Presbiopia? Se for o seu problema, gotas podem eventualmente substituir seus óculos.
Perhaps it doesn’t happen to you, but you surely know people who need to hold their cell phone or the restaurant menu close to their nose, squinting to read the small print. As we age, we all develop age-related presbyopia, the difficulty in focusing the eyes on texts or objects. This is where glasses or lenses, or surgery, usually come into play. However, a new research study suggests that there could be another option.
Researchers demonstrated that after applying special eye drops two or three times a day, most participants in the retrospective study could read two or more lines on the Jaeger chart, used to assess near visual acuity. Giovanna Benozzi, director of the Advanced Research Center for Presbyopia in Buenos Aires, presented the research study on Sunday, September 14th at the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS).
Surgery is not for everyone
“We carried out this research due to the medical need, often unanswered, in managing presbyopia,” said Benozzi at the ESCRS. “There is a group of presbyopia patients who have limited options besides glasses and are not candidates for surgery. They are our main focus of interest. We seek to provide solid clinical evidence to support an innovative pharmacological solution that offers patients an effective, non-invasive, and accessible alternative.”
The family has been dedicated to presbyopia. Benozzi’s father, the late Jorge Benozzi, a researcher at the same center where his daughter works, developed the eye drops. The formula contains two active ingredients: pilocarpine, which causes constriction in the pupils and contracts the ciliary muscle (involved in the eye’s ability to see objects at different distances), and diclofenac, a nonsteroidal anti-inflammatory drug (NSAID) that counteracts the inflammation and discomfort caused by pilocarpine.
The 766 patients (373 women, 393 men, average age 55) used the eye drops twice a day, with the possibility of a third application if necessary. All patients received the eye drops with the same dose of diclofenac, but the concentration of pilocarpine was 1%, 2%, or 3%. Researchers tested the patients’ vision with the Jaeger chart one hour after the first application, and then continued monitoring them over two years.
“Our most important result showed rapid and sustained improvement in near vision in all three concentrations. One hour after the first drops were applied, patients had improved an average of 3.45 lines on the Jaeger chart. The treatment also improved vision at all distances,” Benozzi told the congress participants, as reflected in the statements. “The striking thing is that 99% of the 148 patients in the 1% pilocarpine group achieved optimal near vision and could read two or more extra lines. Approximately 83% of all patients maintained good functional near vision after 12 months.”
69% of the 248 patients using the 2% formula and 84% of the 370 patients using the 3% formula could read three or more extra lines on the Jaeger chart. The improvements observed in the study lasted up to two years, and Benozzi has patients outside of this study who have used the eye drops for over a decade.
More studies are needed
Pilocarpine commonly has side effects such as blurred vision, darkened vision, seeing flashes of light or “floaters,” and in some rare cases, retinal detachment. Some of the adverse side effects experienced by the patients in this research study include temporarily darkened vision, irritation when administering the eye drops, and headaches. None of them discontinued the treatment.
“Almost all patients had positive improvements in their near vision, although the magnitude of improvement depended on the state of their vision before starting the treatment. Patients with less severe presbyopia responded better to the 1% concentrations, while those with more advanced presbyopia required higher concentrations of 2% or 3% to achieve significant visual improvement,” explained Benozzi.
Benozzi explained that the eye drops are a convenient alternative for presbyopia, which can reduce the need for using reading glasses, although the drops are not intended to replace surgery. “Ophthalmic professionals now have a pharmacological evidence-based option that expands the spectrum of presbyopia care beyond glasses and surgery.”
Although the study is significant for the large number of patients followed over an extended period, it is limited by being a study conducted at a single center, meaning that all patients were treated in the same place, and data was collected afterward.
Ophthalmic Drops May Improve Near Vision
A retrospective study of Dr. Benozzi’s single center suggests that eye drops containing pilocarpine and diclofenac may improve near vision for up to two years, but significant limitations mean that the results may not be applicable to everyone,” said Burkhard Dick, chairman of the ophthalmology department at Bochum University Eye Hospital in Germany, who was not involved in the study. “Long-term use of pilocarpine can sometimes cause side effects. Larger, long-term studies at different centers are needed to confirm the safety and effectiveness before this treatment can be widely recommended.”
Potential Future Impact
Despite these limitations, the results point towards a future where a simple eye drop could delay the need for reading glasses.
This article has been translated from Gizmodo US by Romina Fabbretti. You can find the original version here.
