9 ms·

New FDA-approved eye drops could replace reading glasses for millions

199 points by kyleShropshire 5y ago

rubylark 5y ago
Interesting, this eye drop seems to just do the opposite of what those eye dilation drops used at the eye doctor. It makes sense considering that dilation drops make it impossible to read things up close that an inverted purpose drop could help people with weak pupil response.
- toss1 5y ago
  Yup, and this makes me think that the advice to put brighter light on your reading to make things sharper doesn't work because of greater light availability, but because it provokes the pupil to narrow and increase the pinhole camera effect -- or more to the point, not that the bright light doesn't itself help, but how much is due to more light vs provoking smaller pupil opening?
- kortex 5y ago
  In optics, there's a thing called the circle of confusion (1). It's the locus of points that maps to a single point source of photons. A "perfect" focus maps a point source to a point on the image: perfect contrast. Ability to focus is basically how tight you can get this circle, for a focal distance. (this is all super simplified, perfect lenses, no aberration, etc). The smaller the aperture, the more constrained the light field, thus the smaller the circle of confusion (at the expense of light collection). That's how pinhole cameras work in fact. Shrinking the aperture also increases the depth of focus. Pinhole cameras have ~∞ depth of field because there is ~1 path every photon can take (ignoring hole width, diffraction, etc). 1 - https://en.m.wikipedia.org/wiki/Circle_of_confusion https://en.m.wikipedia.org/wiki/Circle_of_confusion
Malic 5y ago
I'm more interested in UNR844-Cl (by Novartis). It appears that it has longer lasting, possibly age-correcting, effects. "This prodrug is topically instilled binocularly, whereupon it penetrates the cornea and degrades into two naturally occurring substances, lipoic acid and choline. The lipoic acid is then hydrolyzed by esterase in the tear film into dihydrolipoic acid, which destroys the disulfide bonds in the lens, improving flexibility as noted earlier. An interesting hypothesis regarding this medication is that it may potentially halt or even reverse the natural lens hardening that occurs with age, thereby allowing a potential restoration of natural accommodation." Source - https://modernod.com/articles/2020-sept/coming-soon-presbyopia-correcting-eye-drops https://modernod.com/articles/2020-sept/coming-soon-presbyop...
- BurningFrog 5y ago
  > This prodrug is topically instilled binocularly Can anyone translate?
  - germinalphrase 5y ago
    Eyedropper into both eyes?
    - Malic 5y ago
      Yup. Twice a day, results show up somewhere before 90 days, ceasing treatment after point appears to continue to provide results. "In phase 1 and 2 studies, UNR844 exhibited a good safety profile and there were no treatment-related study discontinuations. In addition, all patients showed substantial near visual acuity improvements by day 15.3,4 By day 91, 82% of patients had 20/40 or better near vision and 36% had 20/25 or better near vision. Novartis expects the drop to be labeled for use twice daily for approximately 90 days. The effects of this dosing regimen have been found to last up to 7 months without further dosing. " https://modernod.com/articles/2020-sept/coming-soon-presbyopia-correcting-eye-drops https://modernod.com/articles/2020-sept/coming-soon-presbyop... Article mentions a marketing file year of 2021 but I have read that they did a Phase IIa trial that should finish in 2022 (2023? Can't find the citation ATM)
  - bavent 5y ago
    It’s put on your eyeballs, both of them.
    - BurningFrog 5y ago
      prodrug: "a biologically inactive compound which can be metabolized in the body to produce a drug."
- melling 5y ago
  is the loss of flexibility caused by hardening of proteins? is this the same or similar to what causes cataracts?
wallaBBB 5y ago
The thing with presbyopia is about losing the elasticity of your lens - thus not being able to change your focus (muscles pull the lens changing it's shape and with it the focus). With the hardening of the lens the range is getting narrower around the lens' natural focus (far field). Article does a good job at explaining briefly the limitations. This drug by manipulating pupil opening extends the depth of focus, and if the lens is not too hard, in combination with the extended focus you could cover the near field, but the light accommodation becomes a problem, by not being able to dilatate your pupil (driving being the biggest problem). Overall a limited application, and not so life changing as the article title implies. Reading glasses could very well be a better option for all.
- mannykannot 5y ago
  One specific limitation is that it impairs your night vision, so driving at night while still under the influence of this drug becomes riskier.
Kneecaps07 5y ago
> "I was in denial because to me that was a sign of growing older, you know, needing to wear glasses" Seriously? I had to start wearing glasses when I was 11.
- casion 5y ago
  Reading glasses specifically. Presbyopia is a sign of aging for many, and is usually corrected with reading glasses.
  - tiahura 5y ago
    Or bifocals if you already wear glasses for nearsightedness.
- jabroni_salad 5y ago
  Somewhere between ages 40-50 everyone's eyes lose their ability to refocus. Instead of having a limited range of focus, you will have a single fixed point and your prescription will be changed to suit that need, or maybe you will have multiple pairs of glasses for different situations (computer glasses, car glasses, etc). Look forward to it! Telling people about this is one of those xkcd 'my hobby:' things for me. It seems like it is widely not in our public health curriculum even though it is something almost all humans will get to enjoy at that age.
  - swader999 5y ago
    Yep, that's me right now. Gets a little worse every year.
  - kwhitefoot 5y ago
    Not everyone. I am 66 and do not need glasses either for reading or driving. My sight is clearly not as good as it was though. So what proportion of people really lose all focussing ability before the age of 50?
    - Normille 5y ago
its_bbq 5y ago
This is so wasteful. Buy one pair of reading glasses, use them forever, or keep buying plastic drop bottles.
- tiahura 5y ago
  Spoken like someone not developing presbyopia in their mid 40s.
- mrob 5y ago
  This is competing with contact lenses, not glasses. All types of eyeglasses cause image distortion. The higher the correction, and the greater the distance from the lens to the eye, the worse it looks. Correcting the eye directly, with contact lenses/drugs/surgery, gives you less distortion.
  - caymanjim 5y ago
    The article is specifically about reading glasses. Contact lenses have nothing to do with it, unless you think people are popping contact lenses in to read and taking them out after.
- ethanbond 5y ago
  These sorts of comments are so deeply discrediting to the green movement. We need to focus our dialogue on big problems where small changes yield huge environmental results (like transportation and meat production) rather than small problems where even outright perfection (100% of people wearing glasses, no one using these drops) does literally nothing for the outcomes we care about. If plastics is the thing you care about (which is completely reasonable), we should be approaching as how to produce better plastics with less environmentally harmful production and discard. Choosing not to make this particular object or that particular object is simply not going to move the needle.
  - clairity 5y ago
    yes, that's been california 'environmental' policy in a nutshell: take the smallest problem, pass an uncritical law based on manufactured sentiment, back-slap all around, and put hat in hand to elicit political reward. plastic bag bans, lawn watering restrictions, prop 65 warnings, bike lanes to nowhere, even leafblower bans (as much as i hate the pollution i endure from these twice a week) are all examples of empty feel-good legislation. it avoids taking actual political risk and spending real political capital on things that matter (and against moneyed interests) while still reaping political rewards. (this is incidentally why i've started to think that we should be able to vote 'null' for a given office, meaning no one should be in it for the upcoming term.)
gwbas1c 5y ago
I'm wondering if anyone has or knows anyone who has experience with Vuity? Now that I'm reaching that age, I can definitely tell that my eyes are changing... And I really, really don't want to have to wear reading glasses or bifocals. One thing that concerns me is that Vuity constricts the pupil. I definitely can't see as well in low-light situations compared to when I was a kid. Makes me wonder if Vuity will just make everything too dim.
treeman79 5y ago
Hmm my prescription changed based on nerve strength. +3 with no prism, -1, with prism. Anywhere in between depending on how well nerves are doing/how high cranial pressure is. Seems my eye muscles distorted the eye itself. Maybe a more flexible eye would allow me to compensate better.
frankfury 5y ago
This will definitely revolutionize the eye care industry.
par 5y ago
will this work for cataracts patients?
Broken_Hippo 5y ago
"Vuity is by no means a cure-all, and the maker does caution against using the drops when driving at night or performing activities in low-light conditions" I'm in Norway. My days - between sunrise and sunset - are less than 5 hours long right now, and the light produces long shadows and tinted clouds throughout the day. I could not use this product during winter: It lasting between 6 and 10 hours means my daylight is gone before it wears off.
- abrowne 5y ago
  If it ends up working really well, presumably they can reformulate it with a lower dose or one that leaves your body faster.
bcaine 5y ago
It looks like this is just Pilocarpine, which has been used for decades to treat glaucoma, available at pharmacies everywhere, and is commonly used (perhaps off label) to shrink pupils. I wonder what if anything they changed compared to the generic version? I've been using Pilocarpine off label to shrink my pupils at night after ICL surgery (an alternative to lasik) to solve debilitating halos caused by my pupils growing larger than the implanted lens. In my experience, it does increase close range vision (at some minor expense to long range vision). That said, it also gives a mild headache, and blurs your vision substantially for the first 5-15 minutes after use. I don't really see the appeal of using it daily unless you really have to.
- epivosism 5y ago
  supported by a couple searches eg https://en.wikipedia.org/wiki/Pilocarpine https://en.wikipedia.org/wiki/Pilocarpine
wintermutestwin 5y ago
I'm waiting for AR glasses tech to catch up with my imagination. It will fix my presbyopia (along with zoom and magnify functions) and do nifty things like dim oncoming headlights and highlight potential road hazards. I have no idea how far off this is, but I'm starting to wonder if I'll see it in my lifetime based on how weak current AR solutions are.
- soco 5y ago
  I have the feeling that AR was always "around the corner". Even today all we have is either meager PR stunts or announcements about some brand starting yet another never-ending internal trial.
fargle 5y ago
The problem is that as it progresses, that little extra range you get from hacking the aperture is going to eventually not be enough. So this might free you from reading glasses for even a few years, but eventually it will probably not be enough. An interesting thing happened to me. As natural aging occurred, I began to need readers for some things but not always. Then, over the course of about a week I went from just barely being able to use the computer without them to nope. The weird thing was that I'd use my computer at home and definitely absolutely could not see a word without them. I'd get to work and, same monitor, distance, resolution, could still read just fine. I chalked it up to dehydration or just being tired in the morning. But then I go home and couldn't read my home computer again, which was weird. What was happening was this exact effect! My home office is mellow and quite a bit darker. Work is pretty bright (but depressing) fluorescents. I turned off the half the office lights and proved it. The bright light contracts the pupil and a smaller aperture has a deeper depth of field. It can be just enough to pull it back into the usable range again. However, this effect only lasted a couple months. The minimum near-focal range finally moved far enough that I need those readers either way, although it's still less pronounced with bright lights. But I still prefer the darker environ. For $80 a month, I could buy enough readers to throw them away every day. Readers are just the best invention ever - thank you Ben Franklin!
- comeonseriously 5y ago
  > The weird thing was that I'd use my computer at home and definitely absolutely could not see a word without them. I'd get to work and, same monitor, distance, resolution, could still read just fine. I chalked it up to dehydration or just being tired in the morning. But then I go home and couldn't read my home computer again, which was weird. Blood sugar, diet, stress, exercise, etc. also can all have a noticeable effect on vision. When my vision goes to shit, I think back over the past couple days of how my diet has also gone to shit (it's the holidays!).
- newaccount74 5y ago
  Yes! Image capture is all about light! If you want to see better, install really bright lights! I think people put way too little light into their homes. Most homes are dark caves. You could probably add ten times as much light to an average living room and it still wouldn't be anywhere near as bright as an average day outside. It's amazing what a difference more light makes.
1e-9 5y ago
Constricting the pupil can certainly reduce the effect of defects in the eye lens by reducing the amount of lens used; however, it won't work well in dim light. Alternative: Increase environmental lighting and use bright, high contrast displays with dark text on bright backgrounds (no dark mode). This will not just constrict your pupils (as the eyedrops do), but also increase the rate of photons reaching your retina in bright areas of the scene relative to dark areas (in other words, improves contrast, which the eyedrops won't do).
MrWiffles 5y ago
Because why buy glasses only once when you can waste $80 bucks a month for the rest of your life?
- GordonS 5y ago
  It's common to buy multiple pairs of glasses, and breaking/losing them isn't exactly unheard of. That said, aye, you're not going to be spending $960/y on glasses!
xyzzy21 5y ago
This is NOT a good way of treating presbyopia! There absolutely are side effects from administering drugs that dilate or constrict the pupil - this is NOT a safe thing to do. There are general autonomic nerve effects that can have long-term harm. This is medicine 101.

Interesting, this eye drop seems to just do the opposite of what those eye dilation drops used at the eye doctor. It makes sense considering that dilation drops make it impossible to read things up close that an inverted purpose drop could help people with weak pupil response.

toss1 5y ago
Yup, and this makes me think that the advice to put brighter light on your reading to make things sharper doesn't work because of greater light availability, but because it provokes the pupil to narrow and increase the pinhole camera effect -- or more to the point, not that the bright light doesn't itself help, but how much is due to more light vs provoking smaller pupil opening?
kortex 5y ago
In optics, there's a thing called the circle of confusion (1). It's the locus of points that maps to a single point source of photons. A "perfect" focus maps a point source to a point on the image: perfect contrast. Ability to focus is basically how tight you can get this circle, for a focal distance. (this is all super simplified, perfect lenses, no aberration, etc). The smaller the aperture, the more constrained the light field, thus the smaller the circle of confusion (at the expense of light collection). That's how pinhole cameras work in fact. Shrinking the aperture also increases the depth of focus. Pinhole cameras have ~∞ depth of field because there is ~1 path every photon can take (ignoring hole width, diffraction, etc). 1 - https://en.m.wikipedia.org/wiki/Circle_of_confusion https://en.m.wikipedia.org/wiki/Circle_of_confusion

Malic 5y ago

I'm more interested in UNR844-Cl (by Novartis). It appears that it has longer lasting, possibly age-correcting, effects. "This prodrug is topically instilled binocularly, whereupon it penetrates the cornea and degrades into two naturally occurring substances, lipoic acid and choline. The lipoic acid is then hydrolyzed by esterase in the tear film into dihydrolipoic acid, which destroys the disulfide bonds in the lens, improving flexibility as noted earlier. An interesting hypothesis regarding this medication is that it may potentially halt or even reverse the natural lens hardening that occurs with age, thereby allowing a potential restoration of natural accommodation." Source - https://modernod.com/articles/2020-sept/coming-soon-presbyopia-correcting-eye-drops https://modernod.com/articles/2020-sept/coming-soon-presbyop...

BurningFrog 5y ago
> This prodrug is topically instilled binocularly Can anyone translate?
- germinalphrase 5y ago
  Eyedropper into both eyes?
  - Malic 5y ago
    Yup. Twice a day, results show up somewhere before 90 days, ceasing treatment after point appears to continue to provide results. "In phase 1 and 2 studies, UNR844 exhibited a good safety profile and there were no treatment-related study discontinuations. In addition, all patients showed substantial near visual acuity improvements by day 15.3,4 By day 91, 82% of patients had 20/40 or better near vision and 36% had 20/25 or better near vision. Novartis expects the drop to be labeled for use twice daily for approximately 90 days. The effects of this dosing regimen have been found to last up to 7 months without further dosing. " https://modernod.com/articles/2020-sept/coming-soon-presbyopia-correcting-eye-drops https://modernod.com/articles/2020-sept/coming-soon-presbyop... Article mentions a marketing file year of 2021 but I have read that they did a Phase IIa trial that should finish in 2022 (2023? Can't find the citation ATM)
- bavent 5y ago
  It’s put on your eyeballs, both of them.
  - BurningFrog 5y ago
    prodrug: "a biologically inactive compound which can be metabolized in the body to produce a drug."
melling 5y ago
is the loss of flexibility caused by hardening of proteins? is this the same or similar to what causes cataracts?

wallaBBB 5y ago

The thing with presbyopia is about losing the elasticity of your lens - thus not being able to change your focus (muscles pull the lens changing it's shape and with it the focus). With the hardening of the lens the range is getting narrower around the lens' natural focus (far field). Article does a good job at explaining briefly the limitations. This drug by manipulating pupil opening extends the depth of focus, and if the lens is not too hard, in combination with the extended focus you could cover the near field, but the light accommodation becomes a problem, by not being able to dilatate your pupil (driving being the biggest problem). Overall a limited application, and not so life changing as the article title implies. Reading glasses could very well be a better option for all.

mannykannot 5y ago
One specific limitation is that it impairs your night vision, so driving at night while still under the influence of this drug becomes riskier.

Kneecaps07 5y ago

> "I was in denial because to me that was a sign of growing older, you know, needing to wear glasses" Seriously? I had to start wearing glasses when I was 11.

casion 5y ago
Reading glasses specifically. Presbyopia is a sign of aging for many, and is usually corrected with reading glasses.
- tiahura 5y ago
  Or bifocals if you already wear glasses for nearsightedness.
jabroni_salad 5y ago
Somewhere between ages 40-50 everyone's eyes lose their ability to refocus. Instead of having a limited range of focus, you will have a single fixed point and your prescription will be changed to suit that need, or maybe you will have multiple pairs of glasses for different situations (computer glasses, car glasses, etc). Look forward to it! Telling people about this is one of those xkcd 'my hobby:' things for me. It seems like it is widely not in our public health curriculum even though it is something almost all humans will get to enjoy at that age.
- swader999 5y ago
  Yep, that's me right now. Gets a little worse every year.
- kwhitefoot 5y ago
  Not everyone. I am 66 and do not need glasses either for reading or driving. My sight is clearly not as good as it was though. So what proportion of people really lose all focussing ability before the age of 50?
  - Normille 5y ago

its_bbq 5y ago

This is so wasteful. Buy one pair of reading glasses, use them forever, or keep buying plastic drop bottles.

tiahura 5y ago
Spoken like someone not developing presbyopia in their mid 40s.
mrob 5y ago
This is competing with contact lenses, not glasses. All types of eyeglasses cause image distortion. The higher the correction, and the greater the distance from the lens to the eye, the worse it looks. Correcting the eye directly, with contact lenses/drugs/surgery, gives you less distortion.
- caymanjim 5y ago
  The article is specifically about reading glasses. Contact lenses have nothing to do with it, unless you think people are popping contact lenses in to read and taking them out after.
ethanbond 5y ago
These sorts of comments are so deeply discrediting to the green movement. We need to focus our dialogue on big problems where small changes yield huge environmental results (like transportation and meat production) rather than small problems where even outright perfection (100% of people wearing glasses, no one using these drops) does literally nothing for the outcomes we care about. If plastics is the thing you care about (which is completely reasonable), we should be approaching as how to produce better plastics with less environmentally harmful production and discard. Choosing not to make this particular object or that particular object is simply not going to move the needle.
- clairity 5y ago
  yes, that's been california 'environmental' policy in a nutshell: take the smallest problem, pass an uncritical law based on manufactured sentiment, back-slap all around, and put hat in hand to elicit political reward. plastic bag bans, lawn watering restrictions, prop 65 warnings, bike lanes to nowhere, even leafblower bans (as much as i hate the pollution i endure from these twice a week) are all examples of empty feel-good legislation. it avoids taking actual political risk and spending real political capital on things that matter (and against moneyed interests) while still reaping political rewards. (this is incidentally why i've started to think that we should be able to vote 'null' for a given office, meaning no one should be in it for the upcoming term.)

gwbas1c 5y ago

I'm wondering if anyone has or knows anyone who has experience with Vuity? Now that I'm reaching that age, I can definitely tell that my eyes are changing... And I really, really don't want to have to wear reading glasses or bifocals. One thing that concerns me is that Vuity constricts the pupil. I definitely can't see as well in low-light situations compared to when I was a kid. Makes me wonder if Vuity will just make everything too dim.

treeman79 5y ago

Hmm my prescription changed based on nerve strength. +3 with no prism, -1, with prism. Anywhere in between depending on how well nerves are doing/how high cranial pressure is. Seems my eye muscles distorted the eye itself. Maybe a more flexible eye would allow me to compensate better.

frankfury 5y ago

This will definitely revolutionize the eye care industry.

par 5y ago

will this work for cataracts patients?

Broken_Hippo 5y ago

"Vuity is by no means a cure-all, and the maker does caution against using the drops when driving at night or performing activities in low-light conditions" I'm in Norway. My days - between sunrise and sunset - are less than 5 hours long right now, and the light produces long shadows and tinted clouds throughout the day. I could not use this product during winter: It lasting between 6 and 10 hours means my daylight is gone before it wears off.

abrowne 5y ago
If it ends up working really well, presumably they can reformulate it with a lower dose or one that leaves your body faster.

bcaine 5y ago

It looks like this is just Pilocarpine, which has been used for decades to treat glaucoma, available at pharmacies everywhere, and is commonly used (perhaps off label) to shrink pupils. I wonder what if anything they changed compared to the generic version? I've been using Pilocarpine off label to shrink my pupils at night after ICL surgery (an alternative to lasik) to solve debilitating halos caused by my pupils growing larger than the implanted lens. In my experience, it does increase close range vision (at some minor expense to long range vision). That said, it also gives a mild headache, and blurs your vision substantially for the first 5-15 minutes after use. I don't really see the appeal of using it daily unless you really have to.

epivosism 5y ago
supported by a couple searches eg https://en.wikipedia.org/wiki/Pilocarpine https://en.wikipedia.org/wiki/Pilocarpine

wintermutestwin 5y ago

I'm waiting for AR glasses tech to catch up with my imagination. It will fix my presbyopia (along with zoom and magnify functions) and do nifty things like dim oncoming headlights and highlight potential road hazards. I have no idea how far off this is, but I'm starting to wonder if I'll see it in my lifetime based on how weak current AR solutions are.

soco 5y ago
I have the feeling that AR was always "around the corner". Even today all we have is either meager PR stunts or announcements about some brand starting yet another never-ending internal trial.

fargle 5y ago

The problem is that as it progresses, that little extra range you get from hacking the aperture is going to eventually not be enough. So this might free you from reading glasses for even a few years, but eventually it will probably not be enough. An interesting thing happened to me. As natural aging occurred, I began to need readers for some things but not always. Then, over the course of about a week I went from just barely being able to use the computer without them to nope. The weird thing was that I'd use my computer at home and definitely absolutely could not see a word without them. I'd get to work and, same monitor, distance, resolution, could still read just fine. I chalked it up to dehydration or just being tired in the morning. But then I go home and couldn't read my home computer again, which was weird. What was happening was this exact effect! My home office is mellow and quite a bit darker. Work is pretty bright (but depressing) fluorescents. I turned off the half the office lights and proved it. The bright light contracts the pupil and a smaller aperture has a deeper depth of field. It can be just enough to pull it back into the usable range again. However, this effect only lasted a couple months. The minimum near-focal range finally moved far enough that I need those readers either way, although it's still less pronounced with bright lights. But I still prefer the darker environ. For $80 a month, I could buy enough readers to throw them away every day. Readers are just the best invention ever - thank you Ben Franklin!

comeonseriously 5y ago
> The weird thing was that I'd use my computer at home and definitely absolutely could not see a word without them. I'd get to work and, same monitor, distance, resolution, could still read just fine. I chalked it up to dehydration or just being tired in the morning. But then I go home and couldn't read my home computer again, which was weird. Blood sugar, diet, stress, exercise, etc. also can all have a noticeable effect on vision. When my vision goes to shit, I think back over the past couple days of how my diet has also gone to shit (it's the holidays!).
newaccount74 5y ago
Yes! Image capture is all about light! If you want to see better, install really bright lights! I think people put way too little light into their homes. Most homes are dark caves. You could probably add ten times as much light to an average living room and it still wouldn't be anywhere near as bright as an average day outside. It's amazing what a difference more light makes.

1e-9 5y ago

Constricting the pupil can certainly reduce the effect of defects in the eye lens by reducing the amount of lens used; however, it won't work well in dim light. Alternative: Increase environmental lighting and use bright, high contrast displays with dark text on bright backgrounds (no dark mode). This will not just constrict your pupils (as the eyedrops do), but also increase the rate of photons reaching your retina in bright areas of the scene relative to dark areas (in other words, improves contrast, which the eyedrops won't do).

MrWiffles 5y ago

Because why buy glasses only once when you can waste $80 bucks a month for the rest of your life?

GordonS 5y ago
It's common to buy multiple pairs of glasses, and breaking/losing them isn't exactly unheard of. That said, aye, you're not going to be spending $960/y on glasses!

xyzzy21 5y ago

This is NOT a good way of treating presbyopia! There absolutely are side effects from administering drugs that dilate or constrict the pupil - this is NOT a safe thing to do. There are general autonomic nerve effects that can have long-term harm. This is medicine 101.