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December 15, 2021 - As people age, the lens in their eye loses elasticity, and this can cause difficulty in focusing on nearby objects, such as a newspaper or book. The condition is called presbyopia, and it affects millions of people. It usually begins around the age of 45 and progresses until the age of 65. To adapt to presbyopia, people often use reading glasses.

The FDA recently approved a new drug called Vuity to treat presbyopia. Vuity is a once-daily eye drop that contains pilocarpine, a cholinergic muscarinic agonist. Pilocarpine causes the pupil to constrict and ciliary muscles to contract, and these actions improve near vision. In a trial that enrolled 427 patients with presbyopia, near vision improved (defined as gaining 3 or more lines in near visual acuity testing without losing more than 1 line of distance visual acuity at 3 hours after dosing) in 26% of Vuity-treated patients compared to 11% of placebo-treated patients. Maximal benefit occurred 1 hour after dosing, after which the effect steadily declined and became nonsignificant 6 hours post-dose. Side effects that occurred in more than 5% of patients included headache and conjunctival hyperemia.

Patients prescribed Vuity should be aware that their vision in poor lighting may be impaired. The pupil typically dilates in darkness to allow more light to enter the eyeball. Pilocarpine inhibits pupillary dilation, and night vision may be affected. Contact lens wearers are advised to remove their contacts before instilling the drops and wait 10 minutes before reinserting them. The only contraindication listed in the prescribing information is hypersensitivity to the drops.

In summary, around 30% of patients who use Vuity will have noticeable improvement in their near vision. Improvement that is less than what was measured in trials may also be meaningful to some patients. Interested patients will have to try Vuity and see if the pros outweigh the cons. It's hard to imagine an eye drop that works for less than six hours and can impair night and distance vision would be preferable to slipping reading glasses on and off.