For years, I’ve had patients who are in their mid-40s come in describing an acute visual decline that they fear is caused by something very serious like a brain tumor. After confirming that they’re experiencing the early effects of presbyopia, I explain that as we grow older our natural lens doesn’t move the way it used to—just like the rest of our body doesn’t move the way it used to—and we need help with reading glasses. Often, patients look at me and say, “You can reconstruct the front of the eye with lasers and rehabilitate people’s vision, and this is all you’ve got? Reading glasses?” It’s a humbling experience.
Until I reached my 40s. I didn’t know what it was like to not be able to read my text messages or see my food. Now, I understand how presbyopia affects people’s lives. We can’t just overlook it.
Where Are My Readers?
In many ways, presbyopia is your first sign of aging. Psychologically, it’s difficult to deal with the fact that you now have to think about certain things you were able to do without a thought—like what you’ll do in a restaurant if you can’t see the menu, or in my case, how I’ll see the small numbers for my lens calculations. The idea that I always have to have reading glasses with me is a whole paradigm shift.
Many patients don’t want to constantly be putting reading glasses on and taking them off. Presbyopia-correcting contact lenses or even a single contact lens to mimic mini monovision are options, but with dry eye so prevalent in this patient population, contact lenses may be contraindicated. In the end, most people just have to accept the fact that they’ll be dependent on readers.
Being able to prescribe a presbyopia-correcting eye drop that can bridge patients through the period from their mid-40s well into their 50s, before they need cataract surgery in their 60s, is exciting. This means we can actually help people with their day-to-day activities and with so much of what we do in the intermediate world. This seems like an unmet need that we’ve ignored for years.
Key Features of a Drop
The beauty of having an eye drop that corrects presbyopia is that it’s titratable. It puts control in the hands of the users. Patients can instill a drop when they need it, and if the effect starts to wear off, they can instill another drop, up to four times a day. On a day when they don’t need to be spectacle-free, they don’t have to use the drop. I feel good about finally being able to give patients an alternative to readers. In fact, I have an Excel spreadsheet listing the patients that I have to call once the Orasis (OR-uh-sis) Pharmaceuticals drop is approved.
I’m excited about the Orasis eye drop, which is currently in phase 3 clinical trials, as the company reports it has a low side effect profile, is well tolerated, and is preservative free. The side effect profile is extremely important, particularly for a drop that causes miosis to increase depth of focus to correct presbyopia. A drop will be beneficial only if it mimics—or takes patients back to—their pre-presbyopic state without degrading distance vision and night-time vision. We don’t want to take away one problem and cause another problem. In addition, we don’t want to cause new symptoms like headaches and browaches, which may be associated with miotics. Potentially, the lower the concentration, the lower the side effect profile will be. I’ll be looking closely at the clinical trial data, but potentially there are huge benefits to the Orasis product.
Meeting an Unmet Need
Pharmacologic drops to help with presbyopia management is an unmet need that will bridge a huge gap from the mid-40s to mid-50s and help our patients in incredible ways. It’s something that has been neglected because we didn’t have solutions. Now, we can offer patients an option that will enhance their quality of life.