Eyeworld

EW REFRACTIVE 48 February 2018 Presentation spotlight by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer New study demonstrates better near vision and high patient satisfaction in presbyopic patients using topical drops, with unchanged distance vision I mproving near visual acuity without compromising distance is the ultimate treatment goal in patients upward of 40 years of age experiencing a reduction in their accommodative power. Howev- er, getting there can be complicated. Surgical approaches to presbyopia achieve visual improvements but involve less than perfect near or dis- tance visual acuity, limiting efficacy and requiring at least some degree of spectacle dependence. Nonsurgical approaches to presbyopia address different aspects of the accommo- dative process, such as monovision, parasympathetic mediated meiosis and ciliary muscle stimulation, or lens softening, which restores the lens' shape changing ability. How- ever, these approaches aren't ideal either. Pure parasympathetic treat- ments result in a relatively small pupil diameter and a myopic shift, compromising far distance vision. They also cause well-known ad- verse reactions from the muscarinic stimulation of the ciliary muscle and pupillary sphincter. Monovision, despite its appeal for achieving good vision at different distances, is less effective in reduced light conditions compared to a binocular approach, so the drawbacks of current presby- opic treatment approaches go on and on. Observational study An observational study presented at the XXXV Congress of the ESCRS titled "Symptomatic control of presbyopia through pharmacological ciliary body stimulation" described Topical accommodating eye drops Dynamic imaging of accommodation by swept source OCT shows a difference of 50 µ pre- and post-drop. Source: Jorge Alio, MD excellent outcomes using a topical treatment with FOV Tears, which seems to improve near vision for hours at a time, without the usual compromising of distance visual acuity. According to Felipe Vejara- no, MD, Fundacion Oftalmologica Vejarano, Popayan, Colombia, who developed the presbyopic drops, seeing is believing. "FOV Tears improved vision by two to three Snellen lines for near in the short term and by one to two additional lines, with continuous use," Dr. Vejarano said. "This treat- ment improves the physiological deterioration of accommodation with age. We even saw an improve- ment of one line of visual acuity for distance vision and extraordinary intermediate results of 20/25 or better." The observational study in- cluded 588 eyes of 294 patients, of which 157 (53.4%) were male and 137 (46.6%) were female, who received FOV Tears twice daily, in their first application of the drug. The age range was 40 to 71 years (average 51 years). Their average refractive defect pre-drop was sphere +0.54 D and cylinder –0.46 D. The patients had associated findings that included: diabetes three (1.02%), amblyopia three (1.02%), glaucoma one (0.34%), forme fruste KC 12 (4.08%), and dry eye 19 (6.46%); and previous surgeries: RK or AK six (2.04%), LASIK 54 (18.37%), intrastromal rings 2 (0.68%), and pseudophakia four (1.36%). The study data revealed that the difference between the sphere pre- drop and 2 hours post-drop was less than one-tenth of a diopter (–0.09 D) and the difference in the cylinder was even lower (–0.03 D), ruling out a myopic shift. The ocular scatter index was 0.87 pre-drop and 0.69 post-drop (difference 0.18). Pupil size measured using the NIDEK AL-Scan (NIDEK, Gamagori, Japan) revealed a pre-drop pupil size of 3.26 mm and a post-drop pupil size of 3.22 mm under photopic conditions (difference of –0.04 mm), and a 4.77 mm pre-drop pupil size and 4.15 mm post-drop pupil size under scotopic conditions (differ- ence of –0.62 mm), indicating a non-fixed meiotic, dynamic pupil that changes size in accordance with differences in the light intensity. "This treatment allows a truly improved physiological accommo- dation," Dr. Vejarano said. "FOV Tears is an ideal pharmaceutical and topical therapy that is truly accommodative, not pseudoaccom- modative. It improves near vision, but also far vision, or at least doesn't alter it. We saw a dynamic pupil in different light conditions, not fixed meiosis. The treatment caused a mild and controlled dynamic mei- osis that also could diminish glare (dynamic pseudoaccommodation), not an extreme and fixed meiosis that decreases contrast sensitivity." Distance binocular vision was 20/30 or better in 95.69% of the patients pre-drop and 98.76% post- drop, and 20/25 in 87.69% and 95.03%, respectively. Near binocular vision post-drop was 20/40 (J3) or better in 91.52% of patients, 20/30 (J2) or better in 80.57%, and 20/25 (J1) or better in 54.06% of the study patients. Tested monocularly, 62.54% of the patients gained three or more Snellen lines, while 37.1% gained three lines or more binocularly. Pilot study Dr. Vejarano reported the 3-month follow-up findings of a pilot study in 40 patients (age range 40 to 67 years, average age: 51 years) using FOV Tears, that described an in- crease of 0.75 D in accommodation amplitude initially, increasing up to 1.5 D with continued use of the drops up to 3 months. Accom- modation was measured to be 1.5 D, improving with time of use up to 2.5 D. The results mirror those achieved in the 14 presbyopic patients that constituted a previous pilot study using FOV Tears coau- thored by Dr. Vejarano as reported in the literature. 1 Accommodation improvement shown by defocus curve revealed an accommodation amplitude that got wider with continued use over Change of 120 µ is seen in anterior chamber depth pre- and post-drop using UBM. Source: Felipe Vejarano, MD

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