Pinning Down Presbyopia Management: New and Emerging Pharmacologic Treatments (Archived CE Monograph)

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Note: Pilocarpine, 0.4%, discussed in this monograph was US Food and Drug Administration approved on October 18, 2023.

Activity Description and Purpose

Presbyopia is a common cause of visual impairment affecting most adults aged ≥ 40 years. Limitations of conventional methods for presbyopia correction have spurred the development of topical pharmacologic agents as an alternative intervention, with major focus on medications that employ the principles of small aperture optics by inducing miosis. One pharmacologic treatment for presbyopia is already commercially available, another product is undergoing regulatory review for licensing, and others are advancing through clinical trials. This is Part 2 of a 2-part educational activity series designed to enable optometrists to successfully implement pharmacologic treatments for presbyopia for appropriately selected patients. Part 2 reviews the mechanisms of action of the active ingredients found in the approved and investigational topical drops and presents available data from premarketing clinical trials investigating the efficacy and safety of these medications. Through case-based discussions and by sharing their personal experiences, expert faculty provide insights on identifying appropriate candidates for miotic drops, patient counseling, and the practice-building potential of miotics.

Target Audience

This educational activity is intended for optometrists.

Learning Objectives

After completing this activity, participants will be better able to:

  • Discuss the mechanisms of action of the active ingredients in new and emerging pharmacologic treatments for presbyopia
  • Review clinical efficacy and safety of miotics to treat presbyopia
  • Identify characteristics to guide selection of patients who would or would not benefit from miotic treatment for presbyopia
Course summary
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Paul Karpecki, OD, FAAO (Chair)
Director, Cornea and External Disease
Kentucky Eye Institute
Lexington, Kentucky
Associate Professor
University of Pikeville School of Optometry
Pikeville, Kentucky
Nathan Lighthizer, OD
Associate Dean and Associate Professor
Chief, Specialty Care Clinics
Northeastern State University College of Optometry
Tahlequah, Oklahoma
Gina Wesley, OD, MS
Complete Eye Care of Medina
Medina, Minnesota

Disclosure Policy

MedEdicus requires that anyone who is in a position to control the content of this educational activity disclose all relevant financial relationships with any commercial interest. Financial relationship information is collected and resolved prior to the educational activity. All relevant relationships have been mitigated.


Paul Karpecki, OD, is a consultant for AbbVie Inc, AdOM optical technologies Ltd, Akorn, Inc*, Alcon, Aldeyra Therapeutics, Allergan, Ametek, Inc*, Apellis Pharmaceuticals, Atlas Medical GmbH, Aurion Biotechnologies, Avellino, Azura Ophthalmics Ltd, Bausch & Lomb Incorporated, Bio-Tissue, BlephEx*, Bruder Healthcare, Bruno Vision, Cambium Medical Technologies*, Dompé US, Inc, Eyedetec Medical, Gobiquity*, Haag-Streit Group*, Healthe, Hilco Vision*, Horizon Therapeutics plc, iCare USA Inc*, Imprimis Pharmaceuticals, Inc, Iveric Bio, inc, Kala Pharmaceuticals*, Konan Medical USA, Inc, Lentechs, Neurolens, Novartis Pharmaceuticals Corporation, OASIS Medical, OCULUS, Inc, OcuMedic, Inc, Ocuphire Pharma, Inc, OCuSOFT Inc, Olympic Ophthalmics Inc, Orasis Pharmaceuticals, Oyster Point Pharma, Inc*, Regener-Eyes LLC, Reichert, Inc, Rendia, Inc, RVL Pharmaceuticals, Inc, RxSIGHT, Santen Inc, ScienceBased Health, Scope, Sentiss Pharma Pvt Ltd, Sight Sciences, Silk Technologies Ltd, Sun Pharmaceutical Industries, Inc, Surface Pharmaceuticals Inc, Sydnexis, Tarsus Pharmaceuticals, Inc, TearClear Corp, Thea Pharmaceuticals Limited, Vial, Viatris Inc, Visant Medical, Inc, Vital Tears LLC, and Zeiss*; is on the speakers bureau for Aerie Pharmaceuticals, Inc*, Bausch & Lomb Incorporated, Dompé US, Inc, Johnson & Johnson Vision Care, Inc*, Mallinckrodt, and Sun Pharmaceutical Industries, Inc; and is an advisory board member of AstaReal*.

Nathan Lighthizer, OD, is a consultant for Diopsys, Inc, and OCuSOFT Inc; is on the speakers bureau for Dompé US, Inc, Ellex, and Sun Pharmaceutical Industries, Inc; and is an advisory board member of Bruder Healthcare, Horizon Therapeutics plc, Novartis Pharmaceuticals Corporation, Orasis Pharmaceuticals, Sight Sciences, and ZeaVision LLC.

Gina Wesley, OD, MS, is a consultant for Bausch & Lomb Incorporated, Lumenis, and Orasis Pharmaceuticals; and is a contracted researcher for Alcon, CooperVision, and Johnson & Johnson Vision Care, Inc.

* The financial relationship existed during the past 24 months but has now ended.

Planners, Managers, and Writers

MedEdicus planners and managers have no relevant commercial relationships to disclose.

Medical Writer: Cheryl Guttman Krader has individual stocks in Johnson & Johnson Vision Care, Inc.

Accreditation Statement

COPE approved for 1.0 CE credit for optometrists.
COPE Course ID: 84866-GO (Asynchronous)
COPE Course Category: General Optometry


Disclosure of Commercial Support

This continuing education activity is supported through an educational grant from Orasis Pharmaceuticals, Inc.

Off-Label Discussion

This educational activity may include discussion of unlabeled and/or investigational uses of drugs or devices. Please refer to the official prescribing information for each drug or device discussed in this activity for approved dosing, indications, and warnings.

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Provider Contact Information

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The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of the State University of New York College of Optometry, MedEdicus LLC, or Orasis Pharmaceuticals, Inc.

This CE activity is copyrighted to MedEdicus LLC ©2023. All rights reserved. 285.2

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