Up to now, presbyopia treatment has almost always involved the use of a lens, with laser surgery being the one exception. But in what can only be described as a major breakthrough, a new type of treatment has arrived in the form of a prescription medication—Vuity, which was developed by Allergan.

Vuity is not a “cure” for presbyopia, but it can reduce a patient’s need for reading glasses or multifocal lenses.

Vuity, of course, is not a “cure” for presbyopia, but it can reduce a patient’s need for reading glasses or multifocal lenses. It does this by reducing pupil size, increasing depth of focus and improving near vision while not affecting distance vision.

While you might think Vuity would primarily benefit younger presbyopes with low adds, according to Sarika Sood, Allergan’s TA head, U.S. Medical Affairs, Eye Care, “Clinical studies evaluated Vuity in participants in their 40s and 50s who have mild, moderate and advanced presbyopia. Subgroup analyses demonstrated improvements regardless of age, emmetrope status, and baseline severity.”

Chris Lievens, OD, chief of Internal Clinics at Southern College of Optometry, has a great deal of experience with Vuity, having been heavily involved with clinical research, and with patients since the drug was approved by the FDA. He said that he brings it up with almost all of his presbyopic patients, regardless of age.

“The data may say it’s not going to be as effective on a 65- or 69-year-old, but a 69-year-old patient may not need the same impact that a 45-year-old may need to see some quality of life improvements. Spectacle correction, contact lens correction and now a pharmaceutical correction, can comprise a synergistic potential treatment.”

While younger patients may not need additional correction while using Vuity, “As you get a little bit older, I think you do need to supplement the drops with some something else. It delivers additional reading comfort while you’re in your glasses or contact lenses, building fatigue less quickly,” Lievens said.

The FDA has recently approved Vuity for twice-a-day use. Said Sood, “Twice-daily dosing may extend duration up to nine hours to better meet patients’ needs,” but in Lievens’s personal experience, the benefits last even longer. “I typically get at least six to eight hours of effect on the first dose. I put in a second drop three to six hours from the first, and it lasts not only through my work day, but even through my leisure activities at the end of the day.”

According to Lievens, Vuity can relieve not just the visual symptoms of presbyopia, but also the anxiety that younger wearers experience along with these symptoms—especially as the onset of symptoms is occurring at a younger age for many. “It could be one of the first aging feelings in your lifetime, and that carries this undercurrent of anxiety and depression. Anything that we can do to provide more freedom from this dependence on glasses is beneficial.”

But since it works by shrinking the pupil, does it degrade night vision? According to Sood, “Vuity may cause dim or dark vision temporarily, so patients are advised to use caution when it comes to night driving or doing any potentially hazardous activities with low lighting.” However, in Lievens’s experience, it may provide some enhancement at night.

Lievens noted that, “I do make sure that every patient I prescribe this medication to I see myself for a full comprehensive eye exam. Including an eye dilation. I do think it’s critical to make sure the eye is in pristine condition and there’s no concerns anywhere just to make sure this drug is safe for use. He also feels that patient education is very important when prescribing Vuity.

“Unlike a lot of medications and drops after routine use for a new user, at least two weeks is needed for maximum visual effects of this medication. There appears to be some form of adaptation the body and the eye goes through while getting used to this drop. If we don’t tell our patients this, they may actually give up too soon, not knowing that it was only going to get better and better and better.”