Hi Andrew,
Thank you for this post.
PH Phakic lenses: The idea behind such lenses and to keep it simple is to improve depth of focus as you know. The aim is to achieve an ideal pupil size that enhances depth of focus without compromising distance vision and contrast. Is this aim always achievable? From my experience, the answer is no due to surgical unknowns. The last patient I saw with a phakic PH lens ended up with depression as a result. I saw this patient 4 days ago! Reduction in contrast and glare was a problem. If the lens is not centred around 'Purkinje 1 reflex' then optical aberration tends to be a problem.
Now the aim of using miotic and this is actually not a new thing is similar to the above. Pilocarpine has been in existence for a very long time at one point it was one of the main therapeutic management for glaucoma patients. So the use of miotics in the 'presbyopic age group' and even in pre-presbyopic patients have been in existence for quite a while. One of the side effects is obviously an improvement in the depth of focus which is useful for near vision. So even though this is being marketed as 'new', it isn't. What's new is the different formulation available but the aim remains the same-pupil miosis.
The two above methods share more or less the same side effect albeit of different level of severity: reduction in contrast.
The other issue is, patient would need to instil the drop more than once during the day so convenience might be a problem.
All that said, and to directly answer your question, YES, I will prescribe to patients in my practice once approved in the UK. It's effect is reversible unlike surgery!
What appears to be exciting for the future is the 'Lens restoration drops'. If approved, I will prescribe to patients provided that most of the side effect are made very clear.
Exciting times ahead, most definitely.
Gone a bit 'off-tangent'..sorry.
