WITH THE ARRIVAL OF VUITY (ALLERGAN), WE FINALLY HAVE a pharmacologic option to help our patients with presbyopia, and it feels great to have something exciting to offer them. As word gets out, patients are calling in to find out more. I’ve had some come in specifically to ask about the drops, and I’m also offering it to patients who are already in my practice.
Learning from the Early Adopters
I initially had my staff try Vuity, and I then observed their immediate and subsequent reactions. Currently, in my practice, as I prescribe Vuity to patients, I am having them try it during their exams so I can observe and discuss their experience. I have had some patients wait for the 15-20 minutes it takes for the mechanism of action to take effect. I know there is a chance that they are going to experience some redness, that the drops might sting when they put them in, or that they might cause a mild headache. It is informative to me to monitor patients and observe their immediate experience so that I will be better able to counsel patients in the future. As we become more comfortable with what to expect, there will be less need to keep the patients in the office for their first dose, but for now, it has been educational for me.
Patients have different priorities, and this fact will require use of the drops in a number of different ways to achieve the most successful outcomes. It will be a marriage between how much near refractive improvement they need and what they are spending their time doing. For example, some patients have fewer visual needs up close and don’t need to be able to read tiny print all day long.
By trying Vuity, I think patients will learn where and when they need help the most. Some patients are on their computers for much of the day, which is more of an intermediate distance need than a near distance need. For these patients, an approach might be to correct both eyes for distance, if needed, with glasses or contact lenses, and then use Vuity in the morning to improve the intermediate vision, with the use of a light pair of readers as needed to read small print. With this approach, you have both eyes working together at all distances. But for someone who reads books or printed material the majority of the day, that approach may not be sufficient.
A few real-life experiences are found later in this article and demonstrate the need to individualize treatment for each patient’s needs.
Tips for Using
When I counsel patients who would like to try Vuity, I tell them there’s a chance of some stinging when they put the drop in, which usually goes away very quickly. If they have dry eye, I recommend they put in a lubricating drop approximately 15 minutes before using the Vuity drop, which will make it less likely to sting. I also let them know that they may see some mild redness and that only 5% of patients in the clinical trial experienced this effect. When it does occur, it also tends to be very limited in duration.
There is a 15% chance patients will experience a headache. In the study, nearly all of the patients that had headache reported it as being mild and transient. Of those that had headache, 70% had it on the first day, and 50% of the headache group had it for 1 day only. But 85% of patients in the study did not have a headache at all.
Give It a Good Try
We generally tell patients to try Vuity daily for 7 days. As previously noted, patients who had a headache most commonly reported it on the first day. Sometimes patients will say they feel a little brow ache or headache, and they are not sure they want to continue using the drop. I encourage these patients to keep trying it because it is likely either they’re not going to experience a headache again, or it will be less of an issue as they use the drop more consistently.
Each patient will require individual assessment. We use a different approach; depending on whether or not it is a patient I have seen before, and if so, how long it has been since the last exam.
I recently had a patient call in about the drops, and it was someone I had examined just a couple months earlier. She doesn’t have a high prescription, and she is in the right age range with the right level of need for near glasses. Because I had seen her recently, I felt comfortable filling a prescription for her without the need for another in-office exam.
Another patient called, a dentist, and was excited to use the drops as quickly as possible. She had not been seen for a couple of years, so I wanted to see her in person to discuss with her what to expect with regard to efficacy and potential side effects and how she might approach trying it herself.
Some people say they are doing fine the majority of the time with multifocal contact lenses, but they might want to go to a sporting event or participate in an activity with a greater demand for excellent quality of distance vision. These patients may use Vuity in combination with a monofocal contact lens that is corrected for distance, which will generally provide better distance vision than a multifocal contact lens.
I have a patient who works as an accountant, and he is happy when he is in his office using glasses that are focused for intermediate and near distances while working on the computer. He doesn’t see a need for Vuity during the weekday. But on the weekend, he would like to have the flexibility to have more independence from readers, so intermittent use, just on weekends, is another possibility.
Another person reports using Vuity before he goes to bed at night. In bright light in the daytime, his near vision is fine, but he struggles more with near vision in dim light. He doesn’t want to have to wear readers to see better when reading in bed, and Vuity gives him some near vision at night before falling asleep.
I want to encourage people to try Vuity. There are few presbyopia treatments other than glasses or contact lenses that are completely reversible. With Vuity, patients can try it and see how it works for them. If it doesn’t meet their expectations, there’s no harm, and it’s easily reversible by simply discontinuing. It is too early to have much feedback from patients yet, but anecdotally, some patients find Vuity to be a wonderful advancement, while for others, the improvement in near vision is more modest or not sufficient.
I encourage you to try Vuity for your patients, and not with just a single dose but with daily instillation for 7 days. Doing so will allow you and the patient to more effectively experience this novel presbyopia solution. ■