Presbyopia, Aging, and Modern Near-Vision Demands: Real-World Functional Outcomes of Pilocarpine-Diclofenac Eye Drops

Background and Objectives: Presbyopia is an age-related condition that affects daily activities requiring sustained near vision. This study evaluated real-world functional near-vision outcomes, distance-vision preservation, tolerability, and ocular safety after pilocarpine-diclofenac eye drops in presbyopic adults. Materials and Methods: This retrospective single-center cohort included 741 presbyopic patients treated with pilocarpine 1%, 2%, or 3% combined with diclofenac 0.05%. Binocular uncorrected near visual acuity was assessed using a Jaeger near-vision chart. Because Jaeger categories are ordinal and chart-dependent, outcomes were reported as categorical clinical endpoints, including Jaeger 1 and functional near vision, defined as Jaeger ≤ 2. Distance visual acuity, intraocular pressure, adverse events, and retinal complications were assessed at the baseline, 1 h after instillation, and follow-up visits. Results: At 1 h, 462/741 patients achieved Jaeger 1 and 593/741 achieved Jaeger ≤ 2. By concentration, Jaeger ≤ 2 was achieved by 143/143 patients in the 1% group, 222/245 in the 2% group, and 228/353 in the 3% group. Pilocarpine concentration was individualized according to baseline clinical characteristics, with higher concentrations preferentially used in patients with more severe near-vision impairment. Therefore, concentration-specific outcomes and adjusted concentration estimates are susceptible to confounding by indication and should not be interpreted as evidence of an inverse pharmacological doseresponse relationship. Functional near vision was maintained in 551/689 patients (80.0%) at the first follow-up visit and in 445/552 patients (80.6%) at the second follow-up visit. Mild transient adverse events were reported by 308/741 patients (41.6%), most commonly temporary dim vision or decreased light perception in 245/741 (33.1%). No clinically significant intraocular pressure elevation, retinal tear, or rhegmatogenous retinal detachment was documented in the available clinical records during follow-up. Conclusions: Pilocarpine-diclofenac eye drops were associated with rapid and sustained functional near-vision improvement and the preservation of distance vision. No retinal tear or rhegmatogenous retinal detachment was documented in the available records; however, the retrospective design and absence of a comparative monotherapy group preclude conclusions regarding comparative retinal safety.