By Linda Conlin, Pro to Pro Managing Editor

The first time we see many patients is when they finally decide that their arms are too short for reading. We then have to discuss the dreaded words bifocals, reading glasses or progressives. Often, the discussion is met with resistance and depression – “I guess I’m getting old.” But what if there were a solution as easy as a once-a-day eye drop that would improve near vison? It’s a good bet patients would jump at it, and now they can. In late October, Vuity from Allergan was FDA approved as the first eye drop to improve near and intermediate vision.

First, let’s look at the mechanics of near vision. Near vision involves three simultaneous responses - convergence, lens accommodation and pupil constriction. In convergence, the eyes turn inward to focus at near. The pupils constrict to increase the depth of focus by blocking the light scattered by the periphery of the cornea. And the crystalline lens becomes more rounded, increasing its refractive power. In presbyopia, the lens has become more rigid and less able to change to the thicker, rounder shape required for near focus. Optometrists and ophthalmologists have long known that drugs that constrict the pupil (miotics) can improve near vision by creating a pinhole effect. Pilocarpine is a miotic that, in addition to constricting the pupil, may also increase accommodation through mild contraction of the ciliary muscle, allowing the lens to thicken. 

Vuity is an ophthalmic solution with “proprietary pHast technology" that allows pilocarpine to adjust to the pH of the tear film, reducing the stinging sensation of pilocarpine alone and perhaps increasing efficacy. The drops are administered daily, require at least 15 minutes to take effect, and improve near vision up to 6 hours and intermediate vision for up to 10 hours, allowing for a full day of work on a computer. In Phase 3 trials, subjects with mild to moderate presbyopia reported the ability to read three more lines on a reading chart without having their distance vision affected.

We can expect to see another presbyopia eye drop in the near future, too. In May, Eyenovia reported that its drug-device MicroLine also helped presbyopia patients gain three lines or more on a reading chart. Microline uses the company’s Optejet dispenser to deliver small doses of pilocarpine. The device allows more consistent doses at about a fifth the drug volume of a traditional eye drop, according to the company. The biotech is planning to start a second Phase 3 trial by the end of this year. With options in addition to glasses or contacts, our presbyopic patients can see better and feel better about their age-related vision changes.

Get more information about options for presbyopia with our CE, Welcoming Patients to Presbyopia, at This course is free, supported by an educational grant from ESSILOR.