Vuity: First FDA-Approved Eye Drops for Presbyopia

Article: U.S. Food and Drug Administration Approves VUITY
Source: Allergan / Abbvie
Published: October 29, 2021
Article: The First FDA-Approved Eye Drops to Treat Blurry Vision Are Now Available in The US Source: ScienceAlert
Published: December 15, 2021

Vuity: Pilocarpine HCL 1.25% ophthalmic solution

The U.S. Food and Drug Administration (FDA) recently approved Vuity, a daily eye drop indicated for treatment of presbyopia, or age-related decline in near focus due to decreased ability of the eye's crystalline lens to accommodate. Presbyopia onset usually begins in the mid-40s. Available with a prescription, Vuity is a formulation of 1.25% pilocarpine. A direct-acting cholinergic agonist, pilocarpine acts on the smooth muscle muscarinic receptors of the iris sphincter to constrict the pupils in miosis. Its additional mechanism of action to directly stimulate the longitudinal muscles of the ciliary body is thought to affect the mechanics of the scleral spur to widen the spaces in the trabecular meshwork, thereby increasing aqueous outflow; in this capacity, pilocarpine is sometimes used as a treatment for glaucoma. In the context of pupillary constriction in itself, which decreases the "aperture" of the eye's optical system, the effect is an increase in depth of field and depth of focus, respectively, the range of clear vision in object space in front of the eye and in image space on the "screen" of the retina. (Often mentioned together, these two ranges are dioptrically equivalent.)

The increase in range of clear vision means an increase in near vision without sacrificing distance vision, in emmetropic or corrected-to-emmetropic eyes. In a press release, Allergan, the company marketing the drops, reported that clinical trials of participants 40 to 55 years of age with mild presbyopia showed "a statistically significant proportion of participants treated with VUITY gaining three lines or more in mesopic, high contrast, binocular Distance Corrected Near Visual Acuity (DCNVA), without losing more than 1 line (5 letters) of Corrected Distance Visual Acuity (CDVA) at day 30, hour 3, versus placebo." The effect lasts up to 6 hours. Common sides effects mentioned were headache and eye redness. Because pilocarpine constricts the pupils, thereby reducing the amount of light reaching the retina, consideration should be made for low-light settings, such as driving at night. Vuity does not correct refractive error such as myopia or astigmatism, or ocular pathology. Importantly, Vuity is only FDA-approved for once daily use in each eye, and although caution should be exercised in using the drops to "replace" reading glasses entirely, it is nonetheless a valuable addition to the toolbox of options to increase spectacle independence.

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