As I got a little older, I noticed that the words on a book page weren't as sharp as they used to be. Like many people, I have been wearing reading glasses ever since. But recently, I dripped a new prescription drug into my eyes instead. A few minutes later, I could see the text in front of me clearer and sharper. However, I also noticed that the more distant shared kitchen in the office seemed unusually gloomy, even when the lights were on. And I got a slight headache.
After the age of 40, many people develop presbyopia. This is the medical term for presbyopia. Translated, the expression based on Greek words means as much as old eyes. It becomes more difficult for people to read books, food labels or menus. What then helps is reading glasses. Now there is another solution, packaged in medicine vials: eye drops by prescription, which should help the elderly to see nearby objects better.
A therapy that is secure, powerful, and reversible?
The remedy I used is a product of the company Allergan, which belongs to the pharmaceutical company AbbVie. It is called Vuity and is the first of its kind to be available. The drops were approved by the US Food and Drug Administration at the end of 2021. Nearly a dozen companies have similar drops in clinical trials. They all promise a "safe, effective and reversible therapy that gives people what they want, which is good near vision," says Eric Donnenfeld, an ophthalmologist at New York University who advises Allergan and another manufacturer.
The drops should compensate for an aging process. Over the years, the lens becomes stiffer. In a healthy, young person, it is flexible and correctly bundled the light incident from near and distant objects. However, if the lens becomes more immobile, the pictures blur in reading removal.
The retina should receive less light.
The drops fix that problem by reducing the pupil - the part of the eye that leads the light onto the retina, which in turn converts this stimuli into visual signals for the brain. The pupil opening of reducing is roughly the aperture for a photo camera. If it is reduced, less light penetrates from further distant objects, which means that close objects are mapped more sharply. "Similarly, a smaller pupil prevents any non -specific light rays from reaching the retina," says Donnenfeld. "The drops work exactly in this way."
Several preparations, including Vuity, reduce the size of the pupils with the same active ingredient: pilocarpine, which has long been used to treat glaucoma. Pilocarpine irritates the eye muscles, which then contract. In patients with glaucoma, the eye pressure is lowered because excess fluid flows out of the eye through muscle contraction. However, the muscles also squeeze the pupil, causing it to shrink. However, this contraction can also lead to mild headaches behind the eyebrows.
In clinical studies with Vuity, around 30 percent of the subjects treated were able to read three more lines of text on a table attached in arm length. The effect gradually decreased over a period of six hours. Other companies are already working on active ingredients that are supposed to work longer. Visus therapeutics in Irvine, California, for example develops eye drops with two active ingredients: carbachol that narrowed the pupil, and brimonidine that prevents the pupil expansion. "We suspect that the effect of this treatment lasts for at least eight hours," says Rhett Schiffman, ophthalmologist and medical director of the company. So far, investors have put more than $ 100 million into the development of various products.
Side effects and risks of pilocarpine
But the preparations are not without controversy. David Guyton, an ophthalmologist at the Johns Hopkins Wilmer Eye Institute in Baltimore, points out that generic pilocarpine for the treatment of green star is actually quite inexpensive. However, a 2.5-milliliter container from Vuity – which is enough for about a month - is not enough. My vial cost about 80 US dollars, that's about 70 euros. (The manufacturer Allergan justifies the high price by the fact that he changed the recipe to reduce possible complaints and side effects.)
In addition, the drops bring other, less desirable changes in eyesight. »In low light, the pupils widen to let in more light. However, this does not happen if the pupils are narrowed by Pilocarpin, «explains Guyton. "In my opinion, this effect is a danger to driving at night." In fact, the Vuity package insert is warned against driving a car at night when you have used the preparation. Field replies that this should not be a problem for most people if the medication is dripped into the eyes in the morning as prescribed.
After I tested the drops, a colleague who also wears reading glasses tried them out. His conclusion was: "I would say it worked – not perfectly, but it worked. The drops reduced the blurring of the texts on my phone, but didn't eliminate them." As with me, the effect lasted about three hours. For people who are very reluctant to wear their reading glasses, such drops would probably be an alternative – provided they also received approval in Europe.
