Improved Presbyopic Vision With Miotics
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.
Randomized prospective controlled case series. Forty-eight presbyopic subjects participated in this study. Subjects were then divided into 2 treatment groups. Study group (n=30 eyes) received single dose of carbachol 2.25% plus brimonidine 0.2 % eye drops. Control group (n=18 eyes) received placebo drops. Each group was further divided according to age into ≥ 50 years and ˂ 50 years. Drops were given to all subjects in a masked fashion, in their non-dominant eye. Subjects’ pupil size and both near and distance visual acuities were documented before treatment and post treatment at 1, 2, 4, 8 and 10 hours, with same examiner at the same room illumination. Any adverse symptoms and subject satisfaction with near and distance vision were documented.
In this masked study, statistically significant improvement in near visual acuity was achieved in all subjects of both age group who received carbachol plus brimonidine drops (P< 0.0001). Subject satisfaction was extremely high. They all liked and would use this therapy if it was available. None would use the placebo. No serious adverse ocular effects were observed.
Carbachol plus brimonidine appears to be an acceptable and safe alternative to corrective lenses or surgical procedures to reduce or eliminate the effect of presbyopia.