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Article25 Apr 2024

Are Eyedrops the New Glasses?

A recent report from Citi Research’s Yigal Nochomovitz looks into the possibilities presented by a new type of eye-drop for those with deteriorating vision. 


Are you reading this easily? Without the aid of spectacles?

Around the age of 45, most people start to need glasses. The condition is known as Presbyopia- age related loss of near vision. A new type of eye-drop shows signs it could offer a new way to treat this.

First the background. Presbyopia is a progressive and common eye condition which is caused by the gradual loss of elasticity and flexibility of the lens, affecting the ability of the eye to focus on close objects.

It’s estimated there are ~128 million people in the U.S. and ~1.8 billion globally with presbyopia.

The shape of the lens in the eye is controlled by the ciliary muscles.

-When focused on distance vision, the ciliary muscles are relaxed causing the lens to remain in its native shape.

-Focus on near objects causes the ciliary muscles to contract, changing the lens and its shape. This contraction, known as accommodation, allows the eye to focus on close objects, though the hardened lens as observed in presbyopes limits accommodation and near vision.

Presbyopes Have a Hardened/Inflexible Lens Which Limits Near Vision  

Source: Citi Research, Company Reports

Current Non-Pharmaceutical Presbyopia Treatment Options

There is no way to stop or reverse the normal aging process causing presbyopia. But there are several treatment options available.

  • Glasses and contact lenses – Non-prescription glasses, bifocals and contact lenses are options for improved focus on near objects. That said, the need to carry and wear glasses or insert and remove contact lenses can be seen as inconvenient by some.
  • Surgical interventions - Refractive surgery (i.e., LASIK or PRK) can provide a long-term solution. Patients who’ve had such procedures often express satisfaction with the boost in vision, but potential side effects such as dry-eye or glare are often reported too. 

And then there’s the new way.

Known as Miotic Eye Drops, they offer a new pharmaceutical alternative for the treatment of Presbyopia:

Delivered through an eye drop, Miotics are a class of pharmaceuticals that constricts the pupil. In presbyopes this can improve depth of focus and near vision.

At the moment, there is only one approved miotic for the treatment of presbyopia.

It was approved by the FDA in October 2021 and staged a solid commercial launch with 120K prescriptions filled in 2022. But issues with retinal tears and detachments were reported.

In August 2022, the label on the drops was amended by the FDA to include a warning related to cases of such retinal tears and detachments. And according to a survey of eye care professionals, a majority said the eyedrops did not work or did not work for long enough.

This is a market that remains wide open. In theory, the ideal miotic drug for presbyopia would create a pupil pinhole effect while avoiding myopic shift/retinal detachment and would deliver an all-day vision benefit.

For more information on this subject, please see the full report here  So-Long Reading Glasses  (9 April 2024)

Citi Global Insights (CGI) is Citi’s premier non-independent thought leadership curation. It is not investment research; however, it may contain thematic content previously expressed in an Independent Research report. For the full CGI disclosure, click here.


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