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Parsa CF. New Sight for Old: Commentary On the Use of Pilocarpine for Presbyopia. J Ophthalmic Vis Res 2024; 19:392-396. [PMID: 39917451 PMCID: PMC11795007 DOI: 10.18502/jovr.v19i4.17786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/16/2024] [Indexed: 02/09/2025] Open
Abstract
This is an Editorial and does not have an abstract. Please download the PDF or view the article in HTML.
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Affiliation(s)
- Cameron F. Parsa
- Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Faculty of Medicine, Sorbonne University, Paris, France
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Farid M, Rowen SL, Moshirfar M, Cunningham D, Gaddie IB, Smits G, Ignacio T, Gupta PK. Combination Low-Dose Pilocarpine/Diclofenac Sodium and Pilocarpine Alone for Presbyopia: Results of a Randomized Phase 2b Clinical Trial. Clin Ophthalmol 2024; 18:3425-3439. [PMID: 39606177 PMCID: PMC11600938 DOI: 10.2147/opth.s476658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 10/31/2024] [Indexed: 11/29/2024] Open
Abstract
Purpose To evaluate the efficacy of 0.2% and 0.4% pilocarpine HCl (CSF-1) for the treatment of presbyopia and to determine the contributions of pilocarpine HCl and diclofenac sodium on the efficacy of fixed-dose combination (FDC) formulations. Patients and Methods This was a Phase 2b, multicenter, randomized, double-masked, parallel-group clinical trial. Adults (45-64 years) with presbyopia were randomized 1:1:1 to 3 arms (Pilo arm: pilocarpine HCl; Pilo-Diclo FDC arm: pilocarpine HCl with 0.006% diclofenac sodium; Control arm: 0.006% diclofenac sodium). Participants in Pilo and Pilo-Diclo FDC arms received 0.2% pilocarpine HCl (0.2% Pilo or 0.2% Pilo FDC, respectively) from days 1-8, and 0.4% pilocarpine HCl (CSF-1 or CSF-1-FDC, respectively) from days 8-15. Primary efficacy endpoint was achievement of ≥3-line (15-letter) gain in mesopic, monocular distance-corrected near visual acuity (DCNVA) at 40 cm, 1 hour post-treatment of the study eye on days 8 and 15 in the per protocol (PP) population. Safety endpoints were assessed. Results One hundred and sixty-six participants were randomized (intent-to-treat, N = 166; PP, n = 160). There were no statistical differences between 0.2% Pilo or 0.2% Pilo FDC versus Control at 1 hour post-treatment on day 8. On day 15, 43.1% and 46.9% of participants receiving CSF-1-FDC (0.4% Pilo FDC) or CSF-1 (0.4% Pilo), respectively, achieved ≥3-line gain at 1 hour post-treatment in mesopic DCNVA compared with 16.1% of Control group in the PP population, meeting the primary endpoint (P = 0.0015 and P = 0.0002, respectively). All formulations were well tolerated. Conclusion CSF-1 demonstrated significant improvements in mesopic DCNVA and favorable safety. Pilocarpine HCl as a single active ingredient, at the concentration of 0.4% (CSF-1), provided a transient, therapeutic effect for presbyopia.
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Affiliation(s)
| | | | - Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
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Zhang X, Xiong X, Zhang H, Huang T, Zhou X. Pilocarpine in the Treatment of Presbyopia: Progress, Issues, and Future Prospects. Drugs Aging 2024; 41:897-906. [PMID: 39455529 DOI: 10.1007/s40266-024-01155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2024] [Indexed: 10/28/2024]
Abstract
Presbyopia is a common age-related visual impairment. With the aging of the population, the incidence of presbyopia is increasing globally, becoming a worldwide public health concern. Treatment options for presbyopia include optical lens correction, surgical intervention, and pharmacological therapy. Pharmacological treatments for presbyopia are non-invasive, reversible, and have emerged over the past decade. Following the US Food and Drug Administration's approval of 1.25% pilocarpine for presbyopia, the use of pilocarpine and its compound formulations has gained increased attention, with some drugs entering clinical phase II/III trials ( www.clinicaltrials.gov ). Therefore, this article primarily describes and analyzes the progress of research on the use of pilocarpine and its compound formulations for presbyopia, as well as the challenges that remain to be addressed. The optimal dosage form, the optimal concentration, the long-term safety, and patient compliance should be further explored, and there is a lack of multi-center evidence-based medicine research to support it. The aim of this article is to provide a reference for researchers to conduct further in-depth investigations in this area.
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Affiliation(s)
- Xiuwen Zhang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
| | - Xiaomei Xiong
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
| | - Haixin Zhang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
| | - Taomin Huang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Grzybowski A, Kapitanovaite L, Zemaitiene R. An updated systematic review of pharmacological treatments for presbyopia. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:220-225. [PMID: 39512930 PMCID: PMC11541684 DOI: 10.1016/j.aopr.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/17/2024] [Accepted: 09/03/2024] [Indexed: 11/15/2024]
Abstract
Background Presbyopia, a common age-related condition affecting near vision, impacts over a billion people worldwide. The aim of this paper is to review the main reports and results of clinical trials, comparing the newest pharmacological treatment options for presbyopia, their mechanisms of action, and possible side effects. Main text Pharmacological approaches, involving eye drops that target the underlying mechanisms of presbyopia, have gained growing interest. Two key pharmacological agents in this field are miotics and lens softeners. Miotics enhance near vision temporarily by creating a pinhole effect, though they may cause side effects and are under further investigation for long-term use with ongoing research also exploring the potential benefits of combining them with other drugs to improve outcomes and reduce adverse reactions. Lens softeners, on the other hand, aim to restore the flexibility of the lens, addressing one of the primary causes of presbyopia. Despite early trials, further development of lens softeners has been suspended. A notable advancement in this field is the recent FDA approval of 1.25% and 0.4% pilocarpine, a miotic agent, for presbyopia treatment. This milestone highlights the growing interest in pharmacological solutions for presbyopia, with several new drugs and their combinations currently being investigated for potential FDA approval. Conclusions pharmacological treatments, particularly miotics like pilocarpine, represent a promising alternative to conventional methods for managing presbyopia. Continued research into these treatments, especially combinations of drugs, may offer more effective and convenient options for presbyopia patients in the future.
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Affiliation(s)
- Andrzej Grzybowski
- Institute for Research in Ophthalmology, Poznan, Poland
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
| | - Laura Kapitanovaite
- Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, Kaunas, Lithuania
| | - Reda Zemaitiene
- Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, Kaunas, Lithuania
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Novack GD, Robin AL. Ocular Pharmacology. J Clin Pharmacol 2024; 64:1068-1082. [PMID: 38708561 DOI: 10.1002/jcph.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Treatment of ocular diseases presents unique challenges and opportunities for the clinician and for the clinical pharmacologist. Ophthalmic pharmaceuticals, typically given as liquids, require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Ocular tissue levels are challenging to obtain in humans, and the clinical pharmacokinetics is typically blood levels, which are primarily related to safety, rather than efficacy. The eye is a closed compartment with multiple physiological barriers with esterases and transporters, but relatively little cytochrome oxidases. Delivery routes include topical, intravitreal, and systemic. Patient dosing involves not only adherence issues common to all chronic diseases, but also performance requirements on eye drop instillation. Therapeutically, ocular diseases and their pharmacological treatments include both those analogous to systemic diseases (e.g., inflammation, infection, and neuronal degeneration) and those unique to the eye (e.g., cataract and myopia).
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Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, CA, USA
- Department of Ophthalmology and Vision Science, School of Medicine, University of California, Davis, CA, USA
| | - Alan L Robin
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
- Department of Ophthalmology, School of Medicine Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of International Health, Johns Hopkins University, Baltimore, MD, USA
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Gawel K, Hulas-Stasiak M, Marszalek-Grabska M, Grenda A, Siekierska A, Kosheva N, van der Ent W, Esguerra CV, Krawczyk P, Turski WA. Induction of seizures and initiation of epileptogenesis by pilocarpine in zebrafish larvae. Front Mol Neurosci 2024; 17:1418606. [PMID: 39165716 PMCID: PMC11333333 DOI: 10.3389/fnmol.2024.1418606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 08/22/2024] Open
Abstract
Objective Preclinical models of seizures and epilepsy in rodents contributed substantially to the discovery of currently available antiseizure medications. These were also broadly used for investigation of processes of epileptogenesis. Nevertheless, rodent models pose some limitations, thus, new models using alternative species are in high demand. The aim of this study was to describe a new model of seizures/epilepsy induced by the cholinomimetic agent, pilocarpine (PILO), in larval zebrafish. Methods Local field potential (LFP) recordings were conducted to analyze electroencephalographic discharges and correlate it with larval behavior. Hematoxylin and eosin (H&E) staining, as well as TUNEL staining were performed to analyze morphology and apoptosis, respectively. Real-time quantitative polymerase chain reaction (qRT-PCR) was undertaken for gene expression analysis. Results Acute exposure to PILO, in a concentration-dependent manner, induces electroencephalographic discharges in larval zebrafish, which behaviorally manifest as decreased locomotion and moving time, but enhanced movement velocity. The PILO-induced seizure-like activity is behaviorally distinct from this induced by the application of chemoconvulsant pentylenetetrazole (PTZ). Zebrafish larvae previously exposed to PILO (2 h), after a washing out period, exhibit spontaneous, unprovoked discharges and apoptotic changes in their brains. Significance Here, we comprehensively investigated a new model of PILO-induced seizures/epilepsy in larval zebrafish. We propose that this model may be used to study epileptogenesis and for antiseizure drug screening purposes.
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Affiliation(s)
- Kinga Gawel
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Lublin, Poland
| | - Monika Hulas-Stasiak
- Department of Functional Anatomy and Cytobiology, Maria Curie-Sklodowska University, Lublin, Poland
| | - Marta Marszalek-Grabska
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Lublin, Poland
| | - Anna Grenda
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Siekierska
- VirusBank Platform, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Nataliia Kosheva
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Lublin, Poland
| | - Wietske van der Ent
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway, University of Oslo, Forskningsparken, Oslo, Norway
| | - Camila V. Esguerra
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway, University of Oslo, Forskningsparken, Oslo, Norway
| | - Pawel Krawczyk
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Waldemar A. Turski
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Lublin, Poland
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Fernández Jiménez-Ortiz H, Toledano Fernández N. Pharmacological treatments for the correction of presbyopia. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:331-339. [PMID: 38663714 DOI: 10.1016/j.oftale.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/10/2024] [Indexed: 04/29/2024]
Abstract
Presbyopia affects between 1.7 and 2 billion people worldwide. Presbyopia significantly impacts productivity and quality of life in both developed and developing countries. During accommodation, the human eye changes its dioptric power by altering the shape of the lens, but the exact nature of this change has not been fully explained. Recently, topical treatments have been marketed for the treatment of presbyopia and others are under investigation. In order to prepare a review of these novel therapies, we searched the major biomedical search engines. We found 15 randomized clinical trials and 12 reviews that met our review criteria. There are two different strategies for this purpose, the pinhole effect that increases depth of focus and "crystalline lens relaxation" for which parasympathetic mimetics and lens oxidation intermediates have been used. The results are generally favorable in terms of improvement of near visual acuity, although the follow-up period of the studies is short. These are novel strategies in the early stages of research that could be useful in the treatment of presbyopia.
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Affiliation(s)
| | - N Toledano Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Zanjani A, Sohrabi MR, Kabiri Fard H. Colorimetric Concurrent Determination of Ultra-Trace Amounts of Pilocarpine and Timolol as Anti-Glaucoma Drugs in Binary Mixtures Using a Multivariate Calibration Approach Based on the Aggregation of Gold Nanoparticles. J AOAC Int 2024; 107:592-599. [PMID: 38608200 DOI: 10.1093/jaoacint/qsae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To study the ultra-trace simultaneous determination of drugs, the colorimetric method in combination with chemometrics can be used. OBJECTIVE In this study, a simple, rapid, and sensitive UV-Vis spectrophotometric method using gold nanoparticles (AuNPs) was introduced for the simultaneous determination of ultra-trace amounts of pilocarpine (PIL) and timolol (TIM) in binary mixtures and biological samples. METHODS AuNPs interacted with components and the aggregation mode of NPs occurred, and, finally, the color change of the solution (red to gray) was observed with the naked eye without the most modern and expensive instruments. The characterization of AuNPs was evaluated by transmission electron microscopy (TEM) and dynamic light scattering (DLS). RESULTS The validation of the colorimetric way was studied in the concentration range of 100-800 and 100-600 μg/L with good linearity equal to 0.9772 and 0.9891 for PIL and TIM, respectively. The limit of detection (LOD) was found to be 165.00 and 92.40 μg/L, where the limit of quantitation (LOQ) was 500.00 and 280.00 μg/L for PIL and TIM, respectively. The effect of some factors such as interaction time, the concentration of components, and the volume of buffer on absorbance was investigated. Partial least squares (PLS) as an efficient multivariate calibration method was combined with colorimetry for the simultaneous determination of PIL and TIM in binary mixtures. The optimum number of latent variables was selected by k-fold cross-validation based on minimum mean square error prediction (MSEP), and the number of components equal to 1 with MSEP of 1.085 and 0.763 was considered for PIL and TIM, respectively. The mean recovery was obtained at 100.20 and 101.55% for PIL and TIM, respectively. CONCLUSIONS The colorimetric method can be introduced as a proper option for the simultaneous determination of components in pharmaceutical formulations and other samples. HIGHLIGHTS A colorimetric method using AuNPs was proposed. The PLS method was coupled with a colorimetric method for the ultra-trace simultaneous estimation of PIL and TIM in binary mixtures. Ultra-trace amounts of PIL and TIM were also determined in biological samples. The proposed method is simple, fast, and less expensive than chromatography methods.
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Affiliation(s)
- Asma Zanjani
- Department of Pharmaceutical Chemistry, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mahmoud Reza Sohrabi
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hassan Kabiri Fard
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Tehran, Iran
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Shafer BM, McGee SR, Ifantides C, Williamson BK, Kannarr S, Whyte J, Zhang Z, Yanke T, Schachter S. Understanding Perspectives on Presbyopia and Use of Pilocarpine HCl 1.25% Twice Daily from Participants of the Phase 3 VIRGO Study. Ophthalmol Ther 2024; 13:1723-1742. [PMID: 38662193 PMCID: PMC11109051 DOI: 10.1007/s40123-024-00935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The phase 3, randomized, vehicle-controlled, 14-day VIRGO study evaluated the efficacy and safety of twice-daily dosing of pilocarpine hydrochloride ophthalmic solution 1.25% (Pilo) in presbyopia. On VIRGO exit, a companion study was conducted to assess the patient experience with presbyopia and satisfaction with Pilo. METHODS Recruited individuals completed the Presbyopia Patient Satisfaction Questionnaire (PPSQ) plus a three-part exit survey, or a live interview. The PPSQ evaluated respondents' experience with Pilo. Survey parts 1 and 2 evaluated experience managing presbyopia before and during VIRGO, respectively; part 3 assessed future possibilities of using Pilo in real-world situations. The interview further informed the interviewees' experience with presbyopia and Pilo. The primary endpoint was responders (%) in each rating category of the PPSQ items 1-7; the secondary endpoints were summary of categorical (survey) and qualitative (interviews) responses. RESULTS The PPSQ and survey included 62 participants who received Pilo (N = 28) or vehicle (N = 34) in VIRGO; the interview included ten participants (Pilo, N = 4; vehicle, N = 6). Per the PPSQ, 64.3% of Pilo users reported vision improvement, including 17.9% with complete improvement; ≥ 46.4% were satisfied/very satisfied with their ability to perform daily activities, see up close unaided, and read in dim light. Among vehicle users, these percentages were 35.3%, 0%, and ≤ 23.5%, respectively. In both subgroups, ≥ 67.9% were interested in using Pilo or Pilo and eyeglasses/contact lenses in the future. Per the interview, vehicle users (n = 6/6) found the eyedrop easy to use but none experienced meaningful near-vision improvements, stopped using other correction method(s) part of the day, were satisfied with the eyedrop, preferred it over their previous correction method(s), or would continue using it if prescribed. Conversely, 75% (n = 3/4) of Pilo users responded positively to each of these six criteria. CONCLUSIONS Findings validate the VIRGO results and improve our understanding of the patient experience, demonstrating improved vision and satisfaction with Pilo (vs. vehicle) when performing daily activities.
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Affiliation(s)
- Brian M Shafer
- Shafer Vision Institute, 633 W Germantown Pike, Suite 100, Plymouth Meeting, PA, 19462, USA.
| | | | | | | | | | - Julie Whyte
- Endpoint Outcomes, a Lumanity company, Boston, MA, USA
| | - Zuoyi Zhang
- Allergan, an AbbVie company, Irvine, CA, USA
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Ayaki M, Hanyuda A, Negishi K. Symptomatic Presbyopia may Develop Earlier in Patients With Glaucoma-A Cross-Sectional Retrospective Cohort Study. Transl Vis Sci Technol 2024; 13:21. [PMID: 38619925 PMCID: PMC11037495 DOI: 10.1167/tvst.13.4.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/04/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose The purpose of this study was to explore risk factors for symptomatic presbyopia, defined as near add power ≥1.50 diopters, in patients with glaucoma. Methods Treated glaucoma (n = 56), untreated glaucoma (n = 21), and control individuals (n = 376), aged 40 to 55 years at first visit, were enrolled in the study, and near add power, retinal thickness, and visual field were examined. The association between near add power and ocular parameters and the odds ratios (ORs) for symptomatic presbyopia were investigated. Survival analysis for symptomatic presbyopia was conducted. Results Age, astigmatic power, mean deviation, and ganglion cell complex thickness were associated with near add power. The OR for symptomatic presbyopia was significant for age (OR = 1.51), astigmatism (OR = 1.01), mean deviation (OR = 0.72), ganglion cell complex thickness (OR = 0.98), treated and untreated glaucoma (OR = 2.09), and use of glaucoma eye drops (OR = 3.33). Survival analysis showed that the treated glaucoma group reached the near add power endpoint of ≥1.50 D (symptomatic presbyopia) significantly earlier than the other two groups, and there was no difference between the control and untreated glaucoma groups. Conclusions Glaucoma patients treated with eye drops may start near correction earlier. Translational Relevance Symptomatic presbyopia may develop earlier in patients with glaucoma, and our findings could further contribute to better management and understanding of presbyopia with glaucoma.
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Affiliation(s)
- Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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