Eyeworld

SEPTEMBER 2023 | EYEWORLD | 41 R by Ellen Stodola Editorial Co-Director About the physicians Steven Dell, MD Dell Laser Consultants Austin, Texas Jennifer Loh, MD Loh Ophthalmology Associates Miami, Florida Luke Rebenitsch, MD Medical Director ClearSight LASIK/43 Vision Oklahoma City, Oklahoma as the pupil enlarged, the effect was lost. When coupled with the myopic shift encountered, this limited our use of Vuity to a small cohort of pa- tients. Further, we found that very few patients went on to refill the drug. Dimming was less of a concern for patients, and those who contin- ued to use the product found that the dimming seemed to become much less noticeable after the first few days." Dr. Dell also noted that his practice uses Vuity as a "rescue medication" for select indi- viduals with unwanted images from corneal or IOL-related issues. Since the level of higher order aberrations (HOAs) decreases with the square of the pupil radius, shrinking the pupil in size by half results in a four-fold reduction in HOAs. "This has helped a select few patients," he said. "There is a dose-related pupil response with Vuity, so in a pseudophake where ciliary T he approval of Vuity (pilocarpine ophthalmic solution, Allergan) nearly 2 years ago was the first launch of a presbyopia drop into the market. Several physicians discussed their experience using this product in practice and how it has, or has not, worked for their patients. They also shared their thoughts on the future of the presbyopia drop market and other products in the pipeline. Steven Dell, MD, said there were high hopes for this product, but it was quickly discov- ered that the level of miosis obtained was not sufficiently robust or enduring. "This translated into a modest gain in reading ability for a short period of time," he said. "To really achieve sig- nificant improvement in reading ability, a sub-2 mm pupil is needed. Data from the Vuity clinical trial noted that the mean pupil nadir was 2.3 mm, which occurred at 1 hour post-dosing, and Presbyopia drops in practice and products in development continued on page 42 Dr. Loh is still using Vuity in her practice, but she looks for the ideal patient—someone who is in the 40–50 age range, is an early presbyope, and is looking for relief from glasses. Source: Jennifer Loh, MD

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