Biography: Johnston is the clinical and residency director at Georgia Eye Partners in Atlanta.
Disclosures: Johnston reports he is a consultant to Alcon, Allergan, Bio-Tissue, Johnson & Johnson Vision and Shire.
July 22, 2021
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BLOG: Presbyopia correcting drops poised to expand the toolkit

Biography: Johnston is the clinical and residency director at Georgia Eye Partners in Atlanta.
Disclosures: Johnston reports he is a consultant to Alcon, Allergan, Bio-Tissue, Johnson & Johnson Vision and Shire.
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A pharmaceutical approach to presbyopia has clear advantages, will likely be used in combination with other approaches and may serve to drive surgical procedures.

As primary eye care providers, we care for pediatric patients all the way through geriatric age. It is important that we stay abreast of the latest advances and understand the various refractive options available now and on the horizon — from myopia control treatments to presbyopia-correcting drops to advanced technology IOLs and everything in between.

As we look to the near future, presbyopia-correcting pharmaceuticals appear poised to be the next huge wave, and industry and the public will look to optometry to lead. This addition to the tool kit will serve to "cross-pollinate" with refractive and cataract surgery, helping to drive surgical utilization and, ultimately, the adoption of premium implants.

Gap in solutions, awareness

Josh Johnston, OD, FAAO
Josh Johnston

Between glasses and contact lenses and surgery, there is a gap in effective treatment options for presbyopes, particularly for those in their 40s and 50s. In fact, younger presbyopes often believe there is a problem with their vision when they first notice presbyopic changes. A recent survey of 1,339 presbyopic patients divided into three groups found that 20% of the youngest group were worried when they first noticed symptoms, 32% thought their symptoms were due to fatigue, and 26% were concerned that something was wrong with their eyes (Ipsos).

On top of the lack of awareness around presbyopia, the same survey found that 90% were “frustrated or irritated” with presbyopia. While 62% had seen an eye care provider in the previous year, only half received information they thought they needed regarding presbyopia, and only 15% received printed information.

Clearly there is an opportunity for us to have more meaningful conversations with our patients about their presbyopic changes and treatment options. We can reassure them that we are here to help them through this transition period and that when they are ready, they can consider permanent surgical approaches to presbyopia, such as refractive lens exchange with advanced technology IOLs.

The gap between when a patient visits an optometrist and then visits an ophthalmologist for cataract surgery is a significant issue, noted MK Raheja, head of surgical vision research and development at Johnson & Johnson Vision during the Ophthalmic Innovation Summit's recent Presbyopia Innovation Showcase.

“It’s 15, 20 years where sometimes this discussion falls through,” he said. “How do we capture our patients there and how do we educate them? Drops can bridge the gap.”

The presbyopes are coming

To put presbyopia's impact in perspective, here are some statistics: there are 128 million people in the U.S. with presbyopia (Care of the Patient with Presbyopia; Zebardast et al; U.S. Census Bureau) and 1.8 billion globally (Fricke et al). The aging population is only part of the story, however. Increased screen time has sped up the development of symptoms, and our patients’ visual demands continue to increase. American adults spend more than 11 hours per day watching, reading, listening to or interacting with media (MarketWatch website; Neilsen Company website). We check our phones 96 times a day — once every 10 minutes (Asurion). In total, U.S. adults spend 3 hours and 48 minutes per day on computers, tablets and smartphones.

Several companies are investigating pharmaceutical methods for correcting presbyopia, with Allergan, an AbbVie Company, and Orasis Pharmaceuticals as examples of two that have agents in phase 3 clinical trials. We owe it to our patients to stay plugged into the drug and device pipeline so we can take the lead educating on refractive options no matter where patients are in their vision journey.

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