Pharmacological treatment of presbyopia

Presbyopia is a very common condition, which can easily be treated with reading glasses. Although a number of contact lenses and surgical solutions have been introduced, also a number of pharmacological treatments have been proposed in recent years for treating presbyopia. As presbyopia is a multifactorial condition, a number of pharmacological approaches have been explored so far. Most eye drops contain miotic/parasympathomimetic agents (e.g. pilocarpine, carbachol, aceclidine), which create a pinhole effect. Pilocarpine and aceclidine already have been approved. Brimochol (carbachol + brimonidine, an α-agonist that helps further reduce pupil size have been submitted for approval, Tenpoint Therapeutics) and MR-14/Nyxol (phentolamine) will be submitted in the near future. Some newer formulations combine a miotic agent (to create the pinhole effect) with a non-miotic agent (to improve comfort or reduce ciliary spasm).On the other hand, chemical modification of the lens proteins has been explored as potential therapeutic options in presbyopia. These products target specific chemical modification (destruction of disulfide bridges, deglycation). Use of deglycating enzymes (e.g. fructosyl amino oxidase, FAOD) may rejuvenate the lens by removing the advance glycation end products which have been attached to the lens crystallins over the years.As these drugs are relatively new in the treatment of presbyopia, further studies will be needed to study the long-term effects, the effects of the products which are still in the pipeline and to establish the role of drug treatment in presbyopia.