Could eye drops replace reading glasses as we age?

One of the rude awakenings of aging is the deterioration of reading vision. And with that, the daily hunt for reading glasses, which are an obvious sign a person is getting older.

Well, that may be changing with the use of special eye drops two or three times a day.

In mid-September, a study of 766 patients was presented at the 43rd Congress of the European Society of Cataract and Refractive Surgeons in Denmark. It found that most study participants could read an extra two, three or more lines on the standard eye test chart after using specially formulated drops.

Moreover, this improvement was sustained for up to two years.

“In ophthalmology, each line on the reading chart represents a meaningful improvement in real life,” said Dr. Giovanna Benozzi , director of the Center for Advanced Research for Presbyopia, in Buenos Aires, Argentina. “Gaining two or three lines means a patient who previously struggled to read a text message or a menu can now do so with ease.”

She said the research stemmed from a “significant unmet medical need” in managing presbyopia. (That’s the increasing inability to focus on nearby objects as we age.)

The research focused on patients who have limited options other than reading glasses , and are not candidates for surgery. “We sought to provide robust clinical evidence supporting an innovative pharmacological solution to offer patients a non-invasive, convenient and effective alternative.”

The eye drops used in the study were developed by Dr. Benozzi’s father, the late Dr. Jorge Benozzi. They contain a combination of two active agents: pilocarpine, a drug that constricts the pupils and contracts the ciliary muscle, which controls the eye’s ability to see objects at varying distances, and diclofenac, a non-steroidal anti-inflammatory drug that reduces the inflammation and discomfort that pilocarpine can cause.

For the study, patients administered the eye drops twice a day, usually when they woke up, then approximately six hours later. A third dose was an option if symptoms recurred or additional visual comfort was needed.

The group of patients (373 women and 393 men, with an average age of 55) were divided into three groups to receive one of three eye drop formulations. Each formulation had a fixed dose of diclofenac but concentrations of pilocarpine were one, two or three per cent.

The researchers assessed how well patients could read the eye chart without reading glasses one hour after the first administration of the drops. They followed the patients for two years.

“Our most significant result showed rapid and sustained improvements in near vision for all three concentrations,” Benozzi told the Congress. One hour after having the first drops, patients had an average improvement of 3.45 more lines on the eye chart. They also experienced improved focus at all distances.

In the 1 per cent pilocarpine group, 99 per cent of 148 patients reached optimal near vision and were able to read two or more extra lines. Approximately 83 per cent of all patients maintained good near vision at one year.

In the 2 per cent group, 69 per cent of 248 patients were able to read three or more extra lines on the chart, and in the 3 per cent group, 84 per cent of 370 patients could read three or more extra lines.

Adverse side effects were mild, said Benozzi. None of the patients discontinued the treatment.

“Nearly all patients experienced positive improvements in near visual acuity, although the magnitude of the improvement depended on the status of their vision before treatment,” Benozzi said.

These results suggest this therapy “offers a safe, effective, and well-tolerated alternative. It significantly reduces dependence on reading glasses … although these eye drops may not eliminate the need for glasses in all individuals.”

She added that the treatment is not intended to replace surgical intervention, but could serve as a valuable alternative. “Eye care professionals now have an evidence-based pharmacological option that expands the spectrum of presbyopia care beyond glasses and surgery.”

These results could be especially important for people who aren’t eligible for surgery for age-related nearsightedness, said Burkhard Dick, chair of ophthalmology at the University Eye Hospital Bochum in Germany , who reviewed the findings.

However, he noted long-term use of medications in the drops may have some unwanted side effects.

“Broader, long-term, multi-centre studies are needed to confirm safety and effectiveness before this treatment can be widely recommended,” said Dick, who is president-elect of the ESCRS and was not involved in the study.

It is also important to note that findings presented at medical conferences are considered preliminary until published in a peer-reviewed journal.

During the presentation Benozzi said she has other patients who have received the treatment for more than ten years, and she intends conduct further research. Her lab is also looking for partners to “internationalize” the findings.

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