5 Minutes
New topical therapy restores reading vision quickly
Imagine discarding your reading glasses and regaining crisp near vision with a simple topical treatment. New clinical data presented at the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) indicate that a combination eye-drop formulation can produce measurable improvements in near vision within one hour and sustain benefits for months to years in many patients with presbyopia.
Study design, patient group and methods
This retrospective, single-centre analysis reviewed outcomes from 766 patients treated at the Center for Advanced Research for Presbyopia in Buenos Aires. Participants (373 women, 393 men; mean age 55) received one of three formulations that paired a fixed dose of diclofenac (a nonsteroidal anti-inflammatory) with pilocarpine at 1%, 2% or 3%. Pilocarpine is a cholinergic agonist that constricts the pupil and stimulates the ciliary muscle to improve near focus; diclofenac was included to reduce local inflammation and blunt pilocarpine-related discomfort.
Patients instilled drops twice daily—typically on waking and about six hours later—with an optional third dose as needed. Investigators measured uncorrected near visual acuity (UNVA) using the Jaeger chart before treatment, one hour after the first dose, and at scheduled follow-ups over a maximum two-year period.
Key findings: rapid and sustained near-vision gains
Across all groups, patients showed rapid gains in UNVA. One hour after the initial application, average improvement was 3.45 Jaeger lines. Response varied by pilocarpine concentration and baseline presbyopia severity: 99% of the 1% group (148 patients) achieved optimal near vision and read two or more additional Jaeger lines. In the 2% cohort, 69% of 248 patients read three or more extra lines; in the 3% cohort, 84% of 370 achieved three or more extra lines.
Durability was notable: the median duration of benefit was 434 days, and roughly 83% of patients retained functional near vision at 12 months. No cases of major complications such as sustained intraocular pressure elevation or retinal detachment were reported in this series.
Adverse effects and tolerability
Reported adverse effects were generally mild and transient. The most frequent complaint was temporary dimness of vision (32%), followed by instillation-related irritation (3.7%) and headache (3.8%). No participants discontinued therapy due to side effects in this cohort. The authors noted known pilocarpine-associated risks—eye redness, watering, difficulty adapting to low light, problems changing focus, photophobia, and in rare cases floaters or retinal events—and cautioned about prolonged topical NSAID exposure and potential corneal risk.
Mechanism and individualized dosing
The formulation leverages two complementary pharmacologic actions: pilocarpine increases depth of focus via miosis (pupil constriction) and enhanced ciliary muscle contraction, while diclofenac mitigates inflammatory responses that can occur with cholinergic stimulation. Investigators observed that patients with milder presbyopia achieved optimal improvement with the 1% pilocarpine formulation, whereas those with more advanced near-vision loss typically required the 2% or 3% concentration for clinically meaningful gains. This suggests a potential for dose tailoring based on baseline Jaeger scores and symptom severity.
Limitations and expert perspectives
As a retrospective, single-centre study, the findings are hypothesis-generating rather than definitive. Selection bias, absence of randomization or masked comparison, and variable follow-up intervals limit generalisability. ESCRS-affiliated experts have highlighted the promise of a pharmacological, non-surgical option while calling for larger, multicentre randomized controlled trials to confirm safety and long-term effectiveness and to better define patient selection criteria.
Expert Insight
Dr. Elena Marques, clinical ophthalmologist and vision science communicator, notes: 'These results are encouraging for patients seeking non-invasive presbyopia management. The rapid onset is clinically meaningful, especially for patients who find reading glasses inconvenient. However, clinicians should balance benefit with the known pilocarpine and topical NSAID risks and discuss realistic expectations—drops may reduce spectacle dependence but may not fully replace vision correction for every individual.'
Next steps and research directions
Authors plan prospective studies measuring quality-of-life outcomes, objective accommodative responses, and long-term ocular safety. Broader trials should compare fixed formulations against placebo and alternative pharmacological strategies, evaluate nocturnal visual function and contrast sensitivity, and monitor for rare but serious adverse events over extended exposure.
Conclusion
A combination of pilocarpine and diclofenac administered as topical eye drops produced rapid, dose-related improvements in near visual acuity in a large retrospective cohort, with benefits lasting months to years for many patients and generally mild side effects. While promising as a non-invasive option to reduce dependence on reading glasses, these results require confirmation in randomized, multicentre studies before routine adoption. For clinicians and patients, the findings expand the therapeutic landscape for presbyopia and underscore the value of tailored pharmacological approaches alongside optical and surgical options.
Source: scitechdaily
Comments