Prescribing Presbyopia Drops

Five years ago in October, the first presbyopia-correcting eye drop received FDA approval, and today three options are available, adding to the latest treatment category for the patient-dreaded age-related loss of accommodation (Table). My experience in prescribing presbyopia-correcting eye drops has been quite positive. Here, I explain why, along with related action steps.

PATIENTS ARE INTRIGUED

From our patients’ points of view, presbyopia affects not only their vision, but also their quality of life. In fact, a 2020 survey conducted by Burke Healthcare Research of 1,000 patients with presbyopia found that they rated the loss of near vision as the most impactful age-related condition, ahead of hearing loss and dry eye disease (DED), among other serious health conditions.

When I tell my newly diagnosed patients with presbyopia that they have three options for addressing this vision change, many of their eyes light up with excitement and curiosity in hearing there are pharmaceutical options for presbyopia. This is because many of them are unaware of this option, they dislike wearing reading glasses during a busy day, or they don’t want to apply or remove contact lenses.

Essentially, I bring up presbyopia-correcting eye drops with almost all my patients who have presbyopia, unless they have the following conditions: visually significant cataracts, high myopia, or retinal conditions, such as lattice degeneration, retinal holes, or AMD, which would make this treatment contraindicated.

I’VE IDENTIFIED IDEAL CANDIDATES

This may sound a little simplistic, but the ideal candidate for presbyopia drops is someone who is interested in reducing their dependence on reading glasses. A wide range of patients can fit that description, from the emerging patient with presbyopia who is just beginning to struggle with vision at work, to the retiree with presbyopia who isn’t happy with their near vision after cataract surgery. Prior to prescribing, I always perform a thorough retinal examination, including dilation and/or ultra-widefield retinal imaging.

Additionally, I have many patients who are using a presbyopia-correcting drop in conjunction with soft contact lenses, so that they can remain in single-vision contact lenses, or so that they can achieve greater clarity at near with multifocal contact lenses. In such cases, I instruct patients to instill the eye drops 10 to 15 minutes before applying their contact lenses.

Presbyopia-correcting drops create another opportunity to provide more individualized patient care, meeting visual needs, while also expanding medical eyecare opportunities, such as those associated with DED, among other ocular surface conditions. For many patients, the drops complement other presbyopia solutions, allowing us to offer a more personalized approach based on lifestyle, visual demands, and ocular health.

I MANAGE PATIENT EXPECTATIONS

To ensure the patient knows what to expect from the presbyopia-correcting drop, I explain the duration of near vision, how it improves with neuroadaptation, and the common temporary side effects of mild headache and brow ache. Also, I inform them of the rare ocular side effect of a retinal detachment (RD). Specifically, I review the signs and symptoms of RD and advise them to be seen immediately if they experience any of them.

I usually recommend that patients use the presbyopia-correcting drops in the morning, start on a weekend or a day when they aren’t using the computer all day, and then use the drops consistently for about 2 weeks, after which they can switch to occasional use if that is their preference.

Further, I do not sample presbyopia drops in the office, as a single in-office demonstration does not provide patients with an adequate understanding of their potential benefits. It is more important for people to experience how the medication performs in their own environment and during their daily tasks.

A BONUS

Presbyopia-correcting drops are an exciting new category of service that also provide the opportunity to reinforce the importance of comprehensive eye health examinations. As we know, these serve as an early detection mechanism for age-related ocular and systemic conditions. Today’s presbyopia-correcting drops make it easy to customize presbyopia care to each patient. I see them as a great option for presbyopes that rounds out all the other vision care and ocular health services we can provide.