Evolution of the Vuity Candidate

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When Selina McGee, OD, FAAO, Owner BeSpoke Vision, talks with her patients about presbyopia, she wants them to know all their options. It might be spectacles at work with a specific workspace pair of glasses, contact lenses, or a therapeutic drop. Further into their presbyopia journey, it might be a more permanent option that requires surgery or the use of an intraocular lens.

“I always paint this picture for patients of this is a journey and here’s what we have. Then we customize it based on what their needs are today,” said Dr McGee.

Most patients only know about the traditional options—glasses, contacts—but when Dr McGee tells them there’s a drop to help them be less dependent on their current prescription or in place of their reading glasses that they’ve bought over the counter, they are surprised.

Vuity (pilocarpine HCl ophthalmic solution) 1.25%, a daily, prescription eye drop was approved by the FDA in late 2021 for the treatment of presbyopia. The drop is administered at home and starts to work in as short as 15 minutes and it can last 6 hours and beyond depending on the patient.

 Despite more than a year on the market, Dr McGee said almost none of her patients have heard of it.

We have to be intentional about telling patients that this is an option,” she said.

The Ideal Candidate
Vuity has the possibility to benefit lots of people, but the ideal candidate is somebody who has become completely dependent on an over-the-counter reading lens. They’re not used to wearing glasses, but they have gotten to the point that they absolutely have to have some help. Typically, it’s somebody that ranges from the age of 47 to 51 years and has good distance vision. They just need help up close.

Age, however, isn’t as important as vision goals, Dr McGee pointed out. Who will benefit from Vuity is not age specific but more of a patient’s need and frustration level. Somebody that has gone beyond coping mechanisms, like making the font bigger on their phone or increasing the light, can benefit from the eye drops.

Although most clinical trials of Vuity studied patients 40 to 55 years old, Dr McGee has been pleasantly surprised to have more people in their fifties and sixties that are really interested in the medication.

Dr McGee said she’s found that her older patients who are really frustrated because they’re completely dependent on something are more willing to try anything so they’re not completely dependent on their spectacles.

Expanded Possibilities
In the short time Vuity has been on the market, potential candidates have expanded. Dr McGee said that someone that “needs a boost” would likely benefit.

Vuity is approved for once-a-day use, allowing patients to utilize it when it best fits their schedule.

“I teach patients to utilize it every day for the first 2 weeks, figure out how it works best for them, and then once they have that peak effect, then they can dose whenever they want,” said Dr McGee. “For some patients, that’s every day and for some patients, it’s once or twice a week. For some patients, it’s just on the weekend, but then they can customize it beyond that.”

Because of its flexible dosing schedule, the eye drop could be beneficial for someone that already wears contact lenses but couldn’t adapt to a multifocal contact lens or someone that wears a multifocal contact lens during their week but on the weekend wants really sharp distance vision but still needs to wear their garment to see how far they’ve run or biked.

Another possibility is in patients that need a boost if they have a refractive lens post-LASIK. Dr McGee said that these patients often love this option because they’ve already invested in technology years ago to get them out of glasses and they’re not excited about having to do that again.

Similarly, someone that’s in monovision post-cataract surgery may benefit as well.

“I think that as we better understand how the drop works, as we get more comfortable with our conversations, as this becomes more mainstream, that the candidate range is going to grow,” she said. “Doctors are learning sometimes every day how this drop works, how to explain it to patients. The opportunity is still really big, and it is just going to grow as we all learn together.”