New FDA-approved eye drops could replace reading glasses for millions | Hacker News Reader

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

cbsnews.com

199 pointskyleShropshire60 comments

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-presbyop...

is the loss of flexibility caused by hardening of proteins? is this the same or similar to what causes cataracts?

yes

Do you mean nuclear sclerosis? This explains it well: https://www.healthline.com/health/nuclear-sclerosis

The solutions would be to get the protein fibers sorted out. But how?

This is the second attempt of this kind at tackling aging of the lens by Novartis (formerly Alcon). Unfortunately previous drug (some 10ish years ago) got pulled off the market after studies couldn't confirm the claims - basically it did nothing. Hopefully this time it works, because this is the only real solution, and not pupil size manipulation.

Not the only real solution. Maybe the only pharmacologic solution, but it's only a matter of time before someone hits the nail on the head with an accommodating IOL.

Considering how often a mistake is made at calculation the patient's lens even for the standard monofocals, I would not expect it to be a solution around the corner. And really it's not always your doctor's fault. Formulas are empirical, and it is more difficult for post-LASIK patients, as the standard formulas are not that good for them, and specialized ones are still maturing.

And this is not including various complications in cataracts that could easily make you ineligible for progressives.

>> Hopefully this time it works, because this is the only real solution, and not pupil size manipulation.

My optometrist told me something I had a hard time believing. He said there are progressive lenses you can get with cataract surgery. I still can't believe that. This came up after talking about the long term problems with lasik. I said what if I just got cataract surgery now? I still can't believe they can do progressives.

Do you mean progressive inter ocular lens? Or like progressive lens (glasses)?

Both options exist, but both are actually trade offs in all 3 segments (near-mid-far field). Intraocular ones have been existing and evolving in the market for a long time now, but really none are perfect. If your job or lifestyle dictates a good visual acuity at a certain distance don't go with these options.

Its a multi-focal lens. My optometrist and another friend both have them. It splits the incoming light and you need to focus with your attention, not mechanically, which is interesting. The downside my friend reports is that reading requires a very bright light because not all of the light is falling on your retina.

I just got an implant in one eye a month ago. I chose single-focus at distance. I would rather deal with reading glasses than the other oddities, but I did consider the option.

BTW the implant surgery was quick and simple and life is much better afterwards. Recommend.

There are a range of IOLs (intraocular lenses) which can provide more than a single range (monofocal) of vision. While bifocal has existed on the market for some time, trifocal iols now also exist and mostly use a lenticular lens to present focus of near, intermediate and far vision together - however like other multifocal technologies an adjustment period is required and they are not for everyone (your brain needs to adjust to the fuzziness and the fact that the image is not resultant from the natural lens being manipulated can be difficult for some people to work with). There are also other approaches to this problem such as crystalens which is an iol that attempts to solve the same issue by moving forwards and backwards - however this kind of approach is falling out of favour.

The names in this space are johnson and johnson, alcon (novartis), zeiss, bausch and lomb and hoya. This field is rapidly developing with new iols every year, some newer products are promising a wide range of vision without the use of a lenticular lens which seems promising but might be more hype than reality. As for you and your vision: only your ophthalmologist can truly advise if any of these will work for you as there are a myriad of factors at play including some that might not seem obvious such as the patient’s behaviour and expectations.

There's a stromal stem cell treatment that's been developed, went through very successful human clinical trials, and so will likely become standard practice for everyone to heal age related degeneration; it won't be a daily use, recurring monthly revenue stream however, so pharma industry isn't going to push it.

Even once a lifetime treatments like vaccines represent a significant customer base as new people are born every year.

The reality is stem cells alone don’t fix aging, stuff like rates of cancer more inherent than can be cured by such things. Stem cells might possibly slow or reverse bone deterioration etc which would be a massive boon, but this stuff isn’t easy or risk free.

> This prodrug is topically instilled binocularly

Can anyone translate?

Eyedropper into both eyes?

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-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)

It’s put on your eyeballs, both of them.

prodrug: "a biologically inactive compound which can be metabolized in the body to produce a drug."

Interestingly, one treatment for the degenerative eye disorder keratoconus aims to stiffen the cornea (corneal crosslinking) through drops+surgery.

The cornea and the lens are different anatomical entities.

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.

supported by a couple searches eg https://en.wikipedia.org/wiki/Pilocarpine

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!

> 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!).

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.

I use two FEIT Electric PAR38 Daylight 325W-equivalent 5,000-lumen LED lamps in cheap IKEA NOT floor lamps next to my desk. They primarily help my mood and focus. They also help my near vision which has deteriorated recently.

That sounds like a decent amount of light :)

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.

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

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.

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.

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.

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.

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

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?

> "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.

Reading glasses specifically. Presbyopia is a sign of aging for many, and is usually corrected with reading glasses.

Or bifocals if you already wear glasses for nearsightedness.

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.

Yep, that's me right now. Gets a little worse every year.

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?

I'm mid 50s now and, over the past couple of years have noticed a deterioration in how close I can focus. My minimum focussing distance is probably about 30-40cm now. Which means, as long as the font size isn't minuscule, I can still read most things by holding them slightly further away. I 'joke' that as long as my my focal length is shorter than my arm, I can avoid the embarrassment of having to adopt reading glasses.

In this respect, the fact that a lot of the reading we do these days is on-screen, is a godsend, as you can generally increase the font size. However, I do carry a wee magnifying lens in my pocket for those times when I'm out and about and can't make out the small print on the label of something I'm thinking of buying.

Someone said, in effect, "So what. I've worn glasses since I was 11". I think that misses the point. It's not wearing glasses per se that's the problem. For those of us who have always had sharp eyesight [Of which I'm one. My long vision is still pin sharp] it's just another depressing sign of the descent into old age and decrepitude --like losing your hair, becoming harder of hearing, etc. and, irrational though it is, I think most of us feel that, if we can mask the symptoms for a while longer then somehow we've not actually reached that stage yet.

On the subject of this thread; I read a week or so ago [on HN?] about experiments showing that exposure to long wavelength red light in the mornings could 'rejuvenate' ageing eyes. I can't find that link at the mo'.

There's two different things - the stuff you get at birth and the stuff you get as you get older.

Short sightedness (myopia), long sightedness (hyperopia) and astigmatism are effectively genetic conditions that you are born with. They are variations of your eye being slightly the wrong shape to focus correctly. The precise impact of this varies as you grow with your prescription changing, but if you need correction then you'll need it from a young age onwards (unless you have it permanently treated - e.g. Lasik, or cataract surgery).

Presbyopia is an effect that happens over time. The lens hardens and so the muscles that manipulate it to refocus can't quite do the job any more. This impacts on your ability to close distances, and so you can off the shelf reading glasses to aid in that.

"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.

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

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).

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.

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

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!

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.

will this work for cataracts patients?

This will definitely revolutionize the eye care industry.

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

Spoken like someone not developing presbyopia in their mid 40s.

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.

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.

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.

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.)

Poe's law in action, combined with youth's lack of empathy for their future self.

Amusingly, this same account was recently discussing space elevators. Talk about wasting carbon emissions on toys for the rich!

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