daycare), and neither his mother nor I were able to stay home with him. So, off to work with "Dada" at the "eyeball place" went Brooks each day.

Besides being the star of the office and giving our staff some regular comic relief with his antics, Brooks reminded me of how special our profession is. He knows Dada especially loves eyeballs that can't cry (or cry too much) and "gwass" lenses (Brooks speak for glass, aka scleral lenses) for blind patients (or friends, as he refers to them), but his biggest interest is in eyeglasses.

Brooks thinks the fact that I can make glasses for patients is the absolute coolest thing. He even insisted that I buy him an eye doctor kit of his own, which I of course did. His amazement with refractions and the purchase, design, and creation of glasses reminds me of what should continue to be the bread and butter of optometry. Glasses are the core of optometry and will likely always be an essential part of our profession. It's easy to become enamored with the medical aspect of eye care, but we need to remember just how amazing refraction is and how important it is to the general public. Why not try to once again enjoy an examination that we couldn't wait to perform in our younger days during optometry school?

OUTSIDE THE LANE

Inappropriate FaceTiming Is So 2022

While browsing for children's eye doctor kits and getting sucked into an online wormhole, I stumbled across this list of things that should be left in 2022. Below are some of the items included in the list.

1. Charcuterie boards

2. Parting your hair on the side

3. Listening to audio on your phone in public without headphones or earbuds

4. Using the term "Karen"

5. Auto-play when streaming

Although I feel a little attacked by number two, the rest of the list isn't so bad—except maybe for number three: listening to audio on your phone in public without headphones or earbuds. Each day, countless patients, their children, or their spouses will sit in the exam room with their phones absolutely blasting a game, a song, or more often than not, a FaceTime call. Wouldn't it be wonderful if we could banish that and make it a thing of the past? The number of slit-lamp exams that I performed in 2022 while I had a patient hold their phone with an active FaceTime call going on is still mind-boggling! I am all about leaving that behind as we move forward in 2023.

QUOTE OF THE WEEK

“There's nothing that can help you understand your beliefs more than trying to explain them to an inquisitive child.”

—Frank A. Clark, American writer and cartoonist