Journal of Ophthalmic and Vision Research
ISSN: 2008-322X
The latest research in clinical ophthalmology and vision science
Pilocarpine 1% for Improved Near Vision in Pseudophakic Patients
Published date: May 19 2025
Journal Title: Journal of Ophthalmic and Vision Research
Issue title: Volume 20 - 2025
Pages: 1 - 8
Authors:
Abstract:
Purpose: To evaluate the efficacy and safety of 1% pilocarpine to enhance near vision in pseudophakic patients with monofocal intraocular lens (IOL).
Methods: This prospective, nonrandomized, open-label, pre–post interventional study was conducted on patients who had a history of phacoemulsification and monofocal IOL implantation without any complications at least six months before the intervention. One drop of 1% pilocarpine solution was instilled in one of the patients’ eyes, and near and distance visual acuity was assessed before and 20 minutes after monocular administration of the drop. Adverse effects were monitored for 8 hours.
Results: We studied 54 pseudophakic eyes of 54 patients with a mean age of 55.02 ±10.10 years, including 36 males (66.7%). Distance-corrected near visual acuity improved significantly after administering 1% pilocarpine (P < 0.001). After treatment, no significant decrease in corrected distance visual acuity (CDVA) was observed (P = 0.60). Overall, 46 patients (85.2%) exhibited an improvement of more than one line in near vision after treatment; however, eight patients (14.8%) did not show any changes in near vision. Only two patients (3.7%) gained three lines in near vision. Headache, irritation, and nausea were observed in three patients, two patients, and one patient, respectively.
Conclusion: The monocular 1% pilocarpine solution significantly improved near visual acuity among patients with pseudophakia and featured an acceptable safety profile. Although this improvement is considerable, it may not be sufficient for complete spectacle independence. Trial registration: ClinicalTrials.gov identifier: NCT05578001
Keywords: Cataract Surgery, Pilocarpine, Presbyopia, Pseudophakia
References:
1. Mancil GL, Bailey IL, Brookman KE, Bart Campbel J, Cho MH, Rosenbloom AA, et al. Optometric clinical practice guideline: Care of the patient with presbyopia. St Louis MO Am Optom Assoc.;2011.
2. Fricke TR, Tahhan N, Resnikoff S, Papas E, Burnett A, Ho SM, et al. Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: Systematic review, meta-analysis, and modelling. Ophthalmology 2018;125:1492–1499.
3. Kohnen T, Böhm M, Lwowski C. Pseudophakic approaches for addressing presbyopia. In: Albert DM, Miller JW, Azar DT, Young LH, editors. Albert and Jakobiec’s principles and practice of ophthalmology. Cham: Springer International Publishing; 2022: 1507–1524.
4. Liu J, Dong Y, Wang Y. Efficacy and safety of extended depth of focus intraocular lenses in cataract surgery: A systematic review and meta-analysis. BMC Ophthalmol 2019;19:198.
5. de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev 2016;12:CD003169.
6. Stival LR, Figueiredo MN, Santhiago MR. Presbyopic excimer laser ablation: A review. J Refract Surg 2018;34:698–710.
7. Waring GO 4th. Correction of presbyopia with a small aperture corneal inlay. J Refract Surg 2011;27:842–845.
8. Torricelli AA, Junior JB, Santhiago MR, Bechara SJ. Surgical management of presbyopia. Clin Ophthalmol 2012;6:1459–1466.
9. Hipsley A, Hall B, Rocha KM. Scleral surgery for the treatment of presbyopia: Where are we today? Eye Vis 2018;5:4.
10. Grzybowski A, Ruamviboonsuk V. Pharmacological treatment in presbyopia. J Clin Med 2022;11:1385.
11. Waring GO 4th, Price FW Jr, Wirta D, McCabe C, Moshirfar M, Guo Q, et al. Safety and efficacy of AGN- 190584 in individuals with presbyopia: The GEMINI 1 Phase 3 Randomized Clinical Trial. JAMA Ophthalmol 2022;140:363–371.
12. Renna A, Vejarano LF, De la Cruz E, Alió JL. Pharmacological treatment of presbyopia by novel binocularly instilled eye drops: A pilot study. Ophthalmol Ther 2016;5:63–73.
13. Vargas V, Vejarano F, Alió JL. Near vision improvement with the use of a new topical compound for presbyopia correction: A prospective, consecutive interventional noncomparative clinical study. Ophthalmol Ther 2019;8:31–39.
14. Simionescu O. A novel iris colour classification scale. Annu Res Rev Biol 2014;4:2525–2534.
15. Miles WR. Ocular dominance demonstrated by unconscious sighting. J Exp Psychol 1929;12:113–126.
16. Kraushar MF, Steinberg JA. Miotics and retinal detachment: upgrading the community standard. Surv Ophthalmol 1991;35:311–316.
17. Al-Khersan H, Flynn HW Jr, Townsend JH. Retinal detachments associated with topical pilocarpine use for presbyopia. Am J Ophthalmol 2022;242:52–55.
18. Schick T, Heimann H, Schaub F. [Retinal detachment part 1 - Epidemiology, risk factors, clinical characteristics, diagnostic approach]. Klin Monbl Augenheilkd 2020;237:1479–1491.
19. Abdelkader A. Improved presbyopic vision with miotics. Eye Contact Lens 2015;41:323–327.
20. Orman B, Benozzi G. Pharmacological strategies for treating presbyopia. Curr Opin Ophthalmol 2021;32:319–323.
21. Renna A, Alió JL, Vejarano LF. Pharmacological treatments of presbyopia: A review of modern perspectives. Eye Vis 2017;4:3.
22. Shafer BM, McGee SR, Ifantides C, Williamson BK, Kannarr S, Whyte J, et al. 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.
23. Holland E, Karpecki P, Fingeret M, Schaeffer J, Gupta P, Fram N, et al. Efficacy and safety of CSF-1 (0.4% Pilocarpine Hydrochloride) in presbyopia: Pooled results of the NEAR Phase 3 randomized, clinical trials. Clin Ther 2024;46:104–113.
24. Lievens CW, Hom MM, McLaurin EB, Yuan J, Safyan E, Liu H. Pilocarpine HCl 1.25% for treatment of presbyopia after laser vision correction: Pooled analysis of two phase 3 randomized trials (GEMINI 1 and 2). J Cataract Refract Surg 2024;50:57–63.
