Dr. Matthew Sharpe- Founder of SharpeVision

By Dr. Matthew R. Sharpe

February 28, 2022

How can Vuity help me to not need reading glasses?

In October of 2021 there was an FDA approval of an eyedrop that can potentially help people who need reading glasses to see near objects such as their phone, food and watch. I’m sure many of you are looking for information on Vuity eyedrops and are wondering:

Does Vuity work?
How can Vuity help my near vision?
What are the side effects of Vuity?
Why do I need reading glasses in the first place?
What is presbyopia?

I will try to answer these questions and more in the following blog post. I hope this helps. Vuity is available but may have limited distribution as of the writing of this blog post.

What is presbyopia?

First of all, you must know what presbyopia is. There is a lens inside of our eyes called the “crystalline lens“. This lens helps us to focus on near objects. There are muscles in our eyes that squeeze this lens to increase its focusing power. If you naturally see perfectly at distance, this lens changes shape when you look at something near such as your phone, computer, food, or wrist watch. This crystalline lens is amazingly flexible and clear when we are born. As we age this lens loses its elasticity or flexibility. In our mid 40s anyone who has good distance vision will need either bifocals, reading glasses, eye surgery or other help to see near objects. We as eye care providers have not yet developed a perfect cure for presbyopia. The loss of flexibility happens to everyone. Another way of stating this is that you cannot have it both ways after 45. You can either have good near vision, good distance vision, but not both at the same time in both eyes after age 45 or so. Current solutions include “monovision” in which one eye is focused at distance and one eye is focused at near. There are also surgical treatments such as multifocal intraocular lenses that work wonderfully but require surgery. They are excellent solutions for people who are in their 50s or 60s or older who have glasses.

We all also lose transparency of the natural lens of our eyes as we age. This typically occurs at age 60 or older but can occur younger as well. When this happens it’s called a cataract. Cataract surgery is the process of removing the crystalline lens and replacing it with an artificial lens called an intraocular lens (IOL) that has “built-in bifocals“.

The newly approved drop called Vuity offers a medical way to assist with near vision in people aged 40-55.

How does Vuity work?

Vuity (pilocarpine 1.25%, Abbvie) utilizes an extremely old medication called pilocarpine. Pilocarpine was used for many decades for the treatment of glaucoma. It was generally used in 1%, 2%, and 4% solutions. Because of its side effects it was generally replaced with more modern medications for glaucoma. The action of pilocarpine does two things that may help people with some flexibility in their natural crystalline lens.

Stimulate the ciliary muscles, the muscles that naturally flex the crystalline lens for increased focusing power
Pilocarpine also constricts the pupil which gives greater depth of field
With a smaller pupil, the depth of field is increased exactly the same way as a Camera with a higher f-stop give us greater depth of field (a smaller camera aperture letting in less light) as compared to a lower f-stop that gives less depth of field but increases the amount of light let into the camera. This is part of why you need more light to see near objects as you get older. The pupil naturally constricts in response to light which gives you more depth of field. That’s why it’s difficult to read the menu in a dark restaurant. Whenever I see someone pull out their phone at a restaurant and use the flashlight, I know they are over 45 years old!

The trial of this new application for pilocarpine tried different concentrations of the pilocarpine medication. This is the only truly new part-the 1.25% solution. 1.50% was too much and 1.0% was too little. They also tried it in combination with other medications to decrease side effects, but found no significant effect from the combinations. The new pilocarpine is the only medication in the new Vuity eyedrop. There is also a “vehicle“ which is the solution in which the pilocarpine 1.25% is dissolved. This has a buffered solution that causes less burning upon instillation of the drop. Pilocarpine has historically caused some brow ache, headache, blurry distance vision, potential for retinal detachment, and sometimes eye inflammation. In this clinical trial none of that occurred, but there are still potential negative side effects.

Can eyedrops improve eyesight?

Eyedrops for vision improvement such as pilocarpine very much can and have improved eyesight for near objects. There are many other treatments for presbyopia that are in different stages of clinical trials. As many as nine different eyedrops are being considered in clinical trials. There is also recently a new intraocular lens that received “approvable” status and may further improve upon our existing multifocal intraocular lenses. Other eyedrops have not been shown to improve vision. I have treated patients for presbyopia with monovision for a long time, but it also has its pros and cons. The good part of monovision is that most people adapt quite well and have excellent near vision and distance vision. However, they are using opposite eyes to do each of these tasks. One eye is generally focused at a -1.50 goal which gives excellent near vision exactly as a +1.50 reading classes accomplishes. Watches, phones, and all objects 12 to 18 inches away are generally in perfect focus with the -1.50 focal point. The other eye is generally focused at distance. People who adapt to monovision sometimes still wear glasses to sharpen the near eye for distance or the distance eye for near. Certain tasks such as threading a needle can be difficult with mono vision, but in general the depth perception for driving and sports is quite good.

What is the Pilocarpine medication? What are the side effects of Pilocarpine eye drops?

Pilocarpine stimulates the muscles inside our eyes to flex the natural lens and to constrict the pupil. These two actions help with the near vision in people 40-55. After age 55 they may have less effect. Before age 40 you have enough natural ability to flex the lens of your eye that you won’t need an eyedrop to treat presbyopia.

Side effects include brow ache or headache in greater than 5% of patients in this trial. The headache with this low percentage (1.25%) and dose (once a day) will generally be mild and transitory. But for some people the headache may not be worth it for the increase in near vision and cost of the drop (estimated at $80/month). Another reported side effect is red eyes called “conjunctival hyperemia”. There is also a warning for those who have a history of iritis, an inflammation in the eye. Pregnancy and pilocarpine are discussed in the FDA document (see link below) but there are no known adverse effects. There won’t likely be much overlap in this category as women of childbearing age generally are not presbyopic. Presbyopia tends to affect people 45 and older, so I think it will be a very infrequent issue. Another potential negative side effect of pilocarpine is decreased distance vision. Because the eyedrop stimulates focusing muscles, this will most likely be a potential effect in younger presbyopic patients such as those under age 45. The effect was not noticed in the FDA trial however. It should be just fine and not affect your distance vision.

How can I get Vuity eyedrops to try?

The FDA eyedrops for presbyopia are approved and being distributed as of this writing, but may have to be ordered by your pharmacy and take a day or two to acquire. The company that makes Vuity eyedrops is Allergan. The cost to the presbyopia eyedrops is estimated to be about $80/month, and is labeled for use once daily. I suspect that the eyedrops for blurry near vision like this will need to be used twice daily for continuous effect. When will presbyopia eyedrops be available? The answer is “now”, but there will be more and better solutions coming in the next few years that will hopefully offer something more original than using an old glaucoma drop.

Presbyopia Treatment 2021

Eyedrops for presbyopia and presbyopia research in general is a super hot area in ophthalmology. The market is huge and growing, and there is currently no great treatment for presbyopia. The list of FDA approved eyedrops has expanded by zero with the approval of Vuity, but the approved usage has expanded by one. A Novartis compound UNR844 has the potential to retain flexibility of the natural lens or potentially reverse the loss of flexibility. This could potentially make your eyes “younger” rather than just a workaround such as pilocarpine offers. Interesting times in the presbyopia department-It’s exciting! Contact us at sharpe-vision.com for an appointment to see if you may benefit from the newly approved usage of Vuity eyedrops for presbyopia. We look forward to helping you!

https://www.ophthalmologyscience.org/article/S2666-9145(21)00063-4/fulltext

FDA

https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214028s000lbl.pdf

Dr. Matthew Sharpe- Founder of SharpeVision

Dr. Matthew R. Sharpe

Dr. Matthew Sharpe is an Ophthalmologist specializing in refractive surgery and the owner SharpeVision MODERN LASIK, with offices in Seattle, Austin, and Chicago. Dr. Sharpe is a world traveler, pianist, marathon runner, motorcyclist, and fluent French speaker. He enjoys every second of life, but finds he is happiest at home watching Netflix or cheering on The Ohio State Buckeyes with his wife, three children, and two dogs.
Signature of Dr. Matthew Sharpe, MD