One eye at a time: feasibility of unilateral 0.5% pilocarpine therapy in presbyopia management

Abstract

Background: The objective of the study was to evaluate the feasibility, efficacy, and patient tolerance of unilateral instillation of 0.5% pilocarpine for near vision improvement in presbyopic individuals. Methods: This prospective interventional study included 130 eyes of 65 presbyopic individuals. A single drop of 0.5% pilocarpine was instilled in one eye of each participant once daily. Distance corrected near visual acuity was assessed uniocularly and binocularly on the 7th and 15th day following initiation of treatment. Subjective improvement in near vision was recorded using patient feedback on comfort and functional near tasks. Binocular vision, stereopsis, and patient- reported outcomes regarding reading comfort, glare, headache, and overall satisfaction were documented at each visit. After completion of 15 days, the same protocol was repeated in the fellow eye of the patient, following a unilateral sequential treatment approach. Statistical analysis was performed using paired t-test and Wilcoxon signed-rank test, as appropriate. Results: The results demonstrated a clear and progressive improvement in near visual acuity over the two-week period with unilateral administration of 0.5% pilocarpine. Subjective assessment revealed improved reading ease and reduced dependance on near correction in the majority of participants. The treatment was well tolerated. Reported ocular side effects were mild and transient, including brow ache and mild dimming of vision, with no serious adverse effects recorded. Conclusions: Unilateral administration of 0.5% pilocarpine is an effective and safe strategy for presbyopia management, providing meaningful binocular visual function. Sequential unilateral treatment may offer a practical, patient-friendly non-surgical option for presbyopia management.