Study finds daily eye drops could replace reading glasses

By Stephen Beech

Reading glasses could be made redundant by daily eye drops, suggests a new study.

Using specially formulated drops a couple of times a day could replace the need to wear reading specs as we grow older, scientists say.

They explained that everybody develops "presbyopia" as they age – a difficulty in focusing on near objects and text – and often have to resort to reading glasses.

However, the solution might be as simple as using special eye drops two or three times daily.

A study of 766 patients with an average age of 55 found that the majority could read an extra two, three or more lines on the eye Jaeger chart used for testing near visual acuity after using the eye drops.

And the improvement was sustained for up to two years, according to the findings presented at the Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) in Copenhagen, Denmark.

Study leader Dr. Giovanna Benozzi, director of the Centre for Advanced Research for Presbyopia, Argentina, said: “We conducted this research due to the significant unmet medical need in presbyopia management.

"Current solutions such as reading glasses or surgical interventions have limitations, including inconvenience, social discomfort, and potential risks or complications.

"There is a group of presbyopia patients who have limited options besides spectacles, and who are not candidates for surgery; these are our primary focus of interest.

"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, developed by Dr. Benozzi’s father, the late Dr. Jorge Benozzi, contain a combination of two active agents.

One of them is pilocarpine, a drug that constricts the pupils and contracts the ciliary muscle that controls the eye’s accommodation for seeing objects at varying distances.

The other is diclofenac, a non-steroidal anti-inflammatory drug (NSAID) that reduces inflammation and the discomfort that pilocarpine often causes.

Patients administered the eye drops twice a day, usually on waking and again around six hours later, with an optional third dose if symptoms recurred or additional visual comfort was needed.

The participants 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 1%, 2% and 3%.

The researchers assessed the improvement in how well patients could read the Jaeger chart without reading glasses one hour after the first administration of the drops, and they followed the patients for two years.

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Dr. Benozzi said: “Our most significant result showed rapid and sustained improvements in near vision for all three concentrations.

"One hour after having the first drops, patients had an average improvement of 3.45 Jaeger lines.

"The treatment also improved focus at all distances.

“Impressively, 99% of 148 patients in the 1% pilocarpine group reached optimal near vision and were able to read two or more extra lines.

"Approximately 83% of all patients maintained good functional near vision at 12 months.

"Importantly, no significant adverse events like increased intraocular pressure or retinal detachment were observed.”

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

The improvement in the patients’ vision was sustained for up to two years, according to the findings.

Adverse side effects were mild, with the most common being temporary dim vision, which occurred in 32% of cases, irritation when the drops were instilled (3.7%), and headache (3.8%). No patients discontinued the treatment.

Common adverse side effects of pilocarpine can also include eye redness, watery eyes, blurred vision, dim or dark vision, sensitivity to light or problems changing focus between objects, seeing flashes of light or “floaters” in vision, and, in rare cases, detached retinas.

Dr Benozzi said: “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 at baseline.

"Our study revealed that optimal pilocarpine concentrations could be individualized depending on the baseline severity of presbyopia as assessed by the initial Jaeger scores.

"Patients with less severe presbyopia responded best to 1% concentrations, while those with more advanced presbyopia required higher 2% or 3% concentrations to achieve significant visual improvement.”

She added: “These results suggest this combination therapy offers a safe, effective, and well-tolerated alternative to traditional presbyopia management.

"It significantly reduces dependence on reading glasses, providing a convenient, non-invasive option for patients, although these eye drops may not eliminate the need for glasses in all individuals.

“Importantly, this treatment is not intended to replace surgical interventions, but rather to serve as a valuable solution for patients who need safe, effective, and personalized alternatives and seek freedom from the inconvenience of eyewear.

"Eye care professionals now have an evidence-based pharmacological option that expands the spectrum of presbyopia care beyond glasses and surgery.”

As well as the study participants, Dr. Benozzi has other patients who have received the treatment for more than 10 years.

She plans further research to measure improvements in patients’ quality of life and to explore the underlying physiological mechanisms of the eye drops.