EyeWorld India September 2017 Issue

was statistically significant,” Dr. Lindstrom said. The pretreatment near vision was 20/54 on average and the post- treatment was 20/28, he continued. “This is about a 2- to 2.5-line improvement in vision, which is quite meaningful,” Dr. Lindstrom said. In addition, there’s a possibility that the drop can be used to help reduce the progression of cataracts, he explained, adding that the same mechanism of action involved in crosslinking is involved in the development of cataracts. “Those studies need to be done, but from a pathophysiology perspective it’s logical that this drop might also retard the progression of cataract,” Dr. Lindstrom said. With both presbyopia and cataracts, use of EV06 may lead to a mild reversal in the condition and a reduction in the progression. “At 45 you have some level of dysfunctional lens syndrome where your lens is becoming inelas- tic and slightly opaque and there is a loss of contrast,” he said. “Taking a drop like this might make you the way you were at 35, but not at 10.” In general, a good way to think about the drop is that it will make your vision like it was when you were about 10 years younger, Dr. Lindstrom noted. EV06 could also be used to- gether with pupil constriction, Dr. Lindstrom pointed out. As patients get older, they could use the miotic drop to boost the waning effect of EV06 if they don’t want to wear their reading glasses. EV06 could be used in con- junction with certain types of surgery employed to correct refrac- tive error, such as LASIK, PRK, and SMILE, Dr. Lindstrom said. He finds one of the things that keeps some patients from choosing LASIK, particularly mild myopes, is the concern that they may be trading distance glasses for read- ing ones. “We’ll be able to say to these patients, ‘We can do the surgery and if you take this drop, you won’t need the readers, at least until you’re 60. Then hopefully we will have a high-quality extended depth of focus lens to transition into as a goal to be spectacle inde- pendent,’” Dr. Lindstrom said. The next steps with EV06 are Phase 2 and 3 FDA clinical trials with a larger number of patients. Assuming that safety and efficacy holds up, Dr. Lindstrom think U.S. Food and Drug Administration (FDA) approval could take just a few years. “That whole process, depending on how it’s managed, can take 3 years,” he said. Dr. Kim sees EV06 as a possible complementary approach to PRX- 100, which works immediately. “It might be a nice complement to that approach,” he said. Dr. Kim is excited about the potential for such pharmacologic approaches. With close to 2 billion presbyopic people, the market is huge, he stressed. “It’s a lifestyle enhancement product that will be completely elective,” Dr. Kim said, and he views the cost as some- thing patients will readily accept, especially when considering the benefits. EWAP Editors’ note: Dr. Lindstrom has financial interests with Novartis. Dr. Kim has financial interests with Pres- byopia Therapies. Contact information Kim: terry.kim@duke.edu Lindstrom: rllindstrom@mneye.com Nepafenac – from page 41 Nonsurgical treatment – from page 45 retinal vein occlusion, about eight times for those with a macular hole, and about six times for those with an epiretinal membrane. “Interest- ingly, we found no difference with prostaglandi n (use),” he said, add- ing that there was a large retrospec- tive study that also concluded that prostaglandin use does not increase the incidence of PCME, with which they were in agreement. Clinical implications From a clinical perspective, a general ophthalmologist who uses NSAIDs with all patients will see some benefit, according to Dr. Mc- Cafferty. However, if the goal was to target PCME, physicians could tailor their NSAID use to just those patients who have risk factors, he continued. “That would be a savings to the patients and to the whole process of cataract surgery,” he said. “I have changed my own practice accordingly.” For those patients who he thinks may also have some postoperative pain, he will use the NSAID adjunctively in addition to considering the prevention of PCME. “But otherwise I just use it for those patients who have risk factors, which is about 30% of my patients,” he said. Overall, Dr. McCafferty views this as a tool for general ophthal- mologists to enable them to more efficaciously use topical nonsteroid- als in their patients. “Also, they can feel some comfort that in a certain subset of patients, they do not have to use them to prevent this specific problem,” he concluded. EWAP Reference 1. McCafferty S, et al. Pseudophakic cys- toid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo. BMC Ophthalmol . 2017;17:16. Editors’ note: Dr. McCafferty has no financial interests related to his com- ments. Contact information McCafferty: sjmccafferty66@hotmail.com 46 EWAP REFRACTIVE September 2017