A novel pharmacological treatment of pseudophakic presbyopia

Almamoun Abdelkader


Purpose: To evaluate the efficacy of using a parasympathomimetic drug (carbachol) with an alpha agonist (brimonidine) to create optically beneficial miosis to reduce the effect of presbyopia in pseudophakic subjects.

Methods: A prospective, double-masked, randomized, placebo-controlled clinical trial. Forty emmetropic and presbyopic pseudophakes between 30 years and 80 years old with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Subjects were divided into 2 groups. Treatment group (n=25 eyes) received single dose of 3 % carbachol plus 0.2 % brimonidine eye drops. Control group (n=15 eyes) received placebo drops.  Drops were given to all subjects in a masked fashion, in their non-dominant eye. The subjects’ pupil size and both near and distance visual acuities were evaluated pre- and posttreatment at 1, 2, 4, and 8 hours, by a masked examiner at the same room illumination.

Results: Statistically significant improvement in near visual acuity was achieved in all pseudophakic subjects who received carbachol plus brimonidine drops (P< 0.0001). In this masked study, they all liked and would use this therapy if it was available. None would use the placebo.

Conclusions: Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity in pseudophakic subjects. Carbachol plus brimonidine seem to be an acceptable and safe alternative to corrective lenses and surgical procedures.

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