Overview of pharmacological treatments for presbyopia

Abstract

Background: Presbyopia is the normal progressive waning of accommodation with loss of the visual ability to focus on objects residing at different distances. Presbyopia exacts a cost in quality of life and professional efficiency of many people over 40 years of age. Presbyopia is likely to be 1 of the main pressing visual concerns of the 21st century, given that life expectancy is increasing, resulting in an aging population. This review aimed to address the 3 strategies of the pharmacological treatment for presbyopia.
 Methods: A review on PubMed/MEDLINE, Google Scholar, and Clinicaltrials.gov was performed to investigate the English literature on pharmacological treatment for presbyopia from beginning-of-year 2012 to September 30, 2020.
 Results: In addition to the treatment of presbyopia with glasses or contact lenses, new surgical strategies have been developed, some of which have been successful. However, during the last decade, a new, promising, non-invasive option for treating presbyopia has emerged: the pharmacological approach. Many researchers have developed 3 different lines of investigation from different assumptions, on a pharmacological basis. The first consisted of producing miosis, to take advantage of a pharmacologically induced pinhole effect, increasing depth-of-focus, and thus improving uncorrected near visual acuity. The second aimed to rehabilitate accommodation binocularly to enable good vision at all distances. Finally, the third approach attempted to rehabilitate lost elasticity in the human crystalline lens.
 Conclusions: None of the 3 discussed pharmacological strategies for treating presbyopia, prescribed globally, but patients of restoring accommodation strategy can adhere locally, where they are sold so far as master prescriptions.

Pharmacological strategies for treating presbyopia

“…This is assessed by measuring UNVA and UDVA. Both developments reported minor side effects, such as headaches, dizziness and decrease of light perception, which were spontaneously solved during the treatment [5 ▪ ,12–15].…”

“…Based on these previous findings, in 2020 Visus Therapeutics Inc. launched Brimochol, a formulation that combines carbachol and brimonidine tartrate, even though clinical trials have not yet begun [5 ▪ ].…”

“…Orasis Pharmaceuticals incorporated Presbidrops (CSF-1), an oil-based undisclosed combination of a parasympathomimetic agent with an nonsteroidal anti-inflammatory drugs. Results of a phase 2 study (NCT03885011/NCT02745223/NCT02965664) are not yet available, and a phase 3 clinical trial NCT04599972/NCT04599933 to evaluate its efficacy and safety is planned for 2021 [5 ▪ ,6 ▪ ].…”

“…Presbycarrod Drops SL combined pilocarpine with bromfenac and used this combination monocularly in patients after laser assisted in situ keratomileusis procedure. However, there currently are no available published studies based on this formulation [5 ▪ ].…”

“…The second one tries to restore the elasticity the lens has lost due to aging. Finally, the third strategy is based on rehabilitating accommodation; which is to say, in a binocular way, allowing good vision at all distances [5 ▪ ]. This article reviews the pharmacological treatments that are available for treating presbyopia, in order to provide recent advances for an ‘old’ problem in this field, which is constantly growing…”