The use of pilocarpine in the treatment of presbyopia

Presbyopia is a physiological process of progressive loss of accommodation, which leads to a deterioration in the ability to focus vision on objects at different distances. This is now thought to be a direct consequence of two causes: the design of the transparent lens and the way it has to change shape to allow focusing, and the instability of proteins over very long periods of time. In recent years, various substances that temporarily narrow the pupil, causing a pinhole effect, have been intensively investigated to allow improved near vision acuity. The most commonly researched is 1.25% pilocarpine solution. The substance itself has been known for more than 100 years, with a well-documented hypotensive effect and numerous side effects. However, the reduced concentration and less frequent dosing, as well as the addition of drugs with anti-inflammatory effects currently being studied, offer hope for efficacy in the treatment of presbyopia. The results of the studies so far are promising. Researchers point to improved near visual acuity and a low rate of mild side effects. In the future, we will find out whether the optimistic observations mainly in short-term studies will also be effective and applicable in broad practice.