![]() We measured maximum resting pupil size (MAX), reduction pupil size ratio (%CH), latency duration (LAT) and neurological pupil index (NPi). Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane-remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane-remifentanil (DES/REM) group, and a propofol-remifentanil (PRO/REM) group. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. We examined the effects of anesthetic agents on pupillary reactivity. However, whether anesthetic agents affect the accuracy of the technique remains unclear. Repurposing medication for different conditions or diseases is a common thread in the history of medicine, but advances in formulation and delivery can have a significant impact on patients’ experience and compliance.Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. I tell patients that it might take about a week before they experience that desired range of vision because the brain needs time to adapt to the smaller pupillary aperture. These nuances are important to differentiate between pilocarpine for glaucoma and pilocarpine for presbyopia.Īs with all treatments, it is important to set appropriate patient expectations for tolerability and treatment effect with Vuity. With the pilcoparine used today, advances in design and delivery have lowered the side effect profile and have enabled a lower concentration of drug to be used while allowing the pupil to regularly return to its native state. With the vehicle technology in Vuity, the drug rapidly adjusts the physiologic pH of the tear film once instilled this increases corneal penetration, thereby allowing for less drug to reside on the surface, and thus increases safety and decreases tolerability issues. As a result, patients with glaucoma experienced significant burning, hyperemia, and even headaches with the use of pilocarpine. Manufacturers are forced to place pilocarpine in an acidic environment to maintain its stability and concentration (bioavailability). With any drug, the vehicle can play a pivotal role in its bioavailability, tolerability, and overall efficacy. The vehicle for pilocarpine delivery in glaucoma was not optimized for absorption and patient comfort. Because the pupil returns to its native state daily when the drug wears off, the risk of chronic pupillary constriction theoretically should be lower than with past use of pilocarpine. Additionally, Vuity’s duration of action is up to 6 hours. Movement of the iris or the pupil in general is still possible. Vuity does not tend to constrict the pupil as tightly as concentrations of pilocarpine used four times daily in the past. Vuity (pilocarpine HCl ophthalmic solution 1.25%, Allergan) is a low-concentration formulation of pilocarpine in a customized vehicle with proprietary technology designed to optimize its delivery. In 2021, the FDA approved the first pharmacologic solution for presbyopia. Understandably, the drug fell out of favor when newer classes of medication with longer durations and better tolerability emerged on the scene. ![]() With these concentrations dosed frequently over time, prolonged pupillary constriction and poor dilation accompanied pilocarpine’s early use. Further, high concentrations (4% and higher) of pilocarpine were used to treat glaucoma. The drug was effective for achieving significant IOP reductions in several groups of patients, including those with primary open-angle glaucoma, pigmentary glaucoma, steroid-induced glaucoma, and even angle-closure glaucoma.īecause of its short half-life, pilocarpine typically had to be administered four times per day this dosing schedule placed a significant burden on patients and resulted in challenges with compliance. Pilocarpine was a mainstay of medical glaucoma therapy before the advent of prostaglandin analogues in the 1990s. ![]()
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