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Pharmacological Treatments for Presbyopia

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Abstract

Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40–50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field.

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Authors and Affiliations

  1. Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina

    Betina Orman

  2. Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina

    Giovanna Benozzi

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  1. Betina Orman
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  2. Giovanna Benozzi
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Correspondence to Betina Orman.

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This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

Giovanna Benozzi is the owner of the Patent US 8.524.758 B2- EP1.938.839 B1. Betina Orman has no conflicts to report.

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BO: Conception, manuscript drafting, critical revision. GB: Conception, manuscript drafting, critical revision.

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Orman, B., Benozzi, G. Pharmacological Treatments for Presbyopia. Drugs Aging 40, 105–116 (2023). https://doi.org/10.1007/s40266-022-01002-4

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