The Role of Pilocarpine Eye Drops in the Management of Presbyopia: A Systematic Review

  1. Khaldon Abbas
  2. Karanvir Gill
  3. Tiba Al-Helli
  4. Pratik Gajiwala
  5. Arshdeep Judgey
  6. Ahmed Abbas
  7. Mohammed Alenazi
  8. Mona Koaik

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Abstract

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.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/17784154.

    Does the introduction explain the objective of the research presented in the preprint? Yes
    Are the methods well-suited for this research? Somewhat appropriate Since few randomised controlled trials are available, a meta-analysis could be attempted
    Are the conclusions supported by the data? Somewhat supported
    Are the data presentations, including visualizations, well-suited to represent the data? Somewhat appropriate and clear
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Neither clearly nor unclearly
    Is the preprint likely to advance academic knowledge? Highly likely
    Would it benefit from language editing? Yes
    Would you recommend this preprint to others? Yes, but it needs to be improved
    Is it ready for attention from an editor, publisher or broader audience? Yes, as it is

    Competing interests

    The authors declare that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The authors declare that they did not use generative AI to come up with new ideas for their review.

  2. Version published to 10.20944/preprints202511.1856.v1