EyeWorld Asia-Pacific June 2016 Issue

June 2016 EWAP refractive 47 included 20 patients. Each subject was given 1 PresbV Tears drop in each eye and was evaluated before the drop, 0.5, 1, 2, 3, 4, and 5 hours later, as well as 1 week and 1 month later. Dr. Vejarano reported no negative side effects from the drop. He also observed improved vision at 1 line for distance and 3 lines for near, and noted other factors that “[showed] the accommodation stimulus.” Dr. Vejarano is working with European and Colombian pharmaceutical companies to manufacture the drop, and it is expected to be released before June 2016 in Colombia; they will soon begin a larger clinical study in Europe, which he hopes to publish in order to validate his preliminary results. What do his colleagues have to say about this drop? “My good friends congratulate me, but [others say it] doesn’t work, but the best thing is when I apply the drops, then they’re convinced,” he said. Dr. Vejarano is not alone on the drop front. The search for a topical solution has been on for decades. In the past year alone there was a report out of Al-Azhar University in Cairo regarding the safety and efficacy of a carbachol-brimonidine solution, 1 another that EV06—a lipoic acid choline ester—by Encore Vision (Fort Worth, Texas) enrolled its first subject in its phase 1 and 2 clinical trials, and yet another that Presbyopia Therapies (Coronado, California) presented the phase 2 results for its Liquid Vision drop, just to name a few. Dr. Berdahl said presbyopia- correcting drops in general have produced “very promising anecdotal reports,” but ultimately, “what’s going to drive the profession to adopt them are well- controlled trials that show good data on efficacy and safety.” Stimulating the ciliary muscle Another nonsurgical option could be electrostimulation of the ciliary muscle. Luca Gualdi, MD , Rome, recently presented the results of a small, preliminary study involving Ocufit (SOOFT, Montegiorgio, Italy). The device—patented in 2009 by Massimo Filippello, MD, for treatment of glaucoma and presbyopia—consists of a 20-mm polycarbonate scleral contact lens that is placed, for presbyopia- correcting purposes, on the bulbar conjunctiva 3.5 mm from the corneal limbus. This lens has four electrodes connected to a power source, which will emit electricity at a low voltage to passively contract the ciliary muscle for about 8 minutes. Dr. Gualdi’s study, which involved 20 eyes and emmetropic presbyopia patients ranging from 40–50 years old, measured pre- and postoperative uncorrected visual acuity using both objective and subjective tests, ultrasound biomicroscopy, aberrometry, and the AR-1A accommodation module. Dr. Gualdi found patients improved in uncorrected near (40 cm) and intermediate (70 cm) distance and reading speed time, maintained their distance vision, and had no negative side effects. The negatives of this treatment for the patient, he said, are that it requires maintenance and it is not as effective on older presbyopic patients. He recommends four treatments within the first 2 months, followed by one treatment every 3 months to sustain it. Dr. Berdahl said he “loves outside-of-the-box ideas,” such as electrostimulation of the ciliary body to address presbyopia. “I love that companies are willing to take risks on ideas that are unconventional as long as they are studied well,” he said. “The question, of course, is ‘Is the lens flexible enough to change its shape in someone who is presbyopic by increasing the ability of the ciliary muscle to pull on the lens?’ I think that has yet to be shown, but I like the thought process behind it.” Other options Drops and electrostimulation are not all that’s going on in the field of noninvasive presbyopia research. Noninvasive laser thermal keratoplasty (LTK) called optimal keratoplasty (Opti-K) with the Opti-K System (NTK Enterprises, Austin, Texas) is another option. This procedure, according to a 2011 study published by Rogers et al. In the Proceedings of SPIE Ophthalmic Technologies, involves “laser heating of the cornea to change its shape.” 2 While the paper acknowledged that the history of LTK has been “unsatisfactory” in the past, Opti-K, which is currently in clinical trials as a hyperopia treatment, was found to be “simple, rapid, comfortable, and repeatable.” Conductive keratoplasty (CK) is a non-laser thermal treatment that could be used to correct presbyopia. As Rogers et al. said, “CK remains the most widely used technology for presbyopia treatment with over 200,000 procedures completed.” Dr. Berdahl said advances in accommodating contact lenses could provide another avenue as well. With all the work and research being done to create newer presbyopia treatments, Dr. Berdahl said it is a condition that will be solved. “With the amount of effort that people are putting in, it’s going to be a solvable problem and we’re making more progress toward it now than we ever have,” he said. “I’m all for safe and effective surgical options. I’m all for safe and effective pharmaceutical options. I love having new tools in my tool kit because some patients might be able to take drops, for example, others may be averse to surgery or not good candidates for surgery, so the more tools we have in our bag, the better,” Dr. Berdahl said. “I’m mostly concerned about solving the problem for our patients, and the more tools we have, the more likely we’re going to solve it for more people.” EWAP References 1 Abdelkader A. Improved presbyopic vision with miotics. Eye Contact Lens. 2015 Sep;41(5):323–7. 2. Rogers JK, et al. Improved method of laser thermal keratoplasty to overcome presbyopia. Proc. SPIE 7885, Ophthalmic Technologies XXI, 78850N, 12 February 2011. Editors’ note: Dr. Vejarano has financial interests with PresbV Tears. Dr. Berdahl has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Bausch + Lomb (Bridgewater, NJ), and Alcon (Fort Worth, Texas). Dr. Gualdi has no financial interests related to his comments. Contact information Berdahl : johnberdahl@gmail.com Gualdi : luca@gualdi.it Vejarano : felipev@fov.com.co