Write a PREreview

Introduction: Presbyopia is a refractive condition characterized by progressive loss of accommodation resulting in loss of visual acuity and is known to affect quality of life. Mainstay treatment modalities for presbyopia include reading spectacles, contact lenses, and a series of surgical techniques. Until recently, pharmacologic treatments were not available. In this paper, we aim to review the role of pilocarpine eye drops in managing presbyopia. Methods: A comprehensive literature search was performed using Medline, EMBASE, and grey literature databases for articles until 01 May 2023. Search terms included “presbyopia”, “presbyopia correction/treatment”, “pilocarpine”, and “pharmacological presbyopia treatment”. All relevant articles from 01 January 2005 to 01 May 2023 and written in the English language were included in the review. Results: The initial search yielded 497 publications, of which 17 met our inclusion criteria and were included in analysis. Pilocarpine, a parasympathomimetic drug, increases the power of accommodation by increasing the lens thickness via the muscarinic receptors on the iris and ciliary muscles. Clinical trials utilizing pilocarpine eye drops in the management of presbyopia have reported positive outcomes in terms of near visual acuity. Pilocarpine HCL ophthalmic 1.25% formulation (Vuity) is currently the only approved pharmacologic treatment option for presbyopia shown to be effective in managing presbyopia. Conclusion: Overall, pilocarpine eye drops appear to be an effective option in improving near visual acuity in presbyopia patients. Long term follow-up data on the use of pilocarpine-based eye drops is not available. With the increase in the number of users overtime following the approval of Vuity, the long-term effects of its prolonged use may be determined. Further research is needed to optimize the concentrations and combinations of pilocarpine and other substances to maximize efficacy and minimize adverse effects.