More than one-third of Americans have presbyopia, a gradual loss of near vision with age. Most people reach for eyeglasses or specialty contact lenses, but these are easily lost or can seem burdensome. Now, a promising nonsurgical treatment for presbyopia is on the horizon: topical eye drops.

Two kinds of eyedrops

Presbyopia occurs when the clear lens of the eye stiffens over time and loses flexibility. This makes it hard to focus on words on a page or smartphone. Two types of eye drops — each with unique mechanisms – address this. Miotic drops make the pupil contract, limiting out-of-focus information. The first FDA-approved drop for presbyopia is a type of miotic drop. Lens-softening drops help restore the flexibility of the lens.

Miotic drops

Miotic drops change the size of the pupil and may also increase ciliary body tone. By creating a ‘pinhole effect’, this type of drop maximizes near and far focus. This is reminiscent of an original film camera, before the invention of the lens. Allergan released the first FDA-approved miotic drop treatment for presbyopia in 2021.

“The significance of this FDA approval is massive as there are approximately 2 billion people worldwide with presbyopia. Glasses, contact lenses, and surgery are traditional treatments, but, for various reasons, do not work well for every patient,” said Christopher Starr, ophthalmologist at Weill Cornell Medicine in New York City. “Having a novel treatment option in the form of a presbyopia eye drop is a welcome addition to our armamentarium against this universal age-related near vision condition that effects essentially everyone over the age of 40.”

Lens-softening drops

This type of drop softens the eye’s aging lens. When the lens regains flexibility, the eye can better focus on near objects. Lens-softening drops cannot completely restore near vision. But they may be able to turn back the clock by up to 10 years. This type of drop may work best for people without cataracts who are in the beginning stages of presbyopia. That includes nearly half of people diagnosed with the condition. Novartis has developed the first lens-softening drop, and it is currently in phase 2 trials.

Learn more from the American Academy of Ophthalmology