Reading: A New FDA-Approved Eye Drop Could Replace Your Reading Glasses

As I get older, I’m finding it more and more difficult to read the fine print — or any print, for that matter. Like many women over 40, I’ve taken to leaving readers in every room — the kitchen, to make out recipes, the laundry room, for deciphering laundry labels, the bedroom, for nighttime reading — not to mention in my car, so that I can see the words on menus in restaurants and the instructions on parking ticket kiosks. 

Age-related blurry near vision, or presbyopia, affects about 128 million Americans — nearly half of the adult population. But thanks to a new breakthrough in eye care, those of us over 40 may be able to give our readers a rest. Or at least ditch them for all those workday Zoom meetings. Vuity, a once-a-day treatment for presbyopia, last week became the first FDA-approved eye drop available by prescription to help users see close up more clearly — without impacting distance vision.  CoveyClub sat down with Dr. Selina McGee, an Oklahoma-based optometrist and a consultant to Allergan, maker of Vuity, to get the lowdown on this new alternative to reading glasses. 

CoveyClub: I understand that presbyopia affects nearly 90 percent of US adults over 45, including many of our readers. Why is this such a widespread problem? Can you explain what happens to the eye as we age that causes our vision to change? 

Dr. McGee: It’s one of those things that happens with birthdays. It’s like gray hair and wrinkles: There’s nothing we can do to avoid that it is going to happen. And the reason it happens is because the lens inside our eye, as we have more birthdays, starts to lose its ability to focus. And there are a couple of reasons for that. In a non-presbyopic eye, the clear lens behind the iris can change shape and focus light to the retina, making it easier to see things up close. In a presbyopic eye, the lens starts to harden, and does not change shape as easily, making it difficult to focus on near objects. We also think that there’s some component of the actual muscle that makes the lens move that also starts to deteriorate. 

CoveyClub: So how do Vuity eye drops work? Do they somehow soften the lens? Or do they work by a totally different mechanism? 

Dr. McGee: It works by a totally different mechanism. So, most people will experience presbyopia, like you mentioned, in their early 40s and well into their late 40s and 50s. And what people will experience is trouble with small print. So they’ll scoot the print back away from their face or blow up the font on the text on their phones, and that helps. And one thing that a lot of people notice is that if they’re in really good light, they see better. And the reason that happens is because when we’re in a bright light situation, our pupils get smaller. And when we’re in a dimly lit room, our pupil gets bigger to let more light in. So the way that Vuity works is it actually reduces pupil size. 

When you have a smaller pupil, you get something called depth of focus. It is similar to looking through a pinhole. Looking through a small hole reduces peripheral blur and increases the depth of focus. This improves a person’s overall visual acuity. The way that that works, it’s a long equation. But the simple version of the equation is that if you reduce the pupil by half, you reduce the blur by half. That’s the way VUITY works.

CoveyClub: So this sounds like a breakthrough product in eye care…

Dr. McGee: So, it is the first and only FDA-approved eye drop to treat age-related blurry near vision, or presbyopia, in adults. We’ve been doing refraction through a lens for 800 years — so everything that we’ve ever done has been either through a spectacle lens, a contact lens, or an implant lens. That’s the same way we’ve been doing it for 800 years. This is the first time that we’re going to do it through a drop. That gives you some perspective.

CoveyClub: Women who need reading glasses require varying strengths of correction — do the drop prescriptions vary according to the number strength of one’s reading glasses? Would a woman’s eye drop prescription change over time in the same way that the number of diopters needed for reading glasses progresses? And if not, how do they universally work across women of all degrees of presbyopia? 

Dr. McGee: Great question. So because we’re dealing with depth of focus, and not actual power strength, it is going to work for people that have varying degrees of numbers on their reading glasses. And there’s just one strength of the drop, because it’s actually working by making the pupil smaller. And so it goes back to that when you reduce the pupil by half, you reduce blur by half. So it won’t matter if they’re wearing a +1.25 or a +1.75. They’re both going to get benefits. And in the clinical trials, those patients would get three lines of gain [on a reading chart] in low-light conditions. For mild to moderate presbyopia, this is going to be a really good option. And remember, it’s on label for all adults with presbyopia — it’s just that in the clinical trial, they [only] studied patients aged 40 to 55.

CoveyClub: When you wear reading glasses, it’s difficult to focus on things that are further away. How do Vuity drops improve near and intermediate vision without impacting a woman’s distance vision? 

Dr. McGee: The reason goes back to [the fact that] you’re doing refraction through a lens with reading glasses. And so it’s only putting one thing in focus, whereas with the drops — and this is why I think it’s so different — it’s not refraction through a lens. And so you get that depth of focus where you have multiple things in focus. Distance stays in focus, near stays in focus, intermediate stays in focus, because it’s working by a different mechanism. And in the studies, what was shown was three lines of improvement for near and intermediate vision. And we did not impact distance vision, and that’s really key. Because how frustrating is it to take off reading glasses all day long? Because you look up and you can’t see anything!

CoveyClub: I understand that Vuity is, according to Allergan, an “optimized formulation of pilocarpine, an established eye care therapeutic.” What does pilocarpine do, and what else is it used for? 

Dr. McGee: Pilocarpine is a medication that’s actually been around for almost 140 years. It’s a really old, old drug. And we’ve used it historically in the eye care space for glaucoma, because of different mechanisms. But this is a completely re-engineered pilocarpine, where basically the scientists took the things that we wanted to optimize and did it in a way that didn’t have all the adverse effects that we had [when treating] glaucoma. It does not change intraocular pressure. And it comes with “pHast” technology, which makes it work differently on the front surface of the eye. The old pilocarpine had a pH that didn’t feel good on the surface of the eye — it stings. The pHast technology makes the drops adjust quickly to the natural pH of the front surface of the eye, within 30 seconds. This is the first and only time that 1.25% pilocarpine is being specifically formulated to treat presbyopia.

CoveyClub: Do the eye drops have any adverse side effects? 

Dr. McGee: In clinical studies, there were no serious adverse events observed in any participants treated with Vuity. The most common adverse events — occurring at a frequency of  less than 5% in participants — were headache and eye redness. Temporary problems when changing focus between near and distant objects may occur. The important safety information states to use caution when driving at night or performing hazardous activities in poor lighting.

It’s important to talk to your eye care professional to see if Vuity is right for you.

CoveyClub: Can you use the drops if you wear contact lenses? 

Dr. McGee: Yes, Vuity can be used if you wear contact lenses. Remove your contact lenses prior to using Vuity, then wait 10 minutes before putting them back in. 

CoveyClub: The Vuity study showed that the drops work in as little as 15 minutes and last for up to six hours. Can they only be used once a day? Or can they be used again after the six hours is up? 

Dr. McGee: It is a single dose in all of these studies. They are doing second dose studies right now.

CoveyClub: So we can’t ditch our reading glasses just yet? 

Dr. McGee: I don’t think the drops are going to replace reading glasses, but I think this is going to be a really great option. So you’re less dependent on reading glasses. Because there are lots of times when reading glasses are not convenient, you know, even doing what we’re doing right now — [a Zoom call]. If you want to see your computer and your phone at the same time, those are two different working distances. So you’re doing the weird head bob, right? And then you get up to go to the bathroom, and you have to take them off. So there are going to be plenty of times when these drops are going to be a great option for people because they’re not going to have to do that, that version of take off and on. But it’s not going to be a 24-hour drop either. And so I don’t think we can ditch our reading glasses permanently. I think we can ditch them for lots of different activities and possibly throughout the day.

CoveyClub: Are there certain situations where reading glasses might be a preferable option? 

Dr. McGee: That’s going to be patient dependent, right? Because there are some people that, you know, want to wear a contact lens, and there are plenty of people that refuse to put a piece of plastic in their eye. So I think this is going to be the same thing. I think there are going to be lots of people that want to have freedom from their reading glasses. And there may be people that have struggled with putting in eye drops. So, it’s going to be very person dependent. What’s so exciting about this is it’s the first time we have an option in a drop — it’s  different than anything we’ve ever had before.