New eyedrop eliminates bifocals?

Q: I saw an article that a new eyedrop medication may eliminate the need for bifocals as we get older. How soon and how good?

A: It is true that an eyedrop is now in FDA clinical trials to determine how safe and effective it will be. This is not actually a “new” medication, but rather is an old drug called pilocarpine. This was used many years ago as the primary drug treatment for glaucoma because it reduced internal eye pressure. The drug also was widely known to cause the patient’s pupils to constrict...to get very small.

This unpleasant, or unsafe side effect ( for night driving ), has now become the basis of the pending new indication for pilocarpine...to help you see better up close. The theory is well known in the eye care world, and is called “ the pinhole effect”. No matter how strong your glasses prescription is or how blurry your eyesight is, if you look through a tiny opening ( think of a pinhole in heavy paper ) you will see better. This pinhole effect reduces blur and increases the “ depth of field”...meaning things look pretty clear no matter how close or far they are. This is the principle used to make simple cameras that do not require any focusing! Like those cameras, I suspect the images will be pretty good, but not really crisp. How clear or sharp you may require may be different than the sharpness I need to be happy.

So the theory is that if we can make your pupils small enough, your vision will look clearer at all distances...especially for close work. Personally, I think this will help some people and not others. My concern is with the pupil constriction effects. Will the effects on your night driving, or even walking, in the dark be uncomfortable or unsafe? The new medication will be a very low concentration of pilocarpine, but no one yet knows what will be enough to help focusing, but mild enough to avoid vision safety concerns. So, the bottom line….stay tuned for the final FDA clinical studies results.