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Other Ways to Treat Presbyopia

Posted by Ilena Di Toro | Posted on October 10, 2023

Benjamin Franklin is credited with inventing bifocal spectacles, and for over 200 years, they were what persons over the age of 50 used to read and do other near work. However, soon there will be other options, and none of them involve lens.

Collagen Cross-Linking
This entails using UVA light and riboflavin, also known as vitamin B2, and it was first used to stabilize the cornea when someone has keratoconus by inducing cross-links within and between collagen fibers. Research is taking place on a form of collagen cross-linking known as photorefractive intrastromal cross-linking, or PIXL, to treat presbyopia. One of the issues with PIXL is that it is difficult to get a precise level of change, since the corneal shape is being altered. With LASIK, tissue is being removed in order to improve vision. Still, precision isn’t the primary goal when it comes to treating presbyopia. If a patient achieves a degree of improvement, such as intermediate vision, enabling the patient can see his or her phone or tablet, more often than not, the patient is pleased.

Laser Scleral Microporation
This procedure, while still in clinical trials, has shown promise in treating presbyopia. It targets rigidity of the scleral or white portion of the eye by “uncross-linking” it. This improves the ciliary muscle’s ability to relax the zonules, which are the thread-like fibers that hold the eye lens in place. The relaxation of the zonules leads to the reshaping of the lens. Ten-year data on this procedure shows that a three-line improvement in near vision is maintained.

AnnMarie Hipsley, DPT, PhD, is the co-author of a research poster presented at the 2020 virtual Women in Ophthalmology Summer Symposium, showed how effective this procedure is on person with presbyopia. She and her colleagues studied the changes in vision in 16 persons who had this procedure. The patients gained a visual acuity of 0.21 at near and intermediate distances at the three-month mark. Five patients in this study had a baseline of 70.45 mm2. After three months, these persons achieved a binocular summation increase to 104.68 mm2. Some patients, experienced a threefold increase in their binocular visual field at the one-month mark.

Other procedures, such as the intra-ocular lens replacement, restores visual functionality by way of replacing what doesn’t work, namely the patient’s natural lens. What makes laser scleral microporation so great is that it restores vision to the person with presbyopia by manipulating, not replacing, the optical elements to restore visual functionality.

This is a pharmaceutical, namely eye drops that were developed by Orasis Pharmaceuticals. The Food & Drug Administration (FDA) recently accepted a new drug application for CSF-1. The new drug application is where a company formally proposes that a drug becomes approved for sale in the U.S. These drops are low-dose pilocarpine hydrochloride 0.4% and what makes them so great is that they achieved a three-line improvement in near vision and no loss of visual acuity for distance vision.

These drops are a development that both eye doctors and patients have been waiting for, as many people don’t want to rely on reader eye glasses when it comes to near work. These drops are designed to balance efficacy with minimal side effects. The clinical trials of more than 600 patient found that CSF-1 met its primary and secondary safety and efficacy targets by Day 8 of testing. More importantly the drops achieved three or more lines increase in near vision and no vision loss with distance vision.

Bifocals, contacts or intra-ocular lens replacement are no longer the only ways to treat presbyopia—not that there is anything wrong with bifocals, contacts, or intra-ocular lens replacement.


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