RETINAL DETACHMENTS REPORTED WITH DROPS

How one ophthalmologist is approaching the presbyopia drops

BY JULIE GREENBAUM, ASSOCIATE EDITOR

While 1.25% pilocarpine ophthalmic solution (Vuity, Allergan/Abbvie) has been reported safe for most patients, retinal issues have been reported with its use for patients with additional risk factors for retinal detachment, such as peripheral retinal disease or having a longer axial length. In May, American Journal of Ophthalmology published a study of two cases of retinal detachments of patients who had used the presbyopia drops. According to the study, the first patient, a 47-year-old man, showed inferotemporal retinal detachment in the right eye during a dilated examination with an associated retinal tear inferotemporally. This patient had started Vuity a month prior for the treatment of presbyopia in both eyes. Retinal detachment was also reported in his left eye in the superior quadrant with an associated horseshoe tear at 12 o’clock, the study reported.

The second patient, a 46-year-old man, showed a superior retinal detachment from 11 to 3 o’clock during a dilated examination with subretinal fluid extending into the macula. This was 5 weeks after using Vuity drops for presbyopia, according to the study (bit.ly/3S2LSVU ).

IMPACT ON THE WORKUP

In light of this news, Elizabeth Yeu, MD, partner at Virginia Eye Consultants in Norfolk, Va., says that a consensus on the presbyopia eyedrop workup may be needed. “For example, should we consider charging patients for a presbyopia workup since we would be doing tests that we normally would not diagnostically? That may include looking at things like double-pass interferometry to see what the quality of the image is, what the lens status change is, if the patient has dysfunctional lens syndrome and what stage that is because that’s going to determine how well the patient would respond potentially to drops vs needing some other therapeutic. We should also consider if it is best that we do a handover to a contact lens trial; maybe the patient would be better served working with an optometrist.”

Dr. Yeu adds that ophthalmologists should be getting an optical coherence tomography (OCT) of the eye and looking for any vitreous traction. “Does the patient have a vitreous detachment yet? Is there vitreous adherent? Do they have any other pathology? They’re going to need a thorough dilated examination,” she says.

CHOOSE YOUR CANDIDATES WISELY

Because of the risk of retinal detachment with Vuity, some patients should not be candidates due to the risk.

“Anyone who I would now get an OCT on and I saw that there was some vitreous that was attached still to the macula or to the optic nerve head, I would say they are not a candidate for this eye drop,” Dr. Yeu says. “I would also say no to anyone who is even a higher myope, as well as anyone who is concerned about these kind of side effects. Vitreomacular traction is a little bit more concerning because of the cellular body traction.” OM