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Review Presbyopia Update on Presbyopia-correcting Drops Feyza Çalis Karanfil and Burak Turgut Yuksek Ihtisas University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey P resbyopia causes diminishing of vision-targeted life quality and occupational performance for most people over 40 years old. It affects the ability to perform visual tasks at near distance such as book reading, handcrafts, stitching, cooking and surgical operation. Although there are some treatment modalities such as surgery, the use of near-glasses and contact lenses for presbyopia, topical drug treatment for pharmacological control of presbyopia is currently a very popular and attractive nonsurgical option. In this review, we tried to summarise the presbyopia drop treatment. Keywords Presbyopia, para-sympathomimetic, accommodation, ciliary muscle contraction, drop treatment, myosis, lens softening, increased focus depth Disclosure: Feyza Çalis Karanfil and Burak Turgut have nothing to declare in relation to this article. Compliance with Ethics: This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 24 October 2017 Accepted: 5 December 2017 Citation: European Ophthalmic Review, 2017;11(2):99–102 Corresponding Author: Burak Turgut, Yuksek Ihtisas University, Faculty of Medicine, Department of Ophthalmology, 06520, Ankara, Turkey. E: burakturgut@yiu.edu.tr Support: No funding was received in the publication of this article. Presbyopia is progressive age-related reduction in accommodation amplitude and the loss of ability of the eye to focus on near objects. It occurs in almost everyone at around 40 years of age. 1–5 Presbyopia affects visual tasks at near distance such as book reading, handcrafts, stitching, cooking and surgical operation. Thus, it causes the diminishing of vision-targeted life quality and occupational performance of many people over 40. 1–5 The physiopathology of presbyopia is not clearly known. However, it has been demonstrated that various factors including the hardening of the lens, changes in the elasticity of the lens capsule, lens dimension, geometry of zonular attachments and ciliary muscle contraction may be responsible for the accommodative loss in presbyopia. 1,2 Accommodation in humans is performed by ciliary muscle (CM) and iris sphincter contractions, convergence and changes in the shape and position of the lens. The muscles of the iris and ciliary body are stimulated by the parasympathetic system. The parasympathetic cholinergic stimulation causes the contraction of the CM and myosis, providing the increase of focus depth and the shape and position of the lens both to change and for accommodation to develop. 3 In an eye which is un-accommodated and looks at a distant object, CM is relaxed; the anterior zonular fibers (ZF) are stretched by traction from the posterior ZF. Then, anterior ZF flattens the lens. In the accommodated eye, the forward and inward movement of the ciliary muscle allows the tension fiber system to take up the tractional forces from the posterior ZF and releases the tension in the anterior ZF; both the thickness and refractive power of the lens increase. 3–5 There are some surgical modalities including refractive lens exchange, mono-vision laser-assisted in situ keratomileusis (LASIK), blended vision LASIK, multifocal or accommodating intraocular lens (IOL) implantations and corneal inlay implantation for the treatment of presbyopia. 4–7 Nonsurgical treatments for presbyopia include the use of near-glasses and contact lenses. 5 Nowadays, otorities are speculating about topical parasympathomimetic drop treatment for pharmacological control of presbyopia, which is a nonsurgical option for the vast majority of people with near vision spectacle dependence over 40 years old. 8 Presbyopia treatment modalities are based on reducing pupil sizes because smaller pupil sizes increase near visual acuity by increasing focus depth. Also, central light waves reach the retina, which results in clearer vision. A drop for presbyopia treatment must create a similar and long- lasting effect on pupil apertures to be successful. 7 The commercial and noncommercial drops used or tried in the treatment of presbyopia are given in Table 1. Reducing pupil size is not without adverse effects. A constricted pupil decreases vision at night – less light enters the eye, and diffraction at very small pupil sizes can decrease overall vision quality and also lead to myopic shift compromising distance vision. To reduce this side effect drops can be used monocularly. Even monocular pharmacological treatment with a single miotic agent has been shown to result in acceptable reading vision for many presbyopes, even older recipients. But a TOU CH MED ICA L MEDIA 99