Only a few people are lucky enough to embrace their 40s without reading glasses. Wearing glasses, however funky they are, can be a real hassle. For one, they make you look older when you are constantly googling ways to look younger and cooler. Forget about the spectacle marks that come along the way. More embarrassing are the emotional scars of being mocked for searching for your spectacles while wearing them.
Why do we develop presbyopia―the loss of near-vision―as we age? Dr Virender Sangwan, director, innovation and faculty in cornea at Dr Shroff’s Charity Eye Hospital, New Delhi, explains: “Our ability to read fineprint reduces as we approach the age of 40. Presbyopia occurs when your eye lens, also known as crystalline lens, becomes harder as part of the natural ageing process of the eye.” This results in the eyes losing the ability to focus on nearby objects. The simple solution for presbyopia is to use corrective glasses, he says. “But most people find it difficult to adapt to the change, especially if they are not used to wearing glasses,” says Sangwan.
Now, 40-somethings have a reason to rejoice. PresVu eye drops, being developed by Entod Pharmaceuticals in Mumbai, could offer them freedom from reading glasses. The drops will be commercially available next year. “One drop of PresVu in each eye improves near vision in about 15 to 20 minutes,” Nikkhil K. Masurkar, CEO, Entod Pharmaceuticals, tells THE WEEK. “It can give sharper vision for six to 10 hours.” PresVu is useful for people with mild to moderate presbyopia. “It reduces the size of the pupils,” adds Masurkar. “Manipulating the size of the pupil helps to manage near-vision problems.”
Could using the drops every day mean unwarranted exposure to chemicals? “There are no chemicals in it,” says Masurkar. “The safety of the drops has already been established. It is not a new molecule. The drops have to be used every day,’’ he says. “We have finished development and are in the process of applying to the DCGI (Drug Controller General of India). Safety studies have been done. We are confident that we will get the DCGI approval. The process may take six months.”
Eye drops that can replace reading glasses is a dream come true for Benezer Lhouvum, a 26-year-old master's student in Bengaluru. Lhouvum, who hails from Manipur, is sick of having to remove his spectacles while swimming, playing football or taking a shower. During the pandemic, he had trouble wearing his mask without fogging his glasses. Nonetheless, he wonders how safe these drops are. “I might still go for LASIK (laser surgery which reshapes the inner cornea to correct vision) instead of PresVu,” he says.
Meera Nair, who is in her mid 40s, shares Lhouvum's concerns. She finds the idea of the eye drops exciting, but she would hesitate to use them instead of reading glasses.
Masurkar, however, reiterates there is no cause for concern. “The drops are based on a molecule called pyrocarbon, which has been used in the treatment of sepsis in the US for a long time,” he says. “The only problem with pyrocarbon is that everyday use is not an option. So, we optimised its strength and brought its Ph value close to tears. Our R&D has been working on these drops for four years.”
PresVu does not help farsightedness (hyperopia) or nearsightedness (myopia). According to Dr Rohit Shetty, consultant, cornea and refractive surgery, and vice chairman, Narayana Nethralaya, Bengaluru, the drops work best in people with presbyopia, belonging to the age group of 40-45. Older people would need high-power glasses.
Clinical trials will be waived for PresVu in India as the molecule has already been studied in the west, says Masurkar. “That being said, we will be doing an additional trial,” he adds. “Even post-approval, we want to carry out more studies in India. We are planning a multi-centric study in India which will cover a large number of patients. It will involve private and government hospitals. We are yet to decide on the sample size, but it should be around 3,000 patients. We have completed toxicology and animal studies, and all the required preliminary studies.” Entod plans to manufacture PresVu under the Make in India initiative.
However, it is a matter of concern that not many studies have been done on the effect of the drops on the Indian population. Caucasian and Indian eyes differ in size. “Indian pupils are smaller,” says Shetty. “Average pupil size can range from 1.5mm to 7mm. The average Indian pupil size is between 2.5mm to 3.5mm. People in the west typically have bigger pupils ranging from 6.5mm to 7mm. The study done was on larger pupil size. The effect of the drops on smaller pupils is yet to be studied, considering the drops are going to make our eyes even smaller. As far as I know, it has not been studied.”
He adds that when the drops make the pupils smaller, it could result in increased sensitivity to light and headaches. “Some people may experience difficulty in driving or lose some amount of distance perception,” he says. Taking all these into account, Shetty says the drops should not be sold over the counter. “There are even instances where unsupervised drops led to retinal detachments in patients with preexisting diseases like glaucoma,” he says. “It is important that your ophthalmologist goes through your records. The drops may not be suitable for everybody.”
Masurkar says the raw material to make the drops is not easily available in India, but adds that the cost “should be economical”. “It will be affordable for someone to buy it on a monthly basis,” he says. “It should be cheaper than spectacles, if you take into account the cost of the glass, the frame and having to replace the frame.’’