Crazy New Info About Presbyopia Drops

Hot Topic

New Generic Drop for Glaucoma

Amneal Pharmaceuticals received FDA approval for its abbreviated new drug application for bimatoprost ophthalmic solution 0.01%, a generic equivalent to Lumigan 0.01% (Abbvie). This prostaglandin analog is designed to reduce IOP in patients with open-angle glaucoma or ocular hypertension, conditions that can lead to optic nerve damage and vision loss if untreated.

This generic formulation of bimatoprost addresses a critical need for affordable treatment options, particularly as the prevalence of glaucoma increases among our aging population. Srinivas Kone, PhD, senior vice president and chief scientific officer for Amneal’s Affordable Medicines division, emphasized that this approval marks a significant milestone for the company’s product portfolio and a key growth driver for its Affordable Medicines segment. According to IQVIA, annual sales for bimatoprost in the United States reached approximately $685 million in July 2025, underscoring its market significance.

My Two Cents

$685 million in sales over the last year for just one glaucoma drop. That’s wild! Although I am not a fan of generic prescription drops (I feel confident stating that they are not as effective as branded drugs), whenever we have more arrows in our quiver to treat a chronic blinding disease like glaucoma, that’s a win in my book!

However, I would like to remind all readers that there are numerous wonderful interventional glaucoma procedures that studies show are more effective than drops. In Europe, glaucoma procedures are performed first and then drops are used as necessary. Whether it’s selective laser trabeculoplasty, an iStent (Glaukos), Durysta (Abbvie), or some other procedure, I implore you to ask what you would want as a glaucoma patient when considering your patient’s options. For me, that answer is simple: I would like a procedure before I begin chronic glaucoma drop therapy.

OUTSIDE THE LANE

A groundbreaking study published in PNAS Nexus highlights the link between air quality and children’s vision, identifying air pollution as a modifiable risk factor for childhood myopia. The international team of researchers demonstrated that lower levels of nitrogen dioxide and delicate particulate matter correlate with improved uncorrected visual acuity in school-aged children. Using advanced machine-learning models, the researchers analyzed environmental, genetic, and lifestyle factors, revealing that primary school students experience significant benefits to their vision when air pollution levels decrease. In contrast, older students and those with high myopia are less influenced by environmental changes, with their vision outcomes more tied to genetic factors.

As myopia rates rise globally, the study proposes actionable interventions to mitigate air pollution exposure in children’s daily environments, such as installing air purifiers in classrooms, establishing clean-air zones around schools to reduce traffic-related pollution, and closing streets to vehicles during school drop-off and pick-up times. These measures are crucial, given the substantial amount of time children spend at school. Zongbo Shi, PhD, from the University of Birmingham, emphasized that cleaner air not only supports respiratory health, but also protects visual health, particularly during children’s vulnerable developmental years.

The study suggests air pollution may harm vision by inducing inflammation, oxidative stress, reduced sunlight exposure, and chemical changes that alter the shape of the eye, all of which can accelerate the onset of myopia. By prioritizing air quality improvements, schools and communities can implement strategic interventions to safeguard children’s eyesight, offering a proactive approach to addressing the growing global burden of myopia.

My Two Cents

This absolutely makes sense! I would contend that this dirty air affects everyone’s eyes; however, as children’s eyes are obviously growing and changing, it makes sense that this is the population most affected. Dirty air, which causes inflammation and oxidative stress, is a significant concern for our patients and is likely to lead to an increase in dry eye signs and symptoms. Yet another probable reason why the rates and severity of dry eye disease seem to be escalating in all developed countries (along with a deeper reliance on technologies such as cell phones and computers).

One thing that does require more research and attention is the possibility that this dirty air could result in accelerating myopia progression. Wouldn’t that be something? If we could prove that, it would emphasize to everyone just how serious an issue this is and potentially increase public awareness of myopia management.

CAN YOU RELATE

Presbyopia drops. If you’ve been paying attention to industry magazines or have attended any of the major meetings, you’ve also been inundated with information about the two newest entries into the market: Qlosi (Orasis) and Vizz (Lenz Therapeutics). They have been at the forefront for everyone, and rightfully so. I am a big fan of the presbyopia drop category, and it aligns well with my patient base—patients who have had LASIK and may be symptomatic of higher-order aberrations due to a large pupil size, or who may have had a totally perfect LASIK procedure. Now, their reading vision is getting worse. You know those patients…the ones who think their refractive surgery “wore off” and need to get it done again.

As we move forward in developing the presbyopia market, we should look back at where it started with Vuity (Abbvie). Looking back at the launch of Vuity, many lessons could be learned and should serve as a cautionary tale for the profession. Did you know that any practitioner could prescribe Vuity? In fact, among the top 10 prescribers during the initial rollout, only three were optometrists or ophthalmologists; the others were emergency medicine physicians, dermatologists, family medicine doctors, internists, or telemedicine providers. I can guarantee these doctors had no idea who was a good candidate for presbyopia drops and had never even heard of a retinal examination. They were prescribing it when asked. What a terrible idea.

Thankfully, Orasis has taken steps to ensure that only eye care practitioners can prescribe Qlosis through partner pharmacies Medvantix and BlinkRx. They are using a straightforward NPI verification and patient attestation of having had a recent comprehensive eye examination. Once Vizz enters the market, Lenz Therapeutics will be doing the same thing.

Kudos to Orasis and Lenz for doing the right thing and maintaining a presence in the eye care practitioner arena. The presbyopia drop market has evolved significantly since Vuity’s launch, when non-eye care providers dominated prescribing. Although patient selection for presbyopia drops doesn’t have to be complicated, it should be in the hands of doctors who understand what they’re treating.