Update on Presbyopia-correcting Drops

Abstract

P resbyopia causes diminishing of vision-targeted life quality and occupational performance for most people over 40 years old. It affects the ability to perform visual tasks at near distance such as book reading, handcrafts, stitching, cooking and surgical operation. Although there are some treatment modalities such as surgery, the use of near-glasses and contact lenses for presbyopia, topical drug treatment for pharmacological control of presbyopia is currently a very popular and attractive nonsurgical option. In this review, we tried to summarise the presbyopia drop treatment. KeywordsPresbyopia, para-sympathomimetic, accommodation, ciliary muscle contraction, drop treatment, myosis, lens softening, increased focus depth Disclosure: Feyza Çalis Karanfil and Burak Turgut have nothing to declare in relation to this article. Compliance with Ethics:This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Presbyopia is progressive age-related reduction in accommodation amplitude and the loss of ability of the eye to focus on near objects. It occurs in almost everyone at around 40 years of age.1-5 Presbyopia affects visual tasks at near distance such as book reading, handcrafts, stitching, cooking and surgical operation. Thus, it causes the diminishing of vision-targeted life quality and occupational performance of many people over 40. [1][2][3][4][5] The physiopathology of presbyopia is not clearly known. However, it has been demonstrated that various factors including the hardening of the lens, changes in the elasticity of the lens capsule, lens dimension, geometry of zonular attachments and ciliary muscle contraction may be responsible for the accommodative loss in presbyopia. 1,2Accommodation in humans is performed by ciliary muscle (CM) and iris sphincter contractions, convergence and changes in the shape and position of the lens. The muscles of the iris and ciliary body are stimulated by the parasympathetic system. The parasympathetic cholinergic stimulation causes the contraction of the CM and myosis, providing the increase of focus depth and the shape and position of the lens both to change and for accommodation to develop. 3In an eye which is un-accommodated and looks at a distant object, CM is relaxed; the anterior zonular fibers (ZF) are stretched by traction from the posterior ZF. Then, anterior ZF flattens the lens. In the accommodated eye, the forward and inward movement of the ciliary muscle allows the tension...

Near Vision Improvement with the Use of a New Topical Compound for Presbyopia Correction: A Prospective, Consecutive Interventional Non-Comparative Clinical Study

“…Nepafenac, pheniramine, and phenylephrine counteract ciliary muscle spasm, hyperemia, and excessive pupil constriction induced by pilocarpine. Polyethyleneglycol lubricates the eye and stops the burning sensation caused by all the others drugs, leveling the pH [4, 8].…”

“…There are only a few published scientific reports on topical treatment for presbyopia [4, 8–10]. In most of these studies, a miotic was used to increase the depth of focus and improve near vision, and in some others, only one eye was treated [10].…”

Overview of pharmacological treatments for presbyopia

“…The classical solution of presbyopia is the prescription of glasses or contact lenses, while new surgical possibilities have emerged as PresbyLASYK, intracorneal inlays, and IOLs [9]. The newest improvement in the treatment of presbyopia is topical pharmacological treatment [26][27][28], which presents some remarkable advantages when compared to surgical methods in that it is non-invasive, reversible, and shows no significant adverse effects. Three pharmacological treatment approaches are in progress, with different states of development, practical implementation, practice, and results.…”

“…Thus, performing clear lens surgery in young patients with presbyopia, low refractive error, and healthy eyes is promising but remains controversial at present [24,25]. During the last decade, a new promising option for treating presbyopia has emerged, in the form of a pharmacological approach [26][27][28]. In contrast to all the above-described techniques, this method is not invasive and provides good vision at all distances.…”

Oral administration of resveratrol or lactic acid bacterium improves lens elasticity

“…Existing research suggests the administration of lipoic acid choline ester (LACE), derived from lipoic acid, reduced the concentration of disulfides in protein in mice, leading to the restoration of lens elasticity 17 . Some droplets including LACE are currently undergoing clinical trials to evaluate their efficacy and safety as the development of a new therapeutic agent to restore accommodative amplitude is of great interest 18 .…”