Am Fam Physician. 2023;107(6):659-660
Author disclosure: No relevant financial relationships.
Pilocarpine 1.25% ophthalmic solution (Vuity) is a novel ophthalmic form of the well-known cholinergic agonist, pilocarpine. Although other forms of ophthalmic pilocarpine are used to treat glaucoma and ocular hypertension, Vuity is labeled for the treatment of presbyopia. It works to improve near vision by causing pupillary constriction.1
| Drug | Dosage | Dose form | Cost* |
|---|---|---|---|
| Pilocarpine 1.25% ophthalmic solution (Vuity) | One drop per eye once daily | 2.5-mL eyedropper | $80 |
Safety
The most serious adverse effect associated with Vuity is the rare risk of retinal detachment, which is associated with miotics and is more likely to happen in patients with preexisting retinal disease.1 Vuity product labeling recommends a retinal examination before beginning treatment. Patients with vision changes should be evaluated immediately. There are no data from controlled clinical trials to determine the safety of Vuity in pregnant or lactating patients, but retrospective data show no harm in pregnancy when it is used to treat glaucoma.1
Tolerability
Vuity is well tolerated. The most common adverse effects are eye pain, irritation, and blurred vision (1% to 5%) and headache and conjunctival irritation (5%). These effects were mild and did not result in discontinuation of treatment.2 Less than 1% of patients withdrew from clinical studies because of adverse effects.1 Miotics can cause accommodative spasm and darker vision, so patients should avoid operating machinery or driving if their vision is blurry. Patients should determine whether treatment affects night vision.1
Effectiveness
Vuity temporarily improves near visual acuity by three lines on a handheld chart without losing distance vision.1 It has been studied in 750 patients with poor near vision that impacts activities of daily living. The patients were randomized to receive Vuity or a placebo daily for 30 days. After 30 days, participants being treated with Vuity had significant improvement in low-light corrected near vision without losing more than one line of corrected distance vision at three hours (30.7% vs. 8.1%; number needed to treat = 5) and six hours (18.4% vs. 8.8%; number needed to treat = 11).2 Effectiveness beyond six hours has not been studied, but Vuity requires multiple daily doses to control intraocular pressure in patients with glaucoma.
Price
Vuity costs approximately $80 for one 2.5-mL eyedropper. It is currently not covered by Medicare, and no generic form is available. In comparison, generic pilocarpine ophthalmic drops are available as 1% and 2% solutions for about $30.
Simplicity
One drop of Vuity per eye once daily is recommended. Onset of action is about 15 minutes and the effects last at least six hours. Patients with mild presbyopia who have vision problems in low-light conditions might consider using Vuity later in the day as needed rather than daily. Contacts can be worn while using this medication but should be inserted at least 10 minutes after administration. Other topical ophthalmic medications can be used if administered either five minutes before or after Vuity administration.1
Bottom Line
Vuity is an effective drug used to treat age-related vision loss. Its easy administration and rare adverse effects may encourage use. However, the high cost of Vuity in comparison to other available treatment options may limit its availability for most patients.
