Pilocarpine–Diclofenac Eye Drops Show Promise as Long-Term Presbyopia Treatment
A recent real-world study has demonstrated sustained vision improvements for up to two years with a combination of pilocarpine and diclofenac eye drops for the treatment of presbyopia (age-related near vision loss), offering a potential alternative to glasses and surgery. The research, presented as abstract ESCRS25-FP-3944 at the upcoming European Society of Cataract and Refractive surgeons (ESCRS) meeting, evaluated the efficacy and safety of varying concentrations of the eye drops in a meaningful patient cohort.
The study, conducted at a single center, followed patients for a median duration of 434 days. Results indicated positive improvements in near visual acuity for nearly all participants,with the degree of improvement tailored to the severity of their presbyopia at the study’s outset. Patients with milder presbyopia responded best to 1% pilocarpine concentrations, while those with more advanced cases required 2% or 3% concentrations to achieve noticeable gains.
Importantly, the treatment was well-tolerated. Adverse side effects were generally mild, with temporary dim vision reported in 32% of cases, irritation upon instillation in 3.7%, and headache in 3.8%. Notably, no patients discontinued treatment due to side effects.
Dr. Giovanna Benozzi, the lead researcher, emphasized the potential of this combination therapy: “These results suggest this offers a safe, effective, and well-tolerated alternative to traditional presbyopia management. It significantly reduces dependence on reading glasses, providing a convenient, non-invasive option for patients, although these eye drops may not eliminate the need for glasses in all individuals.” She further clarified that the treatment is intended to complement, not replace, surgical interventions, providing a valuable option for those seeking personalized alternatives to eyewear. Dr. Benozzi also noted that some patients have been receiving the treatment for over a decade.
Future research plans include assessing the impact of the drops on patients’ quality of life and investigating the underlying physiological mechanisms responsible for the observed improvements.
the study’s strengths lie in its large patient sample and extended follow-up period. it represents the first systematic comparison of three different pilocarpine concentrations combined with diclofenac.Though, researchers acknowledge limitations, including its retrospective design and single-center location, which could perhaps limit the generalizability of the findings and introduce selection bias.
Professor Burkhard Dick, President-Elect of the ESCRS, commented on the study, stating that while surgical options for presbyopia have advanced, not all patients are suitable candidates. He cautioned that the single-center, retrospective nature of the study necessitates further examination. “Long-term pilocarpine use can sometimes cause side effects such as reduced night vision, dimmer vision in low light, eye strain, irritation and, in rare cases, retinal detachment, while prolonged topical NSAID use may pose corneal risks. Broader, long-term, multi-centre studies are needed to confirm safety and effectiveness before this treatment can be widely recommended.”
The study’s abstract, ”Dose-dependent efficacy and safety of pilocarpine-diclofenac eye drops for presbyopia: a real-world single-center study,” will be presented in a free paper session on ‘Miscellaneous topics in cataract and refractive surgery’ on Sunday, September 14, at 16:30-18:00 hrs CEST. Further details are available at: https://pag.virtual-meeting.org/escrs/escrs2025/en-GB/pag/presentation/570375.
